The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

Maarten L J Smits; Mathijs G Dassen; Jip F Prince; Arthur J A T Braat; Casper Beijst; Rutger C G Bruijnen; Hugo W A M de Jong; Marnix G E H Lam

doi:10.1007/s00259-019-04460-y

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

Maarten L J Smits, Mathijs G Dassen, Jip F Prince, Arthur J A T Braat, Casper Beijst, Rutger C G Bruijnen, Hugo W A M de Jong, Marnix G E H Lam

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Abstract

Purpose: As an alternative to technetium-99m-macroaggregated albumin ( ^99mTc-MAA), a scout dose of holmium-166 ( ¹⁶⁶Ho) microspheres can be used prior to ¹⁶⁶Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between ¹⁶⁶Ho-scout and ¹⁶⁶Ho-therapeutic dose in comparison with the agreement between ^99mTc-MAA and ¹⁶⁶Ho-therapeutic dose. Methods: Two separate scout dose procedures were performed ( ^99mTc-MAA and ¹⁶⁶Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the ^99mTc-MAA, ¹⁶⁶Ho-scout, and ¹⁶⁶Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on ^99mTc-MAA and ¹⁶⁶Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT. Results: A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, ¹⁶⁶Ho-scout was superior with a median score of 4 vs. 2.5 for ^99mTc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for ¹⁶⁶Ho-scout in comparison with ^99mTc-MAA when evaluating lesion absorbed dose (− 90.3 and 105.3 Gy vs. − 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and ¹⁶⁶Ho-therapeutic dose (− 2.9 and 5.5 Gy vs − 3.6 and 4.1 Gy for ^99mTc-MAA and ¹⁶⁶Ho-scout, respectively). Conclusions: In this study, ¹⁶⁶Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with ^99mTc-MAA.

Original language	English
Pages (from-to)	798-806
Number of pages	9
Journal	European Journal of Nuclear Medicine and Molecular Imaging
Volume	47
Issue number	4
DOIs	https://doi.org/10.1007/s00259-019-04460-y
Publication status	Published - 1 Apr 2020

Keywords

Dosimetry
Holmium-166 microspheres
Radioembolization
SIRT
Technetium-99m-MAA

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Smits, M. L. J., Dassen, M. G., Prince, J. F., Braat, A. J. A. T., Beijst, C., Bruijnen, R. C. G., de Jong, H. W. A. M., & Lam, M. G. E. H. (2020). The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases. European Journal of Nuclear Medicine and Molecular Imaging, 47(4), 798-806. https://doi.org/10.1007/s00259-019-04460-y

@article{9c2c0acbf11a4cb5b500cd66aa31b3c3,

title = "The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases",

abstract = "Purpose: As an alternative to technetium-99m-macroaggregated albumin ( 99mTc-MAA), a scout dose of holmium-166 ( 166Ho) microspheres can be used prior to 166Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between 166Ho-scout and 166Ho-therapeutic dose in comparison with the agreement between 99mTc-MAA and 166Ho-therapeutic dose. Methods: Two separate scout dose procedures were performed ( 99mTc-MAA and 166Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the 99mTc-MAA, 166Ho-scout, and 166Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on 99mTc-MAA and 166Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT. Results: A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, 166Ho-scout was superior with a median score of 4 vs. 2.5 for 99mTc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for 166Ho-scout in comparison with 99mTc-MAA when evaluating lesion absorbed dose (− 90.3 and 105.3 Gy vs. − 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and 166Ho-therapeutic dose (− 2.9 and 5.5 Gy vs − 3.6 and 4.1 Gy for 99mTc-MAA and 166Ho-scout, respectively). Conclusions: In this study, 166Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with 99mTc-MAA. ",

keywords = "Dosimetry, Holmium-166 microspheres, Radioembolization, SIRT, Technetium-99m-MAA",

author = "Smits, {Maarten L J} and Dassen, {Mathijs G} and Prince, {Jip F} and Braat, {Arthur J A T} and Casper Beijst and Bruijnen, {Rutger C G} and {de Jong}, {Hugo W A M} and Lam, {Marnix G E H}",

note = "Funding Information: This study was funded by the Dutch Cancer Society. Publisher Copyright: {\textcopyright} 2019, The Author(s).",

year = "2020",

month = apr,

day = "1",

doi = "10.1007/s00259-019-04460-y",

language = "English",

volume = "47",

pages = "798--806",

journal = "European Journal of Nuclear Medicine and Molecular Imaging",

issn = "1619-7070",

publisher = "Springer-Verlag",

number = "4",

}

Smits, MLJ, Dassen, MG, Prince, JF, Braat, AJAT , Beijst, C, Bruijnen, RCG, de Jong, HWAM & Lam, MGEH 2020, 'The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases', European Journal of Nuclear Medicine and Molecular Imaging, vol. 47, no. 4, pp. 798-806. https://doi.org/10.1007/s00259-019-04460-y

