Comparison of PET/CT and PET/MR imaging and dosimetry of yttrium-90 (Y) in patients with unresectable hepatic tumors who have received intra-arterial radioembolization therapy with Y microspheres.

BACKGROUND

The aim of our study was to compare Y dosimetry obtained from PET/MRI versus PET/CT post-therapy imaging among patients with primary or metastatic hepatic tumors. First, a water-filled Jaszczak phantom containing fillable sphere with Y-chloride was acquired on both the PET/CT and PET/MRI systems, in order to check the cross-calibration of the modalities. Following selective internal radiation therapy (SIRT) with Y microspheres, 32 patients were imaged on a PET/CT system, immediately followed by a PET/MRI study. Reconstructed images were transferred to a common platform and used to calculate Y dosimetry. A Passing-Bablok regression scatter diagram and the Bland and Altman method were used to analyze the difference between the dosimetry values.

RESULTS

The phantom study showed that both modalities were calibrated with less than 1% error. The mean liver doses for the 32 subjects calculated from PET/CT and PET/MRI were 51.6 ± 24.7 Gy and 46.5 ± 22.7 Gy, respectively, with a mean difference of 5.1 ± 5.0 Gy. The repeatability coefficient was 9.0 (18.5% of the mean). The Spearman rank correlation coefficient was very high, ρ = 0.97. Although the maximum dose to the liver can be significantly different (up to 40%), mean liver doses from each modalities were relatively close, with a difference of 18.5% or less.

CONCLUSIONS

The two main contributors to the difference in Y dosimetry calculations using PET/CT versus PET/MRI can be attributed to the differences in regions of interest (ROIs) and differences attributed to attenuation correction. Due to the superior soft-tissue contrast of MRI, liver contours are usually better seen than in CT images. However, PET/CT provides better quantification of PET images, due to better attenuation correction. In spite of these differences, our results demonstrate that the dosimetry values obtained from PET/MRI and PET/CT in post-therapy Y studies were similar.