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Baum RP, Prasad V, Hommann M, Hörsch D. Receptor PET/CT imaging of neuroendocrine tumors. Recent Results Cancer Res 2008; 170:225-242. [PMID: 18019630 DOI: 10.1007/978-3-540-31203-1_18] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Affiliation(s)
- R P Baum
- Zentralklinik Bad Berka GmbH Nuklearmedizinische Klinik, Germany
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252
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Dubois S, Morel O, Rodien P, Illouz F, Girault S, Cahouet A, Lacoeuille F, Brousseau M, Picquet J, Rohmer V. A Pulmonary adrenocorticotropin-secreting carcinoid tumor localized by 6-Fluoro-[18F]L-dihydroxyphenylalanine positron emission/computed tomography imaging in a patient with Cushing's syndrome. J Clin Endocrinol Metab 2007; 92:4512-3. [PMID: 18056777 DOI: 10.1210/jc.2007-1337] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- S Dubois
- Département d'Endocrinologie, Centre Hospitalier Universitaire, 4 rue Larrey, 49933 Angers cedex 09, France.
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253
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Plössl K, Chandra R, Qu W, Lieberman BP, Kung MP, Zhou R, Huang B, Kung HF. A novel gallium bisaminothiolate complex as a myocardial perfusion imaging agent. Nucl Med Biol 2007; 35:83-90. [PMID: 18158947 DOI: 10.1016/j.nucmedbio.2007.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2007] [Revised: 08/09/2007] [Accepted: 08/11/2007] [Indexed: 11/15/2022]
Abstract
The development of new myocardial perfusion imaging agents for positron emission tomography (PET) may improve the resolution and quantitation of changes in regional myocardial perfusion measurement. It is known that a (68)Ge/(68)Ga generator can provide a convenient source of PET tracers because of the long physical half-life of (68)Ge (271 days). A new ligand, 7,8-dithia-16,24-diaza-trispiro[5.2.5.2.5.3]pentacosa-15,24-diene, which consists of a N(2)S(2)-chelating core incorporated into three cyclohexyl rings, was prepared. To test feasibility and potential utility, the N(2)S(2) ligand was successfully labeled and tested with (67)Ga (half-life=3.26 day; gamma=93.3, 184.6 and 300.2 keV), which showed >92% radiochemical purity. The corresponding "cold" Ga complex was synthesized, and its structure containing a pyramidal N(2)S(2) chloride core was elucidated with X-ray crystallography. In vivo biodistribution of this novel (67)Ga complex, evaluated in normal rats, exhibited excellent heart uptake and retention, with 2.1% and 0.9% initial dose/organ at 2 and 60 min, respectively, after an intravenous injection. Autoradiography was performed in normal rats and in rats that had the left anterior descending coronary artery permanently ligated surgically. Autoradiography showed an even uptake of activity in the normal heart, and there was a distinctively lower uptake in the damaged side of the surgically modified heart. In conclusion, the new N(2)S(2) ligand was readily prepared and labeled with radioactive (67)Ga. Biodistribution in rats revealed high initial heart uptake and relatively high retention reflecting regional myocardial perfusion.
