Study-Parameter Impact in Quantitative 90-Yttrium PET Imaging for Radioembolization Treatment Monitoring and Dosimetry

Goedicke, Andreas; Berker, Yannick; Verburg, Frederik A.; Behrendt, Florian F.; Mottaghy, Felix M.

doi:10.1109/tmi.2012.2221135

Cited by 33 publications

(30 citation statements)

References 19 publications

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“…We did not perform absorbed dose quantification of the non-tumorous liver or lungs as these are regions of much lower 90 Y radioconcentration which may require further research and technical considerations on its quantitative accuracy by 90 Y PET [39]. However, Elschot et al have recently shown that 90 Y PET-based DVHs of the non-tumorous liver may be feasible [40].…”

Section: Discussionmentioning

confidence: 99%

Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres

et al. 2013

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BackgroundCoincidence imaging of low-abundance yttrium-90 (90Y) internal pair production by positron emission tomography with integrated computed tomography (PET/CT) achieves high-resolution imaging of post-radioembolization microsphere biodistribution. Part 2 analyzes tumor and non-target tissue dose-response by 90Y PET quantification and evaluates the accuracy of tumor 99mTc macroaggregated albumin (MAA) single-photon emission computed tomography with integrated CT (SPECT/CT) predictive dosimetry.MethodsRetrospective dose quantification of 90Y resin microspheres was performed on the same 23-patient data set in part 1. Phantom studies were performed to assure quantitative accuracy of our time-of-flight lutetium-yttrium-oxyorthosilicate system. Dose-responses were analyzed using 90Y dose-volume histograms (DVHs) by PET voxel dosimetry or mean absorbed doses by Medical Internal Radiation Dose macrodosimetry, correlated to follow-up imaging or clinical findings. Intended tumor mean doses by predictive dosimetry were compared to doses by 90Y PET.ResultsPhantom studies demonstrated near-perfect detector linearity and high tumor quantitative accuracy. For hepatocellular carcinomas, complete responses were generally achieved at D70 > 100 Gy (D70, minimum dose to 70% tumor volume), whereas incomplete responses were generally at D70 < 100 Gy; smaller tumors (<80 cm3) achieved D70 > 100 Gy more easily than larger tumors. There was complete response in a cholangiocarcinoma at D70 90 Gy and partial response in an adrenal gastrointestinal stromal tumor metastasis at D70 53 Gy. In two patients, a mean dose of 18 Gy to the stomach was asymptomatic, 49 Gy caused gastritis, 65 Gy caused ulceration, and 53 Gy caused duodenitis. In one patient, a bilateral kidney mean dose of 9 Gy (V20 8%) did not cause clinically relevant nephrotoxicity. Under near-ideal dosimetric conditions, there was excellent correlation between intended tumor mean doses by predictive dosimetry and those by 90Y PET, with a low median relative error of +3.8% (95% confidence interval, -1.2% to +13.2%).ConclusionsTumor and non-target tissue absorbed dose quantification by 90Y PET is accurate and yields radiobiologically meaningful dose-response information to guide adjuvant or mitigative action. Tumor 99mTc MAA SPECT/CT predictive dosimetry is feasible. 90Y DVHs may guide future techniques in predictive dosimetry.

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Section: Discussionmentioning

confidence: 99%

Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres

et al. 2013

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“…The fusion of 90 Y bremsstrahlung SPECT with X-ray computed tomography (CT) allows for attenuation correction and 3D anatomical localization of SPECT findings (i.e., SPECT/CT) [38]. This represents another distinct advantage over bremsstrahlung 2D planar and 3D SPECT only imaging [46]. …”

Section: Bremsstrahlung Radiationmentioning

confidence: 99%

“…Another closely related challenge is that the vast majority of nuclear medicine imaging systems in place around the world are not currently designed or specifically optimized for 90 Y imaging applications. While some manufacturers have provided assistance and expertise to adapt existing imaging systems for 90 Y imaging [46], most imaging centers may have to internally customize imaging protocols with little guidance or validation. It is critical that professional organizations, nuclear medicine physicians, and researchers continue to interface and actively engage the imaging system manufacturers to develop and optimize specific protocols for more consistent and comparable 90 Y image acquisition, image reconstruction, and, ideally, quantification.…”

Section: Challenges and Future Directions For 90 Y Imagingmentioning

confidence: 99%

Theranostic Imaging of Yttrium-90

Wright

Zhang

Tweedle

et al. 2015

BioMed Research International

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This paper overviews Yttrium-90 (90Y) as a theranostic and nuclear medicine imaging of 90Y radioactivity with bremsstrahlung imaging and positron emission tomography. In addition, detection and optical imaging of 90Y radioactivity using Cerenkov luminescence will also be reviewed. Methods and approaches for qualitative and quantitative 90Y imaging will be briefly discussed. Although challenges remain for 90Y imaging, continued clinical demand for predictive imaging response assessment and target/nontarget dosimetry will drive research and technical innovation to provide greater clinical utility of 90Y as a theranostic agent.

