A comparison of methods for in vivo activity and absorbed dose quantification with PET/CT following yttrium-90 radioembolization.

Background: Yttrium-90 (Y) positron emission tomography (PET)/computed tomography (CT) imaging is increasingly being used to perform tumor (T) and normal liver (NL) voxel dosimetry after Y-radioembolization (Y-RE). Yet, the accuracy of in vivo Y-PET/CT imaging, subject to motion blur and co-registration inaccuracies, and Y-PET/CT dose quantification, subject to availability of different voxel dosimetry algorithms, are not well understood.

Purpose: The purpose of this study was to investigate the accuracy of Y-PET/CT-based activity estimates following Y-RE and characterize differences between Y-PET/CT-based voxel dosimetry algorithms.

Methods: Thirty-five patients underwent Y-PET/CT imaging after Y-RE with TheraSphere. The net administered Y activity (A) was determined using a dose calibrator and pre- and post-procedure exposure rate measurements. The summation of image-based activity (A) was extracted from perfused volume (PV) and 3D-isotropically 2-cm expanded PV contour (PV). Absorbed doses were calculated using voxel S-value (VSV), local deposition method (LDM), and LDM with known activity (LDM) dosimetry algorithms. Linear regression and Bland-Altman analysis quantified the relationship between A and A and between mean dose estimates (D, D, D) for PV, T, and perfused NL volumes.

Results: While A and A in PV were highly correlated (R> 0.95), the mean bias ± standard error (SE) and (95% limits of agreement, LOA) was significantly non-zero with -22.7 ± 4.7% (± 28.4%). In PV, the mean bias ± SE (± LOA) decreased to 1.3 ± 3.4% (± 18.0%) consistent with zero mean error. D and D were highly correlated (R> 0.99) for all volumes of interest (VOIs) and the mean bias ± SE (± LOA) was 2.2 ± 0.2% (± 1.0%), 0.7 ± 0.4% (± 2.8%), and 3.2 ± 0.5% (± 2.8%) for PV, T, and NL, respectively. D and D were correlated with R= 0.86, 0.80, and 0.86 for PV, T, and NL, respectively. The mean bias ± SE (± LOA) between D and D was significantly non-zero with -19.6 ± 5.1% (± 31.0%), -20.8 ± 4.4% (± 29.0%), and -18.1 ± 5.3% (± 31.1%) for PV, T, and NL, respectively.

Conclusions: The summation of A in PV was underestimated relative to A. Only by accounting for respiratory motion, limited spatial resolution, and PET/CT co-registration errors through VOI expansion was A, on average, equal to A. The differences between D and D were not clinically relevant, though D was approximately 20% greater than D. Given the high quantitative accuracy of dose calibrators and challenges associated with accurate Y-PET/CT quantification, LDM is the preferred algorithm for accurate Y-PET/CT-based dosimetry following Y-RE.