Correlation of Technetium-99m Macroaggregated Albumin and Yttrium-90 Glass Microsphere Biodistribution in Hepatocellular Carcinoma: A Retrospective Review of Pretreatment Single Photon Emission CT and Posttreatment Positron Emission Tomography/CT

Haste, Paul; Tann, Mark; Persohn, Scott A.; LaRoche, Thomas; Aaron, Vasantha; Mauxion, Thibault; Chauhan, Nikhil; Dreher, Matthew R.; Johnson, Matthew S.

doi:10.1016/j.jvir.2016.12.1221

Cited by 79 publications

(67 citation statements)

References 19 publications

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“…It is therefore not surprising that previous work has shown mixed results on the performance of planning tumor dosimetry based on MAA. 16,20 In terms of dosimetry models, PM offers improvement over the package insert dosimetry for glass microspheres by extracting doses separately for tumor and NL volumes. But PM can still lead to significant deviations in dose estimates in many cases due to (a) the implicit assumption that microsphere distributions are uniform in the tumor and NL compartments, (b) the uncertainty in determining the tumor to NL uptake ratio (TNR) required for PM calculations, and (c) its inability to address multiple tumors with different sizes and/or uptake.…”

Section: Introductionmentioning

confidence: 99%

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

et al. 2020

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Purpose: 99m Tc-MAA-SPECT/CT may be used in 90 Y-glass microsphere radioembolization treatment planning to assess perfused liver volumes and absorbed dose distributions. The partition model (PM) offers a more detailed planning dosimetry option beyond the single-compartment model more traditionally used in 90 Y radioembolization. As 90 Y radioembolization treatments shift toward activities and doses that aim to achieve tumor control, accurate and reliable treatment planning dosimetry for both tumors and normal liver (NL) becomes more critical. In this work, we explore the accuracy and precision of 90 Y dosimetry predictions from pretherapy 99m Tc-MAA and PM. Methods: Both PM and voxel dosimetry models were used to calculate tumor and NL mean doses using both planning 99m Tc-MAA and verification 90 Y-SPECT/CT in this retrospective analysis of hepatocellular carcinoma cases treated with glass microspheres (NCT01900002, n = 32). Linear regression models were developed at first access, and then later correct, the estimates by (a) 99m Tc-MAA for 90 Y voxel dosimetry and (b) 99m Tc-MAA PM for voxel dosimetry, separately for both tumors and NL. Bland-Altman analysis was then used to evaluate the accuracy and precision of the regression model predictions with the mean bias and 95% prediction intervals (PI, AE1.96σ). Two categories of cases were stratified (catheter matched vs catheter unmatched) by establishing the level of 99m Tc-MAA and 90 Y catheter position alignment. Only catheter-matched cases were included in the 99m Tc-MAA vs 90 Y voxel dosimetry comparison, while all cases were used to compare dosimetry models (PM vs voxel). Results: Half (16/32) of cases were deemed catheter matched. 99m Tc-MAA could reliably predict NL doses in catheter-matched cases after application of the linear model, with mean bias (PI) of −1% (AE31%). PM was equivalent to voxel dosimetry for NL doses with mean bias (PI) of 0% (AE1%). Even among catheter-matched cases, 99m Tc-MAA planning for 90 Y tumor voxel doses was poor, overestimating dose by an average of nearly 40%. Upon application of the linear model, 99m Tc-MAA predictions for 90 Y tumor voxel dose were only minimally biased (−4%) but possessed very large PI (AE104%). PM predictions for tumor voxel dose using the linear model also showed small bias (−6%) but maintained similarly high PI of AE90%. Cases with tumors representing a large majority (>80%) of the total tumor volume demonstrated the best scenarios for 99m Tc-MAA and PM tumor dose predictions, with mean biases (PI) of −3% (AE53%) and −4% (AE21%), respectively. Conclusion: The unconditional use of 99m Tc-MAA to predict 90 Y dosimetry across all cases is not recommended due to: (a) demonstrated the risk of unmatched catheter positions between procedures, and (b) large bias and uncertainty in 99m Tc-MAA predictions in cases with matched catheter locations. However, NL voxel dose predictions with 99m Tc-MAA are clinically viable and either PM or voxel dosimetry can be used to produce equivalent predictions. Both 99m Tc-MAA a...

