Abstract
Spectrum of findings in 99mTc-MAA SPECT/CT and their significance in treatment planning for Yttrium 90-microsphere radioembolization for hepatocellular carcinoma
Highlights
Surgical percutaneous intervention and/or resection with the ultimate goal of transplantation for patients with primary hepatocellular carcinoma (HCC) remains the gold standard for treatment and represents an opportunity for cure; candidates for resection or transplantation represent the minority of patients presenting with HCC [1]
The primary purpose of 99mTc-MAA SPECT/CT is to estimate the percent Y90microspheres that would be delivered to the lung so that an appropriate dose can be used, minimizing the possibility of radiation-induced pneumonitis
The nuclear medicine physician plays a critical role in the interpretation of the pre-embolization 99mTc-MAA SPECT/CT image
Summary
Surgical percutaneous intervention and/or resection with the ultimate goal of transplantation for patients with primary hepatocellular carcinoma (HCC) remains the gold standard for treatment and represents an opportunity for cure; candidates for resection or transplantation represent the minority of patients presenting with HCC [1]. Examples of extra-hepatic uptake Tumor embolization therapy carries an ever-present risk of complications due to nontarget embolization. This risk carries greater importance in cases of Y90-microsphere embolization because Y90 is a pure beta emitter with a mean energy of 0.94 MeV and mean tissue penetration of 2.5 mm. Accumulation of 99mTc-MAA in the GI tract is another commonly encountered scenario This may manifest with uptake of 99mTcMAA in the stomach, duodenum, or more distal intestines (Figure 3). Because of the risk of radioembolic material refluxing into the arteries supplying the stomach and intestines, many operators prophylactically coil embolize the GDA and the right gastric artery. Because the intravascular tumor is still supplied by the hepatic artery, SPECT/CT will demonstrate uptake within the portal vein (Figure 5)
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