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. 2023 Dec 15;13(1):22288.
doi: 10.1038/s41598-023-49787-7.

CT texture features and lung shunt fraction measured using 99mTc-macroaggregated albumin SPECT/CT before trans-arterial radioembolization for hepatocellular carcinoma patients

Jae Hwan Lee #  1   2   3 , Chong-Ho Lee #  1 , Minuk Kim  4 , Yoo Sung Song  5   6 , Chang Jin Yoon  1   2   3 , Won Woo Lee  3   7   8   9
Affiliations

CT texture features and lung shunt fraction measured using 99mTc-macroaggregated albumin SPECT/CT before trans-arterial radioembolization for hepatocellular carcinoma patients

Jae Hwan Lee et al. Sci Rep. .

Abstract

The aim of this study is to determine whether contrast-enhanced computed tomography (CECT)-based texture parameters can predict high (> 30 Gy) expected lung dose (ELD) calculated using 99mTc macroaggregated albumin single-photon emission computed tomography/computed tomography (SPECT/CT) for pre-trans-arterial radioembolization (TARE) dosimetry. 35 patients were analyzed, with a treatable planned dose of ≥ 200 Gy for unresectable hepatocellular carcinoma (HCC). Lung shunt fraction (LSF) was obtained from planar and SPECT/CT scans. Texture features of the tumor lesion on CECT before TARE were analyzed. Univariate and multivariate linear regression analyses were performed to determine potential ELD > 30 Gy predictors. Among the 35 patients, nine (25.7%) had ELD > 30 Gy, and had a higher LSF than the ELD ≤ 30 Gy group using the planar (20.7 ± 8.0% vs. 6.3 ± 3.3%; P < 0.001) and SPECT/CT (12.4 ± 5.1% vs. 3.5 ± 2.0%; P < 0.001) scans. The tumor integral total (HU × L) value was a predictor for high LSF using SPECT/CT, with an area under the curve, sensitivity, and specificity of 0.983 (95% confidence interval: 0.869-1.000, P < 0.001), 100%, and 88.5%, respectively. The tumor integral total value is an imaging marker for predicting ELD > 30 Gy. Applying CECT texture analysis may assist in reducing time and cost in patient selection and modifying TARE treatment plans.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Receiver operating characteristic (ROC) curves of the integral total (HU × ml) value for distinguishing patients to receive more than 30 Gy to the lung while receiving 200 Gy to the tumor.
Figure 2
Figure 2
Representative case of a patient with high LSF. The patient (76-year-old male) had an LSF of 29.1% on the planar scan (a). He had a large sized tumor (1730 L) with central necrosis, and an integral total (HU × L) value of 141.28 (b). From the SPECT/CT, LSF was 14.1% (c), and the tumor uptake was 82.1% (d).
Figure 3
Figure 3
Representative cases of a patient with low LSF. The patient (58-year-old male) had an LSF of 2.7% on the planar scan (a), with a smaller sized tumor (36 ml), with an integral total (HU × L) value of 4.08 (b). From the SPECT/CT, LSF was 3.2% (c), and the tumor uptake was 87.5% (d).
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