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Purpose <p>In patients with liver-dominant metastatic disease undergoing yttrium-90 (⁹⁰Y) transarterial radioembolization (TARE), response assessment remains challenging, particularly in multifocal disease where manual RECIST-based measurements may not adequately reflect overall hepatic tumor burden. In addition, the prognostic relevance of volumetric changes in tumor, liver, and spleen after TARE remains unclear. This retrospective study evaluated automated CT-based whole-liver tumor volumetry as a quantitative imaging biomarker for response assessment and progression risk stratification following TARE.</p> Methods <p>We retrospectively analyzed imaging and clinical data from 57 adults with liver-dominant metastatic disease (colorectal, neuroendocrine, uveal melanoma, and breast cancer) treated with yttrium-90 (⁹⁰Y) resin TARE between January 2012 and December 2022. Inclusion criteria were age ≥ 18 years, availability of baseline contrast-enhanced CT imaging, and clinical follow-up. Patients undergoing liver resection, transplantation, or additional locoregional therapies during follow-up were excluded.</p> Results <p>Baseline tumor volume was a strong independent predictor of progression-free survival (PFS), demonstrating excellent discriminatory performance (ROC-AUC 0.91; 95% CI 0.82–1.00). A threshold of 270 mL most accurately identified early progression (&lt; 12 months), with a sensitivity of 0.84 and specificity of 0.92. In contrast, lesion count, embolization strategy, and maximum tumor diameter were not significantly associated with PFS.</p> Conclusions <p>Automated baseline tumor volumetry demonstrated promising prognostic performance compared with conventional clinical and procedural parameters in patients with liver-dominant metastases treated with ⁹⁰Y TARE. Automated quantification of intrahepatic tumor burden may serve as a useful and readily accessible imaging biomarker for early risk stratification, although external validation is required before clinical implementation.</p>

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AI-based tumor and organ volumetry predicts early progression after Y-90 radioembolization in liver-dominant metastatic disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月4日

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  • Daniel Martinez Heinemann,
  • Jannis Bodden,
  • Lukas Endroes,
  • Felianty Teresa,
  • Manuel Nickel,
  • Sebastian Lange,
  • Markus Mergen,
  • Daniel Spitzl,
  • Roland Schmid,
  • Marc Martignoni,
  • Jan Kirschke,
  • Matthias Eiber,
  • Rickmer Braren,
  • Lisa Steinhelfer

摘要

Purpose

In patients with liver-dominant metastatic disease undergoing yttrium-90 (⁹⁰Y) transarterial radioembolization (TARE), response assessment remains challenging, particularly in multifocal disease where manual RECIST-based measurements may not adequately reflect overall hepatic tumor burden. In addition, the prognostic relevance of volumetric changes in tumor, liver, and spleen after TARE remains unclear. This retrospective study evaluated automated CT-based whole-liver tumor volumetry as a quantitative imaging biomarker for response assessment and progression risk stratification following TARE.

Methods

We retrospectively analyzed imaging and clinical data from 57 adults with liver-dominant metastatic disease (colorectal, neuroendocrine, uveal melanoma, and breast cancer) treated with yttrium-90 (⁹⁰Y) resin TARE between January 2012 and December 2022. Inclusion criteria were age ≥ 18 years, availability of baseline contrast-enhanced CT imaging, and clinical follow-up. Patients undergoing liver resection, transplantation, or additional locoregional therapies during follow-up were excluded.

Results

Baseline tumor volume was a strong independent predictor of progression-free survival (PFS), demonstrating excellent discriminatory performance (ROC-AUC 0.91; 95% CI 0.82–1.00). A threshold of 270 mL most accurately identified early progression (< 12 months), with a sensitivity of 0.84 and specificity of 0.92. In contrast, lesion count, embolization strategy, and maximum tumor diameter were not significantly associated with PFS.

Conclusions

Automated baseline tumor volumetry demonstrated promising prognostic performance compared with conventional clinical and procedural parameters in patients with liver-dominant metastases treated with ⁹⁰Y TARE. Automated quantification of intrahepatic tumor burden may serve as a useful and readily accessible imaging biomarker for early risk stratification, although external validation is required before clinical implementation.