To compare radioembolization treatment zone volumes from mapping cone beam CT (CBCT) versus planning CT/MRI and to model their impact on dosimetry.
Y90 cases were retrospectively identified in which intra-procedural CBCT angiograms were performed. Segmental and lobar treatment zone volumes were calculated with semi-automated contouring using Couinaud venous anatomy (planning CT/MRI) or tumor angiosome enhancement (CBCT). Differences were compared with a Wilcoxon signed-rank test. Treatment zone-specific differences in segmental volumes by volumetric method were also calculated and used to model differences in delivered dose using medical internal radiation dosimetry (MIRD) at 200 and 120 Gy targets. Anatomic, pathologic, and technical factors likely affecting segmental volumes by volumetric method were evaluated.
Forty segmental and 48 lobar CBCT angiograms and corresponding planning CT/MRI scans were included. Median Couinaud- and CBCT-derived segmental volumes were 281 and 243 mL, respectively (p = 0.005). Differences between Couinaud and CBCT lobar volumes (right, left) were not significant (p = 0.24, p = 0.07). Couinaud overestimated segmental volumes in 28 cases by a median of 98 mL (83%) and underestimated in 12 cases by median 69 mL (20%). At a 200 Gy dose target, Couinaud estimates produced median delivered doses of 367 and 160 Gy in these 28 and 12 cases. At a 120 Gy target, Couinaud produced doses of 220 and 96 Gy. Proximal vs. distal microcatheter positioning, variant arterial anatomy, and tumor location on or near segmental watersheds were leading factors linked to volumetric differences.
Use of CBCT-based volumetry may allow more accurate, personalized dosimetry for segmental Y90 radioembolization.
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Khajornjiraphan N, Thu NA, Chow PKH. Yttrium-90 microspheres: a review of its emerging clinical indications. Liver cancer. 2015;4(1):6–15. https://doi.org/10.1159/000343876.
Saini A, Wallace A, Alzubaidi S, et al. History and evolution of Yttrium-90 radioembolization for hepatocellular carcinoma. J Clin Med. 2019. https://doi.org/10.3390/jcm8010055.
Salem R, Thurston KG. Radioembolization with 90Yttrium microspheres: a state-of-the-art brachytherapy treatment for primary and secondary liver malignancies. Part 1: technical and methodologic considerations. J Vasc Interv Radiol. 2006;17(8):1251–78. https://doi.org/10.1097/01.RVI.0000233785.75257.9A.
Malhotra A, Liu DM, Talenfeld AD. Radiation segmentectomy and radiation lobectomy: a practical review of techniques. Tech Vasc Interv Radiol. 2019;22(2):49–57. https://doi.org/10.1053/j.tvir.2019.02.003.
Biederman DM, Titano JJ, Bishay VL, et al. Radiation segmentectomy versus TACE combined with microwave ablation for unresectable solitary hepatocellular carcinoma Up to 3 cm: a propensity score matching study. Radiology. 2017;283(3):895–905. https://doi.org/10.1148/radiol.2016160718.
Padia SA, Johnson GE, Horton KJ, et al. Segmental Yttrium-90 radioembolization versus segmental chemoembolization for localized hepatocellular carcinoma: results of a single-center, retrospective, propensity score-matched study. J Vasc Interv Radiol. 2017;28(6):777-785.e1. https://doi.org/10.1016/j.jvir.2017.02.018.
Biederman DM, Titano JJ, Korff RA, et al. Radiation segmentectomy versus selective chemoembolization in the treatment of early-stage hepatocellular carcinoma. J Vasc Interv Radiol. 2018;29(1):30-37.e2. https://doi.org/10.1016/j.jvir.2017.08.026.
Salem R, Padia SA, Lam M, et al. Clinical and dosimetric considerations for Y90: recommendations from an international multidisciplinary working group. Eur J Nucl Med Mol Imaging. 2019;46(8):1695–704. https://doi.org/10.1007/s00259-019-04340-5.
Toskich BB, Liu DM. Y90 Radioembolization dosimetry: concepts for the interventional radiologist. Tech Vasc Interv Radiol. 2019;22(2):100–11. https://doi.org/10.1053/j.tvir.2019.02.011.
Kim SP, Cohalan C, Kopek N, Enger SA. A guide to (90)Y radioembolization and its dosimetry. Phys Med. 2019;68:132–45. https://doi.org/10.1016/j.ejmp.2019.09.236.
Bastiaannet R, Kappadath SC, Kunnen B, Braat AJAT, Lam MGEH, de Jong HWAM. The physics of radioembolization. EJNMMI Phys. 2018;5(1):22. https://doi.org/10.1186/s40658-018-0221-z.
