The joint use of (99m)Tc-MAA-SPECT/CT and cone-beam CT optimizes radioembolization planning

PURPOSE: To determine which imaging method used during radioembolization (RE) work-up: contrast-enhanced computed tomography (CECT), (99m)Tc-MAA-SPECT/CT or cone beam-CT (CBCT), more accurately predicts the final target volume (TgV) as well as the influence that each modality has in the dosimetric calculation. METHODS: TgVs from (99m)Tc-MAA-SPECT/CT, CECT and CBCT were consecutively obtained in 24 patients treated with RE and compared with (90)Y PET/CT TgV. Using the TgVs estimated by each imaging modality and a fictitious activity of 1 GBq, the corresponding absorbed doses by tumor and non-tumoral parenchyma were calculated for each patient. The absorbed doses for each modality were compared with the ones obtained using (90)Y PET/CT TgV. RESULTS: (99m)Tc-MAA-SPECT/CT predicted (90)Y PET/CT TgV better than CBCT or CECT, even for selective or superselective administrations. Likewise, (99m)Tc-MAA-SPECT/CT showed dosimetric values more similar to those obtained with (90)Y PET/CT. Nevertheless, CBCT provided essential information for RE planning, such as ensuring the total coverage of the tumor and, in cases with more than one feeding artery, splitting the activity according to the volume of tumor perfused by each artery. CONCLUSION: The joint use of (99m)Tc-MAA-SPECT/CT and CBCT optimizes dosimetric planning for RE procedures, enabling a more accurate personalized approach.