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Pinot F, Bourhis D, Bourbonne V, Floch R, Mauguen M, Blanc-Béguin F, Schick U, Hamya M, Abgral R, Le Gal G, Salaün PY, Lucia F, Le Roux PY. New Automated Method for Lung Functional Volumes Delineation with Lung Perfusion PET/CT Imaging. Cancers (Basel) 2023; 15:cancers15072166. [PMID: 37046827 PMCID: PMC10093378 DOI: 10.3390/cancers15072166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
Background: Gallium-68 lung perfusion PET/CT is an emerging imaging modality for the assessment of regional lung function, especially to optimise radiotherapy (RT) planning. A key step of lung functional avoidance RT is the delineation of lung functional volumes (LFVs) to be integrated into radiation plans. However, there is currently no consistent and reproducible delineation method for LFVs. The aim of this study was to develop and evaluate an automated delineation threshold method based on total lung function for LFVs delineation with Gallium-68 MAA lung PET/CT imaging. Material and Method: Patients prospectively enrolled in the PEGASUS trial—a pilot study assessing the feasibility of lung functional avoidance using perfusion PET/CT imaging for lung stereotactic body radiotherapy (SBRT) of primary or secondary lesion—were analysed. Patients underwent lung perfusion MAA-68Ga PET/CT imaging and pulmonary function tests (PFTs) as part of pre-treatment evaluation. LFVs were delineated using two methods: the commonly used relative to the maximal pixel value threshold method (pmax threshold method, X%pmax volumes) and a new approach based on a relative to whole lung function threshold method (WLF threshold method, FVX% volumes) using a dedicated iterative algorithm. For both methods, LFVs were expressed in terms of % of the anatomical lung volume (AV) and of % of the total lung activity. Functional volumes were compared for patients with normal PFTs and pre-existing airway disease. Results: 60 patients were analysed. Among the 48 patients who had PFTs, 31 (65%) had pre-existing lung disease. The pmax and WLF threshold methods clearly provided different functional volumes with a wide range of relative lung function for a given pmax volume, and conversely, a wide range of corresponding pmax values for a given WLF volume. The WLF threshold method provided more reliable and consistent volumes with much lower dispersion of LFVs as compared to the pmax method, especially in patients with normal PFTs. Conclusions: We developed a relative to whole lung function threshold segmentation method to delineate lung functional volumes on perfusion PET/CT imaging. The automated algorithm allows for reproducible contouring. This new approach, relatively unaffected by the presence of hot spots, provides reliable and consistent functional volumes, and is clinically meaningful for clinicians.
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Affiliation(s)
- Fanny Pinot
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
| | - David Bourhis
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
- GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, 29200 Brest, France
| | - Vincent Bourbonne
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- LaTIM, INSERM, UMR 1101, University of Brest, 29200 Brest, France
| | - Romain Floch
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
| | - Maelle Mauguen
- Radiation Oncology Department, University Hospital, 29200 Brest, France
| | - Frédérique Blanc-Béguin
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
- GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, 29200 Brest, France
| | - Ulrike Schick
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- LaTIM, INSERM, UMR 1101, University of Brest, 29200 Brest, France
| | - Mohamed Hamya
- Radiation Oncology Department, University Hospital, 29200 Brest, France
| | - Ronan Abgral
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
- GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, 29200 Brest, France
| | - Grégoire Le Gal
- Centre d’Investigation Clinique, CHRU de Brest, 29200 Brest, France
| | - Pierre-Yves Salaün
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
- GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, 29200 Brest, France
| | - François Lucia
- Radiation Oncology Department, University Hospital, 29200 Brest, France
- LaTIM, INSERM, UMR 1101, University of Brest, 29200 Brest, France
| | - Pierre-Yves Le Roux
- Service de Médecine Nucléaire, CHRU de Brest, 29200 Brest, France
- GETBO, INSERM, UMR1304, Université de Bretagne Occidentale, 29200 Brest, France
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Blanc-Béguin F, Damien P, Floch R, Kerleguer K, Hennebicq S, Robin P, Salaün PY, Le Roux PY. Radiation exposure to nuclear medicine technologists performing a V/Q PET: Comparison with conventional V/Q scintigraphy, [18F]FDG PET and [68Ga]Ga DOTATOC PET procedures. Front Med (Lausanne) 2022; 9:1051249. [DOI: 10.3389/fmed.2022.1051249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/16/2022] [Indexed: 12/05/2022] Open
Abstract
IntroductionVentilation/Perfusion (V/Q) PET/CT is an emerging imaging modality for regional lung function evaluation. The same carrier molecules as conventional V/Q scintigraphy are used but they are radiolabelled with gallium-68 (68Ga) instead of technetium-99m (99mTc). A recurrent concern regarding V/Q PET imaging is the radiation dose to the healthcare workers. The aim of this study was to evaluate the total effective dose and the finger dose received by the technologist when performing a V/Q PET procedure, and to compare them with the radiations doses received with conventional V/Q scintigraphy, FDG PET and Ga DOTATOC PET procedures.Materials and methodsThe whole body dose measurement was performed 10 times for each of the evaluated procedures using an electronic personal dosimeter (ED). For V/Q PET and V/Q scintigraphy procedures, ventilation and perfusion stages were separately evaluated. Internal exposure was measured for ventilation procedures. Finger dose measurements were performed 5 times for each of the PET procedures using Thermoluminescence (TL) pellets.ResultsThe technologist effective dose when performing a V/Q PET procedure was 2.83 ± 0.67 μSv, as compared with 1.16 ± 0.34 μSv for conventional V/Q scintigraphy, 2.13 ± 0.77 μSv for [68Ga]Ga-DOTATOC, and 2.86 ± 1.79 μSv for FDG PET procedures, respectively. The finger dose for the V/Q PET procedure was similar to the dose for a [68Ga]Ga-DOTATOC scan (0.35 mSv and 0.32 mSv, respectively).ConclusionThe technologist total effective dose for a V/Q PET procedure is ~2.4 higher than the dose for a conventional V/Q scintigraphy, but in the same range than the radiation exposure when performing common PET procedures, both in terms of total effective dose or finger dose. These results should be reassuring for the healthcare workers performing a V/Q PET procedure.
