Comparison of Cone-Beam Tomography and Cross-Sectional Imaging for Volumetric and Dosimetric Calculations in Resin Yttrium-90 Radioembolization.

Abstract

To compare the use of cone-beam computed tomography versus contrast-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) in the calculation of liver volume and planned dose for yttrium-90 radioembolization. The study retrospectively assessed 47 consecutive patients who underwent resin Y-90 radioembolization consecutively over a 2-year period at a single center. Volume calculation software was used to determine perfused lobar liver volumes from cone-beam CT (CBCT) images obtained during mapping angiography. CBCT-derived volumes were compared with perfused lobar volume derived from contrast-enhanced CT and MRI. Nominal activities as determined by the SIR-Spheres Microspheres Activity Calculator were similarly calculated and compared using both CBCT and conventionally acquired volumes. A total of 82 hepatic lobes were assessed in 47 patients. The mean percentage difference between combined CT-MRI- and CBCT-derived calculated lobar volumes was 25.3% (p = 0.994). The mean percentage difference in calculated dose between the two methods was 21.8 ± 24.6% (p = 0.42). Combined left and right lobar CT-derived dose difference was less than 10% in 22 lobes, between 10 and 25% in 20 lobes, between 25 and 50% in 13 lobes and greater than 50% in 5 lobes. Combined left and right lobar MRI-derived dose difference was less than 10% in 11 lobes, between 10 and 25% in 7 lobes, between 25 and 50% in 2 lobes and greater than 50% in 1 lobe. Although volume measurements derived from CT/MRI did not differ significantly from those derived from CBCT, variability between the two methods led to large and unexpected differences in calculated dose.