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      Feasibility assessment of yttrium-90 liver radioembolization imaging using amplitude-based gated PET/CT

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          Abstract

          Purpose

          The usage of PET/computed tomography (CT) to monitor hepatocellular carcinoma patients following yttrium-90 ( 90Y) radioembolization has increased. Respiratory motion causes liver movement, which can be corrected using gating techniques at the expense of added noise. This work examines the use of amplitude-based gating on 90Y-PET/CT and its potential impact on diagnostic integrity.

          Patients and methods

          Patients were imaged using PET/CT following 90Y radioembolization. A respiratory band was used to collect respiratory cycle data. Patient data were processed as both standard and motion-corrected images. Regions of interest were drawn and compared using three methods. Activity concentrations were calculated and converted into dose estimates using previously determined and published scaling factors. Diagnostic assessments were performed using a binary scale created from published 90Y-PET/CT image interpretation guidelines.

          Results

          Estimates of radiation dose were increased ( P<0.05) when using amplitude-gating methods with 90Y PET/CT imaging. Motion-corrected images show increased noise, but the diagnostic determination of success, using the Kao criteria, did not change between static and motion-corrected data.

          Conclusion

          Amplitude-gated PET/CT following 90Y radioembolization is feasible and may improve 90Y dose estimates while maintaining diagnostic assessment integrity.

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          Optimal gating compared to 3D and 4D PET reconstruction for characterization of lung tumours

          Wouter van Elmpt, James Hamill, Judson Jones … (2011)
          Purpose We investigated the added value of a new respiratory amplitude-based PET reconstruction method called optimal gating (OG) with the aim of providing accurate image quantification in lung cancer. Methods FDG-PET imaging was performed in 26 lung cancer patients during free breathing using a 24-min list-mode acquisition on a PET/CT scanner. The data were reconstructed using three methods: standard 3D PET, respiratory-correlated 4D PET using a phase-binning algorithm, and OG. These datasets were compared in terms of the maximum SUV (SUVmax) in the primary tumour (main endpoint), noise characteristics, and volumes using thresholded regions of SUV 2.5 and 40% of the SUVmax. Results SUVmax values from the 4D method (13.7 ± 5.6) and the OG method (14.1 ± 6.5) were higher (4.9 ± 4.8%, p < 0.001 and 6.9 ± 8.8%, p < 0.001, respectively) than that from the 3D method (13.1 ± 5.4). SUVmax did not differ between the 4D and OG methods (2.0 ± 8.4%, p = NS). Absolute and relative threshold volumes did not differ between methods, except for the 40% SUVmax volume in which the value from the 3D method was lower than that from the 4D method (−5.3 ± 7.1%, p = 0.007). The OG method exhibited less noise than the 4D method. Variations in volumes and SUVmax of up to 40% and 27%, respectively, of the individual gates of the 4D method were also observed. Conclusion The maximum SUVs from the OG and 4D methods were comparable and significantly higher than that from the 3D method, yet the OG method was visibly less noisy than the 4D method. Based on the better quantification of the maximum and the less noisy appearance, we conclude that OG PET is a better alternative to both 3D PET, which suffers from breathing averaging, and the noisy images of a 4D PET.
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            Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting