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Radiopharmaceutical Labelling for Lung Ventilation/Perfusion PET/CT Imaging: A Review of Production and Optimization Processes for Clinical Use. Pharmaceuticals (Basel) 2022; 15:ph15050518. [PMID: 35631345 PMCID: PMC9143102 DOI: 10.3390/ph15050518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022] Open
Abstract
Lung ventilation/perfusion (V/Q) positron emission tomography-computed tomography (PET/CT) is a promising imaging modality for regional lung function assessment. The same carrier molecules as a conventional V/Q scan (i.e., carbon nanoparticles for ventilation and macro aggregated albumin particles for perfusion) are used, but they are labeled with gallium-68 (68Ga) instead of technetium-99m (99mTc). For both radiopharmaceuticals, various production processes have been proposed. This article discusses the challenges associated with the transition from 99mTc- to 68Ga-labelled radiopharmaceuticals. The various production and optimization processes for both radiopharmaceuticals are reviewed and discussed for optimal clinical use.
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Le Roux PY. Lung ventilation/perfusion SPECT/CT imaging of lung cancer. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Blanc-Béguin F, Masset J, Robin P, Tripier R, Hennebicq S, Guilloux V, Vriamont C, Warnier C, Cogulet V, Eu P, Salaün PY, Le Roux PY. Fully Automated 68Ga-Labeling and Purification of Macroaggregated Albumin Particles for Lung Perfusion PET Imaging. FRONTIERS IN NUCLEAR MEDICINE (LAUSANNE, SWITZERLAND) 2021; 1:778191. [PMID: 39355632 PMCID: PMC11440869 DOI: 10.3389/fnume.2021.778191] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 10/04/2021] [Indexed: 10/03/2024]
Abstract
Lung PET/CT is a promising imaging modality for regional lung function assessment. Our aim was to develop and validate a fast, simple, and fully automated GMP compliant [68Ga]Ga-MAA labeling procedure, using a commercially available [99mTc]Tc-MAA kit, a direct gallium-68 eluate and including a purification of the [68Ga]Ga-MAA. Method: The synthesis parameters (pH, heating temperature) were manually determined. Automated 68Ga-labeling of MAA was then developed on a miniAIO (Trasis®, Ans, Belgium) module. An innovative automated process was developed for the purification. The process was then optimized and adapted to automate both the [68Ga]Ga-MAA synthesis and the isolation of gallium-68 eluate required for the pulmonary ventilation PET/CT. Results: The 15-min process demonstrated high reliability and reproducibility, with high synthesis yield (>95 %). Mean [68Ga]Ga-MAA radiochemical purity was 99 % ± 0.6 %. The 68Ga-labeled MAA particles size and morphology remained unchanged. Conclusion: A fast, user friendly, and fully automated process to produce GMP [68Ga]Ga-MAA for clinical use was developed. This automated process combining the advantages of using a non-modified MAA commercial kit, a gallium-68 eluate without pre-purification and an efficient final purification of the [68Ga]Ga-MAA may facilitate the implementation of lung PET/CT imaging in nuclear medicine departments.
