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Costa G, Spencer B, Omidvari N, Foster C, Rusnak M, Hunt H, Caudle DT, Pillai RT, Vu CT, Roncali E. Radioembolization Dosimetry with Total-Body 90Y PET. J Nucl Med 2022; 63:1101-1107. [PMID: 34795015 PMCID: PMC9258581 DOI: 10.2967/jnumed.121.263145] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/08/2021] [Indexed: 01/26/2023] Open
Abstract
Transarterial radioembolization (TARE) is a locoregional radiopharmaceutical therapy based on the delivery of radioactive 90Y microspheres to liver tumors. The importance of personalized dosimetry to make TARE safer and more effective has been demonstrated in recent clinical studies, stressing the need for quantification of the dose-response relationship to ultimately optimize the administered activity before treatment and image it after treatment. 90Y dosimetric studies are challenging because of the lack of accurate and precise methods but are best realized with PET combined with Monte Carlo simulations and other image modalities to calculate a segmental dose distribution. The aim of this study was to assess the suitability of imaging 90Y PET patients with the total-body PET/CT uEXPLORER and to investigate possible improvements in TARE 90Y PET-based dosimetry. The uEXPLORER is the first commercially available ultra-high-resolution (171 cps/kBq) total-body digital PET/CT device with a 194-cm axial PET field of view that enables the whole body to be scanned at a single bed position. Methods: Two PET/CT scanners were evaluated in this study: the Biograph mCT and the total-body uEXPLORER. Images of a National Electrical Manufacturers Association (NEMA) image-quality phantom and 2 patients were reconstructed using our standard clinical oncology protocol. A late portal phase contrast-enhanced CT scan was used to contour the liver segments and create corresponding volumes of interest. To calculate the absorbed dose, Monte Carlo simulations were performed using Geant4 Application for Tomographic Emission (GATE). The absorbed dose and dose-volume histograms were calculated for all 6 spheres (diameters ranging from 10 to 37 mm) of the NEMA phantom, the liver segments, and the entire liver. Differences between the phantom doses and an analytic ground truth were quantified through the root mean squared error. Results: The uEXPLORER showed a higher signal-to-noise ratio at 10- and 13-mm diameters, consistent with its high spatial resolution and system sensitivity. The total liver-absorbed dose showed excellent agreement between the uEXPLORER and the mCT for both patients, with differences lower than 0.2%. Larger differences of up to 60% were observed when comparing the liver segment doses. All dose-volume histograms were in good agreement, with narrower tails for the uEXPLORER in all segments, indicating lower image noise. Conclusion: This patient study is compelling for the use of total-body 90Y PET for liver dosimetry. The uEXPLORER scanner showed a better signal-to-noise ratio than mCT, especially in lower-count regions of interest, which is expected to improve dose quantification and tumor dosimetry.
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Affiliation(s)
- Gustavo Costa
- Department of Biomedical Engineering, University of California–Davis, Davis, California; and
| | - Benjamin Spencer
- Department of Biomedical Engineering, University of California–Davis, Davis, California; and
| | - Negar Omidvari
- Department of Biomedical Engineering, University of California–Davis, Davis, California; and
| | - Cameron Foster
- Department of Radiology, University of California–Davis, Davis, California
| | - Michael Rusnak
- Department of Radiology, University of California–Davis, Davis, California
| | - Heather Hunt
- Department of Radiology, University of California–Davis, Davis, California
| | - Denise T. Caudle
- Department of Radiology, University of California–Davis, Davis, California
| | - Rex T. Pillai
- Department of Radiology, University of California–Davis, Davis, California
| | - Catherine Tram Vu
- Department of Radiology, University of California–Davis, Davis, California
| | - Emilie Roncali
- Department of Biomedical Engineering, University of California–Davis, Davis, California; and,Department of Radiology, University of California–Davis, Davis, California
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van der Meulen NP, Strobel K, Lima TVM. New Radionuclides and Technological Advances in SPECT and PET Scanners. Cancers (Basel) 2021; 13:cancers13246183. [PMID: 34944803 PMCID: PMC8699425 DOI: 10.3390/cancers13246183] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Advances in nuclear medicine are made by technological and radionuclide improvements. Throughout nuclear medicine’s history, these advances were often intertwined and complementary based on different clinical questions, availability and need. This paper covers some of these developments in radionuclides and instrumentation. Abstract Developments throughout the history of nuclear medicine have involved improvements in both instrumentation and radionuclides, which have been intertwined. Instrumentation developments always occurred during the search to improving devices’ sensitivity and included advances in detector technology (with the introduction of cadmium zinc telluride and digital Positron Emission Tomography—PET-devices with silicon photomultipliers), design (total body PET) and configuration (ring-shaped, Single-Photon Emission Computed Tomography (SPECT), Compton camera). In the field of radionuclide development, we observed the continual changing of clinically used radionuclides, which is sometimes influenced by instrumentation technology but also driven by availability, patient safety and clinical questions. Some areas, such as tumour imaging, have faced challenges when changing radionuclides based on availability, when this produced undesirable clinical findings with the introduction of unclear focal uptakes and unspecific uptakes. On the other end of spectrum, further developments of PET technology have seen a resurgence in its use in nuclear cardiology, with rubidium-82 from strontium-82/rubidium-82 generators being the radionuclide of choice, moving away from SPECT nuclides thallium-201 and technetium-99m. These continuing improvements in both instrumentation and radionuclide development have helped the growth of nuclear medicine and its importance in the ever-evolving range of patient care options.
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Affiliation(s)
- Nicholas P. van der Meulen
- Center for Radiopharmaceutical Sciences ETH-PSI-USZ, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Laboratory of Radiochemistry, Paul Scherrer Institute, 5232 Villigen, Switzerland
- Correspondence: (N.P.v.d.M.); (T.V.M.L.)
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland;
| | - Thiago Viana Miranda Lima
- Department of Radiology and Nuclear Medicine, Luzerner Kantonsspital, 6000 Luzern, Switzerland;
- Institute of Radiation Physics, Lausanne University Hospital, University of Lausanne, 1007 Lausanne, Switzerland
- Correspondence: (N.P.v.d.M.); (T.V.M.L.)
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Kubik A, Budzyńska A, Kacperski K, Maciak M, Kuć M, Piasecki P, Wiliński M, Konior M, Dziuk M, Iller E. Evaluation of qualitative and quantitative data of Y-90 imaging in SPECT/CT and PET/CT phantom studies. PLoS One 2021; 16:e0246848. [PMID: 33566845 PMCID: PMC7875374 DOI: 10.1371/journal.pone.0246848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 01/26/2021] [Indexed: 01/06/2023] Open
Abstract
Introduction We aimed to assess the feasibility of SPECT and PET Y-90 imaging, and to compare these modalities by visualizing hot and cold foci in phantoms for varying isotope concentrations. Materials and methods The data was acquired from the Jaszczak and NEMA phantoms. In the Jaszczak phantom Y-90 concentrations of 0.1 MBq/ml and 0.2 MBq/ml were used, while higher concentrations, up to 1.0 MBq/ml, were simulated by acquisition time extension with respect to the standard clinical protocol of 30 sec/projection for SPECT and 30 min/bed position for PET imaging. For NEMA phantom, the hot foci had concentrations of about 4 MB/ml and the background 0.1 or 0.0 MBq/ml. All of the acquired data was analysed both qualitatively and quantitatively. Qualitative assessment was conducted by six observers asked to identify the number of visible cold or hot foci. Inter-observer agreement was assessed. Quantitative analysis included calculations of contrast and contrast-to-noise ratio (CNR), and comparisons with the qualitative results. Results For SPECT data up to two cold foci were discernible, while for PET four foci were visible. We have shown that CNR (with Rose criterion) is a good measure of foci visibility for both modalities. We also found good concordance of qualitative results for the Jaszczak phantom studies between the observers (corresponding Krippendorf’s alpha coefficients of 0.76 to 0.84). In the NEMA phantom without background activity all foci were visible in SPECT/CT images. With isotope in the background, 5 of 6 spheres were discernible (CNR of 3.0 for the smallest foci). For PET studies all hot spheres were visible, regardless of the background activity. Conclusions PET Y-90 imaging provided better results than Bremsstrahlung based SPECT imaging. This indicates that PET/CT might become the method of choice in Y-90 post radioembolization imaging for visualisation of both necrotic and hot lesions in the liver.
