ArticleEuropean journal of nuclear medicine and molecular imaging2026
A novel approach to radioembolization treatment planning using a hybrid [
Article in European journal of nuclear medicine and molecular imaging, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeDosimetry-guided treatment planning is central to radioembolization. Guidelines recommend segmenting volumes on baseline contrast-enhanced CT (ceCT) and registering to a SPECT/low-dose CT. However, this conventional approach is vulnerable to spatial misregistration and potential disease progression. This study evaluates a hybrid SPECT/ceCT-based planning methodology, hypothesising that it yields significantly different dosimetry metrics compared to the conventional workflow. MATERIALS AND
methodsHybrid SPECT/ceCT was performed in 24 patients with hepatocellular carcinoma. Treatment planning followed both the conventional and hybrid workflow, where delineation was performed directly on SPECT/ceCT. Quantification of dosimetric and positional differences between volumes from the two workflows was performed using Simplicit
resultsDirect delineation on SPECT/ceCT yielded higher index lesion (largest single tumour) doses (6% increased) (mean: 19.5 Gy, 95% limits of agreement [LoA]: -43.9 Gy, 83.0 Gy) and lower normal tissue doses (11% decrease) (mean: -17.6 Gy 95% LoA: -104.4 Gy, 69.3 Gy). Index lesion volume increase between baseline CT and SPECT/ceCT was 14% (95% LoA: -55.9%, 82.9%). Index lesion dose (p = 0.01) and volume (p = 0.01) differed significantly between workflows. The median time interval between baseline imaging and SPECT/ceCT was 6 weeks (IQR: 3.7 to 9.3 weeks). The median deviation of the index lesion between the baseline diagnostic image and hybrid SPECT/ceCT image was 4.9 ± 2.2 mm and there was an average DICE score of 0.6 ± 0.2.
conclusionHybrid [99mTc]Tc-MAA SPECT/ceCT treatment planning is technically feasible and leads to significant differences in dosimetry metrics compared with the conventional method.
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