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Affiliation(s)
| | | | - Philippe Robin
- Medecine Nucleaire, CHRU Brest, EA3878 (GETBO) IFR 148, Univ Brest, Brest, France
| | | | - Simon Hennebicq
- Medecine Nucleaire, CHRU Brest, EA3878 (GETBO) IFR 148, Univ Brest, Brest, France
| | - Valérie Guilloux
- Medecine Nucleaire, CHRU Brest, Brest, France
- Univ Brest, EA3878 (GETBO), INSERM 1078, Brest, France
| | | | | | | | - Peter Eu
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Pierre-Yves Salaün
- Medecine Nucleaire, CHRU Brest, EA3878 (GETBO) IFR 148, Univ Brest, Brest, France
| | - Pierre-Yves Le Roux
- Medecine Nucleaire, CHRU Brest, EA3878 (GETBO) IFR 148, Univ Brest, Brest, France
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Lucia F, Rehn M, Blanc-Béguin F, Le Roux PY. Radiation Therapy Planning of Thoracic Tumors: A Review of Challenges Associated With Lung Toxicities and Potential Perspectives of Gallium-68 Lung PET/CT Imaging. Front Med (Lausanne) 2021; 8:723748. [PMID: 34513884 PMCID: PMC8429617 DOI: 10.3389/fmed.2021.723748] [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: 06/11/2021] [Accepted: 08/09/2021] [Indexed: 12/13/2022] Open
Abstract
Despite the introduction of new radiotherapy techniques, such as intensity modulated radiation therapy or stereotactic body radiation therapy, radiation induced lung injury remains a significant treatment related adverse event of thoracic radiation therapy. Functional lung avoidance radiation therapy is an emerging concept in the treatment of lung disease to better preserve lung function and to reduce pulmonary toxicity. While conventional ventilation/perfusion (V/Q) lung scintigraphy is limited by a relatively low spatial and temporal resolution, the recent advent of 68Gallium V/Q lung PET/CT imaging offers a potential to increase the accuracy of lung functional mapping and to better tailor lung radiation therapy plans to the individual's lung function. Lung PET/CT imaging may also improve our understanding of radiation induced lung injury compared to the current anatomical based dose–volume constraints. In this review, recent advances in radiation therapy for the management of primary and secondary lung tumors and in V/Q PET/CT imaging for the assessment of functional lung volumes are reviewed. The new opportunities and challenges arising from the integration of V/Q PET/CT imaging in radiation therapy planning are also discussed.
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Affiliation(s)
- François Lucia
- Radiation Oncology Department, University Hospital, Brest, France
| | - Martin Rehn
- Radiation Oncology Department, University Hospital, Brest, France
| | - Frédérique Blanc-Béguin
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
| | - Pierre-Yves Le Roux
- Service de médecine nucléaire, CHRU de Brest, EA3878 (GETBO), Université de Brest, Brest, France
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McIntosh L, Jackson P, Hardcastle N, Bressel M, Kron T, Callahan JW, Steinfort D, Bucknell N, Hofman MS, Siva S. Automated assessment of functional lung imaging with 68Ga-ventilation/perfusion PET/CT using iterative histogram analysis. EJNMMI Phys 2021; 8:23. [PMID: 33677692 PMCID: PMC7937580 DOI: 10.1186/s40658-021-00375-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Functional lung mapping from Ga68-ventilation/perfusion (V/Q) PET/CT, which has been shown to correlate with pulmonary function tests (PFTs), may be beneficial in a number of clinical applications where sparing regions of high lung function is of interest. Regions of clumping in the proximal airways in patients with airways disease can result in areas of focal intense activity and artefact in ventilation imaging. These artefacts may even shine through to subsequent perfusion images and create a challenge for quantitative analysis of PET imaging. We aimed to develop an automated algorithm that interprets the uptake histogram of PET images to calculate a peak uptake value more representative of the global lung volume. METHODS Sixty-six patients recruited from a prospective clinical trial underwent both V/Q PET/CT imaging and PFT analysis before treatment. PET images were normalised using an iterative histogram analysis technique to account for tracer hotspots prior to the threshold-based delineation of varying values. Pearson's correlation between fractional lung function and PFT score was calculated for ventilation, perfusion, and matched imaging volumes at varying threshold values. RESULTS For all functional imaging thresholds, only FEV1/FVC PFT yielded reasonable correlations to image-based functional volume. For ventilation, a range of 10-30% of adapted peak uptake value provided a reasonable threshold to define a volume that correlated with FEV1/FVC (r = 0.54-0.61). For perfusion imaging, a similar correlation was observed (r = 0.51-0.56) in the range of 20-60% adapted peak threshold. Matched volumes were closely linked to ventilation with a threshold range of 15-35% yielding a similar correlation (r = 0.55-0.58). CONCLUSIONS Histogram normalisation may be implemented to determine the presence of tracer clumping hotspots in Ga-68 V/Q PET imaging allowing for automated delineation of functional lung and standardisation of functional volume reporting.
