Minimal-activity PET/CT for efficacy control after SIRT (MAPECSI) – clinical implementation of a resource-saving, liver-focused protocol

Abstract

Aim SIRT is an established treatment option for liver malignancies. Metabolic information can provide additional knowledge about tumoral characteristics and treatment response. FDG-PET/CT was shown to be advantageous for pre-/post-SIRT evaluation. However, whole-body PET/CT is an elaborate procedure. The aim of the study was to optimize clinical efficacy assessment after SIRT with a low-dose, low-cost protocol for focused diagnostic work-up.

Methods An abdomen-only minimal-activity FDG-PET/CT protocol (MA-PET) was established as an alternative for clinically indicated whole-body PET/CT scans. After administering 40 MBq of F-18-FDG one bed position was scanned for 15 minutes. Scans were acquired before (initial scan), one month after (interim scan) and three months after SIRT (follow-up scan). Metabolic tumor activity was evaluated and was compared to standard CT follow-up results.

Results 50 lobar SIRT procedures in 37 patients were analysed. HCC (28), hepatic metastases (15) and CCC (7) were treated. In 18 liver lobes initial MA-PET did not show hypermetabolic lesions, 32 liver lobes underwent interim and follow-up MA-PET. All 114 MA-PET were technically feasible. Mean radiation dose was 1.9 mSv. 64 % of HCC presented low metabolism at baseline, whereas metastases and CCC were all clearly PET-positive. Majority of radiated liver tumors showed at least partial metabolic response. PET/CT results diverged from follow-up CT in 63 % of cases.

Conclusion Minimal-Activity FDG-PET/CT of the liver is a feasible tool for efficacy assessment after SIRT with low financial and radiation burden. It provides additional information to morphologic imaging modalities, which can be helpful in response appraisal and treatment planning.

Zusammenfassung

Ziel Die FDG-PET/CT erwies sich im Rahmen der SIRT als gewinnbringend für die prä- und posttherapeutische Diagnostik. Dennoch wird diese aufgrund des hohen Aufwands häufig nicht angewendet. Ziel unserer Untersuchung war die Optimierung der Therapiekontrolle nach SIRT mittels eines fokussierten, kostensparenden Niedrigdosis-PET-Protokolls.

Methoden Ein Oberbauch-zentriertes, Minimal-Aktivitäts-FDG-PET/CT-Protokoll (MA-PET) wurde für klinisch indizierte Untersuchungen etabliert. Nach Injektion von 40 MBq F-18-FDG wurde eine Bettposition über 15 Minuten akquiriert. Die MA-PET wurden einen Tag vor, einen Monat nach und drei Monate nach SIRT durchgeführt. Das metabolische Therapieansprechen wurde ermittelt und mit der CT-Verlaufskontrolle verglichen.

Ergebnisse 50 lobäre SIRT-Prozeduren, darunter 28 HCC, 15 hepatische Metastasen und 7 CCC, wurden betrachtet. Von 37 eingeschlossenen Patienten erhielten 13 eine zusätzliche SIRT der Gegenseite. Alle Metastasen und CCC waren PET-positiv, 64 % der HCC hingegen initial PET-negativ. 32 Leberlappen mit initial hypermetabolen Läsionen wurden mittels MA-PET verlaufskontrolliert. Alle 114 MA-PET waren technisch durchführbar. Die mittlere Strahlenbelastung pro Untersuchung lag bei 1,9 mSv. Die Mehrheit der Lebertumoren zeigte mindestens ein partielles Therapieansprechen, wobei sich die MA-PET-Ergebnisse in 63 % der Fälle von denen der Standard-CT unterschieden.

Schlussfolgerung MA-PET der Leber ist ein zuverlässiges und geeignetes Verfahren zur Beurteilung der SIRT-Wirksamkeit, mit welchem Strahlenbelastung und Kosten eingespart werden können. Im Vergleich zur morphologischen Bildgebung werden auch mit dem neu etablierten Protokoll zusätzliche Informationen gewonnen, die für Verlaufskontrolle und Therapieplanung nützlich sein können.

Key words

PET/CT - Minimal-activity - Dose reduction - SIRT

Schlüsselwörter

PET/CT - Minimal-Aktivität - Strahlenschutz - SIRT

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