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“…The phantom design was inspired by a gel-based phantom used by Goedicke et al to overcome the problem of microsphere sedimentation (7). For this phantom, the medium used to suspend the microspheres was gelatin.…”

Section: Phantom Constructionmentioning

confidence: 99%

“…There has been recent interest in 90 Y PET with concomitant lowdose CT. Coincidence imaging of 90 Y is possible because of a minor decay branch to the 0 1 first excited state of 90 Zr, followed by b 2 b 1 internal pair production, at a low branching ratio of 31.86 6 0.47 · 10 26 (1,2). Despite background noise in the reconstructed images due to naturally occurring 176 Lu within the lutetium-based crystal of today's time-offlight PET scanners, recent studies have shown 90 Y PET quantification to be feasible and accurate (3)(4)(5)(6)(7)(8).…”

mentioning

confidence: 99%

A Gelatin Liver Phantom of Suspended 90Y Resin Microspheres to Simulate the Physiologic Microsphere Biodistribution of a Postradioembolization Liver

Kao

Luddington

Culleton

et al. 2014

Journal of Nuclear Medicine Technology

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For phantom studies involving 90 Y PET/CT, homogeneous solutions of 90 Y, for example, 90 Y citrate, are commonly used. However, the microsphere biodistribution of a postradioembolization liver is never homogeneous; therefore, such phantoms are physiologically unrealistic for simulating clinical scenarios. The aim of this work was to develop a safe and practical phantom capable of simulating the heterogeneous microsphere biodistribution of a postradioembolization liver. Methods: Gelatin (5%) was used to suspend 90 Y resin microspheres, poured into plastic containers to simulate a liver with 2 tumors. Microspheres were added while the gelatin was maintained in a liquid state on a hot plate and continuously stirred with magnetic stir bars. The liquid microsphere mixture was then rapidly cooled in an ice bath while being stirred, resulting in a heterogeneous suspension of microspheres. The completed phantom was serially scanned by 90 Y PET/CT over 2 wk. Results: All scans demonstrated a heterogeneous microsphere distribution throughout the liver and tumor inserts. Serendipitously, magnetic stir bars left inside the phantom produced CT artifacts similar to those caused by embolization coils, whereas pockets of air trapped within the gelatin during its preparation mimicked gas within hollow viscus. The microspheres and tumor inserts remained fixed and suspended within the gelatin, with no evidence of breakdown or leakage. Conclusion: A gelatin phantom realistically simulating the physiologic microsphere biodistribution of a postradioembolization liver is feasible to construct in a radiopharmacy. For 90 Y PET/CT phantom studies, homogeneous solutions of 90 Y, for example, 90 Y-citrate, are commonly used. However, the microsphere biodistribution of a postradioembolization liver is never homogeneous (9); therefore, such phantoms are physiologically unrealistic for simulating clinical scenarios. The aim of this work was to develop a safe and practical phantom capable of simulating the heterogeneous microsphere biodistribution of a postradioembolization liver throughout both tumor and nontumor liver compartments with a physiologically realistic tumorto-normal liver ratio. MATERIALS AND METHODS Phantom ConstructionInstitutional Review Board approval was not required for the conduct and publication of this phantom study, which did not involve any human subjects. The phantom design was inspired by a gel-based phantom used by Goedicke et al. to overcome the problem of microsphere sedimentation (7). For this phantom, the medium used to suspend the microspheres was gelatin. A 5%-byweight solution of gelatin was prepared by slowly dissolving 75 g of gelatin into 1,500 mL of distilled sterile water (for injection/ irrigation). The solution was kept at 45°C on a hot plate and magnetically stirred at 300 rpm to ensure that the gelatin would not set. The liver phantom was a 1,330-mL rectangular homeware container made of clear, rigid plastic. The 2 tumor inserts were round containers made of similar plastic material, measuring 27 an...

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Study-Parameter Impact in Quantitative 90-Yttrium PET Imaging for Radioembolization Treatment Monitoring and Dosimetry

Cited by 33 publications

References 19 publications

Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres

Post-radioembolization yttrium-90 PET/CT - part 2: dose-response and tumor predictive dosimetry for resin microspheres

Theranostic Imaging of Yttrium-90

A Gelatin Liver Phantom of Suspended 90Y Resin Microspheres to Simulate the Physiologic Microsphere Biodistribution of a Postradioembolization Liver

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