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Affiliation(s)
- Lachlan McIntosh
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.
| | - Price Jackson
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Nicholas Hardcastle
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, 3010, Australia.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, New South Wales, 2522, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tomas Kron
- Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, 3010, Australia
| | - Jason W Callahan
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Daniel Steinfort
- Respiratory Medicine, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Nicholas Bucknell
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, 3010, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
| | - Michael S Hofman
- Department of Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, 3010, Australia
| | - Shankar Siva
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, 3010, Australia.,Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, 3000, Australia
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8
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Le Pennec R, Iravani A, Woon B, Dissaux B, Gest B, Le Floch PY, Salaün PY, Le Gal G, Hofman MS, Hicks RJ, Le Roux PY. Gallium-68 Ventilation/Perfusion PET-CT and CT Pulmonary Angiography for Pulmonary Embolism Diagnosis: An Interobserver Agreement Study. Front Med (Lausanne) 2021; 7:599901. [PMID: 33665194 PMCID: PMC7921798 DOI: 10.3389/fmed.2020.599901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives:68Ga Ventilation/Perfusion V/Q PET-CT is a promising imaging tool for pulmonary embolism diagnosis. However, no study has verified whether the interpretation is reproducible between different observers. The aim of this study was to assess the interobserver agreement in the interpretation of V/Q PET-CT for the diagnosis of acute PE, and to compare it to the interobserver agreement of CTPA interpretation. Methods: Twenty-four cancer patients with suspected acute PE underwent V/Q PET-CT and CTPA within 24 h as part of a prospective pilot study evaluating V/Q PET-CT for the management of patients with suspected PE. V/Q PET-CT and CTPA scans were reassessed independently by four nuclear medicine physicians and four radiologists, respectively. Physicians had different levels of expertise in reading V/Q scintigraphy and CTPA. Interpretation was blinded to the initial interpretation and any clinical information or imaging test result. For each modality, results were reported on a binary fashion. V/Q PET/CT scans were read as positive if there was at least one segmental or two subsegmental mismatched perfusion defects. CTPA scans were interpreted as positive if there was a constant intraluminal filling defect. Interobserver agreement was assessed by calculating kappa (κ) coefficients. Results: Out of the 24 V/Q PET-CT scans, the diagnostic conclusion was concordantly negative in 22 patients and concordantly positive in one patient. The remaining scan was interpreted as positive by one reader and negative by three readers. Out of the 24 CTPA scans, the diagnostic conclusion was concordantly negative in 16 and concordantly positive in one. Out of the seven remaining scans, PE was reported by one reader in four cases, by two readers in two cases, by three readers in one case. Most of discordant results on CTPA were related to clots reported on subsegmental arteries. Mean kappa coefficient was 0.79 for V/Q PET-CT interpretation and 0.39 for CTPA interpretation. Conclusions: Interobserver agreement in the interpretation of V/Q PET-CT for PE diagnosis was substantial (kappa 0.79) in a population with a low prevalence of significant PE. Agreement was lower with CTPA, mainly as a result of discrepancies at the level of the subsegmental arteries.
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Affiliation(s)
- Romain Le Pennec
- Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France
| | - Amir Iravani
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Beverley Woon
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Brieg Dissaux
- Radiology, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France
| | - Bibiche Gest
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Pierre-Yves Salaün
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Rodney J Hicks
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Pierre-Yves Le Roux
- Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France.,Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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9
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68Ga-Labelled Carbon Nanoparticles for Ventilation PET/CT Imaging: Physical Properties Study and Comparison with Technegas®. Mol Imaging Biol 2020; 23:62-69. [PMID: 32886302 DOI: 10.1007/s11307-020-01532-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/07/2020] [Accepted: 08/12/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The use of 68Ga-labelled carbon nanoparticles has been proposed for lung ventilation PET/CT imaging. However, no study has assessed the physical properties of 68Ga-labelled carbon nanoparticles. The aim of this study therefore was to evaluate the shape and size of 68Ga-labelled carbon nanoparticles, and to determine the composition of the aerosol, as opposed to 99mTc-labelled carbon nanoparticles aerosol. PROCEDURES 99mTc- and 68Ga-labelled carbon nanoparticles, stable gallium carbon nanoparticles, 0.9 % NaCl and 0.1 N HCl-based carbon nanoparticles were produced using an unmodified Technegas® generator, following the usual technique used for clinical Technegas® production. The shape and size of particles were studied by transmission electron microscopy (TEM) after decay of the radioactive samples. The composition of the 68Zn- and 99Tc-labelled carbon nanoparticles aerosols was assessed using scanning electron microscopy (SEM) coupled with energy dispersive X-ray (EDX) analysis after decay of the 68Ga- and 99mTc-labelled carbon nanoparticles, respectively. RESULTS On TEM, all samples showed similar shape with hexagonally structured primary particles, agglomerated in clusters. The mean diameters of primary stable gallium carbon nanoparticles, 99Tc- and 68Zn-labelled carbon nanoparticles were 22.4 ± 10 nm, 20.9 ± 7.2 nm and 19.8 ± 11.7 nm, respectively. CONCLUSION Using Technegas® generator in the usual clinical way, 99mTc- and 68Ga-labelled carbon nanoparticles demonstrated similar shape and diameters in the same size range size. These results support the use of 68Ga-labelled carbon nanoparticles for the assessment of regional lung ventilation function with PET imaging.
