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Ringheim A, Campos Neto GDC, Anazodo U, Cui L, da Cunha ML, Vitor T, Martins KM, Miranda ACC, de Barboza MF, Fuscaldi LL, Lemos GC, Colombo Junior JR, Baroni RH. Kinetic modeling of 68Ga-PSMA-11 and validation of simplified methods for quantification in primary prostate cancer patients. EJNMMI Res 2020; 10:12. [PMID: 32140850 PMCID: PMC7058750 DOI: 10.1186/s13550-020-0594-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The positron emission tomography (PET) ligand 68Ga-Glu-urea-Lys(Ahx)-HBED-CC (68Ga-PSMA-11) targets the prostate-specific membrane antigen (PSMA), upregulated in prostate cancer cells. Although 68Ga-PSMA-11 PET is widely used in research and clinical practice, full kinetic modeling has not yet been reported nor have simplified methods for quantification been validated. The aims of our study were to quantify 68Ga-PSMA-11 uptake in primary prostate cancer patients using compartmental modeling with arterial blood sampling and to validate the use of standardized uptake values (SUV) and image-derived blood for quantification. RESULTS Fifteen patients with histologically proven primary prostate cancer underwent a 60-min dynamic 68Ga-PSMA-11 PET scan of the pelvis with axial T1 Dixon, T2, and diffusion-weighted magnetic resonance (MR) images acquired simultaneously. Time-activity curves were derived from volumes of interest in lesions, normal prostate, and muscle, and mean SUV calculated. In total, 18 positive lesions were identified on both PET and MR. Arterial blood activity was measured by automatic arterial blood sampling and manual blood samples were collected for plasma-to-blood ratio correction and for metabolite analysis. The analysis showed that 68Ga-PSMA-11 was stable in vivo. Based on the Akaike information criterion, 68Ga-PSMA-11 kinetics were best described by an irreversible two-tissue compartment model. The rate constants K1 and k3 and the net influx rate constants Ki were all significantly higher in lesions compared to normal tissue (p < 0.05). Ki derived using image-derived blood from an MR-guided method showed excellent agreement with Ki derived using arterial blood sampling (intraclass correlation coefficient = 0.99). SUV correlated significantly with Ki with the strongest correlation of scan time-window 30-45 min (rho 0.95, p < 0.001). Both Ki and SUV correlated significantly with serum prostate specific antigen (PSA) level and PSA density. CONCLUSIONS 68Ga-PSMA-11 kinetics can be described by an irreversible two-tissue compartment model. An MR-guided method for image-derived blood provides a non-invasive alternative to blood sampling for kinetic modeling studies. SUV showed strong correlation with Ki and can be used in routine clinical settings to quantify 68Ga-PSMA-11 uptake.
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Affiliation(s)
- Anna Ringheim
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil.
| | | | - Udunna Anazodo
- Lawson Health Research Institute, St Joseph's Health Care, 268 Grosvenor Street, London, Ontario, N6A 4V2, Canada.,Department of Medical Biophysics, Western University, 1151 Richmond Street N, London, Ontario, N6A 5C1, Canada
| | - Lumeng Cui
- Division of Biomedical Engineering, University of Saskatchewan, 57 Campus Drive, Saskatoon, Saskatchewan, SK, S7N 5A9, Canada
| | - Marcelo Livorsi da Cunha
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Taise Vitor
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Karine Minaif Martins
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Ana Cláudia Camargo Miranda
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Marycel Figols de Barboza
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Leonardo Lima Fuscaldi
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - José Roberto Colombo Junior
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
| | - Ronaldo Hueb Baroni
- Hospital Israelita Albert Einstein, Avenida Albert Einstein 627/701, Morumbi, Sao Paulo, SP, CEP 05652-900, Brazil
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Abstract
BACKGROUND It is of great importance to understand how patients and their close relatives experience the pros and cons of advanced home care so as to further develop this quickly growing choice of care. OBJECTIVE The aim of this study was to explore the experiences of receiving advanced home care among patients affected by life-threatening illness and their close relatives. DESIGN The study was an interview study conducted with patients in their homes. Some patient interviews were conducted together with a close relative participating. SETTING/PARTICIPANTS Patients registered in advanced home care in 2017 were offered the opportunity to participate in the study. The selection criteria were that the patient was within grade 3 of the Eastern Cooperative Oncology Group's Performance Status, older than 18 years, able to orient to time and place, and not newly registered. ANALYSIS The interviews were recorded and transcribed verbatim and analyzed with qualitative content analysis. RESULTS A total of 11 interviews were conducted: 8 with patients and 1 or 2 close relatives together; and 3 with the patient alone. It resulted in 3 main categories: create a safe environment, see the person, and better to manage care at home. CONCLUSION The results of this study show that patients and close relatives perceived that advanced home care was a safe and secure form of caring during advanced as well as end-of-life care.
