Comparison of Cone-Beam Tomography and Cross-Sectional Imaging for Volumetric and Dosimetric Calculations in Resin Yttrium-90 Radioembolization

Ertreo, Marco; Choi, Hailey H.; Field, D.; Lischalk, Jonathan W.; Cohen, E.; Lynskey, G.; Caridi, T.; Buckley, D.; Unger, Keith; Kim, Alexander Y.

doi:10.1007/s00270-018-2030-0

Cited by 15 publications

(8 citation statements)

References 21 publications

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“…Additionally, CBCT is useful for providing reliable information on extrahepatic arterial perfusion, and is helpful for differentiating areas of segmental perfusion and confirming full tumour coverage from the site of infusion [ 16 , 17 ] (R7, R8, Table 1 ). However, CT and MRI remain valuable options for volumetric analysis before SIRT, and CT can be considered a minimum standard [ 18 ] (R9, Table 1 ). Hybrid CT/angiography is preferred to CBCT where available.…”

Section: Resultsmentioning

confidence: 99%

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

Levillain

Bagni

Deroose

et al. 2021

Eur J Nucl Med Mol Imaging

175

136

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Purpose A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres. Methods A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%–79%, no agreement ≤ 49%). Results Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100–120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement). Conclusion Practitioners are encouraged to work towards adoption of these recommendations.

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Section: Resultsmentioning

confidence: 99%

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

Levillain

Bagni

Deroose

et al. 2021

Eur J Nucl Med Mol Imaging

175

136

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“…Consistent with the results obtained for volumetry, 99m Tc-MAA-SPECT/CT showed lower differences with the values obtained with 90 Y PET/CT TgV, than the rest of modalities. Therefore, and as described before [ 3 , 7 , 8 ], the use of 99m Tc-MAA-SPECT/CT volumes reduces the risk of underdosing. Even so, using 90 Y PET/CT as the method to define the actual TgV, the calculated Gy in the tumor were 18% lower than those predicted using 99m Tc-MAA-SPECT/CT TgV (median of − 14 Gy).…”

Section: Discussionmentioning

confidence: 81%

“…When only these selective administrations were analyzed, 99m Tc-MAA-SPECT/CT showed to be superior to CECT (CCC = 0.5) and to CBCT (CCC = 0.67) for predicting TgV, with a substantial concordance (CCC = 0.71) with 90 Y PET/CT TgV. These findings demonstrate that 99m Tc-MAA-SPECT/CT is also an effective tool for defining the TgV in segmental or subsegmental administrations, where CECT has some limitations [ 2 , 8 ]. Because of the benefit to patient outcome of the parenchyma-sparing RE administrations [ 16 , 17 ], selective administrations are recommended when possible.…”

Section: Discussionmentioning

confidence: 82%

“…The use of the 99m Tc-MAA-SPECT/CT as a method to calculate TgV was first described by Garin et al [ 3 ], demonstrating its accuracy in hepatocellular carcinoma (HCC) [ 4 ] and in cholangiocarcinoma (CC) [ 5 ]. Likewise, CBCT has been proposed as a useful method for defining the TgV in total or lobar administrations [ 6 ]–[ 8 ]. Rangraz et al [ 7 ] demonstrated that using CBCT—instead of CECT—results in a difference in volumetric parameters However, none of the abovementioned studies has been performed in segmental or subsegmental administrations (treatment via direct tumor-feeding vessel) [ 9 ], where the evaluation of the TgV in the CBCT without clear anatomical limits may be more challenging.…”

Section: Introductionmentioning

confidence: 99%

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The joint use of 99mTc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning

et al. 2021

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Purpose To determine which imaging method used during radioembolization (RE) work-up: contrast-enhanced computed tomography (CECT), 99mTc-MAA-SPECT/CT or cone beam-CT (CBCT), more accurately predicts the final target volume (TgV) as well as the influence that each modality has in the dosimetric calculation. Methods TgVs from 99mTc-MAA-SPECT/CT, CECT and CBCT were consecutively obtained in 24 patients treated with RE and compared with 90Y PET/CT TgV. Using the TgVs estimated by each imaging modality and a fictitious activity of 1 GBq, the corresponding absorbed doses by tumor and non-tumoral parenchyma were calculated for each patient. The absorbed doses for each modality were compared with the ones obtained using 90Y PET/CT TgV. Results 99mTc-MAA-SPECT/CT predicted 90Y PET/CT TgV better than CBCT or CECT, even for selective or superselective administrations. Likewise, 99mTc-MAA-SPECT/CT showed dosimetric values more similar to those obtained with 90Y PET/CT. Nevertheless, CBCT provided essential information for RE planning, such as ensuring the total coverage of the tumor and, in cases with more than one feeding artery, splitting the activity according to the volume of tumor perfused by each artery. Conclusion The joint use of 99mTc-MAA-SPECT/CT and CBCT optimizes dosimetric planning for RE procedures, enabling a more accurate personalized approach.