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10
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Bonney A, Wagner CA, Siva S, Callahan J, Le Roux PY, Pascoe DM, Irving L, Hofman MS, Steinfort DP. Correlation of positron emission tomography ventilation-perfusion matching with CT densitometry in severe emphysema. EJNMMI Res 2020; 10:86. [PMID: 32725552 PMCID: PMC7387398 DOI: 10.1186/s13550-020-00672-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022] Open
Abstract
Background Emphysema severity is frequently measured on CT via densitometry. Correlation with scintigraphic and spirometric functional measures of ventilation or perfusion varies widely, and no prior study has evaluated correlation between densitometry and lobar ventilation/perfusion in patients with severe emphysema. The aim of this study was to evaluate the utility and findings of gallium-68 (68Ga) ventilation/perfusion positron emission tomography-CT (68Ga-VQ/PET-CT) in severe emphysema assessment. Methods Fourteen consecutive patients undergoing evaluation for bronchoscopic lung volume reduction between March 2015 and March 2018 underwent 68Ga-VQ/PET-CT assessment for lobar functional lung mapping, in addition to CT densitometry. Correlations between CT densitometry and 68Ga-VQ/PET-CT parameters for individual lobar lung function were sought. Results CT densitometry assessment of emphysema correlated only weakly (R2 = 0.13) with lobar perfusion and was not correlated with ventilation (R2 = 0.04). Densitometry was moderately (R2 = 0.67) correlated with V/Q units in upper lobes, though poorly reflected physiological function in lower lobes (R2 = 0.19). Emphysema severity, as measured by CT densitometry, was moderately correlated with proportion of normal V/Q units and matched V/Q defects in individual lobes. Conclusions Assessment of lobar pulmonary function by 68Ga-VQ/PET-CT provides physiologic information not evident on CT densitometry such as ventilation and perfusion specifics and matched defects. Further research is needed to see if the discordant findings on 68Ga-VQ/PET-CT provide prognostic information or can be used to modify patient management and improve outcomes.
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Affiliation(s)
- Asha Bonney
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Carrie-Anne Wagner
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Shankar Siva
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Radiation Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jason Callahan
- Department of Radiation Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Pierre-Yves Le Roux
- Department of Molecular Imaging and Therapeutic Nuclear Medicine, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Nuclear Medicine Department, University Hospital and EA3878 (GETBO) IFR 148, Brest, France
| | - Diane M Pascoe
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Radiology, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Louis Irving
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael S Hofman
- Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.,Department of Radiation Oncology, Sir Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Daniel P Steinfort
- Department of Respiratory Medicine, Royal Melbourne Hospital, Parkville, Victoria, Australia. .,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia.
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11
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Weinberg L, Cosic L, Louis M, Garry T, Lloyd-Donald P, Barnett S, Miles LF. Intraoperative oxygen challenge for toleration of single lung ventilation in a patient with severe obstructive airway disease: A case report. Ann Med Surg (Lond) 2019; 49:28-32. [PMID: 31871680 PMCID: PMC6909052 DOI: 10.1016/j.amsu.2019.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 11/26/2022] Open
Abstract
Perioperative risk assessment is complex in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery. A 70-year-old female with severe chronic obstructive pulmonary disease and previous right middle and lower lobectomy, presented for left lower lobe superior segmentectomy. Respiratory function tests revealed a forced expiratory volume in 1 second of 0.72L, a forced vital capacity of 1.93L, and a carbon monoxide transfer factor of 10.0 ml/min/mmHg. A cardiopulmonary exercise test demonstrated little ventilatory reserve with profound arterial desaturation on peak exercise, however, a normal peak oxygen consumption (16.7 ml/min/kg) and a nadir minute ventilation/carbon dioxide slope of 24 implied a limited risk of perioperative cardiovascular morbidity. Given these conflicting results we performed an intraoperative oxygen challenge test under general anaesthesia with sequential ventilation of different lobes of the lung. We demonstrate the use of the oxygen challenge test as an effective intervention to further assess safety and tolerance of anaesthesia of patients with limited respiratory reserve being assessed for further complex redo lung resection surgery. Further, this test was a risk stratification tool that allowed informed decisions to be made by the patient about therapeutic options for treating their lung cancer. The prognostic value of traditional physiological parameters in patients with chronic obstructive pulmonary disease who have undergone previous lung resection surgery is uncertain. The intraoperative oxygen challenge test is another risk stratification tool to assist clinicians in assessment of safety and tolerance of anaesthesia for patients being considered for lung resection.
