Comparison of lung shunt fraction calculation using Tc-99m MAA planar and SPECT/CT imaging for Y-90 radioembolization

Nut  Noipinit; Thunyaluk  Sawatnatee; Benchamat  Phromphao; Peangtawan  Ratsameechot; Sutida  Thiambandit; Tanawat  Sontrapornpol

Authors

Nut Noipinit King Chulalongkorn Memorial Hospital, Thai Redcross Society, Bangkok, Thailand
Thunyaluk Sawatnatee King Chulalongkorn Memorial Hospital, Thai Redcross Society, Bangkok, Thailand
Benchamat Phromphao King Chulalongkorn Memorial Hospital, Thai Redcross Society, Bangkok, Thailand
Peangtawan Ratsameechot Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
Sutida Thiambandit Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
Tanawat Sontrapornpol King Chulalongkorn Memorial Hospital, Thai Redcross Society, Bangkok, Thailand

Keywords:

LSF, planar, radioembolization, SPECT/CT, Tc-99m MAA

Abstract

Background: The evaluation of hepatopulmonary blood vessels using technetium-99m macroaggregated albumin (Tc-99m MAA) scintigraphy before radioembolization with yttrium-90 (Y-90) microspheres is a test employed to assess and prevent radiation pneumonitis. Moreover, the lung shunt fraction (LSF) was determined from planar and single-photon emission computed tomography/computed tomography (SPECT/CT) images. This study aimed to compare LSF calculations from Tc-99m MAA planar and SPECT/CT images for Y-90 radioembolization treatment of liver tumors.

Methods: A total of 64 patients (42 males, 22 females; mean age 64.0/ ±/ 12.5 years) who underwent Tc-99m MAA scintigraphy between 2015 and 2022 were included in this study. The LSF was calculated using MIM software, with planar LSF derived from the geometric mean of lung and liver region of interest counts from anterior and posterior views, and SPECT/CT LSF from the volume of interest-based quantification. The two methods were compared using a paired t-test and Bland–Altman analysis. Intra-observer reliability was assessed using the coefficient of variation (%CV) from repeated measurements, while inter-observer reliability was evaluated using the intra-class correlation coefficient (ICC) from measurements by different investigators.

Results: The %CV for LSF remeasurements from planar and SPECT/CT images were 1.09% and 1.9%, respectively, indicating high intra-observer reliability. Inter-observer ICCs were 0.990 (planar) and 0.987 (SPECT/CT), thus confirming excellent agreement. Planar imaging yielded higher mean LSF values (7.03/ ±/ 6.57%) than those of SPECT/CT (5.3/ ±/ 4.6%), suggesting that planar methods tend to report higher LSF values.

Conclusion: This study demonstrates that LSF calculation using planar images yields significantly different results compared to those of SPECT/CT, with the LSF from planar images being slightly higher than those of SPECT/CT. Furthermore, LSF calculation using SPECT/CT combined with appropriate segmentation tools in MIM Encore software may provide more accurate results.

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