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01-07-2014 | Hepatobiliary-Pancreas

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

Authors: Fabian Morsbach, Bert-Ram Sah, Lea Spring, Gilbert Puippe, Sonja Gordic, Burkhardt Seifert, Niklaus Schaefer, Thomas Pfammatter, Hatem Alkadhi, Caecilia S. Reiner

Published in: European Radiology | Issue 7/2014

Abstract

Objective

To determine the best predictor for the response to and survival with transarterial radioembolisation (RE) with ⁹⁰yttrium microspheres in patients with liver metastases.

Methods

Forty consecutive patients with liver metastases undergoing RE were evaluated with multiphase CT, perfusion CT and ^99mTc-MAA SPECT. Arterial perfusion (AP) from perfusion CT, HU values from the arterial (aHU) and portal venous phase (pvHU) CT, and ^99mTc-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 ^99mTc-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 ^99mTc-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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Title: Perfusion CT best predicts outcome after radioembolization of liver metastases: a comparison of radionuclide and CT imaging techniques
Authors: Fabian Morsbach
Bert-Ram Sah
Lea Spring
Gilbert Puippe
Sonja Gordic
Burkhardt Seifert
Niklaus Schaefer
Thomas Pfammatter
Hatem Alkadhi
Caecilia S. Reiner
Publication date: 01-07-2014
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 7/2014
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-014-3180-3

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Objective

Methods

Results

Conclusion

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

Key Points

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