Comparison of PET/CT and PET/MR Imaging and Dosimetry of Yttrium-90 (Y) in Patients with Unresectable Hepatic Tumors Who Have Received Intra-arterial Radioembolization Therapy with Y Microspheres

Overview

Journal EJNMMI Phys

Specialty Radiology

Date 2018 Aug 31

PMID 30159638

Citations 8

Authors

Karin Knesaurek

Abbas Tuli

Edward Kim

Sherif Heiba

Lale Kostakoglu

Affiliations

Soon will be listed here.

Abstract

Background: The aim of our study was to compare Y dosimetry obtained from PET/MRI versus PET/CT post-therapy imaging among patients with primary or metastatic hepatic tumors. First, a water-filled Jaszczak phantom containing fillable sphere with Y-chloride was acquired on both the PET/CT and PET/MRI systems, in order to check the cross-calibration of the modalities. Following selective internal radiation therapy (SIRT) with Y microspheres, 32 patients were imaged on a PET/CT system, immediately followed by a PET/MRI study. Reconstructed images were transferred to a common platform and used to calculate Y dosimetry. A Passing-Bablok regression scatter diagram and the Bland and Altman method were used to analyze the difference between the dosimetry values.

Results: The phantom study showed that both modalities were calibrated with less than 1% error. The mean liver doses for the 32 subjects calculated from PET/CT and PET/MRI were 51.6 ± 24.7 Gy and 46.5 ± 22.7 Gy, respectively, with a mean difference of 5.1 ± 5.0 Gy. The repeatability coefficient was 9.0 (18.5% of the mean). The Spearman rank correlation coefficient was very high, ρ = 0.97. Although the maximum dose to the liver can be significantly different (up to 40%), mean liver doses from each modalities were relatively close, with a difference of 18.5% or less.

Conclusions: The two main contributors to the difference in Y dosimetry calculations using PET/CT versus PET/MRI can be attributed to the differences in regions of interest (ROIs) and differences attributed to attenuation correction. Due to the superior soft-tissue contrast of MRI, liver contours are usually better seen than in CT images. However, PET/CT provides better quantification of PET images, due to better attenuation correction. In spite of these differences, our results demonstrate that the dosimetry values obtained from PET/MRI and PET/CT in post-therapy Y studies were similar.

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References

Bland J, Altman D . Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986; 1(8476):307-10. View

Carlier T, Willowson K, Fourkal E, Bailey D, Doss M, Conti M . (90)Y -PET imaging: Exploring limitations and accuracy under conditions of low counts and high random fraction. Med Phys. 2015; 42(7):4295-309. DOI: 10.1118/1.4922685. View

Ahmadzadehfar H, Muckle M, Sabet A, Wilhelm K, Kuhl C, Biermann K . The significance of bremsstrahlung SPECT/CT after yttrium-90 radioembolization treatment in the prediction of extrahepatic side effects. Eur J Nucl Med Mol Imaging. 2011; 39(2):309-15. DOI: 10.1007/s00259-011-1940-8. View

Pichler B, Kolb A, Nagele T, Schlemmer H . PET/MRI: paving the way for the next generation of clinical multimodality imaging applications. J Nucl Med. 2010; 51(3):333-6. DOI: 10.2967/jnumed.109.061853. View

Conti M . Focus on time-of-flight PET: the benefits of improved time resolution. Eur J Nucl Med Mol Imaging. 2011; 38(6):1147-57. DOI: 10.1007/s00259-010-1711-y. View

Chiesa C, Maccauro M, Romito R, Spreafico C, Pellizzari S, Negri A . Need, feasibility and convenience of dosimetric treatment planning in liver selective internal radiation therapy with (90)Y microspheres: the experience of the National Tumor Institute of Milan. Q J Nucl Med Mol Imaging. 2011; 55(2):168-97. View

Knesaurek K, Machac J, Muzinic M, DaCosta M, Zhang Z, Heiba S . Quantitative comparison of yttrium-90 (90Y)-microspheres and technetium-99m (99mTc)-macroaggregated albumin SPECT images for planning 90Y therapy of liver cancer. Technol Cancer Res Treat. 2010; 9(3):253-62. DOI: 10.1177/153303461000900304. View

