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Radioembolization lung shunt estimation based on a 90 Y pretreatment procedure: A phantom study
Britt Kunnen1,2, Sandra van der Velden1,2, Remco Bastiaannet1,2
1Radiology and Nuclear Medicine, UMC Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
Medical Physics
|September 5, 2018
Summary
Accurate lung shunt fraction (LSF) measurement is crucial for 90Y radioembolization pretreatment. Monte Carlo-based SPECT/CT imaging accurately estimates LSF using low-activity 90Y, improving treatment safety and efficacy.
Area of Science:
- Nuclear Medicine
- Radiology
- Medical Imaging
Background:
- 90Y radioembolization requires pretreatment to assess lung shunt fraction (LSF).
- Current 99mTc-MAA methods have limitations due to particle size differences.
- Accurate LSF measurement is vital for optimizing 90Y treatment activity and preventing complications.
Purpose of the Study:
- To evaluate three nuclear imaging techniques for LSF estimation using low-activity 90Y.
- To compare PET/CT, Bremsstrahlung SPECT/CT, and planar imaging performance in a phantom study.
- To determine the feasibility of using low-activity 90Y for pretreatment LSF assessment.
Main Methods:
- An anthropomorphic phantom with known LSF was used, filled with 90Y chloride.
- 90Y activities ranged from 25 MBq to 1586 MBq.
- PET/CT, Bremsstrahlung SPECT/CT (clinical and MC-based reconstruction), and planar imaging were performed.
Main Results:
- PET/CT accurately estimated LSF above 200 MBq but overestimated at lower activities.
- Clinical SPECT/CT and planar imaging consistently overestimated LSF across activity ranges.
- MC-based SPECT/CT reconstructions accurately estimated LSF with <1.3 pp difference down to 70 MBq.
Conclusions:
- MC-based SPECT/CT provides accurate LSF estimation for 90Y pretreatment at activities as low as 70 MBq.
- This technique allows for safer pretreatment by minimizing radiation exposure.
- Improved LSF accuracy can lead to optimized 90Y radioembolization treatment planning.
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