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Quantifying the effects of absorbed dose from radioembolisation on healthy liver function with [99mTc]TcMebrofenin.

用 [99mTc] TcMebrofenin 量化放射栓塞吸收剂量对健康肝功能的影响。

  • 影响因子:5.36
  • DOI:10.1007/s00259-020-04686-1
  • 作者列表:"Willowson KP","Schembri GP","Bernard EJ","Chan DL","Bailey DL
  • 发表时间:2020-01-20
Abstract

PURPOSE:To quantify the effects of absorbed radiation dose on healthy liver parenchyma following radioembolisation (RE) using [99mTc]TcMebrofenin to analyse both global and regional liver function. METHODS:Patients having RE to treat hepatic disease underwent a [99mTc]TcMebrofenin hepatobilliary scintigraphy (HBS) study at both baseline and 8 weeks following treatment. Changes in global liver uptake rate were compared with healthy liver absorbed dose measures derived from the post-treatment 90Y PET/CT, including average dose, minimum dose to 70% of the volume (D70) and volume receiving at least 50 Gy (V50). Changes in functional burden associated with treatment and spared liver volumes in patients receiving lobar RE were also assessed, as were changes experienced by regional volumes corresponding to various dose ranges. Standard liver function pathology tests (LFTs) (bilirubin, albumin, ALP, AST, ALT and GGT) were examined for changes between baseline and post-treatment. RESULTS:Thirty-five patients were included in the study, of which, 9 had lobar treatment. A significant linear correlation was found between both baseline global liver uptake rate (negative) and D70 with change in global liver uptake rate. Patients undergoing lobar treatments demonstrated a shift in functional burden, and a significant difference was seen between the mean dose corresponding to liver volumes that increased their functional burden (9 Gy) and those that decreased their functional burden (35 Gy). No baseline LFTs predicted a decrease in global liver function; however, D70 demonstrated a linear correlation with changes in bilirubin and GGT. CONCLUSIONS:Given the significant negative relationship between baseline and change in global liver uptake rate, baseline HBS studies should not be used alone to disqualify patients considered for RE. In terms of treatment planning and evaluation, D70 may be the most appropriate metric of dose, with values greater than 15 Gy indicative of a likely drop in global liver function. The evidence of increasing functional burden in spared liver volumes suggests that patients at risk of complications could benefit from a lobar approach to treatment.

摘要

目的: 使用 [99mTc] TcMebrofenin 分析整体和区域肝功能,量化放射性栓塞 (RE) 后吸收辐射剂量对健康肝实质的影响。 方法: 对需再次治疗肝脏疾病的患者在基线和治疗后 8 周进行了 [99mTc] tc甲溴芬宁肝闪烁显像 (HBS) 研究。将全球肝脏摄取率的变化与来自治疗后 90Y PET/CT 的健康肝脏吸收剂量测量进行比较,包括平均剂量、最小剂量至体积的 70% (D70) 和体积接收至少 50 Gy (V50)。还评估了接受脑叶 RE 患者与治疗相关的功能负荷变化和备用肝脏体积,以及对应于各种剂量范围的区域体积的变化。标准肝功能病理学检查 (LFTs) (胆红素,白蛋白,ALP,AST,ALT 和 GGT) 检查基线和治疗后之间的变化。 结果: 35 例患者纳入研究,其中 9 例患者接受了肺叶治疗。发现基线整体肝脏摄取率 (阴性) 和 D70 与整体肝脏摄取率变化之间存在显著的线性相关性。接受脑叶治疗的患者表现出功能负担的变化,并且在增加其功能负担的肝脏体积对应的平均剂量之间存在显著差异 (9 Gy) 和那些减少他们的功能负担 (35 Gy)。没有基线 LFTs 预测整体肝功能下降; 然而,D70 显示与胆红素和 GGT 变化呈线性相关。 结论: 鉴于基线与整体肝脏摄取率变化之间存在显著的负相关关系,基线 HBS 研究不应单独用于取消考虑 RE 的患者资格。在治疗计划和评价方面,D70 可能是最合适的剂量指标,数值大于 15 Gy 表明整体肝功能可能下降。备用肝脏体积功能负担增加的证据表明,有并发症风险的患者可以从肺叶治疗中获益。

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影响因子:5.36
发表时间:2020-01-20
DOI:10.1007/s00259-020-04686-1
作者列表:["Willowson KP","Schembri GP","Bernard EJ","Chan DL","Bailey DL"]

METHODS:PURPOSE:To quantify the effects of absorbed radiation dose on healthy liver parenchyma following radioembolisation (RE) using [99mTc]TcMebrofenin to analyse both global and regional liver function. METHODS:Patients having RE to treat hepatic disease underwent a [99mTc]TcMebrofenin hepatobilliary scintigraphy (HBS) study at both baseline and 8 weeks following treatment. Changes in global liver uptake rate were compared with healthy liver absorbed dose measures derived from the post-treatment 90Y PET/CT, including average dose, minimum dose to 70% of the volume (D70) and volume receiving at least 50 Gy (V50). Changes in functional burden associated with treatment and spared liver volumes in patients receiving lobar RE were also assessed, as were changes experienced by regional volumes corresponding to various dose ranges. Standard liver function pathology tests (LFTs) (bilirubin, albumin, ALP, AST, ALT and GGT) were examined for changes between baseline and post-treatment. RESULTS:Thirty-five patients were included in the study, of which, 9 had lobar treatment. A significant linear correlation was found between both baseline global liver uptake rate (negative) and D70 with change in global liver uptake rate. Patients undergoing lobar treatments demonstrated a shift in functional burden, and a significant difference was seen between the mean dose corresponding to liver volumes that increased their functional burden (9 Gy) and those that decreased their functional burden (35 Gy). No baseline LFTs predicted a decrease in global liver function; however, D70 demonstrated a linear correlation with changes in bilirubin and GGT. CONCLUSIONS:Given the significant negative relationship between baseline and change in global liver uptake rate, baseline HBS studies should not be used alone to disqualify patients considered for RE. In terms of treatment planning and evaluation, D70 may be the most appropriate metric of dose, with values greater than 15 Gy indicative of a likely drop in global liver function. The evidence of increasing functional burden in spared liver volumes suggests that patients at risk of complications could benefit from a lobar approach to treatment.

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