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Affiliation(s)
- Agata Kubik
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- * E-mail:
| | - Anna Budzyńska
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- Affidea Mazovian PET/CT Medical Centre, Warsaw, Poland
| | - Krzysztof Kacperski
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- Particle Acceleration Physics and Technology Division (TJ1), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Maciej Maciak
- Radiological Metrology and Biomedical Physics Division (H2), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Michał Kuć
- Radiological Metrology and Biomedical Physics Division (H2), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Piotr Piasecki
- Department of Interventional Radiology, Military Institute of Medicine, Warsaw, Poland
| | - Maciej Wiliński
- Radiological Metrology and Biomedical Physics Division (H2), National Centre for Nuclear Research, Otwock—Świerk, Poland
| | - Marcin Konior
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock—Świerk, Poland
| | - Mirosław Dziuk
- Department of Nuclear Medicine, Military Institute of Medicine, Warsaw, Poland
- Affidea Mazovian PET/CT Medical Centre, Warsaw, Poland
| | - Edward Iller
- National Centre for Nuclear Research, Radioisotope Centre POLATOM, Otwock—Świerk, Poland
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High quality imaging and dosimetry for yttrium-90 ( 90Y) liver radioembolization using a SiPM-based PET/CT scanner. Eur J Nucl Med Mol Imaging 2021; 48:2426-2436. [PMID: 33443618 DOI: 10.1007/s00259-021-05188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 01/02/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE Transarterial radioembolization (TARE) with yttrium-90 (90Y) microspheres is a liver-directed treatment for primary and secondary hepatic malignancies. Personalized dosimetry aims for maximum treatment effect and reduced toxicity. We aimed to compare pre-treatment voxel-based dosimetry from 99mTc macroaggregated albumin (MAA) SPECT/CT with post-treatment 90Y PET/CT for absorbed dose values, and to evaluate image quality of 90Y SiPM-based PET/CT. METHODS Forty-two patients (28 men, 14 women, mean age: 67 ± 11 years) with advanced hepatic malignancies were prospectively enrolled. Twenty patients were treated with glass and 22 with resin microspheres. Radiation absorbed doses from planning 99mTc-MAA SPECT/CT and post-therapy 90Y PET/CT were assessed. 90Y PET/CT images were acquired for 20 min and reconstructed to produce 5-, 10-, 15-, and 20-min datasets, then evaluated using the 5-point Likert scale. RESULTS The mean administered activity was 3.44 ± 1.5 GBq for glass and 1.62 ± 0.7 GBq for resin microspheres. The mean tumor absorbed doses calculated from 99mTc-MAA SPECT/CT and 90Y PET/CT were 175.69 ± 113.76 Gy and 193.58 ± 111.09 Gy (P = 0.61), respectively for glass microspheres; they were 60.18 ± 42.20 Gy and 70.98 ± 49.65 Gy (P = 0.37), respectively for resin microspheres. The mean normal liver absorbed doses from 99mTc-MAA SPECT/CT and 90Y PET/CT were 32.70 ± 22.25 Gy and 30.62 ± 20.09 Gy (P = 0.77), respectively for glass microspheres; they were 18.33 ± 11.08 Gy and 24.32 ± 15.58 Gy (P = 0.17), respectively for resin microspheres. Image quality of 90Y PET/CT at 5-, 10-, 15-, and 20-min scan time showed a Likert score of 3.6 ± 0.54, 4.57 ± 0.58, 4.84 ± 0.37, and 4.9 ± 0.3, respectively. CONCLUSIONS 99mTc-MAA SPECT/CT demonstrated great accuracy for treatment planning dosimetry. SiPM-based PET/CT scanner showed good image quality at 10-min scan time, acquired in one bed position. A PET/CT scan time of 5 min showed acceptable image quality and suffices for dosimetry and treatment verification. This allows for inclusion of 90Y PET/CT in busy routine clinical workflows. Studies with larger patient cohorts are needed to confirm these findings.
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St James S, Bednarz B, Benedict S, Buchsbaum JC, Dewaraja Y, Frey E, Hobbs R, Grudzinski J, Roncali E, Sgouros G, Capala J, Xiao Y. Current Status of Radiopharmaceutical Therapy. Int J Radiat Oncol Biol Phys 2020; 109:891-901. [PMID: 32805300 DOI: 10.1016/j.ijrobp.2020.08.035] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/06/2020] [Indexed: 02/02/2023]
Abstract
In radiopharmaceutical therapy (RPT), a radionuclide is systemically or locally delivered with the goal of targeting and delivering radiation to cancer cells while minimizing radiation exposure to untargeted cells. Examples of current RPTs include thyroid ablation with the administration of 131I, treatment of liver cancer with 90Y microspheres, the treatment of bony metastases with 223Ra, and the treatment of neuroendocrine tumors with 177Lu-DOTATATE. New RPTs are being developed where radionuclides are incorporated into systemic targeted therapies. To assure that RPT is appropriately implemented, advances in targeting need to be matched with advances in quantitative imaging and dosimetry methods. Currently, radiopharmaceutical therapy is administered by intravenous or locoregional injection, and the treatment planning has typically been implemented like chemotherapy, where the activity administered is either fixed or based on a patient's body weight or body surface area. RPT pharmacokinetics are measurable by quantitative imaging and are known to vary across patients, both in tumors and normal tissues. Therefore, fixed or weight-based activity prescriptions are not currently optimized to deliver a cytotoxic dose to targets while remaining within the tolerance dose of organs at risk. Methods that provide dose estimates to individual patients rather than to reference geometries are needed to assess and adjust the injected RPT dose. Accurate doses to targets and organs at risk will benefit the individual patients and decrease uncertainties in clinical trials. Imaging can be used to measure activity distribution in vivo, and this information can be used to determine patient-specific treatment plans where the dose to the targets and organs at risk can be calculated. The development and adoption of imaging-based dosimetry methods is particularly beneficial in early clinical trials. In this work we discuss dosimetric accuracy needs in modern radiation oncology, uncertainties in the dosimetry in RPT, and best approaches for imaging and dosimetry of internal radionuclide therapy.
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Affiliation(s)
- Sara St James
- Department of Radiation Oncology, University of California San Francisco, San Francisco, California.
| | - Bryan Bednarz
- Department of Medical Physics and Human Oncology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stanley Benedict
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Jeffrey C Buchsbaum
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Yuni Dewaraja
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Eric Frey
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Robert Hobbs
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | | | - Emilie Roncali
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - George Sgouros
- Department of Radiology, Johns Hopkins University, Baltimore, Maryland
| | - Jacek Capala
- Radiation Research Program, Division of Cancer Treatment and Diagnosis, NCI, NIH, Bethesda, Maryland
| | - Ying Xiao
- Hospital of the University of Pennsylvania
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PET-CT post therapy dosimetry in radioembolization with resin 90Y microspheres: Comparison with pre-treatment SPECT-CT 99mTc-MAA results. Phys Med 2019; 64:16-23. [PMID: 31515015 DOI: 10.1016/j.ejmp.2019.05.025] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/02/2019] [Accepted: 05/27/2019] [Indexed: 01/05/2023] Open
Abstract
Resin microspheres radioembolization is an effective treatment for liver tumors when the surgical option is not feasible. Doses delivered to tumor and normal liver can be assess in the pre-therapy phase by means of a 99mTc-MAA SPECT-CT simulation and after the treatment with 90Y PET-CT acquisition. The optimal therapeutic 90Y activity is determined on 99mTc-MAA SPECT-CT dose results in order to avoid healthy parenchyma toxicity and to effectively irradiate the tumor. The assumption of identical radiopharmaceutical distribution between simulation and verification is still under debate and literature data showed controversial results. In this study 10 HCC patient's dosimetry performed on 99mTc SPECT-CT and 90Y PET-CT were compared. Patients were selected when a good agreement between the pre and post-therapy distribution was observed in order to investigate the intrinsic dosimetric variations between the two imaging modalities. Mean doses (MIRD and Voxel approaches) showed a good correlation (Pearson's coefficient r > 0.90) both for tumor and normal liver. Dose Volume Histogram curves were compared with a good agreement particularly for normal liver (D50). Goal doses were achieved for 90% of patients. Bland-Altman analysis indicates lower variations for healthy parenchyma than for tumor (1.96 SD equal to 9.1 Gy and 68 Gy respectively) confirming the robustness of the dose-toxicity approach. PET-CT dosimetry well correlates with SPECT-CT doses (under assumption of same catheter position and 90Y activity). Better agreement was showed for 7/10 and 8/10 patients for T and NL respectively, confirming dosimetry as effective tool to optimize and individualize the treatment.
