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Cheng Z, Ma J, Yin L, Yu L, Yuan Z, Zhang B, Tian J, Du Y. Non-invasive molecular imaging for precision diagnosis of metastatic lymph nodes: opportunities from preclinical to clinical applications. Eur J Nucl Med Mol Imaging 2023; 50:1111-1133. [PMID: 36443568 DOI: 10.1007/s00259-022-06056-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022]
Abstract
Lymph node metastasis is an indicator of the invasiveness and aggressiveness of cancer. It is a vital prognostic factor in clinical staging of the disease and therapeutic decision-making. Patients with positive metastatic lymph nodes are likely to develop recurrent disease, distant metastasis, and succumb to death in the coming few years. Lymph node dissection and histological analysis are needed to detect whether regional lymph nodes have been infiltrated by cancer cells and determine the likely outcome of treatment and the patient's chances of survival. However, these procedures are invasive, and tissue biopsies are prone to sampling error. In recent years, advanced molecular imaging with novel imaging probes has provided new technologies that are contributing to comprehensive management of cancer, including non-invasive investigation of lymphatic drainage from tumors, identifying metastatic lymph nodes, and guiding surgeons to operate efficiently in patients with complex lesions. In this review, first, we outline the current status of different molecular imaging modalities applied for lymph node metastasis management. Second, we summarize the multi-functional imaging probes applied with the different imaging modalities as well as applications of cancer lymph node metastasis from preclinical studies to clinical translations. Third, we describe the limitations that must be considered in the field of molecular imaging for improved detection of lymph node metastasis. Finally, we propose future directions for molecular imaging technology that will allow more personalized treatment plans for patients with lymph node metastasis.
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Affiliation(s)
- Zhongquan Cheng
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China.,CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Jiaojiao Ma
- Department of Medical Ultrasonics, China-Japan Friendship Hospital, Yinghua East Road 2#, ChaoYang Dist., Beijing, 100029, China
| | - Lin Yin
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China.,University of Chinese Academy of Sciences, Beijing, 100080, China
| | - Leyi Yu
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China
| | - Zhu Yuan
- Department of General Surgery, Capital Medical University, Beijing Friendship Hospital, Beijing, 100050, China.
| | - Bo Zhang
- Department of Medical Ultrasonics, China-Japan Friendship Hospital, Yinghua East Road 2#, ChaoYang Dist., Beijing, 100029, China.
| | - Jie Tian
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, School of Medicine Science and Engineering, Beihang University, Beijing, 100191, China.
| | - Yang Du
- CAS Key Laboratory of Molecular Imaging, Beijing Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China. .,University of Chinese Academy of Sciences, Beijing, 100080, China.
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Synthesis, Characterization and In Vitro Evaluation of Hybrid Monomeric Peptides Suited for Multimodal Imaging by PET/OI: Extending the Concept of Charge-Cell Binding Correlation. Pharmaceuticals (Basel) 2021; 14:ph14100989. [PMID: 34681213 PMCID: PMC8541144 DOI: 10.3390/ph14100989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 12/15/2022] Open
Abstract
In the context of hybrid multimodal imaging agents for gastrin releasing peptide receptor (GRPR) targeting, a correlation between the net charge and the receptor affinity of the agents was recently found. In particular, a decrease in in vitro GRPR binding affinity was observed in case of an increasing number of negative charges for dually labeled GRPR-specific peptide dimers suited for positron emission tomography and optical imaging (PET/OI). This adverse influence of anionic charges could be in part compensated by a higher valency of peptide multimerization. However, it remains unknown whether this adverse effect of anionic charges is limited to peptide multimers or if it is also found or even more pronounced when GRPR-specific peptide monomers are dually labeled with fluorescent dye and chelating agent/radionuclide. Moreover, it would be important to know if this effect is limited to GRPR-specific agents only or if these observations also apply to other dually labeled peptides binding to other receptor types. To address these questions, we synthesized hybrid labels, comprising a chelator, different fluorescent dyes carrying different net charges and a functional group for bioconjugation and introduced them into different peptides, specifically targeting the GRPR, the melanocortin-1 receptor (MC1R) and integrin αvβ3. The synthesized conjugates were evaluated with regard to their chemical, radiochemical, photophysical and receptor affinity properties. It was found that neither the 68Ga-radiolabeling nor the fluorescence characteristics of the dyes were altered by the conjugation of the MIUs to the peptides. Further, it was confirmed that the net number of anionic charges has a negative effect on the GRPR-binding affinity of the GRPR-targeting MIU-peptide monomer conjugates and that this same effect was also found to the same extent for the other receptor systems studied.
