The value of yttrium-90 PET/CT after hepatic radioembolization: a pictorial essay

Abstract

Introduction Distribution of microspheres after radioembolization can be accurately visualized using PET/CT. In this pictorial essay, we aim to demonstrate the value of 90 Y-PET/CT after radioembolization. Methods 90 Y-PET/CT imaging was routinely performed after radioembolization at our institute. Patients were scanned the same day or the day after treatment, using a scanner with time-of-flight technology. We retrospectively reviewed all 90 Y-PET/ CTs from patients treated with radioembolization (both glass and resin microspheres) between January 2011 and January 2019. Five cases were selected that are illustrative of the added value of PET/CT after radioembolization. Results 90 Y-PET/CT allows for distribution assessment and dosimetry of 90 Y-microspheres. It was used for the assessment of treatment success by visualization of tumor targeting, quantification of the absorbed dose, prediction of complications such as radioembolization-induced liver disease, and determining the required dosage for retreatment. Conclusion PET/CT is an excellent modality for post-treatment imaging of 90 Y-microspheres and could lead to improved dose planning and more personalized treatment.Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Yttrium-90 Radioembolization Dosimetry: Dose Considerations, Optimization, and Tips

“…Post-Y90-RE distribution and dosimetry assessment is also recommended by the authors—particularly as one is starting their Y90 practice and is seeking to confirm that the delivered dose and distribution is satisfactory. While Y90 PET/CT is considered the best modality for post–Y90-RE distribution and dosimetry assessment, 42 it is acceptable (and more accessible given insurance authorization constrains) to utilize the Y90-bremsstrahlung SPECT/CT for these purposes.…”

Update on PET Radiopharmaceuticals for Imaging Hepatocellular Carcinoma

“…Post-treatment Y-90 PET imaging showed reasonable image quality when using time of flight (TOF) and Silicon photomultiplier-based PET scanners [ 81 , 82 ]. The images are useful for the assessment of treatment success by evaluation of the tracer accumulation and dosimetry in the targeted tumours; predicting complications, such as radioembolisation-induced liver disease; and determining the dose for subsequent treatments when needed [ 83 ].…”

The increasing potential of nuclear medicine imaging for the evaluation and reduction of normal tissue toxicity from radiation treatments

“…Before SIRT with 90 Y-labelled resin microspheres, the treatment is often planned with an intraarterial hepatic SPECT/CT using [ 99m Tc]Tc-macroaggregated albumin (MAA), aggregates of human serum albumin around 20-50 μm in size, to assess biodistribution and screen extrahepatic deposition, which often can occur in the lungs [74]. After administration of the microspheres, a 90 Y PET scan can also be made to accurately determine dose deposition in the tumour and other regions [75,76]. This approach illustrates the current relevance of molecular imaging for treatment optimization, to avoid or limit normal tissue toxicity in the liver.…”