PET/CT-Based Absorbed Dose Maps in ⁹⁰Y Selective Internal Radiation Therapy Correlate with Spatial Changes in Liver...

Functional liver parenchyma can be damaged from treatment of liver malignancies with ⁹⁰Y selective internal radiation therapy (SIRT). Evaluating functional parenchymal changes and developing an absorbed dose (AD)-toxicity model can assist the clinical management of patients receiving SIRT. We aimed to determine whether there is a correlation between ⁹⁰Y PET AD voxel maps and spatial changes in the nontumoral liver (NTL) function derived from dynamic gadoxetic acid-enhanced MRI before and after SIRT. Methods: Dynamic gadoxetic acid-enhanced MRI scans were acquired before and after treatment for 11 patients undergoing ⁹⁰Y SIRT. Gadoxetic acid uptake rate (k₁) maps that directly quantify spatial liver parenchymal function were generated from MRI data. Voxel-based AD maps, derived from the ⁹⁰Y PET/CT scans, were binned according to AD. Pre- and post-SIRT k₁ maps were coregistered to the AD map. Absolute and percentage k₁ loss in each bin was calculated as a measure of loss of liver function, and Spearman correlation coefficients between k₁ loss and AD were evaluated for each patient. Average k₁ loss over the patients was fit to a 3-parameter logistic function based on AD. Patients were further stratified into subgroups based on lesion type, baseline albumin-bilirubin scores and alanine transaminase levels, dose-volume effect, and number of SIRT treatments. Results: Significant positive correlations (ρ = 0.53-0.99, P < 0.001) between both absolute and percentage k₁ loss and AD were observed in most patients (8/11). The average k₁ loss over 9 patients also exhibited a significant strong correlation with AD (ρ ≥ 0.92, P < 0.001). The average percentage k₁ loss of patients across AD bins was 28%, with a logistic function model demonstrating about a 25% k₁ loss at about 100 Gy. Analysis between patient subgroups demonstrated that k₁ loss was greater among patients with hepatocellular carcinoma, higher alanine transaminase levels, larger fractional volumes of NTL receiving an AD of 70 Gy or more, and sequential SIRT treatments. Conclusion: Novel application of multimodality imaging demonstrated a correlation between ⁹⁰Y SIRT AD and spatial functional liver parenchymal degradation, indicating that a higher AD is associated with a larger loss of local hepatocyte function. With the developed response models, PET-derived AD maps can potentially be used prospectively to identify localized damage in liver and to enhance treatment strategies.