Analysis of differences between 99mTc-MAA SPECT- and 90Y-microsphere PET-based dosimetry for hepatocellular carcinoma selective internal radiation therapy

Abstract

Background: The aim of this study was to compare predictive and post-treatment dosimetry and analyze the differences, investigating factors related to activity preparation and delivery, imaging modality used, and interventional radiology.

Methods: Twenty-three HCC patients treated by selective internal radiation therapy with ⁹⁰Y glass microspheres were included in this study. Predictive and post-treatment dosimetry were calculated at the voxel level based on ^99mTc-MAA SPECT/CT and ⁹⁰Y-microsphere PET/CT respectively. Dose distribution was analyzed through mean dose, metrics extracted from dose-volume histograms, and Dice similarity coefficients applied on isodoses. Reproducibility of the radiological gesture and its influence on dose deviation was evaluated.

Results: ⁹⁰Y delivered activity was lower than expected in 67% (16/24) of the cases mainly due to the residual activity. A mean deviation of - 6 ± 11% was observed between the delivered activity and the ⁹⁰Y PET's FOV activity. In addition, a substantial difference of - 20 ± 8% was measured on ⁹⁰Y PET images between the activity in the liver and in the whole FOV. After normalization, ^99mTc-MAA SPECT dosimetry was highly correlated and concordant with ⁹⁰Y-microsphere PET dosimetry for all dose metrics evaluated (ρ = 0.87, ρ_c = 0.86, P = 3.10^-8 and ρ = 0.91, ρ_c = 0.90, P = 7.10^-10 for tumor and normal liver mean dose respectively for example). Besides, mean tumor dose deviation was lower when the catheter position was identical than when it differed (16 Gy vs. 37 Gy, P = 0.007). Concordance between predictive and post-treatment dosimetry, evaluated with Dice similarity coefficients applied on isodoses, significantly correlated with the distance of the catheter position from artery bifurcation (P = 0.04, 0.0004, and 0.05, for 50 Gy, 100 Gy, and 150 Gy isodoses respectively).

Conclusions: Discrepancies between planned activity and activity measured on ⁹⁰Y PET images were observed and seemed to be mainly related to clinical hazards and equipment issues. Predictive vs. post-treatment comparison of relative dose distributions between tumor and normal liver showed a good correlation and no significant difference highlighting the predictive value of ^99mTc MAA SPECT/CT-based dosimetry. Besides, the reproducibility of catheter tip position appears critical in the agreement between predictive and actual dose distribution.

Keywords: Dosimetry; Hepatocellular carcinoma; MAA; SIRT; Y-90 microspheres.

Fig. 1

Relative difference between the activity measured in the whole FOV of ⁹⁰Y-PET images and the delivered activity (a) and between the activity measured in the segmented liver and the whole FOV of ⁹⁰Y-PET images (b), both as a function of BMI

Fig. 2

Post-treatment vs. predictive dosimetry based on normalized ^99mTc-MAA SPECT and ⁹⁰Y-microsphere PET respectively for tumor (a) and normal liver (b). Left: scatter plots. The dotted lines stand for the linear regression (ρ: Pearson’s correlation). Right: Bland-Altman diagrams. The dashed lines indicate the mean bias (grayed is the 95% confidence interval) and the plain lines the 95% limits of agreement. D_T, mean dose to the tumor; D_NL, mean dose to the normal liver

Fig. 3

Difference in dose distribution between normalized ^99mTc-MAA SPECT and ⁹⁰Y-microsphere PET. a Absolute mean dose difference according to the catheter position. Dice coefficient similarity according to the catheter position for 50 Gy isodoses (b) and 100 Gy isodoses (c). Asterisks (*) indicate P values that remained significant in multivariate analysis

Fig. 4

50 Gy (a), 100 Gy (b), and 150 Gy (c) isodose Dice coefficient similarity according to the catheter tip distance from major artery bifurcation at treatment. Asterisk (*) indicates P value that remained significant in multivariate analysis