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Evaluation of Bremsstrahlung radiation dose in stereotactically radiocolloid therapy of cystic craniopharyngioma tumors with 32P radio-colloid. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:697-711. [PMID: 29987510 DOI: 10.1007/s13246-018-0665-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 07/05/2018] [Indexed: 11/27/2022]
Abstract
Over 90% of craniopharyngeal brain tumors are cystic, which enables the injection of beta emitters such as phosphorus-32 (32P) radio-colloid into cysts for their treatment. The aim of this study was to evaluate the clinical and theoretical modelling of Bremsstrahlung radiation dose resulting from stereotactic radio-colloid therapy of cystic craniopharyngioma tumors with 32P. 32P radio-colloid with appropriate activity concentration was injected to a head phantom, and then the Bremsstrahlung radiation spectrum and planar images were obtained using a gamma camera. Both phantom and gamma camera were simulated using MCNPX code, and the results were compared with practical results. Bremsstrahlung radiation spectrum was measured using a handheld gamma spectrometer for two patients treated with stereotactic radio-colloid therapy with 32P in different positions and compared to Monte Carlo simulation. Results of counting and determining sensitivity coefficients in the air and the attenuating environment were obtained. Also, comparing the counting sensitivity from practical and simulation methods indicated the agreement of the data between the two methods. Comparison of the spectra from different positions around patient's head indicated the ability to use this detector to quantify the activity in the operating room. Selection of the spectrum is important in Bremsstrahlung radiation imaging. We can take advantage of spectrometry measurement using gamma camera, handheld gamma spectrometer for patient, and theoretical modeling with Monte Carlo code to evaluate radiopharmaceutical distribution, leakage, as well as estimate activity and predict therapeutic effects in other adjacent structures and ultimately optimize radio-colloid therapy in cystic craniopharyngeal patients.
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Potrebko PS, Shridhar R, Biagioli MC, Sensakovic WF, Andl G, Poleszczuk J, Fox TH. SPECT/CT image-based dosimetry for Yttrium-90 radionuclide therapy: Application to treatment response. J Appl Clin Med Phys 2018; 19:435-443. [PMID: 29962026 PMCID: PMC6123162 DOI: 10.1002/acm2.12400] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/17/2018] [Accepted: 05/29/2018] [Indexed: 12/18/2022] Open
Abstract
This work demonstrates the efficacy of voxel‐based 90Y microsphere dosimetry utilizing post‐therapy SPECT/CT imaging and applies it to the prediction of treatment response for the management of patients with hepatocellular carcinoma (HCC). A 90Y microsphere dosimetry navigator (RapidSphere) within a commercial platform (Velocity, Varian Medical Systems) was demonstrated for three microsphere cases that were imaged using optimized bremsstrahlung SPECT/CT. For each case, the 90Y SPECT/CT was registered to follow‐up diagnostic MR/CT using deformable image registration. The voxel‐based dose distribution was computed using the local deposition method with known injected activity. The system allowed the visualization of the isodose distributions on any of the registered image datasets and the calculation of dose‐volume histograms (DVHs). The dosimetric analysis illustrated high local doses that are characteristic of blood‐flow directed brachytherapy. In the first case, the HCC mass demonstrated a complete response to treatment indicated by a necrotic region in follow‐up MR imaging. This result was dosimetrically predicted since the gross tumor volume (GTV) was well covered by the prescription isodose volume (V150 Gy = 85%). The second case illustrated a partial response to treatment which was characterized by incomplete necrosis of an HCC mass and a remaining area of solid enhancement in follow‐up MR imaging. This result was predicted by dosimetric analysis because the GTV demonstrated incomplete coverage by the prescription isodose volume (V470 Gy = 18%). The third case demonstrated extrahepatic activity. The dosimetry indicated that the prescription (125 Gy) isodose region extended outside of the liver into the duodenum (178 Gy maximum dose). This was predictive of toxicity as the patient later developed a duodenal ulcer. The ability to predict outcomes and complications using deformable image registration, calculated isodose distributions, and DVHs, points to the clinical utility of patient‐specific dose calculations for 90Y radioembolization treatment planning.
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Affiliation(s)
- Peter S Potrebko
- College of Medicine, University of Central Florida, Orlando, FL, USA.,Department of Physics, University of Central Florida, Orlando, FL, USA.,Department of Radiation Oncology, Florida Hospital, Orlando, FL, USA
| | - Ravi Shridhar
- Department of Radiation Oncology, Florida Hospital, Orlando, FL, USA
| | | | - William F Sensakovic
- College of Medicine, University of Central Florida, Orlando, FL, USA.,Department of Radiology, Florida Hospital, Orlando, FL, USA
| | | | - Jan Poleszczuk
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Warsaw, Poland
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Ahmadzadehfar H, Muckle M, Sabet A, Wilhelm K, Kuhl C, Biermann K, Haslerud T, Biersack HJ, Ezziddin S. The significance of bremsstrahlung SPECT/CT after yttrium-90 radioembolization treatment in the prediction of extrahepatic side effects. Eur J Nucl Med Mol Imaging 2016; 39:309-15. [PMID: 21975832 DOI: 10.1007/s00259-011-1940-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 09/09/2011] [Indexed: 01/06/2023]
Abstract
Purpose Unwanted deposition of 90Y microspheres in organs other than the liver during radioembolization of liver tumours may cause severe side effects such as duodenal ulcer. The aim of this study was to evaluate the significance of posttherapy bremsstrahlung (BS) SPECT/CT images of the liver in comparison to planar and SPECT images in the prediction of radioembolization-induced extrahepatic side effects.Methods A total of 188 radioembolization procedures were performed in 123 patients (50 women, 73 men) over a 2-year period. Planar, whole-body and BS SPECT/CT imaging were performed 24 h after treatment as a part of therapy work-up.Any focally increased extrahepatic accumulation was evaluated as suspicious. Clinical follow-up and gastroduodenoscopy served as reference standards. The studies were reviewed to evaluate whether BS SPECT/CT imaging was of benefit.Results In the light of anatomic data obtained from SPECT/CT, apparent extrahepatic BS in 43% of planar and in 52% of SPECT images proved to be in the liver and hence false positive.The results of planar scintigraphy could not be analysed further since 12 images were not assessable due to high scatter artefacts. On the basis of the gastrointestinal (GI)complications and the results of gastroduodenoscopy, true positive,true-negative, false-positive and false-negative results of BS SPECT and SPECT/CT imaging in the prediction of GI ulcers were determined. The sensitivity, specificity, positive and negative predictive values and the accuracy of SPECT and SPECT/CT in the prediction of GI ulcers were 13%, 88%, 8%,92% and 82%, and 87%, 100%, 100%, 99% and 99%,respectively.Conclusion Despite the low quality of BS images, BSSPECT/CT can be used as a reliable method to confirm the safe distribution of 90Y microspheres and in the prediction of GI side effects.
