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Is a Technetium-99m Macroaggregated Albumin Scan Essential in the Workup for Selective Internal Radiation Therapy with Yttrium-90? An Analysis of 532 Patients

Sancho L (1), Rodriguez-Fraile M (2), Bilbao JI (3), Beorlegui Arteta C (4), Iñarrairaegui M (5), Moran V (6), Sangro B (5). (1) Nuclear Medicine Department, Clínica Universidad de Navarra, Avda. Pio XII, no. 36, 31008 Pamplona, Navarra, Spain.
(2) Nuclear Medicine Department, Clínica Universidad de Navarra, Avda. Pio XII, no. 36, 31008 Pamplona, Navarra, Spain.
(3) Radiology Department, Clínica Universidad de Navarra, Avda. Pio XII, no. 36, 31008 Pamplona, Navarra, Spain.
(4) Department of Histology and Pathology, Clínica Universidad de Navarra, Avda. Pio XII, no. 36, 31008 Pamplona, Navarra, Spain; School of Medicine, Universidad de Navarra, Pamplona, Spain.
(5) Hepatology Department, Clínica Universidad de Navarra, Avda. Pio XII, no. 36, 31008 Pamplona, Navarra, Spain.
(6) Medical Physics Department, Clínica Universidad de Navarra, Avda. Pio XII, no. 36, 31008 Pamplona, Navarra, Spain.

Revisão:Journal of Vascular and Interventional Radiology

Data: 13/Set/2017

Radiología [ES] Hepatologia Medicina Nuclear [ES]

PURPOSE:
To determine if baseline patient, tumor, and pretreatment evaluation characteristics could help identify patients who require technetium-99m (99mTc) macroaggregated albumin (99mTc MAA) imaging before selective internal radiation therapy (SIRT).

MATERIALS AND METHODS:
In this retrospective analysis, 532 consecutive patients with primary (n = 248) or metastatic (n = 284) liver tumors were evaluated between 2006 and 2015. Variables were compared between patients in whom 99mTc MAA imaging results contraindicated/modified SIRT administration with yttrium-90 (90Y) resin microspheres and those who were treated as initially planned.

The 99mTc MAA findings that contraindicated/modified SIRT were a lung shunt fraction (LSF) > 20%, gastrointestinal 99mTc MAA uptake, or a mismatch between 99mTc MAA uptake and intrahepatic tumor distribution.

RESULTS:
LSF > 20% and gastrointestinal MAA uptake were observed in 7.5% and 3.9% of patients, respectively, and 11% presented a mismatch. Presence of a single lesion (odds ratio [OR] = 2.4) and vascular invasion (OR = 5.5) predicted LSF > 20%, and GI MAA uptake was predicted by the presence of liver metastases (OR = 3.7) and 99mTc MAA injection through the common/proper hepatic artery (OR = 4.7). Vascular invasion (OR = 4.1) was the only predictor of LSF > 20% and/or GI MAA uptake (sensitivity = 49.2%, specificity = 80.3%, negative predictive value = 92.4%). Previous antiangiogenic treatment (OR = 2.4) and presence of a single lesion (OR = 2.6) predicted mismatch.

CONCLUSIONS:
Imaging with 99mTc MAA is essential in SIRT workup because baseline characteristics may not adequately predict 99mTc MAA results.

Nevertheless, the absence of vascular invasion potentially identifies a group of patients at low risk of SIRT contraindication/modification in whom performing SIRT in a single session (ie, pretreatment evaluation and SIRT on the same day) should be explored.

CITAÇÃO DO ARTIGO  J Vasc Interv Radiol. 2017 Sep 13. pii: S1051-0443(17)30699-1. doi: 10.1016/j.jvir.2017.07.019

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