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Chen Z, Yang Q, Song L, Qiu Y, Wang T, Wu S, Huang W, Sun X, Wang A, Kang L. Enhanced Theranostic Efficacy of 89Zr and 177Lu-Labeled Aflibercept in Renal Cancer: A Viable Option for Clinical Practice. Mol Pharm 2024; 21:2544-2554. [PMID: 38588328 DOI: 10.1021/acs.molpharmaceut.4c00084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Vascular endothelial growth factor (VEGF) targeted therapy serves as an important therapeutic approach for renal cancer, but its clinical effectiveness is unsatisfactory. Moreover, there is a lack of reliable biomarkers for preoperative assessment of tumor VEGF expression. This study aimed to explore the potential for further applications of 177Lu/89Zr-labeled aflibercept (Abe), a VEGF-binding agent, in imaging visualization of VEGF expression and therapy for renal cancer. To determine specificity uptake in renal cancer, BALB/c mice with VEGF-expressing Renca tumor were intravenously injected with [89Zr]Zr-Abe, [177Lu]Lu-Abe, or Cy5.5-Abe and the blocking group was designed as a control group. PET, SPECT, and fluorescence images were acquired, and the biodistribution of [89Zr]Zr-Abe and [177Lu]Lu-Abe was performed. Additionally, the [177Lu]Lu-Abe, [177Lu]Lu-Abe-block, 177Lu only, Abe only, and PBS groups were compared for evaluation of the therapeutic effect. To assess the safety, we monitored and evaluated the body weight, blood biochemistry analysis, and whole blood analysis and major organs were stained with hematoxylin and eosin after [177Lu]Lu-Abe treatment. DOTA-Abe was successfully labeled with 177Lu and Df-Abe with 89Zr in our study. The uptake in tumor of [89Zr]Zr-Abe was significantly higher than that of [89Zr]Zr-Abe-block (P < 0.05) and provided excellent tumor contrast in PET images. [177Lu]Lu-Abe demonstrated promising tumor-specific targeting capability with a high and persistent tumor uptake. The standardized tumor volume of [177Lu]Lu-Abe was significantly smaller than those of other treatment groups (P < 0.05). [177Lu]Lu-Abe also had smaller tumor volumes and reduced expression of VEGF and CD31 compared to those of the control groups. Fluorescence images demonstrate higher tumor uptake in the Cy5.5-Abe group compared to the Cy5.5-Abe-block group (P < 0.05). In conclusion, [89Zr]Zr-Abe enables noninvasive analysis of VEGF expression, serving as a valuable tool for assessing the VEGF-targeted therapy effect. Additionally, all of the findings support the enhanced therapeutic efficacy and safety of [177Lu]Lu-Abe, making it a viable option for clinical practice in renal cancer.
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Affiliation(s)
- Zhao Chen
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Qi Yang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Lele Song
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Yongkang Qiu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Tianyao Wang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Sitong Wu
- Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing 100034, China
| | - Wenpeng Huang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Xinyao Sun
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Aixiang Wang
- Department of Urology, Peking University First Hospital, Beijing 100034, China
- Institute of Urology, Peking University, Beijing 100034, China
| | - Lei Kang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
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Siebinga H, Hendrikx JJMA, de Vries-Huizing DMV, Huitema ADR, de Wit-van der Veen BJ. The cycle effect quantified: reduced tumour uptake in subsequent cycles of [ 177Lu]Lu-HA-DOTATATE during peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging 2024; 51:820-827. [PMID: 37843598 DOI: 10.1007/s00259-023-06463-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/01/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Clear evidence regarding the effect of reduced tumour accumulation in later peptide receptor radionuclide therapy (PRRT) cycles is lacking. Therefore, we aimed to quantify potential cycle effects for patients treated with [177Lu]Lu-HA-DOTATATE using a population pharmacokinetic (PK) modelling approach. METHODS A population PK model was developed using imaging data from 48 patients who received multiple cycles of [177Lu]Lu-HA-DOTATATE. The five-compartment model included a central, kidney, spleen, tumour and lumped rest compartment. Tumour volume and continued use of long-acting somatostatin analogues (SSAs) were tested as covariates in the model. In addition, the presence of a cycle effect was evaluated by relating the uptake rate in a specific cycle as a fraction of the (tumour or organ) uptake rate in the first cycle. RESULTS The final PK model adequately captured observed radioactivity accumulation in kidney, spleen and tumour. A higher tumour volume was identified to increase the tumour uptake rate, where a twofold increase in tumour volume resulted in a 2.3-fold higher uptake rate. Also, continued use of long-acting SSAs significantly reduced the spleen uptake rate (68.4% uptake compared to SSA withdrawal (10.5% RSE)). Lastly, a cycle effect was significantly identified, where tumour uptake rate decreased to 86.9% (5.3% RSE) in the second cycle and even further to 79.7% (5.6% RSE) and 77.6% (6.2% RSE) in the third and fourth cycle, respectively, compared to cycle one. CONCLUSIONS Using a population PK modelling approach, the cycle effect of reduced tumour uptake in subsequent PRRT cycles was quantified. Our findings implied that downregulation of target receptors is probably not the major cause of the cycle effect, due to a plateau in the decrease of tumour uptake in the fourth cycle.