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Takahashi A, Himuro K, Yamashita Y, Komiya I, Baba S, Sasaki M. Monte Carlo simulation of PET and SPECT imaging of 90Y. Med Phys 2015; 42:1926-35. [PMID: 25832083 DOI: 10.1118/1.4915545] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Yittrium-90 ((90)Y) is traditionally thought of as a pure beta emitter, and is used in targeted radionuclide therapy, with imaging performed using bremsstrahlung single-photon emission computed tomography (SPECT). However, because (90)Y also emits positrons through internal pair production with a very small branching ratio, positron emission tomography (PET) imaging is also available. Because of the insufficient image quality of (90)Y bremsstrahlung SPECT, PET imaging has been suggested as an alternative. In this paper, the authors present the Monte Carlo-based simulation-reconstruction framework for (90)Y to comprehensively analyze the PET and SPECT imaging techniques and to quantitatively consider the disadvantages associated with them. METHODS Our PET and SPECT simulation modules were developed using Monte Carlo simulation of Electrons and Photons (MCEP), developed by Dr. S. Uehara. PET code (MCEP-PET) generates a sinogram, and reconstructs the tomography image using a time-of-flight ordered subset expectation maximization (TOF-OSEM) algorithm with attenuation compensation. To evaluate MCEP-PET, simulated results of (18)F PET imaging were compared with the experimental results. The results confirmed that MCEP-PET can simulate the experimental results very well. The SPECT code (MCEP-SPECT) models the collimator and NaI detector system, and generates the projection images and projection data. To save the computational time, the authors adopt the prerecorded (90)Y bremsstrahlung photon data calculated by MCEP. The projection data are also reconstructed using the OSEM algorithm. The authors simulated PET and SPECT images of a water phantom containing six hot spheres filled with different concentrations of (90)Y without background activity. The amount of activity was 163 MBq, with an acquisition time of 40 min. RESULTS The simulated (90)Y-PET image accurately simulated the experimental results. PET image is visually superior to SPECT image because of the low background noise. The simulation reveals that the detected photon number in SPECT is comparable to that of PET, but the large fraction (approximately 75%) of scattered and penetration photons contaminates SPECT image. The lower limit of (90)Y detection in SPECT image was approximately 200 kBq/ml, while that in PET image was approximately 100 kBq/ml. CONCLUSIONS By comparing the background noise level and the image concentration profile of both the techniques, PET image quality was determined to be superior to that of bremsstrahlung SPECT. The developed simulation codes will be very useful in the future investigations of PET and bremsstrahlung SPECT imaging of (90)Y.
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Affiliation(s)
- Akihiko Takahashi
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kazuhiko Himuro
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yasuo Yamashita
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Isao Komiya
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Faculty of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Semi-Quantitative Analysis of Post-Transarterial Radioembolization (90)Y Microsphere Positron Emission Tomography Combined with Computed Tomography (PET/CT) Images in Advanced Liver Malignancy: Comparison With (99m)Tc Macroaggregated Albumin (MAA) Single Photon Emission Computed Tomography (SPECT). Nucl Med Mol Imaging 2015; 50:63-9. [PMID: 26941861 DOI: 10.1007/s13139-015-0366-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 08/24/2015] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES The purpose of this study is to evaluate the correlation between pretreatment planning technetium-99m ((99m)Tc) macroaggregated albumin (MAA) SPECT images and posttreatment transarterial radioembolization (TARE) yttirum-90 ((90)Y) PET/CT images by comparing the ratios of tumor-to-normal liver counts. METHODS Fifty-two patients with advanced hepatic malignancy who underwent (90)Y microsphere radioembolization from January 2010 to December 2012 were retrospectively reviewed. Patients had undergone (99m)Tc MAA intraarterial injection SPECT for a pretreatment evaluation of microsphere distribution and therapy planning. After the administration of (90)Y microspheres, the patients underwent posttreatment (90)Y PET/CT within 24 h. For semiquantitative analysis, the tumor-to-normal uptake ratios in (90)Y PET/CT (TNR-yp) and (99m)Tc MAA SPECT (TNR-ms) as well as the tumor volumes measured in angiographic CT were obtained and analyzed. The relationship of TNR-yp and TNR-ms was evaluated by Spearman's rank correlation and Wilcoxon's matched pairs test. RESULTS In a total of 79 lesions of 52 patients, the distribution of microspheres was well demonstrated in both the SPECT and PET/CT images. A good correlation was observed of between TNR-ms and TNR-yp (rho value = 0.648, p < 0.001). The TNR-yp (median 2.78, interquartile range 2.43) tend to show significantly higher values than TNR-ms (median 2.49, interquartile range of 1.55) (p = 0.012). The TNR-yp showed weak correlation with tumor volume (rho = 0.230, p = 0.041). CONCLUSIONS The (99m)Tc MAA SPECT showed a good correlation with (90)Y PET/CT in TNR values, suggesting that (99m)Tc MAA can be used as an adequate pretreatment evaluation method. However, the (99m)Tc MAA SPECT image consistently shows lower TNR values compared to (90)Y PET/CT, which means the possibility of underestimation of tumorous uptake in the partition dosimetry model using (99m)Tc MAA SPECT. Considering that (99m)Tc MAA is the only clinically available surrogate marker for distribution of microsphere, we recommend measurement of tumorous uptake using (90)Y PET/CT should be included routinely in the posttherapeutic evaluation.
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Roshan HR, Azarm A, Mahmoudian B, Islamian JP. Advances in SPECT for Optimizing the Liver Tumors Radioembolization Using Yttrium-90 Microspheres. World J Nucl Med 2015; 14:75-80. [PMID: 26097416 PMCID: PMC4455176 DOI: 10.4103/1450-1147.157120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Radioembolization (RE) with Yttrium-90 ((90)Y) microspheres is an effective treatment for unresectable liver tumors. The activity of the microspheres to be administered should be calculated based on the type of microspheres. Technetium-99m macroaggregated albumin ((99m)Tc-MAA) single photon emission computed tomography/computed tomography (SPECT/CT) is a reliable assessment before RE to ensure the safe delivery of microspheres into the target. (90)Y bremsstrahlung SPECT imaging as a posttherapeutic assessment approach enables the reliable determination of absorbed dose, which is indispensable for the verification of treatment efficacy. This article intends to provide a review of the methods of optimizing (90)Y bremsstrahlung SPECT imaging to improve the treatment efficacy of liver tumor RE using (90)Y microspheres.
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Affiliation(s)
- Hoda Rezaei Roshan
- Department of Medical Physics, Nuclear Medicine Unit, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmadreza Azarm
- Department of Medical Physics, Nuclear Medicine Unit, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Mahmoudian
- Department of Radiology, Nuclear Medicine Unit, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalil Pirayesh Islamian
- Department of Medical Physics, Nuclear Medicine Unit, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Fujibuchi T, Takahashi A. [9. Application of the Monte Carlo simulation 6: Monte Carlo simulation in nuclear medicine]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2015; 71:460-467. [PMID: 25994400 DOI: 10.6009/jjrt.2015_jsrt_71.5.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Fabbri C, Bartolomei M, Mattone V, Casi M, De Lauro F, Bartolini N, Gentili G, Amadori S, Agostini M, Sarti G. (90)Y-PET/CT Imaging Quantification for Dosimetry in Peptide Receptor Radionuclide Therapy: Analysis and Corrections of the Impairing Factors. Cancer Biother Radiopharm 2015; 30:200-10. [PMID: 25860616 DOI: 10.1089/cbr.2015.1819] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE We evaluated the possibility to assess (90)Y-PET/CT imaging quantification for dosimetry in (90)Y-peptide receptor radionuclide therapy. METHODS Tests were performed by Discovery 710 Elite (GE) PET/CT equipment. A body-phantom containing radioactive-coplanar-spheres was filled with (90)Y water solution to reproduce different signal-to-background-activity-ratios (S/N). We studied minimum detectable activity (MDA) concentration, contrast-to-noise ratio (CNR), and full-width-at-half-maximum (FWHM). Subsequently, three recovery coefficients (RC)-based correction approaches were evaluated: maximum-RC, resolution-RC, and isovolume-RC. The analysis of the volume segmentation thresholding method was also assessed to derive a relationship between the true volume of the targets and the threshold to be applied to the PET images. (90)Y-PET/CT imaging quantification was then achieved on some patients and related with preclinical tests. Moreover, the dosimetric evaluation was obtained on the target regions. RESULTS CNR value was greater than 5 if the MDA was greater than 0.2 MBq/mL with no background activity and 0.5-0.7 MBq/mL with S/N ranging from 3 to 6. FWHM was equal to 7 mm. An exponential fitting of isovolume RCs-based correction technique was adopted for activity quantification. Adaptive segmentation thresholding exponential curves were obtained and applied for target volume identification in three signal-to-background-activity-ratios. The imaging quantification study and dosimetric evaluations in clinical cases was feasible and the results were coherent with those obtained in preclinical tests. CONCLUSIONS (90)Y-PET/CT imaging quantification is possible both in phantoms and in patients. Absorbed dose evaluations in clinical applications are strongly related to targets activity concentration.