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“…Partition models depend on both volumes and activities of the tumor and the target liver tissue [7]. The gold standard for volume assessment involves the segmentation of tumor and target liver tissue on pre-therapeutic magnetic resonance imaging or multi-detector computed tomography, which has recently shown to be comparable to segmentations on C-arm computed tomographies [9][10][11]. Tumor and liver iodine uptake on arterial phase computed tomography correlated with Tc 99 m-MAA uptake in SPECT/CT [12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of the Uptake of Hepatocellular Carcinoma on Pre-Therapeutic MDCT, CACT, and SPECT/CT, and the Correlation with Post-Therapeutic PET/CT in Patients Undergoing Selective Internal Radiation Therapy

Meine

Brunkhorst

Werncke

et al. 2021

JCM

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(1) Background: To comparatively analyze the uptake of hepatocellular carcinoma (HCC) on pre-therapeutic imaging modalities, the arterial phase multi-detector computed tomography (MDCT), the parenchymal phase C-arm computed tomography (CACT), the Technetium99m-macroaggregates of human serum albumin single-photon emission computed tomography/computed tomography (SPECT/CT), and the correlation to the post-therapeutic Yttrium90 positron emission tomography/computed tomography (PET/CT) in patients with selective internal radiation therapy (SIRT). (2) Methods: Between September 2013 and December 2016, 104 SIRT procedures were performed at our institution in 74 patients with HCC not suitable for curative surgery or ablation. Twenty-two patients underwent an identical sequence of pre-therapeutic MDCT, CACT, SPECT/CT, and post-therapeutic PET/CT with a standardized diagnostic and therapeutic protocol. In these 22 patients, 25 SIRT procedures were evaluated. The uptake of the HCC was assessed using tumor-background ratio (TBR). Therefore, regions of interest were placed on the tumor and the adjacent liver tissue on MDCT (TBRMDCT), CACT (TBRCACT), SPECT/CT (TBRSPECT/CT), and PET/CT (TBRPET/CT). Comparisons were made with the Friedman test and the Nemenyi post-hoc test. Correlations were analyzed using Spearman’s Rho and the Benjamini–Hochberg method. The level of significance was p < 0.05. (3) Results: TBR on MDCT (1.4 ± 0.3) was significantly smaller than on CACT (1.9 ± 0.6) and both were significantly smaller compared to SPECT/CT (4.6 ± 2.0) (pFriedman-Test < 0.001; pTBRMDCT/TBRCACT = 0.012, pTBRMDCT/TBRSPECT/CT < 0.001, pTBRCACT/TBRSPECT/CT < 0.001). There was no significant correlation of TBR on MDCT with PET/CT (rTBRMDCT/TBRPET/CT = 0.116; p = 0.534). In contrast, TBR on CACT correlated to TBR on SPECT/CT (rTBRCACT/TBRSPECT/CT = 0.489; p = 0.004) and tended to correlate to TBR on PET/CT (rTBRCACT/TBRPET/CT =0.365; p = 0.043). TBR on SPECT/CT correlated to TBR on PET/CT (rTBRSPECT/CT/TBRPET/CT= 0.706; p < 0.001) (4) Conclusion: The uptake assessment on CACT was in agreement with SPECT/CT and might be consistent with PET/CT. In contrast, MDCT was not comparable to CACT and SPECT/CT, and had no correlation with PET/CT due to the different application techniques. This emphasizes the value of the CACT, which has the potential to improve the dosimetric assessment of the tumor and liver uptake for SIRT.

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Comparison of Cone-Beam Tomography and Cross-Sectional Imaging for Volumetric and Dosimetric Calculations in Resin Yttrium-90 Radioembolization

Abstract: Although volume measurements derived from CT/MRI did not differ significantly from those derived from CBCT, variability between the two methods led to large and unexpected differences in calculated dose.

Cited by 15 publications

References 21 publications

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

The joint use of 99mTc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning

Comparison of the Uptake of Hepatocellular Carcinoma on Pre-Therapeutic MDCT, CACT, and SPECT/CT, and the Correlation with Post-Therapeutic PET/CT in Patients Undergoing Selective Internal Radiation Therapy

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