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Affiliation(s)
- H Siebinga
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - J J M A Hendrikx
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D M V de Vries-Huizing
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - A D R Huitema
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Pharmacology, Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - B J de Wit-van der Veen
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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Yang C, Ko K, Lin P. Reducing scan time in 177 Lu planar scintigraphy using convolutional neural network: A Monte Carlo simulation study. J Appl Clin Med Phys 2023; 24:e14056. [PMID: 37261890 PMCID: PMC10562044 DOI: 10.1002/acm2.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/15/2022] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
PURPOSE The aim of this study was to reduce scan time in 177 Lu planar scintigraphy through the use of convolutional neural network (CNN) to facilitate personalized dosimetry for 177 Lu-based peptide receptor radionuclide therapy. METHODS The CNN model used in this work was based on DenseNet, and the training and testing datasets were generated from Monte Carlo simulation. The CNN input images (IMGinput ) consisted of 177 Lu planar scintigraphy that contained 10-90% of the total photon counts, while the corresponding full-count images (IMG100% ) were used as the CNN label images. Two-sample t-test was conducted to compare the difference in pixel intensities within region of interest between IMG100% and CNN output images (IMGoutput ). RESULTS No difference was found in IMGoutput for rods with diameters ranging from 13 to 33 mm in the Derenzo phantom with a target-to-background ratio of 20:1, while statistically significant differences were found in IMGoutput for the 10-mm diameter rods when IMGinput containing 10% to 60% of the total photon counts were denoised. Statistically significant differences were found in IMGoutput for both right and left kidneys in the NCAT phantom when IMGinput containing 10% of the total photon counts were denoised. No statistically significant differences were found in IMGoutput for any other source organs in the NCAT phantom. CONCLUSION Our results showed that the proposed method can reduce scan time by up to 70% for objects larger than 13 mm, making it a useful tool for personalized dosimetry in 177 Lu-based peptide receptor radionuclide therapy in clinical practice.
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Affiliation(s)
- Ching‐Ching Yang
- Department of Medical Imaging and Radiological SciencesKaohsiung Medical UniversityKaohsiungTaiwan
- Department of Medical ResearchKaohsiung Medical University Chung‐Ho Memorial HospitalKaohsiungTaiwan
| | - Kuan‐Yin Ko
- Department of Nuclear MedicineNational Taiwan University Cancer CenterTaipeiTaiwan
- Graduate Institute of Clinical MedicineCollege of MedicineNational Taiwan UniversityTaipeiTaiwan
| | - Pei‐Yao Lin
- Department of Nuclear MedicineNational Taiwan University Cancer CenterTaipeiTaiwan
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Kim H, Li Z, Son J, Fessler JA, Dewaraja YK, Chun SY. Physics-Guided Deep Scatter Estimation by Weak Supervision for Quantitative SPECT. IEEE TRANSACTIONS ON MEDICAL IMAGING 2023; 42:2961-2973. [PMID: 37104110 PMCID: PMC10593395 DOI: 10.1109/tmi.2023.3270868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Accurate scatter estimation is important in quantitative SPECT for improving image contrast and accuracy. With a large number of photon histories, Monte-Carlo (MC) simulation can yield accurate scatter estimation, but is computationally expensive. Recent deep learning-based approaches can yield accurate scatter estimates quickly, yet full MC simulation is still required to generate scatter estimates as ground truth labels for all training data. Here we propose a physics-guided weakly supervised training framework for fast and accurate scatter estimation in quantitative SPECT by using a 100× shorter MC simulation as weak labels and enhancing them with deep neural networks. Our weakly supervised approach also allows quick fine-tuning of the trained network to any new test data for further improved performance with an additional short MC simulation (weak label) for patient-specific scatter modelling. Our method was trained with 18 XCAT phantoms with diverse anatomies / activities and then was evaluated on 6 XCAT phantoms, 4 realistic virtual patient phantoms, 1 torso phantom and 3 clinical scans from 2 patients for 177Lu SPECT with single / dual photopeaks (113, 208 keV). Our proposed weakly supervised method yielded comparable performance to the supervised counterpart in phantom experiments, but with significantly reduced computation in labeling. Our proposed method with patient-specific fine-tuning achieved more accurate scatter estimates than the supervised method in clinical scans. Our method with physics-guided weak supervision enables accurate deep scatter estimation in quantitative SPECT, while requiring much lower computation in labeling, enabling patient-specific fine-tuning capability in testing.
