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Response of Liver Metastases After Treatment with Yttrium-90 Microspheres: Role of Size, Necrosis, and PET

¹ Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair, Ste. 800, Chicago, IL 60611.
² Department of Preventive Medicine, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.
³ Department of Hematology and Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL 60611.

OBJECTIVE. Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to ⁹⁰Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to ⁹⁰Y therapy.

MATERIALS AND METHODS. We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with ⁹⁰Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed.

RESULTS. The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%).

CONCLUSION. The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to ⁹⁰Y treatment in patients with liver metastases and detect response earlier than standard size criteria.

Keywords: CT imaging • interventional radiology • liver • oncologic imaging • PET • radioembolization

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