Estimation of post-therapeutic liver reserve capacity using 99mTc-GSA scintigraphy prior to carbon-ion radiotherapy for liver tumors

Kana Yamazaki; Ryuichi Nishii; Yoichi Mizutani; Hirokazu Makishima; Takashi Kaneko; Yoshiharu Isobe; Tamasa Terada; Kentaro Tamura; Etsuko Imabayashi; Toshiaki Tani; Masato Kobayashi; Masaru Wakatsuki; Hiroshi Tsuji; Tatsuya Higashi

doi:10.1007/s00259-022-05985-5

Estimation of post-therapeutic liver reserve capacity using ^99mTc-GSA scintigraphy prior to carbon-ion radiotherapy for liver tumors

Eur J Nucl Med Mol Imaging. 2023 Jan;50(2):581-592. doi: 10.1007/s00259-022-05985-5. Epub 2022 Oct 4.

Authors

Kana Yamazaki¹, Ryuichi Nishii², Yoichi Mizutani³, Hirokazu Makishima^{4

5

6}, Takashi Kaneko^{6

7}, Yoshiharu Isobe⁸, Tamasa Terada³, Kentaro Tamura¹, Etsuko Imabayashi¹, Toshiaki Tani⁸, Masato Kobayashi⁹, Masaru Wakatsuki⁶, Hiroshi Tsuji⁶, Tatsuya Higashi¹

Affiliations

¹ Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan.
² Department of Molecular Imaging and Theranostics, Institute for Quantum Medical Science, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), 4-9-1 Anagawa, Inage-ku, Chiba City, Chiba, 263-8555, Japan. nishii.ryuichi@qst.go.jp.
³ Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki City, Miyazaki, Japan.
⁴ Department of Radiation Oncology, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
⁵ Proton Medical Research Center, University of Tsukuba, Tsukuba City, Ibaraki, Japan.
⁶ Department of Diagnostic Radiology and Radiation Oncology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan.
⁷ Department of Radiology, Division of Radiation Oncology, Yamagata University Faculty of Medicine, Yamagata City, Yamagata, Japan.
⁸ Department of Medical Technology, QST Hospital, Quantum Life and Medical Science Directorate, National Institutes for Quantum Science and Technology (QST), Chiba City, Chiba, Japan.
⁹ School of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa City, Ishikawa, Japan.

PMID: 36192469
DOI: 10.1007/s00259-022-05985-5

Abstract

Background: There is currently no established imaging method for assessing liver reserve capacity prior to carbon-ion radiotherapy (CIRT) for liver tumors. In order to perform safe CIRT, it is essential to estimate the post-therapeutic residual reserve capacity of the liver.

Purpose: To evaluate the ability of pre-treatment ^99mTc-galactosyl human serum albumin (^99mTc-GSA) scintigraphy to accurately estimate the residual liver reserve capacity in patients treated with CIRT for liver tumors.

Materials and methods: This retrospective study evaluated patients who were performed CIRT for liver tumors between December 2018 and September 2020 and underwent ^99mTc-GSA scintigraphy before and 3 months after CIRT, and gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced MRI within 1 month before CIRT were evaluated. The maximal removal rate of ^99mTc-GSA (GSA-Rmax) was analyzed for the evaluation of pre-treatment liver reserve capacity. Then, the GSA-Rmax of the estimated residual liver (GSA-RL) was calculated using liver SPECT images fused with the Gd-EOB-DTPA-enhanced MRI. GSA-RL before CIRT and GSA-Rmax at 3 months after CIRT were compared using non-parametric Wilcoxon signed-rank test and linear regression analysis.

Results: Overall, 50 patients were included (mean age ± standard deviation, 73 years ± 11; range, 29-89 years, 35 men). The median GSA-RL was 0.393 [range, 0.057-0.729] mg/min, and the median GSA-Rmax after CIRT was 0.369 [range, 0.037-0.780] mg/min (P = .40). The linear regression equation representing the relationship between the GSA-RL and GSA-Rmax after CIRT was y = 0.05 + 0.84x (R² = 0.67, P < .0001). There was a linear relationship between the estimated and actual post-treatment values for all patients, as well as in the group with impaired liver reserve capacity (y = - 0.02 + 1.09x (R² = 0.62, P = .0005)).

Conclusions: ^99mTc-GSA scintigraphy has potential clinical utility for estimating the residual liver reserve capacity in patients undergoing carbon-ion radiotherapy for liver tumors.

Trial registration: UMIN000038328, https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043545 .

Keywords: 99mTc-GSA scintigraphy; Carbon-ion radiotherapy; GSA-RL; GSA-Rmax; Liver tumor.

Publication types

Comment

MeSH terms

Adult
Aged
Aged, 80 and over
Carbon
Female
Hepatectomy* / methods
Humans
Liver / diagnostic imaging
Liver / pathology
Liver Neoplasms* / diagnostic imaging
Liver Neoplasms* / pathology
Liver Neoplasms* / radiotherapy
Male
Middle Aged
Radionuclide Imaging
Radiopharmaceuticals
Retrospective Studies
Technetium Tc 99m Aggregated Albumin
Technetium Tc 99m Pentetate

Substances

Carbon
gadolinium ethoxybenzyl DTPA
Radiopharmaceuticals
Technetium Tc 99m Aggregated Albumin
technetium Tc 99m DTPA-galactosyl-human serum albumin
Technetium Tc 99m Pentetate