Follow-up Yttrium -90 Internal Pair Production PET/CT...
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Follow-up Yttrium-90 Internal Pair Production PET/CT Imaging in Patients with Primary or Metastatic Liver Tumors as compared with Bremsstrahlung Imaging: A Prospective Case Series Michael O’Neill MD, Jason Salsamendi MD, Michael Georgiou PhD, Mircea Cristescu MD MBA, Tatiana Froud MD, Russ Kuker MD, Shivank Bhatia MD, Govindarajan Narayanan MD University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL Patient 1 : 25 yo female with metastatic Wilms tumor referred for left hepatic artery radioembolization. She was status-post Y-90 embolization of right lobe 2 months prior. Patient 2 : 62 yo female with HCC of 4B referred for Y-90 embolization of the middle hepatic artery. She is status- post GDA and RHA coil- embolization 2 months prior, and Y-90 treatment from the LHA 1-month prior. Patient 3 : 59 yo male with HCC, left portal vein thrombosis, and previous treatment with chemoembolization referred for RHA Y-90 embolization. Patient 2 : Axial, sagittal, and coronal Bremsstrahlung SPECT, PET/CT, and CT imaging. SPECT, PET/CT were obtained on the same day. IV contrast-enhanced CT was obtained one month after embolization. Patient 1 : Axial, sagittal, and coronal Bremsstrahlung SPECT, PET/CT, and CT imaging. SPECT, PET/CT, and IV contrast enhanced CT were obtained the same day and 2 weeks, respectively, after embolization. No recent pre-procedure CT was obtained Patient 3 : Axial, sagittal, and coronal Bremsstrahlung SPECT, PET/CT, and CT imaging. SPECT and PET/CT imaging was obtained on the day of embolization. CT was performed one month before embolization 1. Selwyn RG, Nickles RJ, Thomadsen BR, DeWerd LA, Micka JA. A new internal pair production branching ratio of 90Y: The development of a non-destructive assay for 90Y and 90Sr. Appl Radiat Isot 2007;65:318–27. 2. Ahmadzadehfar H, et al. Imaging of Y90 distribution with PET/CT and bremsstrahlung SPECT/CT after radioembolization: A patient based study. J Nucl Med. 2011; 52 (Supplement 1):92. 3. Lhommel R, van Elmbt L, Goffette P, Van den Eynde M, Jamar F, Pauwels S, Walrand S. Feasibility of 90Y TOF PET-based dosimetry in liver metastasis therapy using SIR-Spheres. Eur J Nucl Med Mol Imaging. 2010 Aug;37(9):1654-62. 4. Gates VL, Esmail AA, Marshall K, Spies S, Salem R. Internal pair production of 90Y permits hepatic localization of microspheres using routine PET: proof of concept. J Nucl Med. 2011 Jan;52(1):72-6. Epub 2010 Dec 13. 5. Kao YH, Tan EH, Lim KY, Ng CE, Goh SW. Yttrium-90 internal pair production imaging using first generation PET/CT provides high resolution images for qualitative diagnostic purposes. Br J Radiol. 2011 Oct 5. Selective internal radiation therapy (SIRT) with Yttrium-90 (Y-90) is an important modality in the treatment of unresectable liver metastases from CRC and NETs, as well as HCC Post-SIRT radiologic assessment is required in order to determine the adequacy of treatment delivery and to detect potential non-target embolization At most institutions, post-therapy localization is achieved with SPECT or SPECT/CT, which are sometimes limited by poor resolution, particularly in SPECT imaging alone. Background References 3 patients received BS SPECT and Y-90 PET/CT post-radioembolization with a commonly used Phillips Gemini scanner. Acquisition time was the major difference at an average of 20-30 minutes. Assessment of Y-90 embolization can be achieved readily with commonly used PET or PET/CT scanners PET may provide superior resolution when compared to traditional Brehmsstrahlung SPECT Improved imaging resolution post-Y-90 embolization may aid in more accurately determining dose distribution and non-target embolization where SPECT/CT is not readily available. Future studies will further explore PET/CT –based dosimetric methadologies, and paired with Pre- and post- Y-90 FDG PET or CTA, may potentially prove to have prognostic value. Yittrium-90 (Y-90) is a radioembolic agent, which primarily undergoes beta-decay. The electrons produced in this process interact with surrounding tissues, producing Bremsstrahlung photons detectable by SPECT Y-90 has a minor branch to the 0+ excited state with an energy of 1.7 MeV, producing an internal e + e - pair in 1 of every 32 million decays. This subsequent internal pair production reaction is detectable by PET. Scientific Basis of Y-90 PET/CT Methods, Results, and Conclusions
Transcript of Follow-up Yttrium -90 Internal Pair Production PET/CT...