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Affiliation(s)
- Ingela Wennman
- Department of Strategic Planning, Sahlgrenska University Hospital, Göteborg, Sweden.,Institute of Caring Sciences and Health, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden
| | - Anna Ringheim
- Department of Quality Development, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Helle Wijk
- Institute of Caring Sciences and Health, Sahlgrenska Academy, Gothenburg University, Göteborg, Sweden.,Department of Quality Development, Sahlgrenska University Hospital, Göteborg, Sweden.,Gothenburg Center of Person Centred Care (GPCC), Gothenburg University, Göteborg, Sweden.,Center for Health Care Architecture, Chalmers University, Göteborg, Sweden
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Höglund J, Shirvan A, Antoni G, Gustavsson SÅ, Långström B, Ringheim A, Sörensen J, Ben-Ami M, Ziv I. 18F-ML-10, a PET Tracer for Apoptosis: First Human Study. J Nucl Med 2011; 52:720-5. [DOI: 10.2967/jnumed.110.081786] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Razifar P, Engler H, Blomquist G, Ringheim A, Estrada S, Långström B, Bergström M. Principal component analysis with pre-normalization improves the signal-to-noise ratio and image quality in positron emission tomography studies of amyloid deposits in Alzheimer's disease. Phys Med Biol 2009; 54:3595-612. [DOI: 10.1088/0031-9155/54/11/021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Razifar P, Engler H, Ringheim A, Estrada S, Wall A, Langstrom B. An Automated Method for Delineating a Reference Region Using Masked Volumewise Principal-Component Analysis in 11C-PIB PET. J Nucl Med Technol 2009; 37:38-44. [DOI: 10.2967/jnmt.108.054296] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Razifar P, Ringheim A, Engler H, Hall H, Långström B. Masked-Volume-Wise PCA and "reference Logan" illustrate similar regional differences in kinetic behavior in human brain PET study using [11C]-PIB. BMC Neurol 2009; 9:2. [PMID: 19126243 PMCID: PMC2647899 DOI: 10.1186/1471-2377-9-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Accepted: 01/07/2009] [Indexed: 11/10/2022] Open
Abstract
Background Kinetic modeling using reference Logan is commonly used to analyze data obtained from dynamic Positron Emission Tomography (PET) studies on patients with Alzheimer's disease (AD) and healthy volunteers (HVs) using amyloid imaging agent N-methyl [11C]2-(4'-methylaminophenyl)-6-hydroxy-benzothiazole, [11C]-PIB. The aim of the present study was to explore whether results obtained using the newly introduced method, Masked Volume Wise Principal Component Analysis, MVW-PCA, were similar to the results obtained using reference Logan. Methods MVW-PCA and reference Logan were performed on dynamic PET images obtained from four Alzheimer's disease (AD) patients on two occasions (baseline and follow-up) and on four healthy volunteers (HVs). Regions of interest (ROIs) of similar sizes were positioned in different parts of the brain in both AD patients and HVs where the difference between AD patients and HVs is largest. Signal-to-noise ratio (SNR) and discrimination power (DP) were calculated for images generated by the different methods and the results were compared both qualitatively and quantitatively. Results MVW-PCA generated images that illustrated similar regional binding patterns compared to reference Logan images and with slightly higher quality, enhanced contrast, improved SNR and DP, without being based on modeling assumptions. MVW-PCA also generated additional MVW-PC images by using the whole dataset, which illustrated regions with different and uncorrelated kinetic behaviors of the administered tracer. This additional information might improve the understanding of kinetic behavior of the administered tracer. Conclusion MVW-PCA is a potential multivariate method that without modeling assumptions generates high quality images, which illustrated similar regional changes compared to modeling methods such as reference Logan. In addition, MVW-PCA could be used as a new technique, applicable not only on dynamic human brain studies but also on dynamic cardiac studies when using PET.
