Comparison of the Uptake of Hepatocellular Carcinoma on Pre-Therapeutic MDCT, CACT, and SPECT/CT, and the Correlation with Post-Therapeutic PET/CT in Patients Undergoing Selective Internal Radiation Therapy.

Frank K. Wacker,Cornelia L. A. Dewald,Sabine K. Maschke,Nils Kretschmann,Thomas Brunkhorst,Arndt Vogel,Lena S. Becker,Timo C. Meine,Bernhard C. Meyer,Martha M. Kirstein,Jan B. Hinrichs,Christian Schütze,Thomas Werncke

doi:10.3390/jcm10173837

Abstract

(1) Background: To comparatively analyze the uptake of hepatocellular carcinoma (HCC) on pre-therapeutic imaging modalities, the arterial phase multi-detector computed tomography (MDCT), the parenchymal phase C-arm computed tomography (CACT), the Technetium99m-macroaggregates of human serum albumin single-photon emission computed tomography/computed tomography (SPECT/CT), and the correlation to the post-therapeutic Yttrium90 positron emission tomography/computed tomography (PET/CT) in patients with selective internal radiation therapy (SIRT). (2) Methods: Between September 2013 and December 2016, 104 SIRT procedures were performed at our institution in 74 patients with HCC not suitable for curative surgery or ablation. Twenty-two patients underwent an identical sequence of pre-therapeutic MDCT, CACT, SPECT/CT, and post-therapeutic PET/CT with a standardized diagnostic and therapeutic protocol. In these 22 patients, 25 SIRT procedures were evaluated. The uptake of the HCC was assessed using tumor-background ratio (TBR). Therefore, regions of interest were placed on the tumor and the adjacent liver tissue on MDCT (TBRMDCT), CACT (TBRCACT), SPECT/CT (TBRSPECT/CT), and PET/CT (TBRPET/CT). Comparisons were made with the Friedman test and the Nemenyi post-hoc test. Correlations were analyzed using Spearman’s Rho and the Benjamini–Hochberg method. The level of significance was p < 0.05. (3) Results: TBR on MDCT (1.4 ± 0.3) was significantly smaller than on CACT (1.9 ± 0.6) and both were significantly smaller compared to SPECT/CT (4.6 ± 2.0) (pFriedman-Test < 0.001; pTBRMDCT/TBRCACT = 0.012, pTBRMDCT/TBRSPECT/CT < 0.001, pTBRCACT/TBRSPECT/CT < 0.001). There was no significant correlation of TBR on MDCT with PET/CT (rTBRMDCT/TBRPET/CT = 0.116; p = 0.534). In contrast, TBR on CACT correlated to TBR on SPECT/CT (rTBRCACT/TBRSPECT/CT = 0.489; p = 0.004) and tended to correlate to TBR on PET/CT (rTBRCACT/TBRPET/CT =0.365; p = 0.043). TBR on SPECT/CT correlated to TBR on PET/CT (rTBRSPECT/CT/TBRPET/CT = 0.706; p < 0.001) (4) Conclusion: The uptake assessment on CACT was in agreement with SPECT/CT and might be consistent with PET/CT. In contrast, MDCT was not comparable to CACT and SPECT/CT, and had no correlation with PET/CT due to the different application techniques. This emphasizes the value of the CACT, which has the potential to improve the dosimetric assessment of the tumor and liver uptake for SIRT.

Highlights

Selective internal radiation therapy (SIRT) with Yttrium90 (Y90) microsphere is a transarterial liver-directed therapy used to treat primary and secondary hepatic malignancies [1,2]
Calculation of the dose distribution is classically performed in a pre-therapeutic evaluation session supra-selectively administering Technetium99 m-macroaggregates of albumin (Tc99 m-MAA) or -human serum albumin (Tc99 m-HSA) in the liver artery of interest followed by single-photon emission computed tomography/computed tomography (SPECT/CT) [8]
Relative contrast differences are detectable using multidetector computed tomography (MDCT) and using C-arm computed tomography acquired in the parenchymal phase (CACT) [14,15]

Summary

Introduction

Selective internal radiation therapy (SIRT) with Yttrium (Y90) microsphere is a transarterial liver-directed therapy used to treat primary and secondary hepatic malignancies [1,2]. Calculation of the dose distribution is classically performed in a pre-therapeutic evaluation session supra-selectively administering Technetium m-macroaggregates of albumin (Tc99 m-MAA) or -human serum albumin (Tc99 m-HSA) in the liver artery of interest followed by single-photon emission computed tomography/computed tomography (SPECT/CT) [8]. The uptake of Tc99 m-MAA or -HSA in the tumor in relation to nontumoral liver tissue represents the relative hypervascularization and is the key for the dose calculation in partition models [7]. The gold standard for volume assessment involves the segmentation of tumor and target liver tissue on pre-therapeutic magnetic resonance imaging or multi-detector computed tomography, which has recently shown to be comparable to segmentations on C-arm computed tomographies [9,10,11]. Relative contrast differences are detectable using MDCT and using C-arm computed tomography acquired in the parenchymal phase (CACT) [14,15]

Methods

Results

Discussion

Conclusion