Mount Sinai Hospital, New York, NY, USA.
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Cardiovasc Intervent Radiol. 2020 Feb;43(2):295-301. doi: 10.1007/s00270-019-02198-6. Epub 2019 Oct 2.
Dose calculation for transarterial radioembolization (TARE) with glass yttrium-90 (Y) labeled microspheres is based on liver lobe and tumor volumes, currently measured from preprocedural MRI or CT. The variable time between MRI and radioembolization may not account for relevant tumor progression. Advances in cone beam computed tomography (CBCT) allow for intra-procedural assessment of these volumes that avoids this factor. Liver lobe and hepatocellular carcinoma tumor volume measurements and dose calculations using intra-procedural CBCT were compared to those using preprocedural MRI in order to determine feasibility.
Retrospective analysis was performed in 20 patients with proven hepatocellular carcinoma (HCC) who underwent planning angiography with open trajectory CBCT acquisitions prior to radioembolization, and an MRI performed within 6 weeks prior to treatment planning. Liver lobe and tumor burden volumes were measured based on CBCT using embolization planning and guidance software and measured on preprocedural MRI using standard volume analysis software. Y doses were subsequently calculated using each measured volume. Comparisons of volume measurements and calculated Y doses between the two modalities were evaluated for significance using paired t tests.
All target liver lobes and all tumors were completely depicted on CBCT. Mean liver lobe and tumor burden volumes measured on intra-procedural CBCT and preprocedural MRI showed no significant difference (p = 0.71). Mean calculated Y dose based on each modality showed no significant difference (p = 0.18).
Lobar and tumor volume measurement with CBCT is a reliable alternative to measurement with preprocedural MRI. Utilization of CBCT 3D segmentation software during planning angiography may be useful to provide up-to-date volume measurements and dose calculations prior to radioembolization.
经动脉放射性栓塞（TARE）的剂量计算基于肝叶和肿瘤体积，目前通过术前 MRI 或 CT 进行测量。MRI 和放射性栓塞之间的可变时间可能无法说明相关的肿瘤进展。锥形束 CT（CBCT）的进步允许在术中评估这些体积，从而避免了这一因素。本研究旨在比较术中 CBCT 与术前 MRI 用于肝叶和肝细胞癌肿瘤体积测量和剂量计算，以确定其可行性。
回顾性分析了 20 例经证实患有肝细胞癌（HCC）的患者，这些患者在进行放射性栓塞前进行了开放轨迹 CBCT 采集的计划血管造影，并在治疗计划前 6 周内进行了 MRI。使用栓塞计划和引导软件基于 CBCT 测量肝叶和肿瘤负担体积，并使用标准体积分析软件在术前 MRI 上进行测量。随后，使用每种测量体积计算 Y 剂量。使用配对 t 检验评估两种方式的体积测量和计算 Y 剂量的比较结果的显著性。
所有目标肝叶和所有肿瘤均在 CBCT 上完全显示。术中 CBCT 和术前 MRI 测量的平均肝叶和肿瘤负担体积无显著差异（p=0.71）。基于每种方式计算的平均 Y 剂量无显著差异（p=0.18）。
使用 CBCT 进行肝叶和肿瘤体积测量是术前 MRI 的可靠替代方法。在计划血管造影期间使用 CBCT 3D 分割软件可能有助于在放射性栓塞前提供最新的体积测量和剂量计算。