Bini J, Eldib M, Robson P, Fayad Z . Wavelet-based partial volume effect correction for simultaneous MR/PET of the carotid arteries. EJNMMI Phys. 2015; 1(Suppl 1):A71. PMC: 4545959. DOI: 10.1186/2197-7364-1-S1-A71. View

Passing H, Bablok . A new biometrical procedure for testing the equality of measurements from two different analytical methods. Application of linear regression procedures for method comparison studies in clinical chemistry, Part I. J Clin Chem Clin Biochem. 1983; 21(11):709-20. DOI: 10.1515/cclm.1983.21.11.709. View

10.

Pasciak A, Bourgeois A, Bradley Y . A Comparison of Techniques for (90)Y PET/CT Image-Based Dosimetry Following Radioembolization with Resin Microspheres. Front Oncol. 2014; 4:121. PMC: 4033229. DOI: 10.3389/fonc.2014.00121. View

11.

Eldib M, Oesingmann N, Faul D, Kostakoglu L, Knesaurek K, Fayad Z . Optimization of yttrium-90 PET for simultaneous PET/MR imaging: A phantom study. Med Phys. 2016; 43(8):4768. DOI: 10.1118/1.4958958. View

12.

Grimm R, Furst S, Souvatzoglou M, Forman C, Hutter J, Dregely I . Self-gated MRI motion modeling for respiratory motion compensation in integrated PET/MRI. Med Image Anal. 2014; 19(1):110-20. DOI: 10.1016/j.media.2014.08.003. View

13.

Dezarn W, Cessna J, DeWerd L, Feng W, Gates V, Halama J . Recommendations of the American Association of Physicists in Medicine on dosimetry, imaging, and quality assurance procedures for 90Y microsphere brachytherapy in the treatment of hepatic malignancies. Med Phys. 2011; 38(8):4824-45. DOI: 10.1118/1.3608909. View

14.

Izquierdo-Garcia D, Sawiak S, Knesaurek K, Narula J, Fuster V, Machac J . Comparison of MR-based attenuation correction and CT-based attenuation correction of whole-body PET/MR imaging. Eur J Nucl Med Mol Imaging. 2014; 41(8):1574-84. PMC: 4090355. DOI: 10.1007/s00259-014-2751-5. View

15.

Martinez-Moller A, Souvatzoglou M, Delso G, Bundschuh R, Chefdhotel C, Ziegler S . Tissue classification as a potential approach for attenuation correction in whole-body PET/MRI: evaluation with PET/CT data. J Nucl Med. 2009; 50(4):520-6. DOI: 10.2967/jnumed.108.054726. View

16.

Murthy R, Brown D, Salem R, Meranze S, Coldwell D, Krishnan S . Gastrointestinal complications associated with hepatic arterial Yttrium-90 microsphere therapy. J Vasc Interv Radiol. 2007; 18(4):553-61. DOI: 10.1016/j.jvir.2007.02.002. View

17.

Goedicke A, Berker Y, Verburg F, Behrendt F, Winz O, Mottaghy F . Study-parameter impact in quantitative 90-Yttrium PET imaging for radioembolization treatment monitoring and dosimetry. IEEE Trans Med Imaging. 2012; 32(3):485-92. DOI: 10.1109/TMI.2012.2221135. View

18.

Elschot M, Vermolen B, Lam M, de Keizer B, van den Bosch M, W A M de Jong H . Quantitative comparison of PET and Bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS One. 2013; 8(2):e55742. PMC: 3566032. DOI: 10.1371/journal.pone.0055742. View

19.

Kennedy A, Salem R . Radioembolization (yttrium-90 microspheres) for primary and metastatic hepatic malignancies. Cancer J. 2010; 16(2):163-75. DOI: 10.1097/PPO.0b013e3181d7e8cf. View

20.

Wondergem M, Smits M, Elschot M, W A M de Jong H, Verkooijen H, van den Bosch M . 99mTc-macroaggregated albumin poorly predicts the intrahepatic distribution of 90Y resin microspheres in hepatic radioembolization. J Nucl Med. 2013; 54(8):1294-301. DOI: 10.2967/jnumed.112.117614. View