Dynamic contrast-enhanced ultrasound predicts microsphere biodistribution in real-time during transarterial radioembolization
4 affiliations
- 1Multi-Modality Medical Imaging Group, TechMed Centre, Faculty of Science and Technology, University of Twente
- 2TechMed Simulation Centre, University of Twente
- 3Physics of Fluids Group, TechMed Centre, Faculty of Science and Technology, University of Twente
- 4Engineering Organ Support Technologies Group, Faculty of Engineering Technology, University of Twente
Abstract
Background Transarterial radioembolization (TARE) treatment efficacy critically depends on the microsphere biodistribution in the liver. Current treatment planning protocols rely on a pre-treatment scout procedure to evaluate this biodistribution for a selected catheter configuration. However, replication of the catheter configuration during treatment is challenging and often results in suboptimal tumor targeting. Here we present and experimentally validate a concept to improve tumor targeting using dynamic contrast-enhanced ultrasound (DCE-US) imaging to predict the microsphere biodistribution in real-time, using ultrasound contrast microbubbles as microsphere precursors. Methods DCE-US-guided TARE was performed in three ex vivo perfused porcine livers using a customized normothermic machine-perfusion platform. In each liver, one lobe was selected for targeting, and a 9L4 ultrasound transducer was fixed to image this location. A microcatheter was inserted in the hepatic artery under fluoroscopic guidance. Several catheter positions were analyzed in real-time using ultrasound contrast microbubbles and time-intensity curves (TICs). The catheter position was optimized based on peak TIC intensity, which was retained for subsequent injection of non-irradiated 165Ho-microspheres. The resulting microsphere biodistribution was evaluated by R2* mapping in MRI. Results Here we show that DCE-US can be used to identify feeding arteries, enabling optimization of the catheter placement to maximize peak intensity within the target lobe. MRI confirms the relative microsphere biodistribution as predicted by DCE-US in two quantifiable cases (Case 2: 99.2% [MRI] vs. 98% [DCE-US]; Case 3: 70.2% [MRI] vs. 80.9% [DCE-US]). Conclusions DCE-US enables accurate prediction of microsphere biodistribution, providing real-time feedback for immediate intra-operative optimization of the catheter position during TARE.
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BibTeX
@article{hoek2026dynamic,
title = {{Dynamic contrast-enhanced ultrasound predicts microsphere biodistribution in real-time during transarterial radioembolization}},
author = {J. L. van der Hoek and T. J. Snoeijink and A. Visser and K. D. E. de Bree and M. E. Krommendijk and J. G. M. Greve and H. R. Liefers and W. M. Brink and M. Versluis and J. Arens and S. Manohar and E. Groot Jebbink},
journal = {Communications Medicine},
year = {2026},
month = jun,
doi = {10.1038/s43856-026-01760-x},
url = {https://doi.org/10.1038/s43856-026-01760-x},
note = {CC BY},
}
RIS
TY - JOUR
TI - Dynamic contrast-enhanced ultrasound predicts microsphere biodistribution in real-time during transarterial radioembolization
AU - J. L. van der Hoek
AU - T. J. Snoeijink
AU - A. Visser
AU - K. D. E. de Bree
AU - M. E. Krommendijk
AU - J. G. M. Greve
AU - H. R. Liefers
AU - W. M. Brink
AU - M. Versluis
AU - J. Arens
AU - S. Manohar
AU - E. Groot Jebbink
PY - 2026
DA - 2026/06/01
JO - Communications Medicine
DO - 10.1038/s43856-026-01760-x
UR - https://doi.org/10.1038/s43856-026-01760-x
AB - Background Transarterial radioembolization (TARE) treatment efficacy critically depends on the microsphere biodistribution in the liver. Current treatment planning protocols rely on a pre-treatment scout procedure to evaluate this biodistribution for a selected catheter configuration. However, replication of the catheter configuration during treatment is challenging and often results in suboptimal tumor targeting. Here we present and experimentally validate a concept to improve tumor targeting using dynamic contrast-enhanced ultrasound (DCE-US) imaging to predict the microsphere biodistribution in real-time, using ultrasound contrast microbubbles as microsphere precursors. Methods DCE-US-guided TARE was performed in three ex vivo perfused porcine livers using a customized normothermic machine-perfusion platform. In each liver, one lobe was selected for targeting, and a 9L4 ultrasound transducer was fixed to image this location. A microcatheter was inserted in the hepatic artery under fluoroscopic guidance. Several catheter positions were analyzed in real-time using ultrasound contrast microbubbles and time-intensity curves (TICs). The catheter position was optimized based on peak TIC intensity, which was retained for subsequent injection of non-irradiated 165Ho-microspheres. The resulting microsphere biodistribution was evaluated by R2* mapping in MRI. Results Here we show that DCE-US can be used to identify feeding arteries, enabling optimization of the catheter placement to maximize peak intensity within the target lobe. MRI confirms the relative microsphere biodistribution as predicted by DCE-US in two quantifiable cases (Case 2: 99.2% [MRI] vs. 98% [DCE-US]; Case 3: 70.2% [MRI] vs. 80.9% [DCE-US]). Conclusions DCE-US enables accurate prediction of microsphere biodistribution, providing real-time feedback for immediate intra-operative optimization of the catheter position during TARE.
SN - 2730-664X
ER -