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Affiliation(s)
- Hanvit Kim
- Digital Biomedical Research Division, Electronics and Telecommunications Research Institute, Daejeon, South Korea
- Department of Electrical Engineering, Ulsan National Institute of Science and Technology (UNIST), Ulsan, South Korea
| | - Zongyu Li
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Jiye Son
- Interdisciplinary Program for Bioengineering, Seoul National University (SNU), Seoul, South Korea. This work was done when she was with the School of Electrical and Computer Engineering (ECE), UNIST
| | - Jeffrey A. Fessler
- Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI, USA
| | - Yuni K. Dewaraja
- Dewaraja is with the Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Se Young Chun
- Department of ECE, INMC & IPAI, SNU, Seoul, South Korea
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Huh Y, Caravaca J, Kim J, Cui Y, Huang Q, Gullberg G, Seo Y. Simulation studies of a full-ring, CZT SPECT system for whole-body imaging of 99m Tc and 177 Lu. Med Phys 2023; 50:3726-3737. [PMID: 36916755 PMCID: PMC10503418 DOI: 10.1002/mp.16360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/26/2023] [Accepted: 02/26/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Single photon emission computed tomography (SPECT) is an imaging modality that has demonstrated its utility in a number of clinical indications. Despite this progress, a high sensitivity, high spatial resolution, multi-tracer SPECT with a large field of view suitable for whole-body imaging of a broad range of radiotracers for theranostics is not available. PURPOSE With the goal of filling this technological gap, we have designed a cadmium zinc telluride (CZT) full-ring SPECT scanner instrumented with a broad-energy tungsten collimator. The final purpose is to provide a multi-tracer solution for brain and whole-body imaging. Our static SPECT does not rely on the dual- and the triple-head rotational SPECT standard paradigm, enabling a larger effective area in each scan to increase the sensitivity. We provide a demonstration of the performance of our design using a realistic model of our detector with simulated body-sized phantoms filled with 99m Tc and 177 Lu. METHODS We create a realistic model of our detector by using a combination of a Geant4 Application for Tomographic Emission (GATE) Monte Carlo simulation and a finite element model for the CZT response, accounting for low-energy tail effects in CZT that affects the sensitivity and the scatter correction. We implement a modified dual-energy-window scatter correction adapted for CZT. Other corrections for attenuation, detector and collimator response, and detector gaps and edges are also included. The images are reconstructed using the maximum-likelihood expectation-maximization. Detector and reconstruction performance are characterized with point sources, Derenzo phantoms, and a body-sized National Electrical Manufacturers Association (NEMA) Image Quality (IQ) phantom for both 99m Tc and 177 Lu. RESULTS Our SPECT design can resolve 7.9 mm rods for 99m Tc (140 keV) and 9.5 mm for 177 Lu (208 keV) in a hot-rod Derenzo phantom with a 3-min exposure and reach an image contrast of 78% for 99m Tc and 57% for 177 Lu using the NEMA IQ phantom with a 6-min exposure. Our modified scatter correction shows an improved contrast-recovery ratio compared to a standard correction. CONCLUSIONS In this paper, we demonstrate the good performance of our design for whole-body imaging purposes. This adds to our previous demonstration of improved qualitative and quantitative 99m Tc imaging of brain perfusion and 123 I imaging of dopamine transport with respect to state-of-the-art NaI dual-head cameras. We show that our design provides similar IQ and contrast to the commercial full-ring SPECT VERITON for 99m Tc. Regarding 177 Lu imaging of the 208 keV emissions, our design provides similar contrast to that of other state-of-the-art SPECTs with a significant reduction in exposure. The high sensitivity and extended energy range up to 250 keV makes our SPECT design a promising alternative for clinical imaging and theranostics of emerging radionuclides.
