Liver Perfusion Imaging in Patients with Primary and Metastatic Liver Malignancy: Prospective Comparison between 99mTc-MAA SPECT and Dynamic CT Perfusion.

Rationale and Objectives: To prospectively analyze the correlation between parameters of liver perfusion from technetium^99m-macroaggregates of albumin (^99mTc-MAA) single photon emission computed tomography (SPECT) with those obtained from dynamic CT perfusion in patients with primary or metastatic liver malignancy. Materials and Methods: Twenty-five consecutive patients (11 women, 14 men; mean age 60.9 ± 10.8; range: 32–78 years) with primary (n = 5) or metastatic (n = 20) liver malignancy planned to undergo selective internal radiotherapy underwent dynamic contrast-enhanced CT liver perfusion imaging (four-dimensional spiral mode, scan range 14.8 cm, 15 scans, cycle time 3 seconds) and ^99mTc-MAA SPECT after intraarterial injection of 180 MBq ^99mTc–MAA on the same day. Data were evaluated by two blinded and independent readers for the parameters arterial liver perfusion (ALP), portal venous perfusion (PVP), and total liver perfusion (TLP) from CT, and the ^99mTc-MAA uptake-ratio of tumors in relation to normal liver parenchyma from SPECT. Results: Interreader agreements for quantitative perfusion parameters were high for dynamic CT (r = 0.90–0.98, each P < .01) and ^99mTc -MAA SPECT (r = 0.91, P < .01). Significant correlation was found between ^99mTc-MAA uptake ratio and ALP (r = 0.7, P < .01) in liver tumors. No significant correlation was found between ^99mTc-MAA uptake ratio, PVP (r = −0.381, P = .081), and TLP (r = 0.039, P = .862). Conclusion: This study indicates that in patients with primary and metastatic liver malignancy, ALP obtained by dynamic CT liver perfusion significantly correlates with the ^99mTc-MAA uptake ratio obtained by SPECT. [Copyright &y& Elsevier]