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Key Words
- Anaesthesia
- Bronchial blocker
- COPD, chronic obstructive pulmonary disease
- CPET, cardiopulmonary exercise testing
- CT, computed tomography
- Case report
- FEV1, forced expiratory volume in 1 second
- FVC, forced vital capacity
- Risk stratification
- SABR, stereotactic ablative radiotherapy
- SPECT, single photon emission computed tomography
- TLCO, carbon monoxide transfer factor
- Thoracic surgery
- VE/VCO2, minute ventilation/carbon dioxide
- VO2, maximum oxygen consumption
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Affiliation(s)
- Laurence Weinberg
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
| | - Luka Cosic
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
| | - Maleck Louis
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
| | - Tom Garry
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
| | - Patryck Lloyd-Donald
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
| | - Stephen Barnett
- Department of Cardiothoracic Surgery, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
| | - Lachlan F Miles
- Department of Anaesthesia, Austin Hospital, 145 Studley Road, Victoria, 3084, Australia
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12
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Arnon-Sheleg E, Haberfeld O, Kremer R, Keidar Z, Weiler-Sagie M. Head-to-Head Prospective Comparison of Quantitative Lung Scintigraphy and Segment Counting in Predicting Pulmonary Function in Lung Cancer Patients Undergoing Video-Assisted Thoracoscopic Lobectomy. J Nucl Med 2019; 61:981-989. [PMID: 31862797 DOI: 10.2967/jnumed.119.234526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/06/2019] [Indexed: 12/25/2022] Open
Abstract
Prediction of postoperative pulmonary function in lung cancer patients before tumor resection is essential for patient selection for surgery and is conventionally done with a nonimaging segment counting method (SC) or 2-dimensional planar lung perfusion scintigraphy (PS). The purpose of this study was to compare quantitative analysis of PS to SPECT/CT and to estimate the accuracy of SC, PS, and SPECT/CT in predicting postoperative pulmonary function in patients undergoing lobectomy. Methods: Seventy-five non-small cell lung cancer patients planned for lobectomy were prospectively enrolled (68% male; average age, 68.1 ± 8 y). All patients completed tests of preoperative forced expiratory volume capacity in 1 s (FEV1) and diffusing capacity of the lungs for carbon monoxide (DLCO), as well as 99mTc-macroaggregated albumin PS and SPECT/CT quantification. A subgroup of 60 patients underwent video-assisted thoracoscopic lobectomy and measurement of postoperative FEV1 and DLCO. Relative uptake of the lung lobes estimated by PS and SPECT/CT was compared. Predicted postoperative FEV1 and DLCO were derived from SC, PS, and SPECT/CT. Prediction results were compared between the different methods and the true postoperative measurements in patients who underwent lobectomy. Results: Relative uptake measurements differed significantly between PS and SPECT/CT in right lung lobes, with a mean difference of -8.2 ± 3.8, 18.0 ± 5.0, and -11.5 ± 6.1 for right upper, middle, and lower lobes, respectively (P < 0.001). The differences between the methods in the left lung lobes were minor, with a mean difference of -0.4 ± 4.4 (P > 0.05) and -2.0 ± 4.0 (P < 0.001) for left upper and lower lobes, respectively. No significant difference and a strong correlation (R = 0.6-0.76, P < 0.001) were found between predicted postoperative lung function values according to SC, PS, SPECT/CT, and the actual postoperative FEV1 and DLCO. Conclusion: Although lobar quantification parameters differed significantly between PS and SPECT/CT, no significant differences were found between the predicted postoperative lung function results derived from these methods and the actual postoperative results. The additional time and effort of SPECT/CT quantification may not have an added value in patient selection for surgery. SPECT/CT may be advantageous in patients planned for right lobectomy, but further research is warranted.
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Affiliation(s)
| | - Ori Haberfeld
- Rambam Medical Center, Haifa, Israel; and.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Ran Kremer
- Rambam Medical Center, Haifa, Israel; and.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Zohar Keidar
- Rambam Medical Center, Haifa, Israel; and.,Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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13
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Le Roux PY, Iravani A, Callahan J, Burbury K, Eu P, Steinfort DP, Lau E, Woon B, Salaun PY, Hicks RJ, Hofman MS. Independent and incremental value of ventilation/perfusion PET/CT and CT pulmonary angiography for pulmonary embolism diagnosis: results of the PECAN pilot study. Eur J Nucl Med Mol Imaging 2019; 46:1596-1604. [PMID: 31044265 DOI: 10.1007/s00259-019-04338-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 04/15/2019] [Indexed: 01/22/2023]
Abstract
PURPOSE This pilot study assessed the independent and incremental value of 68Ga-V/Q PET/CT as compared with CT pulmonary angiography (CTPA) for the management of cancer patients with suspected acute pulmonary embolism (PE). METHODS All 24 cancer patients with suspected acute PE prospectively recruited underwent both 68Ga-V/Q PET/CT and CTPA within 24 h. PET/CT was acquired after inhalation of Galligas prepared using a Technegas generator and administration of 68Ga-macroaggregated albumin. Initially, PET/CT and CTPA scans were read independently with the reader blinded to the results of the other imaging study. CTPA and PET/CT were then coregistered and reviewed by consensus between a radiologist and nuclear medicine physician. The therapeutic management was established by the managing physician based on all available data. RESULTS The diagnostic conclusion was concordantly negative in 18 patients (75%). Of the six discordant diagnoses on independent reading, combined interpretation of V/Q PET/CTPA enabled a consensus conclusion in two patients, excluding PE in one and confirming PE in the other, similar to the initial diagnostic conclusion of the V/Q PET/CT. Of the remaining four patients, three had a single subsegmental thrombus on CTPA but a negative V/Q PET/CT scan, and two of these did not receive long-term anticoagulation and did not have a venous thromboembolic event during a 3-year follow-up period. The third patient, along with a patient with a positive V/Q PET/CT scan but a negative CTPA scan, presented with acute complications preventing any conclusions with regard to the appropriateness of the V/Q PET/CT results in the management of PE. Overall, V/Q PET had an impact on management in four patients (17%). CONCLUSION In this pilot study, we demonstrated the feasibility and potential utility of V/Q PET/CT for the management of patients with suspected PE. V/Q PET/CT may be of particular relevance in patients with equivocal findings or isolated subsegmental findings on CTPA, adding further discriminatory information to allow important decision-making regarding the use or withholding of anticoagulation. Given the other advantages of V/Q PET/CT (reduced acquisition time, low radiation dose), and with the increasing availability of 68Ga generators, PET/CT is a potential replacement for V/Q SPECT/CT imaging.