Follow-up Yttrium-90 Internal Pair Production PET/CT Imaging in Patients with Primary or Metastatic Liver Tumors as compared with Bremsstrahlung Imaging: A Prospective Case Series
Michael O’Neill MD, Jason Salsamendi MD, Michael Georgiou PhD, Mircea Cristescu MD MBA, Tatiana Froud MD, Russ Kuker MD, Shivank Bhatia MD, Govindarajan Narayanan MD
University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL
Patient 1: 25 yo female with metastatic Wilms tumor referred for left hepatic artery radioembolization. She was status-post Y-90 embolization of right lobe 2 months prior.
Patient 2: 62 yo female with HCC of 4B referred for Y-90 embolization of the middle hepatic artery. She is status-post GDA and RHA coil-embolization 2 months prior, and Y-90 treatment from the LHA 1-month prior.
Patient 3: 59 yo male with HCC, left portal vein thrombosis, and previous treatment with chemoembolization referred for RHA Y-90 embolization.
Patient 2: Axial, sagittal, and coronal Bremsstrahlung SPECT, PET/CT, and CT imaging. SPECT, PET/CT were obtained on the same day. IV contrast-enhanced CT was obtained one month after embolization.
Patient 1: Axial, sagittal, and coronal Bremsstrahlung SPECT, PET/CT, and CT imaging. SPECT, PET/CT, and IV contrast enhanced CT were obtained the same day and 2 weeks, respectively, after embolization. No recent pre-procedure CT was obtained
Patient 3: Axial, sagittal, and coronal Bremsstrahlung SPECT, PET/CT, and CT imaging. SPECT and PET/CT imaging was obtained on the day of embolization. CT was performed one month before embolization
1. Selwyn RG, Nickles RJ, Thomadsen BR, DeWerd LA, Micka JA. A new internal pair production branching ratio of
90Y: The development of a non-destructive assay for 90Y and 90Sr. Appl Radiat Isot 2007;65:318–27. 2. Ahmadzadehfar H, et al. Imaging of Y90 distribution with PET/CT and bremsstrahlung SPECT/CT after
radioembolization: A patient based study. J Nucl Med. 2011; 52 (Supplement 1):92. 3. Lhommel R, van Elmbt L, Goffette P, Van den Eynde M, Jamar F, Pauwels S, Walrand S. Feasibility of 90Y TOF
PET-based dosimetry in liver metastasis therapy using SIR-Spheres. Eur J Nucl Med Mol Imaging. 2010 Aug;37(9):1654-62.
4. Gates VL, Esmail AA, Marshall K, Spies S, Salem R. Internal pair production of 90Y permits hepatic localization of microspheres using routine PET: proof of concept. J Nucl Med. 2011 Jan;52(1):72-6. Epub 2010 Dec 13.
5. Kao YH, Tan EH, Lim KY, Ng CE, Goh SW. Yttrium-90 internal pair production imaging using first generation PET/CT provides high resolution images for qualitative diagnostic purposes. Br J Radiol. 2011 Oct 5.
Selective internal radiation therapy (SIRT) with Yttrium-90 (Y-90) is an important
modality in the treatment of unresectable liver metastases from CRC and NETs, as well as HCC
Post-SIRT radiologic assessment is required in order to determine the adequacy of treatment delivery and to detect potential non-target embolization
At most institutions, post-therapy localization is achieved with SPECT or SPECT/CT, which are sometimes limited by poor resolution, particularly in SPECT imaging alone.
Background References 3 patients received BS SPECT and Y-90 PET/CT post-radioembolization with a commonly used Phillips
Gemini scanner. Acquisition time was the major difference at an average of 20-30 minutes. Assessment of Y-90 embolization can be achieved readily with commonly used PET or PET/CT scanners PET may provide superior resolution when compared to traditional Brehmsstrahlung SPECT Improved imaging resolution post-Y-90 embolization may aid in more accurately determining dose
distribution and non-target embolization where SPECT/CT is not readily available. Future studies will further explore PET/CT –based dosimetric methadologies, and paired with Pre- and
post- Y-90 FDG PET or CTA, may potentially prove to have prognostic value.
Yittrium-90 (Y-90) is a radioembolic agent, which primarily undergoes beta-decay. The electrons produced in this process interact with surrounding tissues, producing Bremsstrahlung photons detectable by SPECT
Y-90 has a minor branch to the 0+ excited state with an energy of 1.7 MeV, producing an internal e+e- pair in 1 of every 32 million decays. This subsequent internal pair production reaction is detectable by PET.
Scientific Basis of Y-90 PET/CT Methods, Results, and Conclusions
