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. 2022 Oct 17;12(10):2518.
doi: 10.3390/diagnostics12102518.

Radioembolization-Induced Changes in Hepatic [18F]FDG Metabolism in Non-Tumorous Liver Parenchyma

Manon N Braat  1 , Caren van Roekel  1 , Marnix G Lam  1 , Arthur J Braat  1
Affiliations

Radioembolization-Induced Changes in Hepatic [18F]FDG Metabolism in Non-Tumorous Liver Parenchyma

Manon N Braat et al. Diagnostics (Basel). .

Abstract

Background: [18F]FDG-PET/CT is increasingly used for response assessments after oncologic treatment. The known response criteria for [18F]FDG-PET/CT use healthy liver parenchyma as the reference standard. However, the [18F]FDG liver metabolism results may change as a result of the given therapy. The aim of this study was to assess changes in [18F]FDG liver metabolism after hepatic 90Y resin radioembolization. Methods: [18F]FDG-PET/CT scans prior to radioembolization and one and three months after radioembolization (consistent with the PERCIST comparability criteria), as well as 90Y-PET/CT scans, were analyzed using 3 cm VOIs. The FDG activity concentration and absorbed dose were measured. A linear mixed-effects logistic regression model and logistic mixed-effects model were used to assess the correlation between the FDG-activity concentration, absorbed dose, and biochemical changes. Results: The median SULVOI,liver at baseline was 1.8 (range = 1.2−2.8). The mean change in SULVOI,liver per month with an increase in time was 0.05 (95%CI 0.02−0.09) at p < 0.001. The median absorbed dose per VOI was 31.3 Gy (range = 0.1−82.3 Gy). The mean percent change in ΔSULVOI,liver for every Gy increase in the absorbed dose was −0.04 (95%CI −0.22−0.14) at p = 0.67. The SULblood and SULspleen results showed no increase. Conclusions: The [18F]FDG metabolism in the normal liver parenchyma is significantly but mildly increased after radioembolization, which can interfere with its use as a threshold for therapy response.

Keywords: FDG-PET; PERCIST; SIRT; radioembolization.

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Conflict of interest statement

The authors of this manuscript declare relationships with the following companies: BTG/Boston Scientific, Terumo, and Quirem. A. Braat is a speaker for BTG/Boston Scientific and Terumo. M. Lam receives research support from Terumo, Quirem, and Boston Scientific, and is a consultant on their behalf. The department of Radiology and Nuclear Medicine of the University Medical Center Utrecht receives royalty payments from Quirem. Their radioembolization products were, however, not used in this article. The other authors of this manuscript (C. van Roekel, M.N.G.J.A. Braat) declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Changes in SULVOI,liver over time compared to baseline values.
Figure 3
Figure 3
Differences in SULliver (patient-level) versus biochemical toxicity. Numbers represent the different durations of biochemical toxicity determination per patient. Some patients had measurements at two follow-up times so numbers do not equal total number of patients.
Figure 4
Figure 4
Changes in SULblood (A) and SULspleen (B) over time compared to baseline and changes in splenic volume (C) over time compared to baseline.
Figure 4
Figure 4
Changes in SULblood (A) and SULspleen (B) over time compared to baseline and changes in splenic volume (C) over time compared to baseline.
Figure 5
Figure 5
Case example of visual increase in [18F]FDG activity concentration in non-tumorous liver tissue. A 75 year old woman with colorectal liver metastases underwent a [18F]FDG-PET/CTprior (A) and a [18F]FDG-PET/CTfollow-up (B) 15 days prior and 29 days after radioembolization, respectively. The images are similarly scaled (0–7 SUVlean body mass). One month after radioembolization, a reduced [18F]FDG activity concentration can be seen in the metastases, but the background non-tumorous liver activity concentration has visually increased (SULVOI,liver increase from 1.8 to 2.4 in the VOIright liver).
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