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Affiliation(s)
- Yoonsuk Huh
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Javier Caravaca
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Jaehyuk Kim
- Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Yonggang Cui
- Department of Nonproliferation and National Security, Brookhaven National Laboratory, Upton, New York, USA
| | - Qiu Huang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Grant Gullberg
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Youngho Seo
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
- Molecular Biophysics and Integrated Bioimaging Division, Lawrence Berkeley National Laboratory, Berkeley, California, USA
- Joint Graduate Group in Bioengineering, University of California, San Francisco, Berkeley, California, USA
- Department of Nuclear Engineering, University of California, Berkeley, California, USA
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Veerman CHAM, Siebinga H, de Vries-Huizing DMV, Tesselaar MET, Hendrikx JJMA, Stokkel MPM, Aalbersberg EA. The effect of long-acting somatostatin analogues on the uptake of [ 177Lu]Lu-HA-DOTATATE. Eur J Nucl Med Mol Imaging 2023; 50:1434-1441. [PMID: 36598536 DOI: 10.1007/s00259-022-06094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 12/22/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE According to IAEA/EANM/SNMMI guidelines, long-acting somatostatin analogues (LA-SSAs) should be discontinued 4-6 weeks prior to peptide receptor radionuclide therapy (PRRT) to prevent somatostatin receptor saturation. The aim of this study was to determine the effect of continued use of long-acting SSAs during PRRT on the uptake of [177Lu]Lu-HA-DOTATATE on SPECT/CT. METHODS Consecutive patients with neuroendocrine tumours who were treated with PRRT receiving 7.4 GBq of [177Lu]Lu-HA-DOTATATE were included. Patients were divided into 3 groups: (1) control (LA-SSA stopped > 6 weeks prior to PRRT), or continued treatment with (2) long-acting octreotide < 6 weeks prior to PRRT, or (3) long-acting lanreotide < 6 weeks prior to PRRT. The uptake of [177Lu]Lu-HA-DOTATATE was quantified in healthy tissues (spleen, liver, kidneys, bone marrow) and tumour lesions on SPECT/CT performed 24 h after PRRT. A Mann-Whitney U test was used to determine differences in uptake between the long-acting octreotide and long-acting lanreotide groups compared to the control group. RESULTS Forty-two patients with 135 cycles of PRRT were included: 28 with lanreotide, 50 with octreotide, and 57 cycles without LA-SSAs. Uptake of [177Lu]Lu-HA-DOTATATE was significantly decreased in liver parenchyma in patients with lanreotide (p < 0.001) and in the spleen in patients with either octreotide or lanreotide (both p < 0.001). No differences were observed for uptake in kidneys, bone marrow, and blood pool. Uptake of [177Lu]Lu-HA-DOTATATE in tumours was the same in patients with lanreotide compared to the control (p = 0.862) and in patients with octreotide compared to the control (p = 0.201), independent of tumour location. CONCLUSION Long-acting octreotide and lanreotide do not interfere with the uptake of [177Lu]Lu-HA-DOTATATE in tumour lesions 24 h post-injection. Uptake in healthy liver parenchyma significantly decreases after lanreotide administration prior to PRRT, while uptake in healthy spleen tissue significantly decreases with both octreotide and lanreotide administration.