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Affiliation(s)
- Cinzia Fabbri
- 1 Physics and Biomedical Technologies Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy .,2 Medical Physics Unit, AORMN , Pesaro, Italy
| | - Mirco Bartolomei
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Vincenzo Mattone
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Michela Casi
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Francesco De Lauro
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Nerio Bartolini
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Giovanni Gentili
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Sonia Amadori
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Monica Agostini
- 3 Nuclear Medicine Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
| | - Graziella Sarti
- 1 Physics and Biomedical Technologies Unit, Bufalini Hospital , AUSL della Romagna, Cesena, Italy
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Hanaoka K, Hosono M, Tatsumi Y, Ishii K, Im SW, Tsuchiya N, Sakaguchi K, Matsumura I. Heterogeneity of intratumoral (111)In-ibritumomab tiuxetan and (18)F-FDG distribution in association with therapeutic response in radioimmunotherapy for B-cell non-Hodgkin's lymphoma. EJNMMI Res 2015; 5:10. [PMID: 25853016 PMCID: PMC4385239 DOI: 10.1186/s13550-015-0093-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 02/25/2015] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND The purpose of this study was to quantitatively evaluate the tumor accumulation and heterogeneity of (111)In-ibritumomab tiuxetan (Zevalin®) and tumor accumulation of (18)F-fluoro-deoxyglucose (FDG) and compare them to the tumor response in B-cell non-Hodgkin's lymphoma patients receiving (90)Y-ibritumomab tiuxetan (Zevalin®) therapy. METHODS Sixteen patients with histologically confirmed non-Hodgkin's B-cell lymphoma who underwent (90)Y-ibritumomab tiuxetan therapy along with (111)In-ibritumomab tiuxetan single-photon emission computerized tomography (SPECT)/CT and FDG positron emission tomography (PET)/CT were enrolled in this retrospective study. On pretherapeutic FDG PET/CT images, the maximum standardized uptake value (SUVmax) was measured. On SPECT/CT images, a percentage of the injected dose per gram (%ID/g) and SUVmax of (111)In-ibritumomab tiuxetan were measured at 48 h after its administration. The skewness and kurtosis of the voxel distribution were calculated to evaluate the intratumoral heterogeneity of tumor accumulation. As another intratumoral heterogeneity index, cumulative SUV-volume histograms describing the percentage of the total tumor volume above the percentage thresholds of pretherapeutic FDG and (111)In-ibritumomab tiuxetan SUVmax (area under the curve of the cumulative SUV histograms (AUC-CSH)) were calculated. All lesions (n = 42) were classified into responders and non-responders lesion-by-lesion on pre- and post-therapeutic CT images. RESULTS A positive correlation was observed between the FDG SUVmax and accumulation of (111)In-ibritumomab tiuxetan in lesions. A significant difference in pretherapeutic FDG SUVmax was observed between responders and non-responders, while no significant difference in (111)In-ibritumomab tiuxetan SUVmax was observed between the two groups. In contrast, voxel distribution of FDG demonstrated no significant differences in the three heterogeneity indices between responders and non-responders, while (111)In-ibritumomab tiuxetan demonstrated skewness of 0.58 ± 0.16 and 0.73 ± 0.24 (p < 0.05), kurtosis of 2.39 ± 0.32 and 2.78 ± 0.53 (p < 0.02), and AUC-CSH of 0.37 ± 0.04 and 0.34 ± 0.05 (p < 0.05) for responders and non-responders. CONCLUSIONS Pretherapeutic FDG accumulation was predictive of the tumor response in (90)Y-ibritumomab tiuxetan therapy. The heterogeneity of the intratumoral distribution rather than the absolute level of (111)In-ibritumomab tiuxetan was correlated with the tumor response.
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Affiliation(s)
- Kohei Hanaoka
- Department of Radiology, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Makoto Hosono
- Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Yoichi Tatsumi
- Department of Hematology, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Kazunari Ishii
- Neurocognitive Disorders Center, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Sung-Woon Im
- Department of Radiology, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Norio Tsuchiya
- Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Kenta Sakaguchi
- Division of Positron Emission Tomography, Institute of Advanced Clinical Medicine, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
| | - Itaru Matsumura
- Department of Hematology, Faculty of Medicine, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, 589-8511 Japan
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99mTc-sestamibi thigh SPECT/CT imaging for assessment of myopathy in cerebrotendinous xanthomatosis with histopathological and immunohistochemical correlation. Clin Nucl Med 2014; 39:e202-7. [PMID: 23989447 DOI: 10.1097/rlu.0b013e3182a20d8e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to determine the effectiveness of using Tc-sestamibi thigh SPECT/CT imaging for evaluating myopathy in cerebrotendinous xanthomatosis (CTX). PATIENTS AND METHODS Four genetically proven CTX patients (Family I, Cases I-1 and I-2; Family II, Cases II-1 and II-2) were included. They all underwent muscle biopsies for histopathologic and ultrastructural studies. Immunohistochemical staining for vinculin expression was also performed. Tc-sestamibi thigh SPECT/CT imaging was conducted on all 4 CTX patients, and both visual interpretation and muscle-to-background (M/B) ratio count were applied for assessment. Correlation analysis of the imaging findings and results of the ultrastructural and immunohistochemical studies was done. RESULTS In the Tc-sestamibi thigh SPECT/CT imaging study, all 4 CTX cases had abnormal scores of visual interpretation and M/B ratios. The ultrastructural features of the skeletal muscle of the 4 CTX cases showed mitochondrial and membrane system abnormalities, with increased depositions of metabolites. They also had abnormal increases in vinculin expression after immunohistochemical staining of the skeletal muscle. CONCLUSIONS This is the first report on the use of Tc-sestamibi thigh SPECT/CT imaging to assess the mitochondrial status of CTX. The imaging findings may have a correlation with the ultrastructural and immunohistochemical findings on skeletal muscle. Although the Tc-sestamibi thigh SPECT/CT imaging is not specific for CTX, this noninvasive in vivo assessment can be an important tool for the detection and follow-up study of skeletal muscle involvement in CTX.
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Van Binnebeek S, Baete K, Vanbilloen B, Terwinghe C, Koole M, Mottaghy FM, Clement PM, Mortelmans L, Haustermans K, Van Cutsem E, Verbruggen A, Bogaerts K, Verslype C, Deroose CM. Individualized dosimetry-based activity reduction of ⁹⁰Y-DOTATOC prevents severe and rapid kidney function deterioration from peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging 2014; 41:1141-57. [PMID: 24668274 DOI: 10.1007/s00259-013-2670-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/10/2013] [Indexed: 12/25/2022]
Abstract
PURPOSE Assessment of kidney function evolution after (90)Y-DOTATOC peptide receptor radionuclide therapy (PRRT) with capped activity administration based on a 37-Gy threshold of biological effective dose (BED) to the kidney. METHODS In a prospective phase II study, patients with metastasized neuroendocrine tumours were evaluated for therapy using 185 MBq (111)In-pentetreotide with amino acid coinfusion. Planar whole-body images were acquired at four time-points after injection and kidney volumes were measured using CT/MRI. BED to the kidneys was estimated using an extended BED formula and biexponential renal clearance. Based on published BED dose-toxicity relationships, we allowed a maximal kidney BED of 37 Gy; if the calculated BED exceeded 37 Gy, treatment activity was reduced accordingly. Kidney function was assessed at baseline and at 18 months, predominantly using (51)Cr-EDTA. The rate of renal function decline was expressed as annual glomerular filtration rate loss (aGFRL). RESULTS Only 22 of 50 patients reached the 18-months time-point, with most missing patients having died due to disease progression. In the 22 patients who reached 18 months, no rapid kidney function deterioration was observed over the 18 months, aGFRL >33% was not seen, and only three patients showed an increase of one toxicity grade and one patient an increase of two grades. No significant correlations between kidney volume (p = 0.35), baseline GFR (p = 0.18), risk factors for renal function loss (p = 0.74) and aGFRL were observed. Among the 28 patients who did not reach 18 months, one developed grade 4 kidney toxicity at 15 months after PRRT. CONCLUSION Prospective dosimetry using a 37 Gy BED as the threshold for kidney toxicity is a good guide for (90)Y-DOTATOC PRRT and is associated with a low risk of rapid renal function deterioration and evolution to severe nephrotoxicity.
