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

Abstract

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. 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. 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). In this study, ¹⁶⁶Ho-scout was shown to have a superior predictive value for intrahepatic distribution in comparison with ^99mTc-MAA.