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases. / Smits, Maarten L J; Dassen, Mathijs G; Prince, Jip F et al.
In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 47, No. 4, 01.04.2020, p. 798-806.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

AU - Smits, Maarten L J

AU - Dassen, Mathijs G

AU - Prince, Jip F

AU - Braat, Arthur J A T

AU - Beijst, Casper

AU - Bruijnen, Rutger C G

AU - de Jong, Hugo W A M

AU - Lam, Marnix G E H

PY - 2020/4/1

Y1 - 2020/4/1

N2 - Purpose: As an alternative to technetium-99m-macroaggregated albumin ( 99mTc-MAA), a scout dose of holmium-166 ( 166Ho) microspheres can be used prior to 166Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between 166Ho-scout and 166Ho-therapeutic dose in comparison with the agreement between 99mTc-MAA and 166Ho-therapeutic dose. Methods: Two separate scout dose procedures were performed ( 99mTc-MAA and 166Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the 99mTc-MAA, 166Ho-scout, and 166Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on 99mTc-MAA and 166Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT. Results: A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, 166Ho-scout was superior with a median score of 4 vs. 2.5 for 99mTc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for 166Ho-scout in comparison with 99mTc-MAA when evaluating lesion absorbed dose (− 90.3 and 105.3 Gy vs. − 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and 166Ho-therapeutic dose (− 2.9 and 5.5 Gy vs − 3.6 and 4.1 Gy for 99mTc-MAA and 166Ho-scout, respectively). Conclusions: In this study, 166Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with 99mTc-MAA.

AB - Purpose: As an alternative to technetium-99m-macroaggregated albumin ( 99mTc-MAA), a scout dose of holmium-166 ( 166Ho) microspheres can be used prior to 166Ho-radioembolization. The use of identical particles for pre-treatment and treatment procedures may improve the predictive value of pre-treatment analysis of distribution. The aim of this study was to analyze the agreement between 166Ho-scout and 166Ho-therapeutic dose in comparison with the agreement between 99mTc-MAA and 166Ho-therapeutic dose. Methods: Two separate scout dose procedures were performed ( 99mTc-MAA and 166Ho-scout) before treatment in 53 patients. First, qualitative assessment was performed by two blinded nuclear medicine physicians who visually rated the agreement between the 99mTc-MAA, 166Ho-scout, and 166Ho-therapeutic dose SPECT-scans (i.e., all performed in the same patient) on a 5-point scale. Second, agreement was measured quantitatively by delineating lesions and normal liver on FDG-PET/CT. These volumes of interest (VOIs) were co-registered to the SPECT/CT images. The predicted absorbed doses (based on 99mTc-MAA and 166Ho-scout) were compared with the actual absorbed dose on post-treatment SPECT. Results: A total of 23 procedures (71 lesions, 22 patients) were included for analysis. In the qualitative analysis, 166Ho-scout was superior with a median score of 4 vs. 2.5 for 99mTc-MAA (p < 0.001). The quantitative analysis showed significantly narrower 95%-limits of agreement for 166Ho-scout in comparison with 99mTc-MAA when evaluating lesion absorbed dose (− 90.3 and 105.3 Gy vs. − 164.1 and 197.0 Gy, respectively). Evaluation of normal liver absorbed dose did not show difference in agreement between both scout doses and 166Ho-therapeutic dose (− 2.9 and 5.5 Gy vs − 3.6 and 4.1 Gy for 99mTc-MAA and 166Ho-scout, respectively). Conclusions: In this study, 166Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with 99mTc-MAA.

KW - Dosimetry

KW - Holmium-166 microspheres

KW - Radioembolization

KW - SIRT

KW - Technetium-99m-MAA

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U2 - 10.1007/s00259-019-04460-y

DO - 10.1007/s00259-019-04460-y

M3 - Article

C2 - 31399801

SN - 1619-7070

VL - 47

SP - 798

EP - 806

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

IS - 4

ER -

The superior predictive value of 166Ho-scout compared with 99mTc-macroaggregated albumin prior to 166Ho-microspheres radioembolization in patients with liver metastases

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