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Affiliation(s)
- Pierre-Yves Le Roux
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France.
| | - Amir Iravani
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jason Callahan
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Burbury
- Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Peter Eu
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Daniel P Steinfort
- Respiratory Medicine, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Eddie Lau
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Beverly Woon
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Pierre-Yves Salaun
- Nuclear Medicine, Brest University Hospital, EA3878 (GETBO) IFR 148, Brest, France
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Michael S Hofman
- Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia.
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14
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Le Roux PY, Hicks RJ, Siva S, Hofman MS. PET/CT Lung Ventilation and Perfusion Scanning using Galligas and Gallium-68-MAA. Semin Nucl Med 2019; 49:71-81. [DOI: 10.1053/j.semnuclmed.2018.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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15
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Fernández-Rodríguez L, Torres I, Romera D, Galera R, Casitas R, Martínez-Cerón E, Díaz-Agero P, Utrilla C, García-Río F. Prediction of postoperative lung function after major lung resection for lung cancer using volumetric computed tomography. J Thorac Cardiovasc Surg 2018; 156:2297-2308.e5. [PMID: 30195604 DOI: 10.1016/j.jtcvs.2018.07.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The study objectives were to assess the accuracy of volumetric computed tomography to predict postoperative lung function in patients with lung cancer in relation to anatomic segments counting and perfusion scintigraphy, to generate specific predictive equations for each functional parameter, and to evaluate accuracy and precision of these in a validation cohort. METHODS We assessed pulmonary functions preoperatively and 3 to 4 months postoperatively after lung resection for lung cancer (n = 114). Absolute and relative lung volumes (total and upper/middle/lower) were determined using volumetric software analysis for staging thoracic computed tomography scans. Predicted postoperative function was calculated by segments counting, scintigraphy, and volumetric computed tomography. RESULTS Volumetric computed tomography achieves a higher correlation and precision with measured postoperative lung function than segments counting or scintigraphy (correlation and intraclass correlation coefficients, 0.779-0.969 and 0.776-0.969; 0.573-0.887 and 0.552-0.882; and 0.578-0.834 and 0.532-0.815, respectively), as well as greater accuracy, determined by narrower agreement coefficients for forced vital capacity, forced expiratory volume in 1 second, lung diffusing capacity, and peak oxygen uptake. After validation in an independent cohort (n = 43), adjusted linear regression including volumetric estimation of decreased postoperative ventilation for postoperative lung function parameters explains 98% to 99% of variance. CONCLUSIONS Volumetric computed tomography is a reliable and accurate method to predict postoperative lung function in patients undergoing lung resection that provides better accuracy than conventional procedures. Because lung computed tomography is systematically performed in the staging of patients with suspected lung cancer, this volumetric analysis might simultaneously provide the information necessary to evaluate operability.
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Affiliation(s)
| | - Isabel Torres
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - Delia Romera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Raúl Galera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Raquel Casitas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Elisabet Martínez-Cerón
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain
| | - Prudencio Díaz-Agero
- Servicio de Cirugía Torácica, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Cristina Utrilla
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; CIBER de Enfermedades Respiratorias, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain.
