Significance of Oral Administration of Sodium Perchlorate in Planning Liver-Directed Radioembolization

Journal of Nuclear Medicine

Samer Ezziddin¹  Kai Wilhelm¹  Hans-Jürgen Biersack¹  Marianne Muckle¹  Hojjat Ahmadzadehfar¹  Torjan Haslerud¹  Amir Sabet¹ 

关键词: hepatology;    oncology;    SPECT;    sodium perchlorate;    radioembolization;   

DOI  :  10.2967/jnumed.110.083626

学科分类：医学（综合）

来源: Society of Nuclear Medicine

【 摘 要 】

99mTc-macroaggregated albumin (99mTc-MAA) scanning precedes radioembolization of the liver to detect extrahepatic shunting to the lung or gastrointestinal tract. Despite strict preventive measures in the production of 99mTc-MAA and in scanning protocols, the images frequently show a gastric concentration of free 99mTc-pertechnetate, hindering accurate evaluation of the gastroduodenal region. Our aim was to evaluate whether oral administration of sodium perchlorate (NaClO4) before 99mTc-MAA scanning will improve its accuracy by blocking free 99mTc-pertechnetate gastric uptake. Methods: In 144 patients, 171 diagnostic hepatic angiograms combined with a 99mTc-MAA scan were performed; 86 angiograms were performed after oral administration of NaClO4, and 85 were performed without this premedication. Clinical follow-up, esophagogastroduodenoscopy, and angiography served as reference standards. Results: 99mTc-MAA studies showed tracer uptake in the gastric region of 25 patients who did not receive NaClO4. The uptake was interpreted as a free 99mTc-pertechnetate concentration in 21 studies and as a 99mTc-MAA accumulation in 4 studies. In 5 patients with a free 99mTc-pertechnetate concentration, aberrant vessels were detected in angiographic reexamination, and 3 patients developed gastrointestinal ulcer. In 7 studies, gastric findings viewed pretherapeutically as free 99mTc-pertechnetate were retrospectively classified as equivocal. Of the patients receiving NaClO4, 2 showed gastric accumulation of 99mTc-MAA but no equivocal or free 99mTc-pertechnetate. Oral administration of NaClO4 increased the negative predictive value and accuracy of the test concerning the detection of gastric perfusion from 68% and 69%, respectively, to 93% and 94%, respectively. Conclusion: Oral administration of NaClO4 before the test angiogram with 99mTc-MAA resulted in effective avoidance of free 99mTc-pertechnetate concentration and, consequently, of equivocal findings in the gastroduodenal region. This technique increased test accuracy and reporter confidence, saved time in reviewing the angiograms, and can improve treatment planning and reduce therapeutic side effects.

【 授权许可】

Unknown