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Ahmadzadehfar H, Duan H, Haug AR, Walrand S, Hoffmann M. The role of SPECT/CT in radioembolization of liver tumours. Eur J Nucl Med Mol Imaging 2014; 41 Suppl 1:S115-24. [PMID: 24442600 DOI: 10.1007/s00259-013-2675-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 01/14/2023]
Abstract
Radioembolization (RE) with (90)Y microspheres is a promising catheter-based therapeutic option for patients with unresectable primary and metastatic liver tumours. Its rationale arises from the dual blood supply of liver tissue through the hepatic artery and the portal vein. Metastatic hepatic tumours measuring >3 mm derive 80 - 100 % of their blood supply from the arterial rather than the portal hepatic circulation. Typically, an angiographic evaluation combined with (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) scan precedes therapy to map the tumour feeding vessels as well as to avoid the inadvertent deposition of microspheres in organs other than the liver. Prior to administration of (99m)Tc-MAA, prophylactic coil embolization of the gastroduodenal artery is recommended to avoid extrahepatic deposition of the microspheres. SPECT/CT allows direct correlation of anatomic and functional information in patients with unresectable liver disease. SPECT/CT is recommended to assess intrahepatic distribution as well as extrahepatic gastrointestinal uptake in these patients. Pretherapeutic SPECT/CT is an important component of treatment planning including catheter positioning and dose finding. A post-therapy bremsstrahlung (BS) scan should follow RE to verify the distribution of the administered tracer. BS SPECT/CT imaging enables better localization and definition of intrahepatic and possible extrahepatic sphere distribution and to a certain degree allows posttreatment dosimetry. In this paper we address the usefulness and significance of SPECT/CT in therapy planning and therapy monitoring of RE.
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Muylle K, Vanderlinden B. Reply to letter re: general theory of predictive dosimetry for yttrium-90 radioembolization to sites other than the liver. Cardiovasc Intervent Radiol 2013; 37:1118-9. [PMID: 24218175 DOI: 10.1007/s00270-013-0784-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 10/18/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Kristoff Muylle
- Department of Nuclear Medicine, Jules Bordet Institute, ULB, Héger Bordetstraat 1, 1000, Brussels, Belgium,
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Eaton BR, Kim HS, Schreibmann E, Schuster DM, Galt JR, Barron B, Kim S, Liu Y, Landry J, Fox T. Quantitative dosimetry for yttrium-90 radionuclide therapy: tumor dose predicts fluorodeoxyglucose positron emission tomography response in hepatic metastatic melanoma. J Vasc Interv Radiol 2013; 25:288-95. [PMID: 24269792 DOI: 10.1016/j.jvir.2013.08.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 08/15/2013] [Accepted: 08/26/2013] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To assess a new method for generating patient-specific volumetric dose calculations and analyze the relationship between tumor dose and positron emission tomography (PET) response after radioembolization of hepatic melanoma metastases. METHODS AND MATERIALS Yttrium-90 ((90)Y) bremsstrahlung single photon emission computed tomography (SPECT)/computed tomography (CT) acquired after (90)Y radioembolization was convolved with published (90)Y Monte Carlo estimated dose deposition kernels to create a three-dimensional dose distribution. Dose-volume histograms were calculated for tumor volumes manually defined from magnetic resonance imaging or PET/CT imaging. Tumor response was assessed by absolute reduction in maximum standardized uptake value (SUV(max)) and total lesion glycolysis (TLG). RESULTS Seven patients with 30 tumors treated with (90)Y for hepatic metastatic melanoma with available (90)Y SPECT/CT and PET/CT before and after treatment were identified for analysis. The median (range) for minimum, mean, and maximum dose per tumor volume was 16.9 Gy (5.7-43.5 Gy), 28.6 Gy (13.8-65.6 Gy) and 36.6 Gy (20-124 Gy), respectively. Response was assessed by fluorodeoxyglucose PET/CT at a median time after treatment of 2.8 months (range, 1.2-7.9 months). Mean tumor dose (P = .03) and the percentage of tumor volume receiving ≥ 50 Gy (P < .01) significantly predicted for decrease in tumor SUV(max), whereas maximum tumor dose predicted for decrease in tumor TLG (P < .01). CONCLUSIONS Volumetric dose calculations showed a statistically significant association with metabolic tumor response. The significant dose-response relationship points to the clinical utility of patient-specific absorbed dose calculations for radionuclide therapy.
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Affiliation(s)
- Bree R Eaton
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322.
| | - Hyun S Kim
- Department of Radiology and Imaging Sciences, Divisions of Interventional Radiology and Image Guided Medicine, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Eduard Schreibmann
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - David M Schuster
- Divisions of Nuclear Medicine and Molecular Imaging, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - James R Galt
- Divisions of Nuclear Medicine and Molecular Imaging, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Bruce Barron
- Divisions of Nuclear Medicine and Molecular Imaging, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Sungjin Kim
- Departments of Biostatistics and Bioinformatics, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Jerome Landry
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
| | - Tim Fox
- Department of Radiation Oncology, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322; Winship Cancer Institute, Emory University, 1365 Clifton Road NE, Suite CT 104, Atlanta, GA 30322
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Abstract
Personalized dosimetry in radionuclide therapy has gained much attention in recent years. This attention has also an impact on peptide receptor radionuclide therapy (PRRT). This article reviews the PET-based imaging techniques that can be used for pretherapeutic prediction of doses in PRRT. More specifically the usage of (86)Y, (90)Y, (68)Ga, and (44)Sc are discussed: their characteristics for PET acquisition, the available peptides for labeling, the specifics of the imaging protocols, and the experiences gained from phantom and clinical studies. These techniques are evaluated with regard to their usefulness for dosimetry predictions in PRRT, and future perspectives are discussed.
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Kao YH, Steinberg JD, Tay YS, Lim GK, Yan J, Townsend DW, Takano A, Burgmans MC, Irani FG, Teo TK, Yeow TN, Gogna A, Lo RH, Tay KH, Tan BS, Chow PK, Satchithanantham S, Tan AE, Ng DC, Goh AS. Post-radioembolization yttrium-90 PET/CT - part 1: diagnostic reporting. EJNMMI Res 2013; 3:56. [PMID: 23883566 PMCID: PMC3726297 DOI: 10.1186/2191-219x-3-56] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/16/2013] [Indexed: 11/15/2022] Open
Abstract
Background Yttrium-90 (90Y) positron emission tomography with integrated computed tomography (PET/CT) represents a technological leap from 90Y bremsstrahlung single-photon emission computed tomography with integrated computed tomography (SPECT/CT) by coincidence imaging of low abundance internal pair production. Encouraged by favorable early experiences, we implemented post-radioembolization 90Y PET/CT as an adjunct to 90Y bremsstrahlung SPECT/CT in diagnostic reporting. Methods This is a retrospective review of all paired 90Y PET/CT and 90Y bremsstrahlung SPECT/CT scans over a 1-year period. We compared image resolution, ability to confirm technical success, detection of non-target activity, and providing conclusive information about 90Y activity within targeted tumor vascular thrombosis. 90Y resin microspheres were used. 90Y PET/CT was performed on a conventional time-of-flight lutetium-yttrium-oxyorthosilicate scanner with minor modifications to acquisition and reconstruction parameters. Specific findings on 90Y PET/CT were corroborated by 90Y bremsstrahlung SPECT/CT, 99mTc macroaggregated albumin SPECT/CT, follow-up diagnostic imaging or review of clinical records. Results Diagnostic reporting recommendations were developed from our collective experience across 44 paired scans. Emphasis on the continuity of care improved overall diagnostic accuracy and reporting confidence of the operator. With proper technique, the presence of background noise did not pose a problem for diagnostic reporting. A counter-intuitive but effective technique of detecting non-target activity is proposed, based on the pattern of activity and its relation to underlying anatomy, instead of its visual intensity. In a sub-analysis of 23 patients with a median follow-up of 5.4 months, 90Y PET/CT consistently outperformed 90Y bremsstrahlung SPECT/CT in all aspects of qualitative analysis, including assessment for non-target activity and tumor vascular thrombosis. Parts of viscera closely adjacent to the liver remain challenging for non-target activity detection, compounded by a tendency for mis-registration. Conclusions Adherence to proper diagnostic reporting technique and emphasis on continuity of care are vital to the clinical utility of post-radioembolization 90Y PET/CT. 90Y PET/CT is superior to 90Y bremsstrahlung SPECT/CT for the assessment of target and non-target activity.