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Affiliation(s)
- Karl Plössl
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
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254
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Park JY, Lee TS, Choi TH, Cheon GJ, Choi CW, Awh OD. A comparative study of 188Re(V)-meso-DMSA and 188Re(V)-rac-DMSA: preparation and in vivo evaluation in nude mice xenografted with a neuroendocrine tumor. Nucl Med Biol 2007; 34:1029-36. [PMID: 17998108 DOI: 10.1016/j.nucmedbio.2007.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 06/01/2007] [Accepted: 06/25/2007] [Indexed: 11/16/2022]
Affiliation(s)
- Jun-Young Park
- Department of Biomedical Laboratory Science, College of Health Science, Yonsei University, Wonju 220-710, South Korea
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255
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Wehrmann C, Senftleben S, Zachert C, Müller D, Baum RP. Results of individual patient dosimetry in peptide receptor radionuclide therapy with 177Lu DOTA-TATE and 177Lu DOTA-NOC. Cancer Biother Radiopharm 2007; 22:406-16. [PMID: 17651048 DOI: 10.1089/cbr.2006.325] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
UNLABELLED One of the few treatment options for inoperable neuroendocrine tumors (NET) is peptide receptor radiotherapy with somatostatin analogs. In this study, we compared the dosimetric parameter uptake, half-life (kinetics), and mean absorbed organ and tumor doses of (177)Lu DOTA-NOC and (177)Lu DOTA-TATE. METHODS Ninety-five (95) post-therapeutic dosimetric assessments using (177)Lu DOTA-TATE and 8 using (177)Lu DOTA-NOC in 69 patients with neuroendocrine tumors with high somatostatin receptor expression (verified by Ga-68 DOTA-NOC positron emission tomography/computed tomography) were analyzed. Dosimetric calculations were performed according to the Medical Internal Radiation Dose scheme. RESULTS (177)Lu DOTA-NOC showed a significantly (p < or = 0.05; sign test) higher uptake for whole-body and normal tissue, as compared to (177)Lu DOTA-TATE, leading to a significant higher whole-body dose of 0.07 mGy/ MBq for DOTA-NOC, as compared to 0.05 mGy/MBq for DOTA-TATE. Renal and spleen uptake and radiation doses were not significantly higher for DOTA-NOC. The uptake in tumor lesions and the mean absorbed tumor dose were higher for DOTA-TATE. The red marrow dose was approximately 0.2 Gy. CONCLUSIONS Our first results demonstrated that the higher in vitro affinity of DOTA-NOC leads to a higher uptake in normal tissues and, therefore, to an increase in the whole-body dose. The high interpatient variability of these results makes an individual patient dosimetry obligatory.
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Affiliation(s)
- Christiane Wehrmann
- Department of Nuclear Medicine/Center for P.E.T., Zentralklinik Bad Berka, Bad Berka, Germany
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256
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Abstract
The majority of Neuroendocrine tumors (NET) express somatostatin (SS) receptors, and thus can be successfully targeted with radiolabeled SS analogs in vivo. Somatostatin receptor scintigraphy (SRS) with (111)In-DTPA Octreotide is the main imaging technique for evaluation of NETs. Radio-guided surgery for NETs, therefore, primarily utilizes (111)In-DTPA Octreotide tumor localization mechanism and kinetics. Somatostatin analog radiopharmacy continues to evolve to include the development of more selective and higher affinity analogs and PET tracers. These changes are expected to open new venues for radio-guided surgery technology.
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Affiliation(s)
- Seza A Gulec
- Center for Cancer Care at Goshen Health System, Goshen, IN, USA
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257
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Abstract
Intraoperative localization of PET-positive recurrent/metastatic lesions can be facilitated using a hand-held PET probe. PET probe is a high-energy gamma probe designed to process the 511 keV photons of PET tracers. Intraoperative gamma probe performance is a function of radiopharmaceutical uptake, clearance kinetics, and probe engineering, all determining the target to background ratio (TBR) and detection threshold. A minimum TBR of 1.5:1 is needed in the operative field for the operating surgeon to be comfortable the differences between tumor tissue and normal adjacent tissue are real. Due to high-energy photon fluxes, achieving a satisfactory TBR intraoperatively is challenging and requires development of a clinically feasible PET-probe guided surgery protocol.
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Affiliation(s)
- Seza A Gulec
- Center for Cancer Care, Goshen Health System, Goshen, IN, USA.
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258
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Abstract
Neuroblastoma is the most common extracranial solid tumor of childhood. It commonly presents in children younger than 2 years of age, with 90% being younger than 5 years of age. There is marked variability in clinical behavior ranging from spontaneous regression or differentiation into benign tumors to rapid and progressive fatal disease. Approximately 50% of patients will have metastases at presentation. The management is dependent on age, stage of disease, and biological and biochemical markers. Nuclear medicine plays an important role in the initial staging, as a prognostic indicator, for assessment of response to treatment, and also in therapy. The most common nuclear medicine diagnostic studies are (99m)Tc-disphosphonate bone scintigraphy and (123)I-MIBG (metaiodobenzylguanidine) scintigraphy. Bone scintigraphy has been the main investigational modality to diagnose skeletal metastases. Whole body imaging with (123)I-MIBG has become the preferred diagnostic test because this agent accumulates in neuroblastoma in 90% to 95% of cases and will accumulate in the primary tumor and metastases particularly in bone, bone marrow, lymph nodes, and soft tissues. MIBG can be used to assess therapy response and is a significant prognostic indicator. Other diagnostic techniques include positron emission tomography (PET)/computed tomography, mainly using (18)F-fluorodeoxyglucose. Other more experimental PET agents, as well as radiolabeled antibodies and octreotide, also are being investigated. Therapy has mainly focused on palliation and has been used alone or in combination with chemotherapy in high-risk refractory or relapsed patients. Major attention is being placed on stratification of patients to try and reduce the side effects associated with intensive megatherapy in the low to intermediate risk patients. Neuroendocrine tumors (NETs) are rare in childhood, but nuclear medicine techniques, mainly using MIBG and somatostatin receptor agents, have a role in diagnosis, staging, and a limited role in therapy. Newer radiopharmaceuticals, including PET agents, are being evaluated for the assessment of NET. Nuclear medicine techniques play a major role in the management of neuroblastoma and NET.
