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Review
. 2021 Oct;38(4):460-465.
doi: 10.1055/s-0041-1735569. Epub 2021 Oct 7.

Post Yttrium-90 Imaging

Mitchell Rice  1 , Matthew Krosin  1 , Paul Haste  1
Affiliations
Review

Post Yttrium-90 Imaging

Mitchell Rice et al. Semin Intervent Radiol. 2021 Oct.

Abstract

Transarterial radioembolization with yttrium-90 ( 90 Y) is a mainstay for the treatment of liver cancer. Imaging the distribution following delivery is a concept that dates back to the 1960s. As β particles are created during 90 Y decay, bremsstrahlung radiation is created as the particles interact with tissues, allowing for imaging with a gamma camera. Inherent qualities of bremsstrahlung radiation make its imaging difficult. SPECT and SPECT/CT can be used but suffer from limitations related to low signal-to-noise bremsstrahlung radiation. However, with optimized imaging protocols, clinically adequate images can still be obtained. A finite but detectable number of positrons are also emitted during 90 Y decay, and many studies have demonstrated the ability of commercial PET/CT and PET/MR scanners to image these positrons to understand 90 Y distribution and help quantify dose. PET imaging has been proven to be superior to SPECT for quantitative imaging, and therefore will play an important role going forward as we try and better understand dose/response and dose/toxicity relationships to optimize personalized dosimetry. The availability of PET imaging will likely remain the biggest barrier to its use in routine post- 90 Y imaging; thus, SPECT/CT imaging with optimized protocols should be sufficient for most posttherapy subjective imaging.

Keywords: PET; SPECT; bremsstrahlung; imaging; interventional radiology; radioembolization; yttrium-90.

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Conflict of interest statement

Conflict of Interest P.H. serves as consultant for Boston Scientific. Other authors have no conflicts to disclose.

Figures

Fig. 1
Fig. 1
Anterior planar bremsstrahlung image over the upper abdomen following a right lobar 90 Y administration.
Fig. 2
Fig. 2
Fused bremsstrahlung SPECT/CT image following a posterior right and segment 2/3 radioembolization. Note the lack of adequate resolution to distinguish between tumor and background, particularly along the posterior margin of the right lobe tumor (arrow).
Fig. 3
Fig. 3
( a ) Axial CT image through liver showing left lobe tumor. ( b ) Fused SPECT/CT images showing 90 Y distribution in left lobe. ( c, d ) CT images through the chest (obtained with SPECT) revealing previously unknown metastatic lymphadenopathy.
Fig. 4
Fig. 4
Fused 90 Y PET/CT image following a left lobar radioembolization. Improved spatial resolution when compared with SPECT ( Fig. 2 ) allows for more reliable/reproducible tumor contouring (blue outlines).
See this image and copyright information in PMC

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