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Affiliation(s)
- Yung-Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
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Quantitative comparison of PET and Bremsstrahlung SPECT for imaging the in vivo yttrium-90 microsphere distribution after liver radioembolization. PLoS One 2013; 8:e55742. [PMID: 23405207 PMCID: PMC3566032 DOI: 10.1371/journal.pone.0055742] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 12/30/2012] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND After yttrium-90 ((90)Y) microsphere radioembolization (RE), evaluation of extrahepatic activity and liver dosimetry is typically performed on (90)Y Bremsstrahlung SPECT images. Since these images demonstrate a low quantitative accuracy, (90)Y PET has been suggested as an alternative. The aim of this study is to quantitatively compare SPECT and state-of-the-art PET on the ability to detect small accumulations of (90)Y and on the accuracy of liver dosimetry. METHODOLOGY/PRINCIPAL FINDINGS SPECT/CT and PET/CT phantom data were acquired using several acquisition and reconstruction protocols, including resolution recovery and Time-Of-Flight (TOF) PET. Image contrast and noise were compared using a torso-shaped phantom containing six hot spheres of various sizes. The ability to detect extra- and intrahepatic accumulations of activity was tested by quantitative evaluation of the visibility and unique detectability of the phantom hot spheres. Image-based dose estimates of the phantom were compared to the true dose. For clinical illustration, the SPECT and PET-based estimated liver dose distributions of five RE patients were compared. At equal noise level, PET showed higher contrast recovery coefficients than SPECT. The highest contrast recovery coefficients were obtained with TOF PET reconstruction including resolution recovery. All six spheres were consistently visible on SPECT and PET images, but PET was able to uniquely detect smaller spheres than SPECT. TOF PET-based estimates of the dose in the phantom spheres were more accurate than SPECT-based dose estimates, with underestimations ranging from 45% (10-mm sphere) to 11% (37-mm sphere) for PET, and 75% to 58% for SPECT, respectively. The differences between TOF PET and SPECT dose-estimates were supported by the patient data. CONCLUSIONS/SIGNIFICANCE In this study we quantitatively demonstrated that the image quality of state-of-the-art PET is superior over Bremsstrahlung SPECT for the assessment of the (90)Y microsphere distribution after radioembolization.
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Amato E, Minutoli F, Pacilio M, Campennì A, Baldari S. An analytical method for computing voxel S values for electrons and photons. Med Phys 2012; 39:6808-17. [DOI: 10.1118/1.4757912] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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van de Maat GH, Seevinck PR, Elschot M, Smits MLJ, de Leeuw H, van Het Schip AD, Vente MAD, Zonnenberg BA, de Jong HWAM, Lam MGEH, Viergever MA, van den Bosch MAAJ, Nijsen JFW, Bakker CJG. MRI-based biodistribution assessment of holmium-166 poly(L-lactic acid) microspheres after radioembolisation. Eur Radiol 2012; 23:827-35. [PMID: 23014797 PMCID: PMC3563959 DOI: 10.1007/s00330-012-2648-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 07/20/2012] [Accepted: 08/15/2012] [Indexed: 12/16/2022]
Abstract
Objectives To demonstrate the feasibility of MRI-based assessment of the intrahepatic Ho-PLLA-MS biodistribution after radioembolisation in order to estimate the absorbed radiation dose. Methods Fifteen patients were treated with holmium-166 (166Ho) poly(L-lactic acid)-loaded microspheres (Ho-PLLA-MS, mean 484 mg; range 408–593 mg) in a phase I study. Multi-echo gradient-echo MR images were acquired from which R2* maps were constructed. The amount of Ho-PLLA-MS in the liver was determined by using the relaxivity r2* of the Ho-PLLA-MS and compared with the administered amount. Quantitative single photon emission computed tomography (SPECT) was used for comparison with MRI regarding the whole liver absorbed radiation dose. Results R2* maps visualised the deposition of Ho-PLLA-MS with great detail. The mean total amount of Ho-PLLA-MS detected in the liver based on MRI was 431 mg (range 236–666 mg) or 89 ± 19 % of the delivered amount (correlation coefficient r = 0.7; P < 0.01). A good correlation was found between the whole liver mean absorbed radiation dose as assessed by MRI and SPECT (correlation coefficient r = 0.927; P < 0.001). Conclusion MRI-based dosimetry for holmium-166 radioembolisation is feasible. Biodistribution is visualised with great detail and quantitative measurements are possible. Key Points • Radioembolisation is increasingly used for treating unresectable primary or metastatic liver tumours. • MRI-based intrahepatic microsphere biodistribution assessment is feasible after holmium-166 radioembolisation. • MRI enables quantification of holmium-166 microspheres in liver in a short imaging time. • MRI can estimate the whole liver absorbed radiation dose following holmium-166 radioembolisation.
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Affiliation(s)
- Gerrit H van de Maat
- Image Sciences Institute, University Medical Center Utrecht, Q S.459, PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Fabbri C, Mattone V, Sarti G, Casi M, De Lauro F, Agostini M, Bartolini N, Bartolomei M. 90Y-based PET and SPECT/CT imaging in locoregional brain treatment for high-grade gliomas: retrospective fusion with MRI. Eur J Nucl Med Mol Imaging 2012; 39:1822-3. [DOI: 10.1007/s00259-012-2200-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 07/13/2012] [Indexed: 11/28/2022]
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Claudio Traino A, Boni G, Mariani G. Radiodosimetric estimates for radioembolic therapy of liver tumors: challenges and opportunities. J Nucl Med 2012; 53:509-11. [PMID: 22410462 DOI: 10.2967/jnumed.111.100537] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- A Claudio Traino
- Division of Health Physics University Hospital of Pisa Pisa, Italy
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Radioembolisation mit 90Y-markierten Mikrosphären: Posttherapeutische Therapievalidierung mit Bremsstrahlungs-SPECT. Z Med Phys 2011; 21:274-80. [DOI: 10.1016/j.zemedi.2011.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 05/11/2011] [Accepted: 05/12/2011] [Indexed: 11/19/2022]
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Elschot M, Nijsen JFW, Dam AJ, de Jong HWAM. Quantitative evaluation of scintillation camera imaging characteristics of isotopes used in liver radioembolization. PLoS One 2011; 6:e26174. [PMID: 22073149 PMCID: PMC3207835 DOI: 10.1371/journal.pone.0026174] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 09/21/2011] [Indexed: 02/07/2023] Open
Abstract
Background Scintillation camera imaging is used for treatment planning and post-treatment dosimetry in liver radioembolization (RE). In yttrium-90 (90Y) RE, scintigraphic images of technetium-99m (99mTc) are used for treatment planning, while 90Y Bremsstrahlung images are used for post-treatment dosimetry. In holmium-166 (166Ho) RE, scintigraphic images of 166Ho can be used for both treatment planning and post-treatment dosimetry. The aim of this study is to quantitatively evaluate and compare the imaging characteristics of these three isotopes, in order that imaging protocols can be optimized and RE studies with varying isotopes can be compared. Methodology/Principal Findings Phantom experiments were performed in line with NEMA guidelines to assess the spatial resolution, sensitivity, count rate linearity, and contrast recovery of 99mTc, 90Y and 166Ho. In addition, Monte Carlo simulations were performed to obtain detailed information about the history of detected photons. The results showed that the use of a broad energy window and the high-energy collimator gave optimal combination of sensitivity, spatial resolution, and primary photon fraction for 90Y Bremsstrahlung imaging, although differences with the medium-energy collimator were small. For 166Ho, the high-energy collimator also slightly outperformed the medium-energy collimator. In comparison with 99mTc, the image quality of both 90Y and 166Ho is degraded by a lower spatial resolution, a lower sensitivity, and larger scatter and collimator penetration fractions. Conclusions/Significance The quantitative evaluation of the scintillation camera characteristics presented in this study helps to optimize acquisition parameters and supports future analysis of clinical comparisons between RE studies.