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Affiliation(s)
- Robert Howman-Giles
- Department of Nuclear Medicine, Children's Hospital at Westmead, Sydney, NSW, Australia.
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259
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Okarvi SM. Peptide-based radiopharmaceuticals and cytotoxic conjugates: potential tools against cancer. Cancer Treat Rev 2007; 34:13-26. [PMID: 17870245 DOI: 10.1016/j.ctrv.2007.07.017] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 06/28/2007] [Accepted: 07/25/2007] [Indexed: 02/08/2023]
Abstract
A hope for the diagnosis and treatment of cancer is the development of new tumor-specific peptide-based radiopharmaceuticals. The overexpression of many peptide receptors on human tumors makes such receptors an attractive potential target for diagnostic imaging and radiotherapy with specifically designed radiolabeled peptides. The use of solid-phase peptide synthesis, and the availability of a wide range of bifunctional chelating agents for the convenient radiolabeling of bioactive peptides with different radionuclides have produced a wide variety of medicinally useful peptide radiopharmaceuticals. A few of these peptides, such as somatostatin, bombesin, cholecystokinin/gastrin, neurotensin and vasoactive intestinal peptide are currently under investigation for their possible clinical applications in nuclear oncology. This article presents the recent development in radiolabeled small peptides, with major emphasis on somatostatin and bombesin analogs.
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Affiliation(s)
- S M Okarvi
- Cyclotron and Radiopharmaceuticals Department, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
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260
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Pettinato C, Sarnelli A, Di Donna M, Civollani S, Nanni C, Montini G, Di Pierro D, Ferrari M, Marengo M, Bergamini C. 68Ga-DOTANOC: biodistribution and dosimetry in patients affected by neuroendocrine tumors. Eur J Nucl Med Mol Imaging 2007; 35:72-9. [PMID: 17874094 DOI: 10.1007/s00259-007-0587-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 08/09/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The aim of this work was the evaluation of biodistribution and radiation dosimetry of (68)Ga-DOTANOC in patients affected by neuroendocrine tumors. MATERIALS AND METHODS We enrolled nine patients (six male and three female) affected by different types of neuroendocrine tumors (NETs). Each patient underwent four whole body positron emission tomography (PET) scans, respectively, at 5, 20, 60, and 120 min after the intravenous injection of about 185 MBq of (68)Ga-DOTANOC. Blood and urine samples were taken at different time points post injection: respectively, at about 5, 18, 40, 60, and 120 min for blood and every 40-50 min from injection time up to 4 h for urine. The organs involved in the dosimetric evaluations were liver, heart, spleen, kidneys, lungs, pituitary gland, and urinary bladder. Dosimetric evaluations were done using the OLINDA/EXM 1.0 software. RESULTS A physiological uptake of (68)Ga-DOTANOC was seen in all patients in the pituitary gland, the spleen, the liver, and the urinary tract (kidneys and urinary bladder). Organs with the highest absorbed doses were kidneys (9.0E-02+/-3.2E-02mSv/MBq). The mean effective dose equivalent (EDE) was 2.5E-02+/-4.6E-03 mSv/MBq. DISCUSSION AND CONCLUSIONS The excretion of the compound was principally via urine, giving dose to the kidney and the urinary bladder wall. As SSTR2 is the most frequently expressed somatostatin receptor and (68)Ga-DOTANOC has high affinity to it, this compound might play an important role in PET oncology in the future. The dosimetric evaluation carried out by our team demonstrated that (68)Ga-DOTANOC delivers a dose to organs comparable to, and even lower than, analogous diagnostic compounds.
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Affiliation(s)
- C Pettinato
- Health Physics, A.O. S. Orsola-Malpighi, Bologna, Italy.
