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Objective: The purpose of our study is to validate the utility of 90Y PET/CT compared to SPECT/CT simulation in dosimetry and prediction of treatment response. Subject and method: Thirty-four consecutive hepatocellular carcinoma (HCC) patients, intermediate and advanced stage who underwent 90Y resin microsphere transarterial embolization (TARE) were recruited in the study. Lung shunt fraction (LSF), tumor to-normal liver uptake ratio (TNr) and absorbed dose for target tumors were estimated on 99m Tc-MAA SPECT/CT and 90Y PET/CT. The patients were followed up after treatment within 3 months (2.8 ± 0.84 months) on contrast-enhanced CT to assess treatment response using mRECIST criteria. Result: The imaging characteristics including heterogeneity, necrosis and thrombosis uptake were better delineated on PET/CT imaging than SPECT/CT. The agreement and correlation of TNr on PET/CT and SPECT/CT were stronger. Dose delivery to tumor (Dtumor) threshold of 125Gy estimated on 99mTc-MAA SPECT/CT was more accurate than PET/CT for prediction of treatment response after 90Y-radioembolization in HCC patients with sensitivity of 87.5% and specificity of 90%. Conclusion: 99mTc-MAA SPECT/CT is superior to PET/CT to predict treatment response after 90Y resin microsphere treatment.
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