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Affiliation(s)
- Chayenne H A M Veerman
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Hinke Siebinga
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daphne M V de Vries-Huizing
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - Margot E T Tesselaar
- Department of Medical and Gastrointestinal Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Jeroen J M A Hendrikx
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
- Department of Pharmacy & Pharmacology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Else A Aalbersberg
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
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Slart RHJA, de Geus-Oei LF. A new colleague in nuclear medicine, the clinical technologist: quo vadis? Eur J Nucl Med Mol Imaging 2022; 49:3012-3015. [PMID: 35384463 DOI: 10.1007/s00259-022-05789-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Riemer H J A Slart
- Medical Imaging Centre, Department of Nuclear Medicine and Molecular Imaging (EB50), University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB, Groningen, The Netherlands. .,Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.
| | - Lioe-Fee de Geus-Oei
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands.,Department of Radiology, Section of Nuclear Medicine, Leiden University Medical Center, Leiden, The Netherlands
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Aalbersberg EA, de Vries-Huizing DMV, Tesselaar MET, Stokkel MPM, Versleijen MWJ. Post-PRRT scans: which scans to make and what to look for. Cancer Imaging 2022; 22:29. [PMID: 35715867 PMCID: PMC9205039 DOI: 10.1186/s40644-022-00467-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
Aim The aim of this study was to evaluate the clinical utility of SPECT/CT (imaging of uptake in tumor lesions and additional findings) and the additional value of planar imaging in order to simplify clinical imaging protocols and decrease patients burden. Materials and methods One hundred consecutive patients with metastatic neuroendocrine tumor (NET) treated with PRRT were included. Post-therapy imaging was performed 24 h after each PRRT cycle by both whole-body planar imaging and abdominal- and thoracic SPECT/CT. All images were evaluated for (1) the presence of new lesions, (2) discordant lesions between the two acquisitions (planar or SPECT), (3) location of lesions on SPECT (abdominal, thoracic, or both), and (4) additional findings on non-contrast enhanced CT imaging. Results In total 368 PRRT cycles including post-therapy imaging were performed in 100 patients. 45 patients had abdominal disease only, whilst in 55 patients the disease was observed on both abdominal and thoracic SPECT. 16 patients had known bone lesions that were visible only on planar imaging as these were out of range of the SPECT/CT. During PRRT, one patient developed multiple new bone metastases after the second cycle of PRRT, which were visible on both planar and SPECT/CT images. In 11 patients additional findings were found on CT images, the most common and relevant being bowel obstruction, pleural effusion, and ascites. Patients who developed ascites during PRRT appeared to do extremely poor; a post-hoc analysis showed that overall survival was 13.2 months in patients that showed ascites during PRRT at any moment and 37.9 months in patients without ascites (p < 0.001). Conclusion From a clinical point of view, thoracoabdominal SPECT/CT imaging is the preferred method for post-PRRT imaging; planar imaging had no added value over SPECT/CT in this cohort. In patients with abdominal disease only on baseline imaging, SPECT/CT of the abdomen only might be sufficient for imaging during the PRRT course. All accompanying CT images should be reviewed for additional findings, especially ascites, which is suggested to be a poor prognostic factor in patients receiving PRRT.
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Affiliation(s)
- Else A Aalbersberg
- Department of Nuclear Medicine, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands.
| | | | - Margot E T Tesselaar
- Department of Medical Oncology, Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Marcel P M Stokkel
- Department of Nuclear Medicine, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands
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Alqahtani MM, Willowson KP, Constable C, Fulton R, Kench PL. Optimization of
99m
Tc whole‐body SPECT/CT image quality: A phantom study. J Appl Clin Med Phys 2022; 23:e13528. [PMID: 35049129 PMCID: PMC8992937 DOI: 10.1002/acm2.13528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 11/10/2022] Open
Affiliation(s)
- Mansour M. Alqahtani
- Faculty of Medicine and Health University of Sydney Sydney Australia
- Department of Radiological sciences College of Applied Medical Science Najran University Najran Saudi Arabia
| | - Kathy P. Willowson
- Department of Nuclear Medicine Royal North Shore Hospital Sydney Australia
- Institute of Medical Physics Faculty of Science The University of Sydney Sydney Australia
| | - Chris Constable
- Faculty of Medicine and Health University of Sydney Sydney Australia
- HERMES Medical Solutions, Strandbergsgatan 16 Stockholm Sweden
| | - Roger Fulton
- Faculty of Medicine and Health University of Sydney Sydney Australia
- Department of Medical Physics Westmead Hospital Sydney Australia
| | - Peter L. Kench
- Faculty of Medicine and Health University of Sydney Sydney Australia
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