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261
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Rufini V, Castaldi P, Treglia G, Perotti G, Gross MD, Al-Nahhas A, Rubello D. Nuclear medicine procedures in the diagnosis and therapy of medullary thyroid carcinoma. Biomed Pharmacother 2007; 62:139-46. [PMID: 17892924 DOI: 10.1016/j.biopha.2007.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 07/25/2007] [Indexed: 01/02/2023] Open
Abstract
Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumor originating in the parafollicular cells (C cells) of the thyroid and secretes both calcitonin and carcino-embryonic antigen (CEA). Genetic and biochemical testing allow early pre-clinical identification of familial forms. Sporadic MTC usually presents as a solitary thyroid nodule; the diagnosis can be made preoperatively by fine-needle aspiration or by calcitonin assay, though it is usually established at the time of surgery. In the diagnostic assessment of MTC, nuclear medicine imaging provides its contribution mainly in the post-operative work-up to detect residual/recurrent tumor. For such purpose a number of radiopharmaceuticals, which take advantage of the specific expression of receptors (the somatostatin analogue (111)In-octreotide), hormone transporters (radiolabelled MIBG) or molecular targets (radiolabelled anti-CEA monoclonal antibodies) by MTC lesions are available; these tracers may be used also for the palliative treatment of advanced MTC. Interesting perspectives for MTC imaging are offered by PET radiopharmaceuticals.
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Affiliation(s)
- Vittoria Rufini
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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262
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Vardanian AJ, Hines OJ, Farrell JJ, Yeh MW. Incidentally discovered tumors of the endocrine glands. Future Oncol 2007; 3:463-74. [PMID: 17661721 DOI: 10.2217/14796694.3.4.463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Clinically inapparent masses, or ‘incidentalomas’ of the endocrine glands are increasingly common owing to continued advancements in medical imaging. Incidentalomas of the adrenal glandS have received substantial attention in the literature, whereas lesions of the thyroid and endocrine pancreas, though frequently encountered in the clinic, have received relatively little attention. We review the detection and subsequent management of incidentalomas of the thyroid, adrenal and pancreas, with specific attention paid to the mode of detection and risk stratification of lesions.
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Affiliation(s)
- Andrew J Vardanian
- UCLA David Geffen School of Medicine, Department of Surgery, Los Angeles, CA 90095, USA.
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263
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Gulec SA, Hoenie E, Hostetter R, Schwartzentruber D. PET probe-guided surgery: applications and clinical protocol. World J Surg Oncol 2007; 5:65. [PMID: 17555587 PMCID: PMC1896163 DOI: 10.1186/1477-7819-5-65] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Accepted: 06/07/2007] [Indexed: 11/13/2022] Open
Abstract
Introduction Parallel to the advances in diagnostic imaging using positron emission tomography (PET), and availability of new systemic treatment options, the treatment paradigm in oncology has shifted towards more aggressive therapeutic interventions to include cytoreductive techniques and metastasectomies. Intraoperative localization of PET positive recurrent/metastatic lesions can be facilitated using a hand-held PET probe. Materials and methods Records of patients who underwent PET probe-guided surgery were reviewed. Surgical indications and operative targets were determined based on diagnostic PET/PET-CT images performed prior to probe-guided surgical planning. PET probe-guided surgery was performed on a separate day using a high-energy gamma probe (PET probe, Care Wise Medical, Morgan Hills CA) 2–6 hours post-injection of 5–15 mCi FDG. Probe count rates, target-to-background ratios, and lesion detection success were analyzed. Results Twenty-four patients underwent PET probe-guided surgery; one patient had two PET-probe guided surgeries resulting in a total of 25 cases (5 colorectal cancer cases, 4 thyroid cancer cases, 6 lymphoma cancer cases, and 10 other cancer cases). Surgical indication was diagnostic exploration in 6 cases with lymphoma and 1 case with head and neck cancer (28%). The remaining 18 cases (72%) underwent PET probe-guided surgery with a therapeutic intent in a recurrent or metastatic disease setting. All the lesions identified and targeted on a preoperative FDG-PET scan were detected by the PET probe with satisfactory in-vivo lesion count rates and a TBR of ≥ 1.5. PET probe allowed localization of lesions that were non-palpable and non-obvious at surgical exploration in 8 patients. Conclusion The use of the PET probe improves the success of surgical exploration in selected indications. Separate day protocol is clinically feasible allowing for flexible operating room scheduling.
