Quantitative Monte Carlo-Based 90Y SPECT Reconstruction

The evaluation of radiation absorbed doses in tumorous and healthy tissues is of increasing interest for Y-90 microsphere radioembolization of liver malignancies. The objectives of this work were to introduce and validate a new reconstruction method for quantitative Y-90 bremsstrahlung SPECT to improve posttreatment dosimetry. Methods: A fast Monte Carlo simulator was adapted for Y-90 and incorporated into a statistical reconstruction algorithm (SPECT-MC). Photon scatter and attenuation for all photons sampled from the full Y-90 energy spectrum were modeled during reconstruction by Monte Carlo simulations. The energy-and distance-dependent collimator-detector response was modeled with precalculated convolution kernels. The National Electrical Manufacturers Association 2007/International Electrotechnical Commission 2008 image quality phantom was used to quantitatively evaluate the performance of SPECT-MC in comparison with those of state-of-the-art clinical SPECT reconstruction and PET. The liver radiation absorbed doses estimated by SPECT, PET, and SPECT-MC were evaluated in 5 patients consecutively treated with radioembolization. Results: In comparison with state-of-the-art clinical Y-90 SPECT reconstruction, SPECT-MC substantially improved image contrast (e. g., from 25% to 88% for the 37-mm sphere) and decreased the mean residual count error in the lung insert (from 73% to 15%) at the cost of higher image noise. Image noise and the mean count error were lower for SPECT-MC than for PET. Image contrast was higher in the larger spheres (diameter of >= 28 mm) but lower in the smaller spheres (<= 22 mm) for SPECT-MC than for PET. In the clinical study, mean absorbed dose estimates in liver regions with high absorbed doses were consistently higher for SPECT-MC than for SPECT (P = 0.0625) and consistently higher for SPECT-MC than for PET (P = 0.0625). Conclusion: The quantitative accuracy of Y-90 bremsstrahlung SPECT is substantially improved by Monte Carlo-based modeling of the image-degrading factors. Consequently, Y-90 bremsstrahlung SPECT may be used as an alternative to Y-90 PET.