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

Abstract

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.

Radioembolization, Principles and indications

“…In addition to 166 Ho-and 90 Y-microspheres SPECT/CT, conebeam CT (CBCT) represents a promising tool for the definition of 3 D vascular anatomy and the evaluation of non-target embolization during pre-treatment angiography and is used in many centres [40][41][42][43]. CBCT visualises segmental perfusion and can be used to improve the positioning of the catheter for optimal tumour coverage during intra-arterial therapy [44].…”

Maximum tumor-absorbed dose measured by voxel-based multicompartmental dosimetry as a response predictor in yttrium-90 radiation segmentectomy for hepatocellular carcinoma

“…Currently, the technology available in most centers performing TARE, comprising the incorporation of cone beam CT (CBCT), SPECT/CT gamma cameras and the design of dedicated software for voxel-based multicompartment dosimetric analysis, allows for much safer planning of the procedure and the implementation of highly personalized therapies [ 3 , 4 ].…”

Intraprocedural C‐arm dual‐phase cone‐beam enhancement patterns correlate with tumor absorbed dose after radioembolization

“…For instance, Gordic et al have shown that for dual-energy CT the contrast enhancement at a specific time point correlates strongly with arterial perfusion, a metric that was normally extracted from a dynamic CT scan with 16 temporal frames. 17 Timed CE interventional cone-beam CT (CBCT) is already routinely and widely used for the determination of the optimal injection site and perfusion territories, [18][19][20][21][22] making this a good candidate for prospective treatment planning.…”