Accuracy and reproducibility of a cone beam CT-based virtual parenchymal perfusion algorithm in the prediction of SPECT/CT anatomical and volumetric results during the planification of radioembolization for HCC

ObjectivesTo evaluate anatomical and volumetric predictability of a cone beam computed tomography (CBCT)-based virtual parenchymal perfusion (VPP) software for the single-photon-emission computed tomography (SPECT)/CT imaging results during the work-up for transarterial radioembolization (TARE) procedure in patients with hepatocellular carcinoma (HCC).MethodsVPP was evaluated retrospectively on CBCT data of patients treated by TARE for HCC. Tc-99m macroaggregated albumin particles (Tc-99m-MAA) uptake territories on work-up SPECT/CT was used as ground truth for the evaluation. Semi-quantitative evaluation consisted of the ranking of visual consistency of the parenchymal enhancement and portal vein tumoral involvement on VPP and Tc-99m-MAA SPECT/CT, using a three-rank scale and two-rank scale, respectively. Inter-reader agreement was evaluated using a kappa coefficient. Quantitative evaluation included absolute volume error calculation and Pearson correlation between volumes enhanced territories on VPP and Tc-99m-MAA SPECT/CT.ResultsFifty-two CBCTs were performed in 33 included patients. Semi-quantitative evaluation showed a good concordance between actual Tc-99m-MAA uptake and the virtual enhanced territories in 73% and 75% of cases; a mild concordance in 12% and 10% and a poor concordance in 15%, for the two readers. Kappa coefficient was 0.86. Portal vein involvement evaluation showed a good concordance in 58.3% and 66.7% for the two readers, respectively, with a kappa coefficient of 0.82. Quantitative evaluation showed a volume error of 0.46 +/- 0.78 mL [0.01-3.55], and Pearson R-2 factor at 0.75 with a p value < 0.01.ConclusionCBCT-based VPP software is accurate and reliable to predict Tc-99m-MAA SPECT/CT anatomical and volumetric results in HCC patients during TARE.