            Yung Kao, Jeffrey D Steinberg, Young-Soon Tay … (2013)
            Background Yttrium-90 (90Y) positron emission tomography with integrated computed tomography (PET/CT) represents a technological leap from 90Y bremsstrahlung single-photon emission computed tomography with integrated computed tomography (SPECT/CT) by coincidence imaging of low abundance internal pair production. Encouraged by favorable early experiences, we implemented post-radioembolization 90Y PET/CT as an adjunct to 90Y bremsstrahlung SPECT/CT in diagnostic reporting. Methods This is a retrospective review of all paired 90Y PET/CT and 90Y bremsstrahlung SPECT/CT scans over a 1-year period. We compared image resolution, ability to confirm technical success, detection of non-target activity, and providing conclusive information about 90Y activity within targeted tumor vascular thrombosis. 90Y resin microspheres were used. 90Y PET/CT was performed on a conventional time-of-flight lutetium-yttrium-oxyorthosilicate scanner with minor modifications to acquisition and reconstruction parameters. Specific findings on 90Y PET/CT were corroborated by 90Y bremsstrahlung SPECT/CT, 99mTc macroaggregated albumin SPECT/CT, follow-up diagnostic imaging or review of clinical records. Results Diagnostic reporting recommendations were developed from our collective experience across 44 paired scans. Emphasis on the continuity of care improved overall diagnostic accuracy and reporting confidence of the operator. With proper technique, the presence of background noise did not pose a problem for diagnostic reporting. A counter-intuitive but effective technique of detecting non-target activity is proposed, based on the pattern of activity and its relation to underlying anatomy, instead of its visual intensity. In a sub-analysis of 23 patients with a median follow-up of 5.4 months, 90Y PET/CT consistently outperformed 90Y bremsstrahlung SPECT/CT in all aspects of qualitative analysis, including assessment for non-target activity and tumor vascular thrombosis. Parts of viscera closely adjacent to the liver remain challenging for non-target activity detection, compounded by a tendency for mis-registration. Conclusions Adherence to proper diagnostic reporting technique and emphasis on continuity of care are vital to the clinical utility of post-radioembolization 90Y PET/CT. 90Y PET/CT is superior to 90Y bremsstrahlung SPECT/CT for the assessment of target and non-target activity.
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              A Comparison of Techniques for 90Y PET/CT Image-Based Dosimetry Following Radioembolization with Resin Microspheres

              Alexander S. Pasciak, Austin Bourgeois, Yong Bradley (2014)
              90Y PET/CT following radioembolization has recently been established as a viable diagnostic tool, capable of producing images that are both quantitative and have superior image quality than alternative 90Y imaging modalities. Because radioembolization is assumed to be a permanent implant, it is possible to convert quantitative 90Y PET image sets into data representative of spatial committed absorbed-dose. Multiple authors have performed this transformation using dose-point kernel (DPK) convolution to account for the transport of the high-energy 90Y β-particles. This article explores a technique called the Local Deposition Method (LDM), an alternative to DPK convolution for 90Y image-based dosimetry. The LDM assumes that the kinetic energy from each 90Y β-particle is deposited locally, within the voxel where the decay occurred. Using the combined analysis of phantoms scanned using 90Y PET/CT and ideal mathematical phantoms, an accuracy comparison of DPK convolution and the LDM has been performed. Based on the presented analysis, DPK convolution provides no detectible accuracy benefit over the LDM for 90Y PET-based dosimetry. For PET systems with 90Y resolution poorer than 3.25 mm at full-width and half-max using a small voxel size, the LDM may produce a dosimetric solution that is more accurate than DPK convolution under ideal conditions; however, image noise can obscure some of the perceived benefit. As voxel size increases and resolution decreases, differences between the LDM and DPK convolution are reduced. The LDM method of post-radioembolization dosimetry has the advantage of not requiring additional post-processing. The provided conversion factors can be used to determine committed absorbed-dose using conventional PET image analysis tools. The LDM is a recommended option for routine post-radioembolization 90Y dosimetry based on PET/CT imaging.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nucl Med Commun
                Journal ID (iso-abbrev): Nucl Med Commun
                Journal ID (publisher-id): MNM
                Title: Nuclear Medicine Communications
                Publisher: Lippincott Williams & Wilkins
                ISSN (Print): 0143-3636
                ISSN (Electronic): 1473-5628
                Publication date (Print): March 2018
                Publication date (Electronic): 06 March 2018
                Volume: 39
                Issue: 3
                Pages: 222-227
                Affiliations
                Department of Radiology, University of Tennessee Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee, USA
                Author notes
                Correspondence to Dustin R. Osborne, PhD, DABSNM, Molecular Imaging and Translational Research Program, University of Tennessee Medical Center, 1924 Alcoa Hwy, Knoxville, TN 37920, USA Tel: +1 865 305 8264; fax: +1 865 305 8694; e-mail: dosborne@ 123456utmck.edu
                Article
                DOI: 10.1097/MNM.0000000000000794
                PMC ID: 5882249
                PubMed ID: 29351124
                SO-VID: 102a21eb-6750-4981-a32e-20430e9ffe93
                Copyright © Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
                History
                Date received : 28 June 2017
                Date revision received : 6 December 2017
                Date accepted : 7 December 2017
                Categories
                Subject: Original Articles

                Keywords: gating,motion correction,pet/ct,radioembolization,yttrium-90 dosimetry,yttrium
                Data availability:
                Keywords: gating, motion correction, pet/ct, radioembolization, yttrium-90 dosimetry, yttrium

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