SPECT and CT misregistration reduction in [99mTc]Tc-MAA SPECT/CT for precision liver radioembolization treatment planning

• Published in: European journal of nuclear medicine and molecular imaging Vol. 50; no. 8; pp. 2319 - 2330
• Main Authors: Lu, Zhonglin, Chen, Gefei, Jiang, Han, Sun, Jingzhang, Lin, Ko-Han, Mok, Greta S. P.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2023; Springer Nature B.V
• Subjects: Algorithms; Cardiology; Computer simulation; Dosimetry; Embolization, Therapeutic - methods; Errors; Humans; Imaging; Liver; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - radiotherapy; Lungs; Medicine; Medicine & Public Health; Microspheres; Nuclear Medicine; Oncology; Original Article; Orthopedics; Patients; Radiology; Rank tests; Registration; Retrospective Studies; Segmentation; Simulation; Single photon emission computed tomography; Single Photon Emission Computed Tomography Computed Tomography; Technetium Tc 99m Aggregated Albumin; Tomography, Emission-Computed, Single-Photon - methods; Tumors; Yttrium isotopes; Yttrium Radioisotopes - therapeutic use; Respiratory motion; [; Tc]Tc-macroaggregated albumin; Registration; SPECT/CT; [99mTc]Tc-macroaggregated albumin
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-023-06149-9

Purpose Respiration and body movement induce misregistration between static [ 99m Tc]Tc-MAA SPECT and CT, causing lung shunting fraction (LSF) and tumor-to-normal liver ratio (TNR) errors for 90 Y radioembolization planning. We aim to alleviate the misregistration between [ 99m Tc]Tc-MAA SPECT and CT using two registration schemes on simulation and clinical data. Methods In the simulation study, 70 XCAT phantoms were modeled. The SIMIND Monte Carlo program and OS-EM algorithm were used for projection generation and reconstruction, respectively. Low-dose CT (LDCT) at end-inspiration was simulated for attenuation correction (AC), lungs and liver segmentation, while contrast-enhanced CT (CECT) was simulated for tumor and perfused liver segmentation. In the clinical study, 16 patient data including [ 99m Tc]Tc-MAA SPECT/LDCT and CECT with observed SPECT and CT mismatch were analyzed. Two liver-based registration schemes were studied: SPECT registered to LDCT/CECT and vice versa. Mean count density (MCD) of different volumes-of-interest (VOIs), normalized mutual information (NMI), LSF, TNR, and maximum injected activity (MIA) based on the partition model before and after registration were compared. Wilcoxon signed-rank test was performed. Results In the simulation study, compared to before registration, registrations significantly reduced estimation errors of MCD of all VOIs, LSF (Scheme 1: − 100.28%, Scheme 2: − 101.59%), and TNR (Scheme 1: − 7.00%, Scheme 2: − 5.67%), as well as MIA (Scheme 1: − 3.22%, Scheme 2: − 2.40%). In the clinical study, Scheme 1 reduced 33.68% LSF and increased 14.75% TNR, while Scheme 2 reduced 38.88% LSF and increased 6.28% TNR compared to before registration. One patient may change from 90 Y radioembolization untreatable to treatable and other patients may change the MIA up to 25% after registration. NMI between SPECT and CT was significantly increased after registrations in both studies. Conclusion Registration between static [ 99m Tc]Tc-MAA SPECT and corresponding CTs is feasible to reduce their spatial mismatch and improve dosimetric estimation. The improvement of LSF is larger than TNR. Our method can potentially improve patient selection and personalized treatment planning for liver radioembolization.