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Ma W, Quan Z, Wang J, Li X, Li G. The one-in-all diagnostic value of 99mTc-MDP bone scan combining with single-photon emission tomography (SPECT)/CT imaging in spinal osteoblastoma. J Orthop Surg Res 2020; 15:181. [PMID: 32448317 PMCID: PMC7245782 DOI: 10.1186/s13018-020-01653-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoblastoma (OB) is an intermediate lesion, which makes the accurate preoperative diagnosis very important. 99mTc-methylene diphosphonate (99mTc-MDP) bone scan and SPECT/CT imaging were evaluated for their diagnostic value in spinal OB. METHODS This study was a retrospective analysis of patients with spinal OB lesions confirmed by pathology and diagnosed with bone scan and SPECT/CT for preoperative diagnosis from January 2008 to December 2018. The uptake levels of OB on planar bone scan were divided into low, medium, and high groups by visual assessment referring to the uptake of the normal rib, spine, and bladder. X-ray, CT, MRI, bone scan, and SPECT/CT imaging of the patients were analyzed for characteristics summary. RESULTS Twenty-five patients were diagnosed for spinal OB (17 males and 8 females with a proportion of 2.1:1), and the average age was 26.8 ± 10.8 years (range 5~59). There were 8 lesions located in the cervical, 6 in the thoracic, and 11 in the lumbar vertebrae. Twenty-four lesions involved posterior elements, especially the pedicles (14/25). Symptoms were predominantly painful with a duration of 18.3 ± 13.9 months (range 0.5~60 months). The lesion size ranged from 9 to 35 mm. All the lesions were low to high uptake in the planar bone scan, and the percentages of low to high levels were 1 (4%), 8 (32%), and 16 (64%) cases. CONCLUSIONS Spinal OB mainly involved the posterior area, and elderly patients should be considered as well. SPECT/CT combined the characteristics of bone uptake and anatomical features of bone tumors, proving its one-in-all diagnostic value for spinal OB and other osteogenic tumors.
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Affiliation(s)
- Wenhui Ma
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Zhiyong Quan
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Jing Wang
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Xiangdong Li
- Department of Orthopedic Oncology, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China.
| | - Guoquan Li
- Department of Nuclear Medicine, Xijing Hospital, Fourth Military Medical University, 127# West Changle Road, Xi'an, 710032, Shaanxi Province, China.
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Pulagam KR, Gómez-Vallejo V, Llop J, Rejc L. Radiochemistry: A Useful Tool in the Ophthalmic Drug Discovery. Curr Med Chem 2020; 27:501-522. [PMID: 31142249 DOI: 10.2174/0929867326666190530122032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/04/2019] [Accepted: 04/15/2019] [Indexed: 01/28/2023]
Abstract
Positron Emission Tomography (PET) and Single Photon Emission Computerized Tomography (SPECT) are ultra-sensitive, fully translational and minimally invasive nuclear imaging techniques capable of tracing the spatiotemporal distribution of positron (PET) or gamma (SPECT) emitter-labeled molecules after administration into a living organism. Besides their impact in the clinical diagnostic, PET and SPECT are playing an increasing role in the process of drug development, both during the evaluation of the pharmacokinetic properties of new chemical entities as well as in the proof of concept, proof of mechanism and proof of efficacy studies. However, they have been scarcely applied in the context of ophthalmic drugs. In this paper, the basics of nuclear imaging and radiochemistry are briefly discussed, and the few examples of the use of these imaging modalities in ophthalmic drug development reported in the literature are presented and discussed. Finally, in a purely theoretical exercise, some labeling strategies that could be applied to the preparation of selected ophthalmic drugs are proposed and potential applications of nuclear imaging in ophthalmology are projected.
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Affiliation(s)
- Krishna R Pulagam
- Radiochemistry and Nuclear Imaging Group, CIC biomaGUNE, San Sebastian, Spain
| | | | - Jordi Llop
- Radiochemistry and Nuclear Imaging Group, CIC biomaGUNE, San Sebastian, Spain
| | - Luka Rejc
- Radiochemistry and Nuclear Imaging Group, CIC biomaGUNE, San Sebastian, Spain
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Costa PF, Testanera G, Camoni L, Terwinghe C, Bailey EA, Bolus NE, Alden TM. Technologist Approach to Global Dose Optimization. J Nucl Med Technol 2018; 47:75-82. [PMID: 30413598 DOI: 10.2967/jnmt.118.218131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/25/2018] [Indexed: 01/15/2023] Open
Abstract
Nuclear medicine technologists are specialized health professionals who cover a wide range of tasks from clinical routine (including image acquisition and processing, radiopharmaceutical dispensing and administration, patient care, and radioprotection tasks) to leading clinical research in the field of nuclear medicine. As a fundamental concern in all radiation sciences applied to medicine, protection of individuals against the harmful effects of ionizing radiation must be constantly revised and applied by the professionals involved in medical exposures. The acknowledgment that nuclear medicine technologists play a prominent role in patient management and several procedural steps, both in diagnostic and in therapeutic nuclear medicine applications, carries the duty to be trained and knowledgeable on the topic of radiation protection and dose optimization. An overview on selected topics related to dose optimization is presented in this article, reflecting the similarities and particularities of dose reduction-related principles, initiatives, and practicalities from a global perspective.
