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

摘要

Abstract Purpose To determine if baseline patient, tumor, and pretreatment evaluation characteristics could help identify patients who require technetium-99m ( 99m Tc) macroaggregated albumin ( 99m Tc 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 99m Tc MAA imaging results contraindicated/modified SIRT administration with yttrium-90 ( 90 Y) resin microspheres and those who were treated as initially planned. The 99m Tc MAA findings that contraindicated/modified SIRT were a lung shunt fraction (LSF) > 20%, gastrointestinal 99m Tc MAA uptake, or a mismatch between 99m Tc 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 99m Tc 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 99m Tc MAA is essential in SIRT workup because baseline characteristics may not adequately predict 99m Tc 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. ]]>