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. 2023 Dec;51(1):245-257.
doi: 10.1007/s00259-023-06416-9. Epub 2023 Sep 12.

Direct comparison and reproducibility of two segmentation methods for multicompartment dosimetry: round robin study on radioembolization treatment planning in hepatocellular carcinoma

Marnix Lam  1 , Etienne Garin  2 , Xavier Palard-Novello  2 , Armeen Mahvash  3 , Cheenu Kappadath  3 , Paul Haste  4 , Mark Tann  4 , Ken Herrmann  5 , Francesco Barbato  5 , Brian Geller  6 , Niklaus Schaefer  7 , Alban Denys  8 , Matthew Dreher  9 , Kirk D Fowers  9 , Vanessa Gates  10 , Riad Salem  10
Affiliations

Direct comparison and reproducibility of two segmentation methods for multicompartment dosimetry: round robin study on radioembolization treatment planning in hepatocellular carcinoma

Marnix Lam et al. Eur J Nucl Med Mol Imaging. 2023 Dec.

Abstract

Purpose: Investigate reproducibility of two segmentation methods for multicompartment dosimetry, including normal tissue absorbed dose (NTAD) and tumour absorbed dose (TAD), in hepatocellular carcinoma patients treated with yttrium-90 (90Y) glass microspheres.

Methods: TARGET was a retrospective investigation in 209 patients with < 10 tumours per lobe and at least one tumour ≥ 3 cm ± portal vein thrombosis. Dosimetry was compared using two distinct segmentation methods: anatomic (CT/MRI-based) and count threshold-based on pre-procedural 99mTc-MAA SPECT. In a round robin substudy in 20 patients with ≤ 5 unilobar tumours, the inter-observer reproducibility of eight reviewers was evaluated by computing reproducibility coefficient (RDC) of volume and absorbed dose for whole liver, whole liver normal tissue, perfused normal tissue, perfused liver, total perfused tumour, and target lesion. Intra-observer reproducibility was based on second assessments in 10 patients ≥ 2 weeks later.

Results: 99mTc-MAA segmentation calculated higher absorbed doses compared to anatomic segmentation (n = 209), 43.9% higher for TAD (95% limits of agreement [LoA]: - 49.0%, 306.2%) and 21.3% for NTAD (95% LoA: - 67.6%, 354.0%). For the round robin substudy (n = 20), inter-observer reproducibility was better for anatomic (RDC range: 1.17 to 3.53) than 99mTc-MAA SPECT segmentation (1.29 to 7.00) and similar between anatomic imaging modalities (CT: 1.09 to 3.56; MRI: 1.24 to 3.50). Inter-observer reproducibility was better for larger volumes. Perfused normal tissue volume RDC was 1.95 by anatomic and 3.19 by 99mTc-MAA SPECT, with corresponding absorbed dose RDC 1.46 and 1.75. Total perfused tumour volume RDC was higher, 2.92 for anatomic and 7.0 by 99mTc-MAA SPECT with corresponding absorbed dose RDC of 1.84 and 2.78. Intra-observer variability was lower for perfused NTAD (range: 14.3 to 19.7 Gy) than total perfused TAD (range: 42.8 to 121.4 Gy).

Conclusion: Anatomic segmentation-based dosimetry, versus 99mTc-MAA segmentation, results in lower absorbed doses with superior reproducibility. Higher volume compartments, such as normal tissue versus tumour, exhibit improved reproducibility.

Trial registration: NCT03295006.

Keywords: Dosimetry; Hepatocellular carcinoma; Radioembolization; Yttrium-90.

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Conflict of interest statement

Marnix Lam, MD, PhD, is a consultant for Boston Scientific, Terumo, and Quirem Medical. He receives research support from Boston Scientific, Terumo, and Quirem Medical. The UMC Utrecht receives royalties from Quirem Medical.

Etienne Garin, MD, PhD, serves as a consultant for Boston Scientific.

Xavier Palard-Novello, MD, PhD: none.

Armeen Mahvash, MD, is a consultant for Boston Scientific, Sirtex Medical, and ABK Biomedical. He received research support from Boston Scientific, Sirtex Medical, ABK Biomedical, and Siemens Healthineers.

Cheenu Kappadath, PhD, is a consultant for Boston Scientific, Sirtex Medical, and Terumo Medical. He receives research support from Boston Scientific, Sirtex Medical, and Terumo Medical.

Paul Haste, MD, is a consultant for Boston Scientific.

Mark Tann, MD: none.

Ken Herrmann, MD, reports personal fees from Bayer, personal fees and others from Sofie Biosciences, personal fees from SIRTEX, non-financial support from ABX, personal fees from Adacap, personal fees from Curium, personal fees from Endocyte, grants and personal fees from BTG, personal fees from IPSEN, personal fees from Siemens Healthineers, personal fees from GE Healthcare, personal fees from Amgen, personal fees from Novartis, personal fees from ymabs, personal fees from Aktis Oncology, personal fees from Theragnostics, personal fees from Pharma15, and outside the submitted work.

Francesco Barbato, MD: none.

Brian Geller, MD, is a consultant for Boston Scientific.

Niklaus Schaefer, MD: none.

Alban Denys, MD, MSc, is a consultant for Cook, Neuwave, and received grand from Johnson and Johnson.

Matthew R. Dreher, PhD, works for Boston Scientific.

Kirk D. Fowers, PhD, works for Boston Scientific.

Riad Salem, MD, is a consultant for Boston Scientific, Astrazeneca, Genentech, Sirtex, Cook, Eisai, Bard, and QED Therapeutics.

Vanessa L. Gates, MS, is a consultant for Boston Scientific.

Figures

Fig. 1
Fig. 1
Percentage difference of NTAD (top) and total perfused TAD (bottom) by segmentation method, anatomic or 99mTc-MAA segmentation. The center horizontal line shows the bias, and the horizontal lines above and below the center line show the 95% limits of agreement, as computed from a Bland–Altman analysis of log-transformed data
Fig. 2
Fig. 2
Bar charts of mean and standard deviation (as shown by error bars) over reviewers in patients with hepatocellular carcinoma treated with yttrium-90 (90Y) glass microspheres
Fig. 3
Fig. 3
Well-defined high 99mTc-MAA accumulation in and around the tumour favors threshold-based segmentation on SPECT (panels A and B) over CT-based segmentation (panels C and D) because threshold-based segmentation automatically excludes central necrosis in this case and overcomes misalignment issues between CT and SPECT (arrow). Note: perfused volume definition between both methods is similar
Fig. 4
Fig. 4
Heterogeneous 99mTc-MAA in and around the tumour limits threshold-based segmentation on SPECT (panels A and B), where CT-based segmentation (panels C and D) better captures the contrast-enhancing tumour, central necrosis, and satellite lesions. Note: a difference in perfused volume definition between both methods is also present
Fig. 5
Fig. 5
Threshold-based segmentation of the tumour on SPECT (panels A and B) is similar to CT-based segmentation (panels C and D) because of well-defined.99mTc-MAA accumulation in the tumour and contrast enhancement on CT. Both methods work in this case. Note: perfused volume definition between both methods is very different with overestimation on SPECT (arrows)
See this image and copyright information in PMC

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