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SIR 2025
Interventional Oncology
Scientific Session
Patrick Sutphin, MD, PhD (he/him/his)
Assistant Professor
Massachusetts General Hospital, United States
Sanjeeva Kalva, MD, FACR, FSIR, MBBS, RPVI (he/him/his)
Vice-Chair, Image-Guided Interventions
University of Texas Southwestern Medical Center, United States
Ammar Sarwar, MD, FSIR (he/him/his)
Associate Professor of Radiology
Beth Israel Deaconess Medical Center, United States
Eric Wehrenberg-Klee, MD
Interventional Radiologist
Massachusetts General Hospital, United States
To quantify differences in the tumor to normal (T:N) distribution of 99m-technetium-labeled macroaggregated albumin(99mTc- MAA) delivered via a 2.4 Fr standard microcatheter (SMC) compared to a 2.4 Fr device that uses pressure-enabled drug delivery (PEDD) in pre-radioembolization mapping procedures.
Materials and Methods:
Twenty-one patients with either hepatocellular carcinoma (HCC, n=15) or hypovascular liver metastases (n=6) were enrolled in this ongoing IRB-approved investigator-initiated prospective randomized-controlled study. Each patient underwent two mapping procedures on different days: one with a 2.4 Fr SMC and the other with a 2.4 Fr PEDD device. The sequence of device used for 99mTc-MAA delivery was randomized, and the catheter locations were the same (within 1 cm) for both mapping procedures. A SPECT/CT was performed after each mapping procedure and the T:N ratio was calculated for each mapping procedure using MIMpacs version 7.0.4 (MIM Software, Inc. Beachwood, OH). The analysis was blinded as to which catheter was used.
Results:
Both the SMC and PEDD microcatheters were successfully navigated and positioned in the appropriate location for radiotracer delivery without associated catheter related complications in 18 patients. The remaining three 3 patients were withdrawn prior to using both catheters. 10 of 15 patients in the HCC cohort were evaluable and the average T:N ratio with the SMC is 3.9 +/- 0.6 and 5.2 +/- 1.4 (p = 0.47) with PEDD, an increase of approximately 33%, though not statistically significant. 4 of 6 patients in the hypovascular cohort were evaluable, all with metastatic colorectal cancer. In the hypovascular cohort the average T:N ratio with SMC is 2.7 +/- 1.1 vs. with PEDD 3.3 +/- 1.2 (p = 0.04) an increase of approximately 22%.
Conclusion: PEDD delivery of 99mTc-MAA improved the T:N ratio in both HCC and hypovascular tumors. This effect was statistically significant in the hypovascular tumor cohort which had an increase of 22% when the PEDD device was used.