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Section: Introductionmentioning

confidence: 99%

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

et al. 2020

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“…Although we demonstrated that the ECM porosity of the THLE-3/ TIME (healthy liver) microenvironment is higher than the ECM porosity of both cancer microenvironments, the particle accumulation rate in the MDA-MB-231/TIME and C3Asub28/TIME microenvironments are 3.45-and 4.81-fold (P < 0.05) higher than the healthy liver microenvironment, respectively. Similarly, a recent clinical study on drug delivery indicated that uptake by tumorigenic portions of the liver is significantly higher than healthy portions (Haste et al, 2017). This indicates that vessel porosity plays a more dominant role compared with ECM porosity in the accumulation rates of particles in the ECM.…”

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confidence: 95%

In vitro vascularized liver and tumor tissue microenvironments on a chip for dynamic determination of nanoparticle transport and toxicity

Özkan

Ghousifam

Hoopes

et al. 2019

Biotech & Bioengineering

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This paper presents the development of a vascularized breast tumor and healthy or tumorigenic liver microenvironments‐on‐a‐chip connected in series. This is the first description of a vascularized multi tissue‐on‐a‐chip microenvironment for modeling cancerous breast and cancerous/healthy liver microenvironments, to allow for the study of dynamic and spatial transport of particles. This device enables the dynamic determination of vessel permeability, the measurement of drug and nanoparticle transport, and the assessment of the associated efficacy and toxicity to the liver. The platform is utilized to determine the effect of particle size on the spatiotemporal diffusion of particles through each microenvironment, both independently and in response to the circulation of particles in varying sequences of microenvironments. The results show that when breast cancer cells were cultured in the microenvironments they had a 2.62‐fold higher vessel porosity relative to vessels within healthy liver microenvironments. Hence, the permeability of the tumor microenvironment increased by 2.35‐ and 2.77‐fold compared with a healthy liver for small and large particles, respectively. The extracellular matrix accumulation rate of larger particles was 2.57‐fold lower than smaller particles in a healthy liver. However, the accumulation rate was 5.57‐fold greater in the breast tumor microenvironment. These results are in agreement with comparable in vivo studies. Ultimately, the platform could be utilized to determine the impact of the tissue or tumor microenvironment, or drug and nanoparticle properties, on transport, efficacy, selectivity, and toxicity in a dynamic, and high‐throughput manner for use in treatment optimization.

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“…Radioembolization (RE) via Yttrium‐90 ( 90 Y) microspheres enables selective internal radiotherapy (SIRT) for hepatic malignancies. Guidelines exist for the careful planning of the RE procedure, specifically with the use of pretreatment angiograms and Technetium‐99m labeled macroaggregated albumin ( 99m Tc‐MAA) single photon emission computed tomography (SPECT) for calculating lung shunt fraction and predicting extrahepatic flow . However, these images are often imprecise simulators of actual microsphere distribution and poor predictors of individual lesion response in patients with metastatic disease, such as colorectal cancer .…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines exist for the careful planning of the RE procedure, specifically with the use of pretreatment angiograms and Technetium-99m labeled macroaggregated albumin ( 99m Tc-MAA) single photon emission computed tomography (SPECT) for calculating lung shunt fraction and predicting extrahepatic flow. 1,2 However, these images are often imprecise simulators of actual microsphere distribution and poor predictors of individual lesion response in patients with metastatic disease, such as colorectal cancer. 3 Possible reasons for these discrepancies include differences in sizes and in the range of sizes between the 99m Tc-MAA particles (~5-100 lm diameter) and 90 Y microspheres (~20-30 lm diameter) and the delay between pretreatment imaging and radioembolization (~2 weeks).…”

