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Perfusion CT best predicts outcome after radioembolization of liver metastases: a comparison of radionuclide and CT imaging techniques


Morsbach, Fabian; Sah, Bert-Ram; Spring, Lea; Puippe, Gilbert; Gordic, Sonja; Seifert, Burkhardt; Schaefer, Niklaus; Pfammatter, Thomas; Alkadhi, Hatem; Reiner, Caecilia S (2014). Perfusion CT best predicts outcome after radioembolization of liver metastases: a comparison of radionuclide and CT imaging techniques. European Radiology, 24(7):1455-1465.

Abstract

OBJECTIVE: To determine the best predictor for the response to and survival with transarterial radioembolisation (RE) with (90)yttrium microspheres in patients with liver metastases.
METHODS: Forty consecutive patients with liver metastases undergoing RE were evaluated with multiphase CT, perfusion CT and (99m)Tc-MAA SPECT. Arterial perfusion (AP) from perfusion CT, HU values from the arterial (aHU) and portal venous phase (pvHU) CT, and (99m)Tc-MAA uptake ratio of metastases were determined. Morphologic response was evaluated after 4 months and available in 30 patients. One-year survival was calculated with Kaplan-Meier curves.
RESULTS: We found significant differences between responders and non-responders for AP (P < 0.001) and aHU (P = 0.001) of metastases, while no differences were found for pvHU (P = 0.07) and the (99m)Tc-MAA uptake ratio (P = 0.40). AP had a significantly higher specificity than aHU (P = 0.003) for determining responders to RE. Patients with an AP >20 ml/100 ml/min had a significantly (P = 0.01) higher 1-year survival, whereas an aHU value >55 HU did not discriminate survival (P = 0.12). The Cox proportional hazard model revealed AP as the only significant (P = 0.02) independent predictor of survival.
CONCLUSION: Compared to arterial and portal venous enhancement and the (99m)Tc-MAA uptake ratio of liver metastases, the AP from perfusion CT is the best predictor of morphologic response to and 1-year survival with RE.
KEY POINTS: • Perfusion CT allows for calculation of the liver arterial perfusion. • Arterial perfusion of liver metastases differs between responders and non-responders to RE. • Arterial perfusion can be used to select patients responding to RE.

Abstract

OBJECTIVE: To determine the best predictor for the response to and survival with transarterial radioembolisation (RE) with (90)yttrium microspheres in patients with liver metastases.
METHODS: Forty consecutive patients with liver metastases undergoing RE were evaluated with multiphase CT, perfusion CT and (99m)Tc-MAA SPECT. Arterial perfusion (AP) from perfusion CT, HU values from the arterial (aHU) and portal venous phase (pvHU) CT, and (99m)Tc-MAA uptake ratio of metastases were determined. Morphologic response was evaluated after 4 months and available in 30 patients. One-year survival was calculated with Kaplan-Meier curves.
RESULTS: We found significant differences between responders and non-responders for AP (P < 0.001) and aHU (P = 0.001) of metastases, while no differences were found for pvHU (P = 0.07) and the (99m)Tc-MAA uptake ratio (P = 0.40). AP had a significantly higher specificity than aHU (P = 0.003) for determining responders to RE. Patients with an AP >20 ml/100 ml/min had a significantly (P = 0.01) higher 1-year survival, whereas an aHU value >55 HU did not discriminate survival (P = 0.12). The Cox proportional hazard model revealed AP as the only significant (P = 0.02) independent predictor of survival.
CONCLUSION: Compared to arterial and portal venous enhancement and the (99m)Tc-MAA uptake ratio of liver metastases, the AP from perfusion CT is the best predictor of morphologic response to and 1-year survival with RE.
KEY POINTS: • Perfusion CT allows for calculation of the liver arterial perfusion. • Arterial perfusion of liver metastases differs between responders and non-responders to RE. • Arterial perfusion can be used to select patients responding to RE.

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12 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Diagnostic and Interventional Radiology
04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Clinic for Nuclear Medicine
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2014
Deposited On:21 May 2014 15:43
Last Modified:05 Apr 2016 17:52
Publisher:Springer
ISSN:0938-7994
Publisher DOI:https://doi.org/10.1007/s00330-014-3180-3
PubMed ID:24817083

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