hepatic scintigraphy for liver function reserve pre-sirt · yttrium-90 radioembolization: third...
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Hepatic Scintigraphy for Liver Function
reserve pre-SIRT
Marnix G.E.H. Lam, MD, PhD
Professor of Nuclear Medicine UMC Utrecht
Courtesy
Roel J. Bennink, MD, PhD
Professor of Nuclear Medicine AMC Amsterdam
Disclosure of speaker’s interests
Consultant for BTG, Sirtex and Terumo
The department of Radiology and Nuclear Medicine
of the UMC Utrecht receives royalties and research
support from Terumo / Quirem Medical
Regional liver function and SIRT
• Safety assessment, e.g. repeated treatment
• Patient selection
• Pre-surgical induction of hypertrophy of future liver remnant
Regional liver function and SIRT
• Safety assessment, e.g. repeated treatment
• Patient selection
• Pre-surgical induction of hypertrophy of future liver remnant
Baseline CT
Follow-up PET
Baseline PET Yttrium-90 resin
microspheres: 1196 MBq
RHA; 613 MBq LHA
Follow-up CT
Yttrium-90 radioembolization
1 year CT
Follow-up PET
1 year PET Yttrium-90 resin
microspheres: 613 MBq
LHA
Follow-up CT
Yttrium-90 radioembolization: second treatment
1.5 year CT
Follow-up PET
1.5 year PET Yttrium-90 resin
microspheres: 1122 MBq
RHA
Yttrium-90 radioembolization: third treatment
Follow-up PET
2.5 year PET Yttrium-90 glass
microspheres: 200 Gy
segment 8
Yttrium-90 radioembolization: fourth treatment
3.5 year PET
Hepatobiliary Scintigraphy
Imino-diacetic acid (IDA)
– Lidocaine analogue
– 99mTc-Mebrofenin
– Liver uptake, excretion, biliary kinetics
Krishnamurthy et al. Nuclear Hepatology
OATP1B1: IDA, bilirubin
OATP1B3: IDA, ICG
NTCP: ICG
HBS: Protocol
Dual head dynamic
scintigraphy
– 36 frames 10 sec/frame
– Liver, heart, geometric
mean dataset
– Liver uptake %/min
– Ekman algorithm*
* Ekman M. et al. Nucl Med Comm 1996; 17:235-242 150 350 sec
%/min
• Left (2-3) ± 4
• Right (5-8)
• Ext. Right (4-8)
R. Smitshuis, Radiology Assistant.nl
3.5 year PET
Follow-up PET August 2017, >4 years
after first radioembolization
3.5 year PET Yttrium-90 glass
microspheres: 200 Gy
segment 8
Yttrium-90 radioembolization: fifth treatment
Regional liver function and SIRT
• Safety assessment, e.g. repeated treatment
• Patient selection
• Pre-surgical induction of hypertrophy of future liver remnant
Child-Pugh: Case 1 A6 Case 2 B8 Case 3 B8
Regional liver function and SIRT
• Safety assessment, e.g. repeated treatment
• Patient selection
• Pre-surgical induction of hypertrophy of future liver remnant
Pre-surgical induction of hypertrophy of
future liver remnant
• Portal Vein Embolisation
– Polyvinyl alcohol particles and coils
– Atrophy embolised lobes
– Compensatory hypertrophy future remnant liver
• SIRT
Pre-operative screening with hepatobiliary scintigraphy
Multifocal HCC segment 5-8
Yttrium-90 radioembolization
PET/CT after 120 Gy yttrium-90 glass
radioembolization
Multifocal HCC segment 5-8
Yttrium-90 radioembolization
3 months post-radioembolization Multifocal HCC segment 5-8
Yttrium-90 radioembolization
Yttrium-90 radioembolization
Post-hemihepatectomy right, segment 5-8
3.5 year PET
Yttrium-90 radioembolization
ALPPS
Associating Liver Partition and Portal vein Ligation for Staged hepatectomy
ALPPS function
Preliminary conclusions
• Hepatobiliary scintigraphy may be used for safety assessment
in repeated treatment
• Hepatobiliary scintigraphy may be used for improved patient
selection
• Hepatobiliary scintigraphy may be used for assessment of
future remnant liver function after SIRT as an alternative for
PVE