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16
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Le Roux PY, Siva S, Callahan J, Claudic Y, Bourhis D, Steinfort DP, Hicks RJ, Hofman MS. Automatic delineation of functional lung volumes with 68Ga-ventilation/perfusion PET/CT. EJNMMI Res 2017; 7:82. [PMID: 29019109 PMCID: PMC5634989 DOI: 10.1186/s13550-017-0332-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 10/06/2017] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Functional volumes computed from 68Ga-ventilation/perfusion (V/Q) PET/CT, which we have shown to correlate with pulmonary function test parameters (PFTs), have potential diagnostic utility in a variety of clinical applications, including radiotherapy planning. An automatic segmentation method would facilitate delineation of such volumes. The aim of this study was to develop an automated threshold-based approach to delineate functional volumes that best correlates with manual delineation. Thirty lung cancer patients undergoing both V/Q PET/CT and PFTs were analyzed. Images were acquired following inhalation of Galligas and, subsequently, intravenous administration of 68Ga-macroaggreted-albumin (MAA). Using visually defined manual contours as the reference standard, various cutoff values, expressed as a percentage of the maximal pixel value, were applied. The average volume difference and Dice similarity coefficient (DSC) were calculated, measuring the similarity of the automatic segmentation and the reference standard. Pearson's correlation was also calculated to compare automated volumes with manual volumes, and automated volumes optimized to PFT indices. RESULTS For ventilation volumes, mean volume difference was lowest (- 0.4%) using a 15%max threshold with Pearson's coefficient of 0.71. Applying this cutoff, median DSC was 0.93 (0.87-0.95). Nevertheless, limits of agreement in volume differences were large (- 31.0 and 30.2%) with differences ranging from - 40.4 to + 33.0%. For perfusion volumes, mean volume difference was lowest and Pearson's coefficient was highest using a 15%max threshold (3.3% and 0.81, respectively). Applying this cutoff, median DSC was 0.93 (0.88-0.93). Nevertheless, limits of agreement were again large (- 21.1 and 27.8%) with volume differences ranging from - 18.6 to + 35.5%. Using the 15%max threshold, moderate correlation was demonstrated with FEV1/FVC (r = 0.48 and r = 0.46 for ventilation and perfusion images, respectively). No correlation was found between other PFT indices. CONCLUSIONS To automatically delineate functional volumes with 68Ga-V/Q PET/CT, the most appropriate cutoff was 15%max for both ventilation and perfusion images. However, using this unique threshold systematically provided unacceptable variability compared to the reference volume and relatively poor correlation with PFT parameters. Accordingly, a visually adapted semi-automatic method is favored, enabling rapid and quantitative delineation of lung functional volumes with 68Ga-V/Q PET/CT.
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Affiliation(s)
- Pierre-Yves Le Roux
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia. .,Nuclear Medicine Department, Brest University Hospital, EA3878 (GETBO) IFR, 148, Brest, France. .,Service de médecine nucléaire, CHRU de Brest, 29609, Brest CEDEX, France.
| | - Shankar Siva
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Jason Callahan
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia
| | - Yannis Claudic
- Nuclear Medicine Department, Brest University Hospital, EA3878 (GETBO) IFR, 148, Brest, France
| | - David Bourhis
- Nuclear Medicine Department, Brest University Hospital, EA3878 (GETBO) IFR, 148, Brest, France
| | - Daniel P Steinfort
- Respiratory Medicine, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Australia
| | - Rodney J Hicks
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia.,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
| | - Michael S Hofman
- Cancer Imaging, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, 3000, Australia. .,The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia.
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Le Roux PY, Robin P, Salaun PY. New developments and future challenges of nuclear medicine and molecular imaging for pulmonary embolism. Thromb Res 2017; 163:236-241. [PMID: 28673474 DOI: 10.1016/j.thromres.2017.06.031] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 06/20/2017] [Accepted: 06/25/2017] [Indexed: 11/29/2022]
Abstract
Although widely validated, current tests for pulmonary embolism (PE) diagnosis, i.e. computed tomography pulmonary angiography (CTPA) and V/Q planar scintigraphy, have some limitations. Drawbacks of CTPA include the radiation dose, some contra indications and a rising concern about a possible overdiagnosis/overtreatment of PE. On the other hand, V/Q planar scintigraphy has a high rate of non-diagnostic tests responsible for complex diagnostic algorithms. Since the PIOPED study, imaging equipment and radiopharmaceuticals have greatly evolved allowing the introduction of techniques that improve imaging of lung ventilation and perfusion. Single photon emission computed tomography (SPECT) and SPECT/CT techniques are already largely used in daily practice and have been described to have greater diagnostic performance and much fewer non-diagnostic tests as compared with planar scintigraphy. However, they have not yet been firmly validated in large scale prospective outcome studies. More recently, it has also been proposed to image pulmonary perfusion and ventilation using positron emission tomography (PET), which has an inherent technical superiority as compared to conventional scintigraphy and may provide new insight for pulmonary embolism. Regardless of modality, these new thoracic imaging modalities have to be integrated into diagnostic strategies. The other major challenge for venous thromboembolism diagnosis may be the potential additional value of molecular imaging allowing specific targeting of thrombi in order, for example, to differentiate venous thromboembolism from tumor or septic thrombus, or acute from residual disease. In this article, the new imaging procedures of lung ventilation perfusion imaging with SPECT, SPECT/CT and PET/CT are discussed. We also review the current status and future challenge of molecular imaging for the in vivo characterization of venous thromboembolism.
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Affiliation(s)
- Pierre-Yves Le Roux
- Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France.
| | - Philippe Robin
- Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France
| | - Pierre-Yves Salaun
- Université Européenne de Bretagne, Université de Brest, EA3878 (GETBO) IFR 148, CHRU de Brest, Service de Médecine Nucléaire, Brest, France
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