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Affiliation(s)
- Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Giorgio Testanera
- Barts Health NHS Trust, Department of Nuclear Medicine, St. Bartholomew's Hospital, London, United Kingdom
| | - Luca Camoni
- Nuclear Medicine Unit, Department of Nuclear Medicine, Spedali Civili of Brescia, Brescia, Italy
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Klausen TL, Mortensen J, de Nijs R, Andersen FL, Højgaard L, Beyer T, Holm S. Intravenous contrast-enhanced CT can be used for CT-based attenuation correction in clinical (111)In-octreotide SPECT/CT. EJNMMI Phys 2015; 2:3. [PMID: 26501805 PMCID: PMC4545801 DOI: 10.1186/s40658-015-0108-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 01/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND CT-based attenuation correction (CT-AC) using contrast-enhancement CT impacts (111)In-SPECT image quality and quantification. In this study we assessed and evaluated the effect. METHODS A phantom (5.15 L) was filled with an aqueous solution of In-111. Three SPECT/CT scans were performed: (A) no IV contrast, (B) with 100-mL IV contrast, and (C) with 200-mL IV contrast added. Scan protocol included a localization CT, a low-dose CT (LD), and a full-dose CT (FD). Phantom, LD and FD scan series were performed at 90, 120, and 140 kVp. Phantom data were evaluated looking at mean counts in a central volume. Ten patients referred for (111)In-octreotide scintigraphy were scanned according to our clinical (111)In-SPECT/CT protocol including a topogram, a LD (140 kVp), and a FD (120 kVp). The FD/contrast-enhanced CT was acquired in both arterial (FDAP) and venous phase (FDVP) following a mono-phasic IV injection of 125-mL Optiray (4.5 mL/s). For patient data, we report image quality, Krenning scores, and mean/max values for liver and tumor regions. RESULTS Phantoms: in uncorrected emission data, mean counts (average ± SD) decreased with increasing IV concentration: (A) 119 ± 9, (B) 113 ± 8, and (C) 110 ± 9. For all attenuation correction (AC) scans, the mean values increased with increasing iodine concentration. PATIENTS there were no visible artifacts in single photon emission computed tomography (SPECT) following CT-AC with contrast-enhanced CT. The average score of image quality was 4.1 ± 0.3, 3.8 ± 0.4, and 4.2 ± 0.4 for LD, arterial phase, and venous phase, respectively. A total of 16 lesions were detected. The Krenning scores of 13/16 lesions were identical across all scan series. The max pixel values for the 16 lesions showed generally lower values for LD than for contrast-enhanced CT. CONCLUSIONS In (111)In-SPECT/CT imaging of phantoms and patients, the use of IV CT contrast did neither degrade the SPECT image quality nor affect the clinical Krenning score. Reconstructed counts in healthy liver tissues were unaffected, and there was a generally lower count value in lesions following CT-AC based on the LD non-enhanced images. Overall, for clinical interpretation, no separate low-dose CT is required for CT-AC in (111)In-SPECT/CT.
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Affiliation(s)
- Thomas Levin Klausen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Jann Mortensen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Robin de Nijs
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Flemming Littrup Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Liselotte Højgaard
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
| | - Thomas Beyer
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark. .,Center for Medical Physics and Biomedical Engineering, General Hospital Vienna, Medical University of Vienna, Waehringer Guertel 18-20/4L, 1090, Vienna, Austria.
| | - Søren Holm
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark.
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Beckers C, Hustinx R. SPECT/CT workflow and imaging protocols. Eur J Nucl Med Mol Imaging 2013; 41 Suppl 1:S137-45. [PMID: 24318158 DOI: 10.1007/s00259-013-2629-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 10/31/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Introducing a hybrid imaging method such as single photon emission computed tomography (SPECT)/CT greatly alters the routine in the nuclear medicine department. It requires designing new workflow processes and the revision of original scheduling process and imaging protocols. In addition, the imaging protocol should be adapted for each individual patient, so that performing CT is fully justified and the CT procedure is fully tailored to address the clinical issue. Such refinements often occur before the procedure is started but may be required at some intermediate stage of the procedure. Furthermore, SPECT/CT leads in many instances to a new partnership with the radiology department. This article presents practical advice and highlights the key clinical elements which need to be considered to help understand the workflow process of SPECT/CT and optimise imaging protocols. METHODS The workflow process using SPECT/CT is complex in particular because of its bimodal character, the large spectrum of stakeholders, the multiplicity of their activities at various time points and the need for real-time decision-making. RESULTS With help from analytical tools developed for quality assessment, the workflow process using SPECT/CT may be separated into related, but independent steps, each with its specific human and material resources to use as inputs or outputs. This helps identify factors that could contribute to failure in routine clinical practice. At each step of the process, practical aspects to optimise imaging procedure and protocols are developed. A decision-making algorithm for justifying each CT indication as well as the appropriateness of each CT protocol is the cornerstone of routine clinical practice using SPECT/CT. CONCLUSION In conclusion, implementing hybrid SPECT/CT imaging requires new ways of working. It is highly rewarding from a clinical perspective, but it also proves to be a daily challenge in terms of management.
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Affiliation(s)
- Catherine Beckers
- Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, University Hospital of Liège, Liège, Belgium
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