Assessment of Tc-99m sestamibi tumor tissue uptake under the influence of increased arterial oxygen saturation

Lung 99mTc-MIBI scintigraphy: impact on diagnosis of solitary pulmonary nodule

Most of today available non-invasive procedures cannot clearly determinate between benign and malignant solitary pulmonary nodules (SPN). The purpose of the study was to assess the possibility of using 99mTc labeled hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) to differentiate benign from malignant SPN. Sixty patients were included in the study if the CT scan showed indeterminate SPN. Prior to definitive diagnosis 99mTc-MIBI single photon emission computerized tomography (SPECT) was performed: early scan 10 minutes and delayed 60-120 minutes after the intravenous injection of 740 MBq 99mTc-MIBI using dual-headed Gamma camera. The results were considered positive if there was an increased accumulation of the radiopharmaceutical in the area of the lung corresponding to the location of the lesion. The mean nodule size ± SD measured on CT scan was 2.96 cm. Lung cancer was diagnosed in 30/60 patients (14 squamocellular, 10 adenocarcinoma, 3 large-cell and 3 microcellular lung carcinomas). Of the 30 patients with malignant lesions, 27 patients (90%) had positive 99mTc-MIBI scan results by qualitative assessment. Among benign lesions, 23/30 (76.7%) were negative on 99mTc-MIBI scan. The size and PH report of SPN is statistically significantly influencing on 99mTc-MIBI accumulation in the SPN (p<0.01). The sensitivity, specificity, accuracy, positive and negative predictive value were 90%, 76.6%, 79.4%, 88.5% and 83.3% respectively. 99mTc-MIBI SPECT is an inexpensive non-invasive diagnostic procedure which might be useful diagnostic modality in the evaluation of SPN. Easy availability and low cost makes 99mTc-MIBI SPECT an attractive method in evaluating SPN.

Radionuclide imaging of perfusion and hypoxia

PURPOSE

We present a review of radionuclide imaging of tumour vascular physiology as it relates to angiogenesis. We focus on clinical trials in human subjects using PET and SPECT to evaluate tumour physiology, in particular blood flow and hypoxia.

METHODS

A systematic review of literature based on MEDLINE searches updated in February 2010 was performed.

RESULTS

Twenty-nine studies were identified for review: 14 dealt with (15)O-water PET perfusion imaging, while 8 dealt with (18)F-fluoromisonidazole PET hypoxia imaging. Five used SPECT methods. The studies varied widely in technical quality and reporting of methods.

CONCLUSIONS

A subset of radionuclide methods offers accurate quantitative scientific observations on tumour vascular physiology of relevance to angiogenesis and its treatment. The relationship between cellular processes of angiogenesis and changing physiological function remains poorly defined. The promise of quantitative functional imaging at high specificity and low administered dose sustains interest in radionuclide methods.

Retention of the radiotracers 64Cu-ATSM and 64Cu-PTSM in human and murine tumors is influenced by MDR1 protein expression

Tumor hypoxia is often associated with resistance to chemotherapy. Multidrug resistance type 1 (MDR1) protein is a member of the adenosine triphosphate binding cassette (ABC) proteins, some of which are involved in the multidrug resistance (MDR) phenotype in tumors. Many studies have focused on the role of these proteins in modulating drug resistance, but their effect on retention of imaging agents is less well studied. To study the role of MDR1 expression on the accumulation of (64)Cu-diacetyl-bis(N4-methylthiosemicarbazone) ((64)Cu-ATSM) and (64)Cu-pyruvaldehyde-bis(N4-methylthiosemicarbazone) ((64)Cu-PTSM) in human tumors in vitro and in vivo, we used a model system composed of a low MDR1-expressing parent uterine sarcoma cell line and a daughter cell line selected for overexpression of MDR1. Aromatase knockout (ArKO) mice that spontaneously developed liver tumors were used as an additional in vivo model to study the effect of MDR expression on (64)Cu-ATSM and -PTSM retention.

METHODS

Biodistribution experiments after injection of (64)Cu-ATSM or -PTSM were performed in wild-type mice, ArKO mice, and ArKO mice bearing liver tumors (n = 3-5/group), and in nude mice bearing human tumor xenografts for in vivo PET/CT. Liver expression of Abcb1a and Abcb1b, the MDR1 proteins in mouse liver, was determined by real-time polymerase chain reaction. (64)Cu-ATSM and -PTSM accumulation and efflux studies were conducted in tumor cell lines. The uptake experiments were repeated after knockdown of MDR1 protein expression using MDR1-specific small interfering RNAs.

RESULTS

In vivo, the hepatic tumors had a lower percentage injected dose per gram of (64)Cu-ATSM or -PTSM and more highly expressed Abcb1b than did wild-type liver or nontumor-bearing ArKO liver. High MDR1-expressing tumors showed lower tracer activity on PET/CT images. In vitro, cells highly expressing MDR1 had significantly decreased (64)Cu-ATSM and -PTSM retention and enhanced efflux. Knockdown of MDR1 expression significantly enhanced the (64)Cu-ATSM and -PTSM retention and decreased the efflux in MDR1-positive cells.

CONCLUSION

The expression of MDR1 glycoprotein (or its equivalents in mice) affects the retention of (64)Cu-ATSM and -PTSM in the human and murine tumors tested. These results may have implications for clinical hypoxia imaging in tumors and the therapeutic efficacy of (64)Cu-ATSM.