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Affiliation(s)
- Mattijs Elschot
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
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Walrand S, Flux GD, Konijnenberg MW, Valkema R, Krenning EP, Lhommel R, Pauwels S, Jamar F. Dosimetry of yttrium-labelled radiopharmaceuticals for internal therapy: 86Y or 90Y imaging? Eur J Nucl Med Mol Imaging 2011; 38 Suppl 1:S57-68. [DOI: 10.1007/s00259-011-1771-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 02/22/2011] [Indexed: 12/31/2022]
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Nicolas G, Giovacchini G, Müller-Brand J, Forrer F. Targeted radiotherapy with radiolabeled somatostatin analogs. Endocrinol Metab Clin North Am 2011; 40:187-204, ix-x. [PMID: 21349419 DOI: 10.1016/j.ecl.2010.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Targeted radiopeptide therapy with (90)Yttrium- or (177)Lutetium-labeled somatostatin analogs has been proven to improve significantly quality of life and survival in patients suffering from metastatic or unresectable neuroendocrine tumors (NETs). Roughly 25% of patients achieve partial remission; progression-free survival is estimated to be 30 to 40 months. A wide range of protocols using different somatostatin analogs, isotopes, injected activity per cycle of administration, and number of cycles are reported. More patient-based therapy protocols are under development, taking into consideration the complexity of NET cell biology, dosimetric issues, and the availability of different radiolabeled analogs. This article reviews the effectiveness and safety of the different protocols and discusses several clinical algorithms used in an attempt to optimize targeted radiopeptide therapy.
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Affiliation(s)
- Guillaume Nicolas
- Department of Radiology and Nuclear Medicine, University Hospital Basel, 4031 Basel, Switzerland
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Tc99m-Sestamibi Thigh SPECT/CT Images for Noninvasive Assessment of Skeletal Muscle Injury in Carbon Monoxide Intoxication With Clinical and Pathological Correlation. Clin Nucl Med 2011; 36:199-205. [DOI: 10.1097/rlu.0b013e318208f117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ahmadzadehfar H, Sabet A, Muckle M, Wilhelm K, Reichmann K, Biersack HJ, Ezziddin S. 99mTc-MAA/90Y-Bremsstrahlung SPECT/CT after simultaneous Tc-MAA/90Y-microsphere injection for immediate treatment monitoring and further therapy planning for radioembolization. Eur J Nucl Med Mol Imaging 2011; 38:1281-8. [DOI: 10.1007/s00259-011-1751-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 02/01/2011] [Indexed: 11/28/2022]
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Rault E, Staelens S, Van Holen R, De Beenhouwer J, Vandenberghe S. Fast simulation of yttrium-90 bremsstrahlung photons with GATE. Med Phys 2010; 37:2943-50. [PMID: 20632606 DOI: 10.1118/1.3431998] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Multiple investigators have recently reported the use of yttrium-90 (90Y) bremsstrahlung single photon emission computed tomography (SPECT) imaging for the dosimetry of targeted radionuclide therapies. Because Monte Carlo (MC) simulations are useful for studying SPECT imaging, this study investigates the MC simulation of 90Y bremsstrahlung photons in SPECT. To overcome the computationally expensive simulation of electrons, the authors propose a fast way to simulate the emission of 90Y bremsstrahlung photons based on prerecorded bremsstrahlung photon probability density functions (PDFs). METHODS The accuracy of bremsstrahlung photon simulation is evaluated in two steps. First, the validity of the fast bremsstrahlung photon generator is checked. To that end, fast and analog simulations of photons emitted from a 90Y point source in a water phantom are compared. The same setup is then used to verify the accuracy of the bremsstrahlung photon simulations, comparing the results obtained with PDFs generated from both simulated and measured data to measurements. In both cases, the energy spectra and point spread functions of the photons detected in a scintillation camera are used. RESULTS Results show that the fast simulation method is responsible for a 5% overestimation of the low-energy fluence (below 75 keV) of the bremsstrahlung photons detected using a scintillation camera. The spatial distribution of the detected photons is, however, accurately reproduced with the fast method and a computational acceleration of approximately 17-fold is achieved. When measured PDFs are used in the simulations, the simulated energy spectrum of photons emitted from a point source of 90Y in a water phantom and detected in a scintillation camera closely approximates the measured spectrum. The PSF of the photons imaged in the 50-300 keV energy window is also accurately estimated with a 12.4% underestimation of the full width at half maximum and 4.5% underestimation of the full width at tenth maximum. CONCLUSIONS Despite its limited accuracy, the fast bremsstrahlung photon generator is well suited for the simulation of bremsstrahlung photons emitted in large homogeneous organs, such as the liver, and detected in a scintillation camera. The computational acceleration makes it very useful for future investigations of 90Y bremsstrahlung SPECT imaging.
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Affiliation(s)
- Erwann Rault
- Department of Electronics and Information Systems, MEDISIP Ghent University-IBBT-IBiTech, De Pintelaan 185, Block B, B-9000 Ghent, Belgium.
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Ahmadzadehfar H, Biersack HJ, Ezziddin S. Radioembolization of liver tumors with yttrium-90 microspheres. Semin Nucl Med 2010; 40:105-21. [PMID: 20113679 DOI: 10.1053/j.semnuclmed.2009.11.001] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Radioembolization (RE), also termed selective internal radiation therapy (SIRT), has been gradually introduced to the clinical arsenal of cytoreductive modalities in recent years. There is growing evidence for efficiency in liver tumors of various entities, with the most prominent ones being hepatocellular carcinoma, colorectal cancer, and neuroendocrine tumors. Hepatic metastases of numerous other tumor entities including breast cancer, cholangiocarcinoma, and pancreatic cancer are treatment-sensitive, even when being refractory to other treatment modalities such as bland-embolization, regional, or systemic chemotherapy. The antitumor effect of SIRT is related to radiation rather than embolization, with extraordinary high local radiation doses obtained selectively at the site of viable tumor and little affection of the surrounding normal liver tissue. Morphologic changes after RE may pose difficulties for interpretation in conventional restaging with regard to tumor viability and true response to treatment. Therefore, functional imaging, that is, metabolic imaging with (18)F fluorodeoxyglucose positron emission tomography (computed tomography) in the majority of treated tumors, is regarded the gold standard in this respect and should be included for pre- and post-SIRT assessment. To prevent serious toxicity to be associated with the potent antitumor efficacy, meticulous pretreatment evaluation is of particular importance. Improvements in predicting dosimetry will help optimize treatment and patient selection. Nuclear medicine procedures are essential for planning, performing, and monitoring of RE. However, the interdisciplinary aspect of patient management has to be emphasized for this particular treatment form. As SIRT is moving forward from the salvage setting indication to the use in earlier stages of hepatic tumor disease and with the advent of new treatment protocols and targeted therapies, embedding SIRT into a multidisciplinary approach will become even more important. This article focuses on procedural and technical aspects for selection, preparation, and performance of treatment as well as post-therapeutic monitoring and response assessment.
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