Usefulness of multiphasic MRI in assessing suitability for SIRT in treatment of liver malignancies

Abstract Aim To evaluate the predictive value of multiphasic magnetic resonance imaging (MRI) in identifying liver tumor perfusion characteristics and to compare it with hepatic artery perfusion scintigraphy findings in patients considered for selective internal radiation therapy (SIRT) with yttrium-90 (Y-90). Methods This study included 93 patients diagnosed with primary or secondary liver cancer between May 2021 and February 2024, comprising 47 patients (27 M/20F) deemed unsuitable for SIRT and 46 patients (26 M/20F) eligible for SIRT. The relationship between multiphasic MRI and scintigraphy findings in determining perfusion of tumors was analyzed. Predictive performance was evaluated with receiver operating characteristic (ROC) analysis, and the optimal cut-off values were determined using the Youden index. Results The SIRT unsuitable group had a lower frequency of intratumoral arterial phase hyperenhancement(APHE) (40.43% vs. 69.57%, p = 0.042), presence of hyperintensity on T2 sequence (72.34% vs. 95.65%, p = 0.026), lower lesion intensity in the portal phase ( p = 0.033), and a lower lesion-to-liver intensity ratio in the portal phase (≤ 0.97, p = 0.011). The absence of intratumoral APHE [ p = 0.049, AUC (95% CI) = 0.646 (0.508–0.783)] and a lesion-to-liver intensity ratio in the portal phase with a cut-off value of ≤ 0.97 [ p = 0.011, AUC (95% CI) = 0.689 (0.564–0.815)] were significant predictors of SIRT unsuitability. Conclusion Both the absence of intratumoral APHE and a lower lesion-to-liver intensity ratio in the portal phase were significant predictors of SIRT unsuitability. Graphical Abstract