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Affiliation(s)
- Seza A Gulec
- Center for Cancer Care at Goshen Health System, Goshen, IN, USA
| | - Erica Hoenie
- Center for Cancer Care at Goshen Health System, Goshen, IN, USA
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264
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Abstract
The diagnosis of neuroendocrine tumours (NETs) and monitoring of therapy in many patients relies mainly on morphological imaging techniques such as computed tomography (CT), ultrasound (US) and magnetic resonance imaging (MRI). However, functional imaging modalities--such as somatostatin receptor scintigraphy (SRS)--have great impact on patient management by providing tools for better staging of the disease, visualization of occult tumour, and evaluation of eligibility for somatostatin analogue treatment. Positron emission tomography (PET) using (18)F-fluoro-deoxy-glucose (FDG) is a powerful functional modality for oncological imaging. Unfortunately, FDG is not accumulated in NETs except in the case of dedifferentiated tumours and tumours with high proliferative activity. Based on the concept of amine precursor uptake and decarboxylation (APUD), the (18)F- and (11)C-labelled amine precursors L-dihydroxyphenylalanine and 5-hydroxy-L-tryptophan (5-HTP) have been utilized for PET imaging of NETs. In comparative studies of patients with a variety of NETs, (11)C5-HTP-PET proved better than CT and SRS by visualizing additional small lesions. With carbidopa premedication orally before (11)C5-HTP-PET examination the tumour uptake could be increased and the urinary radioactivity concentration considerably reduced. This concept may also be applied to (18)F-L-DOPA-PET, a method which in a limited number of studies has gained additional diagnostic information in NET patients compared to SRS and morphological imaging. (68)Ga is available from an in-house generator and has been utilized for labelling of somatostatin analogues for PET imaging of NETs with promising results in a small number of patients. However, SRS is an established functional imaging method for patients with NETs, whereas the role for PET in the clinical routine needs further evaluation in comparative studies in larger groups of patients.
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Affiliation(s)
- Anders Sundin
- Centre for Medical Imaging, Department of Radiology, Uppsala University Hospital, SE-751 85 Uppsala, Sweden.
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265
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Antunes P, Ginj M, Zhang H, Waser B, Baum RP, Reubi JC, Maecke H. Are radiogallium-labelled DOTA-conjugated somatostatin analogues superior to those labelled with other radiometals? Eur J Nucl Med Mol Imaging 2007; 34:982-93. [PMID: 17225119 DOI: 10.1007/s00259-006-0317-x] [Citation(s) in RCA: 304] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 11/05/2006] [Indexed: 01/29/2023]
Abstract
PURPOSE Gallium-68 is a metallic positron emitter with a half-life of 68 min that is ideal for the in vivo use of small molecules, such as [68Ga-DOTA,Tyr3]octreotide, in the diagnostic imaging of somatostatin receptor-positive tumours. In preclinical studies it has shown a striking superiority over its 111In-labelled congener. The purpose of this study was to evaluate whether third-generation somatostatin-based, radiogallium-labelled peptides show the same superiority. METHODS Peptides were synthesised on solid phase. The receptor affinity was determined by in vitro receptor autoradiography. The internalisation rate was studied in AR4-2J and hsst-HEK-transfected cell lines. The pharmacokinetics was studied in a rat xenograft tumour model, AR4-2J. RESULTS All peptides showed high affinities on hsst2, with the highest affinity for the Ga(III)-complexed peptides. On hsst3 the situation was reversed, with a trend towards lower affinity of the Ga(III) peptides. A significantly increased internalisation rate was found in sst2-expressing cells for all 67Ga-labelled peptides. Internalisation into HEK-sst3 was usually faster for the 111In-labelled peptides. No internalisation was found into sst5. Biodistribution studies employing [67Ga-DOTA,1-Nal3]octreotide in comparison to [111In-DOTA,1-Nal3]octreotide and [67Ga-DOTA,Tyr3]octreotide showed a significantly higher and receptor-mediated uptake of the two 67Ga-labelled peptides in the tumour and somatostatin receptor-positive tissues. A patient study illustrated the potential advantage of a broad receptor subtype profile radiopeptide over a high-affinity sst2-selective radiopeptide. CONCLUSION This study demonstrates that 67/68Ga-DOTA-octapeptides show distinctly better preclinical, pharmacological performances than the 111In-labelled peptides, especially on sst2-expressing cells and the corresponding animal models. They may be excellent candidates for further development for clinical studies.
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Affiliation(s)
- P Antunes
- Division of Radiological Chemistry, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
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