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Conventional Hepatic Volumetry May Lead to Inaccurate Segmental Yttrium-90 Radiation Dosimetry

Abstract

Objective

To compare radioembolization treatment zone volumes from mapping cone beam CT (CBCT) versus planning CT/MRI and to model their impact on dosimetry.

Methods

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.

Results

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.

Conclusion

Use of CBCT-based volumetry may allow more accurate, personalized dosimetry for segmental Y90 radioembolization.

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Funding

This study was not supported by any funding.

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Affiliations

Authors

Contributions

S.I.S contributed to conceptualization, data curation, formal analysis, investigation, methodology, resources, software, visualization, writing—original draft, and writing—review/editing. M.M.S was involved in conceptualization, data curation, formal analysis, investigation, methodology, resources, software, visualization, writing—original draft, and writing—review/editing. J.S contributed to data curation, investigation, and writing—review/editing. R.D was involved in methodology, resources, software, visualization, writing—original draft, and writing—review/editing. B.W.C contributed to resources, software, visualization. K.S.L was involved in investigation, writing—review/editing. A.M, B.M, R.A.C, B.J.M., D.C.M contributed to writing—review/editing. A.D.T was involved in conceptualization, methodology, data curation, formal analysis, project administration, investigation, resources, supervision, validation, writing—original draft, and writing—review/editing.

Corresponding author

Correspondence to Adam D. Talenfeld.

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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 44, 1973–1985 (2021). https://doi.org/10.1007/s00270-021-02898-y

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Keywords

  • Selective internal radiation therapy
  • Radioembolization
  • Yttrium 90 dosimetry
  • Radiation segmentectomy
  • Liver volumetry