Prior ablation and progression of disease correlate with higher tumor-to-normal liver 99mTc-MAA uptake ratio in hepatocellular carcinoma

• Published in: Abdominal imaging Vol. 48; no. 2; pp. 752 - 757
• Main Authors: Patel, Mikin V., McNiel, David, Brunson, Christopher, Kuo, Phillip H., Hennemeyer, Charles T., Woodhead, Gregory, McGregor, Hugh
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2023; Springer Nature B.V
• Subjects: Ablation; Angiography; Correlation; Dosimeters; Dosimetry; Gastroenterology; Hepatocellular carcinoma; Hepatology; Imaging; Interventional Radiology; Liver; Liver cancer; Liver diseases; Mathematical analysis; Medical imaging; Medical treatment; Medicine; Medicine & Public Health; Parameters; Radiology; Scintigraphy; Segmentation; Single photon emission computed tomography; Tumors; Hepatocellular carcinoma; Interventional oncology; Dosimetry; Radioembolization
• ISSN: 2366-0058; 2366-004X; 2366-0058
• DOI: 10.1007/s00261-022-03718-8

Purpose Factors affecting tumor-to-normal tissue ratio (T:N) have implications for patient selection, dosimetry, and outcomes when considering radioembolization for HCC. This study sought to evaluate patient, disease specific, and technical parameters that predict T:N as measured on planning pre- 90 Y radioembolization 99m Tc-MAA scintigraphy for hepatocellular carcinoma (HCC). Methods 99m Tc-MAA hepatic angiography procedures with SPECT/CT over a 4-year period were reviewed. Data recorded included patient demographics, details of underlying liver disease, tumor size, history of prior treatments for HCC and technical parameters from angiography. Anatomic-based segmentation was performed in 93 cases for measurement of tumor and perfused liver volumes and SPECT counts. T:N were calculated and correlated with collected variables. Results Mean calculated T:N was 2.52. History of prior ablation was significantly correlated with higher T:N (mean 3.39 vs 2.24, p  = 0.003). Cases in which mapping was being performed for treatment of disease progression was significantly correlated with higher T:N (mean 3.35 vs 2.14, p  = 0.001). Larger tumor size trended toward lower T:N ( p  = 0.052). Conclusion Patients with history of ablation and those undergoing treatment for disease progression have higher T:N and, therefore, could be considered for radioembolization preferentially over alternative treatments.