Section: Introductionmentioning

confidence: 99%

Validation of post‐treatment PET‐based dosimetry software for hepatic radioembolization of Yttrium‐90 microspheres

et al. 2019

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Purpose Yttrium‐90 (90Y) microsphere radioembolization enables selective internal radiotherapy for hepatic malignancies. Currently, there is no standard postdelivery imaging and dosimetry of the microsphere distribution to verify treatment. Recent studies have reported utilizing the small positron yield of 90Y (32 ppm) with positron emission tomography (PET) to perform treatment verification and dosimetry analysis. In this study, we validated a commercial dosimetry software, MIM SurePlan™ LiverY90 (MIM Software Inc., Cleveland, OH), for clinical use. Methods A MATLAB‐based algorithm for 90Y PET‐based dosimetry was developed in‐house and validated for the purpose of commissioning the commercial software. The algorithm is based on voxel S values and dosimetry formalism reported in MIRD Pamphlet 17. We validated the in‐house algorithm to establish it as the ground truth by comparing results from a digital point phantom and a digital uniform cylinder to manual calculations. Once we validated our in‐house MATLAB‐based algorithm, we used it to perform acceptance testing and commissioning of the commercial dosimetry software, MIM SurePlan, which uses the same dosimetry formalism. A 0.4 cm/5% gamma test was performed on PET‐derived dose maps from each algorithm of uniform digital and nonuniform physical phantoms filled with 90Y chloride solution. Average dose (Davg) and minimum dose to 70% (D70) of a given volume of interest (VOI) were compared for the digital phantom, the physical phantom, and five patient cases (27 tumor VOIs), representing different clinical scenarios. Results The gamma‐pass rates were 97.26% and 97.66% for the digital and physical phantoms, respectively. The differences between Davg and D70 were 0.076% and 0.10% for the digital phantom, respectively, and <5.2% for various VOIs in the physical phantom. In the clinical cases, 96.3% of the VOIs had a difference <5% for Davg, and 88.9% of the VOIs had a difference <5% for D70. Conclusions Dose calculation results from MIM SurePlan were found to be in good agreement with our in‐house algorithm. This indicates that MIM SurePlan performs as it should and, hence, can be deemed accepted and commissioned for clinical use for post‐implant PET‐based dosimetry of 90Y radioembolization.

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Correlation of Technetium-99m Macroaggregated Albumin and Yttrium-90 Glass Microsphere Biodistribution in Hepatocellular Carcinoma: A Retrospective Review of Pretreatment Single Photon Emission CT and Posttreatment Positron Emission Tomography/CT

Cited by 79 publications

References 19 publications

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

In vitro vascularized liver and tumor tissue microenvironments on a chip for dynamic determination of nanoparticle transport and toxicity

Validation of post‐treatment PET‐based dosimetry software for hepatic radioembolization of Yttrium‐90 microspheres

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Correlation of Technetium-99m Macroaggregated Albumin and Yttrium-90 Glass Microsphere Biodistribution in Hepatocellular Carcinoma: A Retrospective Review of Pretreatment Single Photon Emission CT and Posttreatment Positron Emission Tomography/CT

Cited by 79 publications

References 19 publications

Planning dosimetry for 90Y radioembolization with glass microspheres: Evaluating the fidelity of 99mTc‐MAA and partition model predictions

Planning dosimetry for 90Y radioembolization with glass microspheres: Evaluating the fidelity of 99mTc‐MAA and partition model predictions

In vitro vascularized liver and tumor tissue microenvironments on a chip for dynamic determination of nanoparticle transport and toxicity

Validation of post‐treatment PET‐based dosimetry software for hepatic radioembolization of Yttrium‐90 microspheres

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Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions

Planning dosimetry for ⁹⁰Y radioembolization with glass microspheres: Evaluating the fidelity of ^99mTc‐MAA and partition model predictions