Comparison of Fusion Imaging Using a Combined SPECT/CT System and Intra-arterial CT: Assessment of Drug Distribution by an Implantable Port System in Patients Undergoing Hepatic Arterial Infusion Chemotherapy

Abstract

Hepatic arterial infusion (HAI) chemotherapy is effective for treating primary and metastatic carcinoma of the liver. We compared the perfusion patterns of HAI chemotherapy on intra-arterial port-catheter computed tomography (iapc-CT) and fused images obtained with a combined single-photon emission computed tomography/computed tomography (SPECT/CT) system. We studied 28 patients with primary or metastatic carcinoma of the liver who bore an implantable HAI port system. All underwent abdominal SPECT using Tc-99m-MAA (185 Mbq); the injection rate was 1 mL/min, identical to the chemotherapy infusion rate, and 0.5 mL/sec for iapc-CT. Delivery was through an implantable port. We compared the intrahepatic perfusion (IHP) and extrahepatic perfusion (EHP) patterns of HAI chemotherapy on iapc-CT images and fused images obtained with a combined SPECT/CT system. In 23 of 28 patients (82%), IHP patterns on iapc-CT images and fused images were identical. In 5 of the 28 patients (18%), IHP on fusion images was different from IHP on iapc-CT images. EHP was seen on fused images in 12 of the 28 patients (43%) and on iapc-CT images in 8 patients (29%). In 17 patients (61%), upper gastrointestinal endoscopy revealed gastroduodenal mucosal lesions. EHP was revealed on fused images in 10 of these patients; 9 of them manifested gastroduodenal toxicity at the time of subsequent HAI chemotherapy. Fusion imaging using the combined SPECT/CT system reflects the actual distribution of the infused anticancer agent. This information is valuable not only for monitoring adequate drug distribution but also for avoiding potential extrahepatic complications.

Technological Development and Advances in Single-Photon Emission Computed Tomography/Computed Tomography

“…(Adapted and reproduced permission of reference [115].) Anatomic localization, evaluation of therapeutic efficacy for pancreatic chemotherapy [180,[191][192][193] Parathyroid gland 99m Tc-sestamibi Anatomical localization [161,[194][195][196][197][198] Pheochromocytoma 123 I-metaiodobenzylguanidine Anatomical localization [189] Prostate cancer 111 In-capromab pendetide Attenuation correction, anatomical localization, monitoring brachytherapy [12,26,[199][200][201][202][203][204] Whole body (phantom study) Technetium-99m Attenuation correction, radioimmunotherapy dosimetry [226] …”

“…Clinical Applications of SPECT/CT Cited Anatomical/Disease Site Radiopharmaceutical SPECT/CT Application Adrenal masses 123 I-metaiodobenzylguanidine, 75 Se-cholesterol Anatomical localization [161] Biliary leak 99m Tc-diisopropyl iminodiacetic acid Anatomical localization [141] Bone scintigraphy 99m Tc-methylene diphosphonate, 99m Tc-dicarboxypropane diphosphonate Anatomical localization, attenuation correction [162][163][164][165][166][167][168][169] Brain cancer 99m Tc-tetrofosmin Anatomical localization [170] Breast cancer 99m Tc-sestamibi Anatomical localization [171] Colorectal cancer 99m Tc-labelled macroaggregated albumin Hepatic artery infusion of chemotherapy [172] Coronary artery calcification 99m Tc-tetrofosmin Head/neck cancer L-3-123 I-iodine-alpha-methyl-tyrosine, 123 I-labeled L19(scFv)2 antibody Anatomical localization [175][176][177] Hepatic haemangioma 99m Tc-labelled red blood cells Anatomical localization [178,179] Hepatic carcinoma 99m Tc-macroaggregated albumin Anatomical localization [180] Human immunodeficiency virus (HIV) 99m Tc-sulfur colloid Anatomical localization of microbicide surrogate [138] Infection Gallium-67, 111 In-labeled leukocytes Anatomical localization [133][134][135][136] Left ventricular function 99m Tc-tetrofosmin Regional wall motion evaluation, myocardial muscle mass, ejection fraction, cardiac volumes [118] Lung (ventilation/perfusion) 99m Tc-Technegas, 99m Tc-macroaggregated albumin Anatomical localization and registration of ventilation-perfusion patterns [139,140] Lung cancer 99m Tc-sestamibi, 99m Tc-depreotide Anatomical localization [181][182]…”

SPECT/CT Imaging: Clinical Utility of an Emerging Technology

“…therapy planning should be feasible (64)(65)(66)(67)(68). Use for hepatic infusion chemotherapy (69,70), after beta-emitter therapy (71), for quantitation in order to develop a measurement similar to the standardized uptake value in PET, and in guided biopsy (to have fused images for defining sites of functional importance) (72) has been described in the literature. In cardiology, a variety of imaging protocols are possible (73).…”

Possible role of the scintigraphic estimation of the relative liver perfusion in the diagnosis and therapy of liver carcinomas

“…This information is valuable also for avoiding potential extrahepatic complications. 31 RI-angiography with 99m Tc-MAA plus degradable starch microspheres (DSM) revealed the increased accumulation in the tumor, compared to 99m Tc-MAA only, which indicates that intra-arterial chemotherapy combined with mitomycin C and DSM achieve higher regional selectivity 32 . Kaplan et al 33 concluded that radiotracers introduced at flow rates approximating those attained with infusion pumps will offer the best estimates of both initial catheter placement and subsequent patterns of hepatic distribution of chemotherapeutic agents.…”