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. 2023 Dec 3;15(12):e49861.
doi: 10.7759/cureus.49861. eCollection 2023 Dec.

Liver Tumor Enhancement at Hybrid Angio-CT and Comparison With Tumor and Hepatic Parenchymal Distribution of Yttrium-90 Microspheres by Positron Emission Tomography

Garth S Campbell  1 , Dustin K Reed  2 , Ajinkya Desai  1 , Seth T Lirette  3
Affiliations

Liver Tumor Enhancement at Hybrid Angio-CT and Comparison With Tumor and Hepatic Parenchymal Distribution of Yttrium-90 Microspheres by Positron Emission Tomography

Garth S Campbell et al. Cureus. .

Abstract

This single-center retrospective study evaluated patients who underwent treatment of a primary or secondary hepatic malignancy with injection of glass or resin yttrium-90 (90Y) microspheres with a corresponding hybrid angiography-computed tomography (angio-CT) and 90Y positron emission tomography (PET). Volumetric contours were defined by three independent observers and were used to calculate relative tumoral enhancement at angio-CT. This parameter was compared with the tumor-to-normal (T/N) activity ratio predicted by technetium-99m macro-aggregated albumin (99mTc-MAA) single photon emission computed tomography (SPECT) and microsphere activity distribution by 90Y PET. A similar correlation was observed for the enhancement ratio at angio-CT with observed microsphere distribution at 90Y PET (r=0.34) to that predicted by 99mTc-MAA SPECT (r=0.32). The enhancement ratio on angio-CT performed as well as 99mTc-MAA in the prediction of 90Y PET activity distribution. The technique could not be readily applied to tumors with large areas of hypoattenuation (necrosis) on angio-CT. With refinement and further study, this technique could be used as a quantitative adjunct to standard-of-care 99mTc-MAA SPECT for dosimetry calculations and prediction of microsphere distribution to maximize tumor response and minimize hepatotoxicity.

Keywords: angiography; hepatocellular carcinoma; interventional radiology; liver metastases; positron emission tomography; radiation microsphere therapy; radioembolization; selective internal radiotherapy; yttrium-90.

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Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Representative cross-section of operator-defined contours defined on intraprocedural angio-CT
Shown are the total liver (magenta), perfused territory (yellow), and tumor (cyan) contours.  The nontumor perfused and unperfused contours are derived from these operator-defined contours by Boolean operation in the software.
Figure 2
Figure 2. Representative cross-section of operator-defined contours projected on fused 90Y PET/CT
Shown are the total liver (magenta), perfused territory (yellow), and tumor (cyan) contours.  The nontumor perfused and unperfused contours are derived from these operator-defined contours by Boolean operation in the software.
Figure 3
Figure 3. Representative cross-section from operator-defined contours in a patient with a tumor featuring a large area of low-attenuation (necrosis)
Shown are the total liver (magenta), perfused territory (yellow), and tumor (cyan) contours.  The tumor contour contains a large nonenhancing and low-attenuation area.
Figure 4
Figure 4. Scatterplot of ENR vs. PTNR
The correlation coefficient is listed for each comparison for glass microspheres (blue), resin microspheres (red), and overall (purple). ENR: Enhancement ratio; PTNR: tumor-to-normal activity ratio observed on 90Y PET
Figure 5
Figure 5. Scatterplot of STNR vs. PTNR
The correlation coefficient is listed for each comparison for glass microspheres (blue), resin microspheres (red), and overall (purple). STNR:  Tumor-to-normal activity ratio predicted by SPECT; PTNR: tumor-to-normal activity ratio observed on 90Y PET
Figure 6
Figure 6. Scatterplot of ENR vs. STNR
The correlation coefficient is listed for each comparison for glass microspheres (blue), resin microspheres (red), and overall (purple). ENR: Enhancement ratio; STNR: tumor-to-normal activity ratio predicted by SPECT
Figure 7
Figure 7. Differences in observer measurements of ENR and calculated ICC
Differences in ENR from the mean for each measurement are plotted against the mean for observer 1 (orange), observer 2 (green), and observer 3 (purple).  The calculated intraclass correlation coefficient (ICC) is listed above. ENR: Enhancement ratio
Figure 8
Figure 8. Differences in observer measurements of STNR and calculated ICC
Differences in STNR from the mean for each measurement are plotted against the mean for observer 1 (orange), observer 2 (green), and observer 3 (purple).  The calculated intraclass correlation coefficient (ICC) is listed above. STNR: Tumor-to-normal activity ratio predicted by SPECT
Figure 9
Figure 9. Differences in observer measurements of PTNR and calculated ICC
Differences in PTNR from the mean for each measurement are plotted against the mean for observer 1 (orange), observer 2 (green), and observer 3 (purple).  The calculated intraclass correlation coefficient (ICC) is listed above. PTNR: Tumor-to-normal activity ratio observed on 90Y PET
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