Cardarelli-Leite L, Chung J, Klass D, et al. Ablative transarterial radioembolization improves survival in patients with HCC and portal vein tumor thrombus. Cardiovasc Intervent Radiol. 2020;43(3):411–22. https://doi.org/10.1007/s00270-019-02404-5.
Lau W-Y, Kennedy AS, Kim YH, et al. Patient selection and activity planning guide for selective internal radiotherapy with yttrium-90 resin microspheres. Int J Radiat Oncol Biol Phys. 2012;82(1):401–7. https://doi.org/10.1016/j.ijrobp.2010.08.015.
SIR-Spheres Package Insert, SIRTeX Medical Limited
TheraSphere Yttrium-90 Microspheres Package Insert, Boston Scientific Corporation
Liu DM, Westcott M, Garcia-Monaco R, Abraham R, Gandhi R. Down and dirty with dosimetry: a practical understanding and approach to radioembolization. Endovasc Today. 2016;15(9):70–6.
Germain T, Favelier S, Cercueil JP, Denys A, Krausé D, Guiu B. Liver segmentation: practical tips. Diagn Interv Imaging. 2014;95(11):1003–16. https://doi.org/10.1016/j.diii.2013.11.004.
Couinaud C (1954) Liver lobes and segments: notes on the anatomical architecture and surgery of the liver TT—Lobes et segments hépatiques: notes sur l’architecture anatomiques et chirurgicale du foie. Presse Med 62(33): 709–712. https://pubmed.ncbi.nlm.nih.gov/13177441
Tacher V, Radaelli A, Lin M, Geschwind J-F. How I do it: cone-beam CT during transarterial chemoembolization for liver cancer. Radiology. 2015;274(2):320–34. https://doi.org/10.1148/radiol.14131925.
Wang X, Yarmohammadi H, Cao G, et al. Dual phase cone-beam computed tomography in detecting <3 cm hepatocellular carcinomas during transarterial chemoembolization. J Cancer Res Ther. 2017;13(1):38–43. https://doi.org/10.4103/0973-1482.206242.
Pung L, Ahmad M, Mueller K, et al. The role of cone-beam CT in transcatheter arterial chemoembolization for hepatocellular carcinoma: a systematic review and meta-analysis. J Vasc Interv Radiol. 2017;28(3):334–41. https://doi.org/10.1016/j.jvir.2016.11.037.
Gabr A, Riaz A, Johnson GE, et al. Correlation of Y90-absorbed radiation dose to pathological necrosis in hepatocellular carcinoma: confirmatory multicenter analysis in 45 explants. Eur J Nuc Med Mol Imaging. 2020. https://doi.org/10.1007/s00259-020-04976-8.
Kawasaki S, Makuuchi M, Matsunami H, et al. Preoperative measurement of segmental liver volume of donors for living related liver transplantation. Hepatology. 1993;18:1115–20.
Ertreo M, Choi H, Field D, et al. Comparison of cone-beam tomography and cross-sectional imaging for volumetric and dosimetric calculations in resin Yttrium-90 radioembolization. Cardiovasc Intervent Radiol. 2018;41(12):1857–66. https://doi.org/10.1007/s00270-018-2030-0.
Elsayed M, Ermentrout RM, Sethi I et al (2020) Incidence of radioembolization-induced liver disease and liver toxicity following repeat 90Y-radioembolization: outcomes at a large tertiary care center. Clin Nucl Med. https://journals.lww.com/nuclearmed/Fulltext/2020/02000/Incidence_of_Radioembolization_Induced_Liver.2.aspx
Riaz A, Awais R, Salem R. Side effects of Yttrium-90 radioembolization. Front Oncol. 2014. https://doi.org/10.3389/fonc.2014.00198.
Lam MGEH, Louie JD, Iagaru AH, Goris ML, Sze DY. Safety of repeated Yttrium-90 radioembolization. Cardiovasc Intervent Radiol. 2013;36(5):1320–8. https://doi.org/10.1007/s00270-013-0547-9.
This study was not supported by any funding.
Conflict of Interest
A.D.T receives research funding from SIRTex medical. R.D. is a salaried employee of General Electric. R.A.C is the recipient grants from General Electric, administered by the Association of University Radiologists (GERRAF grant), SIR Foundation, and FDA NEST as well as speaker honoraria from SIRTex and the American College of Surgery. D.C.M is a consultant for Boston, Scientific, General Electric and SIRTex.
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Seth I. Stein and Mohamed M. Soliman shared co-first authors
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Stein, S.I., Soliman, M.M., Sparapani, J. et al. Conventional Hepatic Volumetry May Lead to Inaccurate Segmental Yttrium-90 Radiation Dosimetry. Cardiovasc Intervent Radiol (2021). https://doi.org/10.1007/s00270-021-02898-y
- Selective internal radiation therapy
- Yttrium 90 dosimetry
- Radiation segmentectomy
- Liver volumetry