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Affiliation(s)
- Pasha Razifar
- Molecular Imaging & CT Research, GE Healthcare, WI 53188, Waukesha, USA.
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Blomquist G, Engler H, Nordberg A, Ringheim A, Wall A, Forsberg A, Estrada S, Frändberg P, Antoni G, Långström B. Unidirectional Influx and Net Accumulation of PIB. Open Neuroimag J 2008; 2:114-25. [PMID: 19526073 PMCID: PMC2695622 DOI: 10.2174/1874440000802010114] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/25/2008] [Accepted: 09/17/2008] [Indexed: 11/22/2022] Open
Abstract
The compound {N-methyl-[(11)C]}2-(4'-methylaminophenyl)-6-hydroxybenzothiazole, "PIB", measured by positron emission tomography, has been demonstrated to image brain beta-amyloid deposition in Alzheimer's disease (AD). In the present study the benefit of measuring the PIB accumulation rate together with the unidirectional influx of PIB into the brain was investigated in healthy control subjects and patients with AD. In a monkey changes in the influx rate constant K(1) of PIB closely followed changes in CBF, caused by alteration of Pa(CO2). In addition, K(1) was high both in the monkey and in humans, suggesting that this parameter reflects CBF. Most AD patients studied showed clearly higher accumulation rate for PIB than the controls in cortical brain areas, while a few patients showed as low accumulation as the controls. K(1) did not correlate with the accumulation rate, indicating that K(1) for PIB provides extra information besides the accumulation rate.
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Affiliation(s)
- Gunnar Blomquist
- Department of Oncology, Radiology and Clinical Immunology, Uppsala University, Uppsala, Sweden
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Kadir A, Darreh-Shori T, Almkvist O, Wall A, Grut M, Strandberg B, Ringheim A, Blomquist G, Långström B, Nordberg A. PET imaging of the in vivo brain acetylcholinesterase activity and nicotine binding in galantamine-treated patients with AD. Neurobiol Aging 2008; 29:1204-17. [PMID: 17379359 DOI: 10.1016/j.neurobiolaging.2007.02.020] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 01/18/2007] [Accepted: 02/14/2007] [Indexed: 10/23/2022]
Abstract
The effect of galantamine treatment on cortical acetylcholinesterase (AChE) activity and nicotinic receptor binding was investigated by positron emission tomography (PET) in 18 patients with mild Alzheimer's disease (AD) in relation to galantamine concentration and the patients' cognitive performances. The first 3 months of the study was of a randomized double-blind placebo-controlled design, during which 12 patients received galantamine (16-24mg/day) and 6 patients the placebo, and this was followed by 9 months' galantamine treatment in all patients. The patients underwent PET examinations to measure cortical AChE activity ((11)C-PMP) and (11)C-nicotine binding. Neuropsychological tests were performed throughout the study. Inhibition (30-40%) of cortical AChE activity was observed after 3 weeks to 12 months of galantamine treatment. No significant change in mean cortical (11)C-nicotine binding was observed during the study. (11)C-Nicotine binding, however, positively correlated with plasma galantamine concentration. Both the changes of AChE activity and (11)C-nicotine binding correlated positively with the results of a cognitive test of attention. In conclusion, galantamine caused sustained AChE inhibition for up to 12 months. At the individual level, the in vivo cortical AChE inhibition and (11)C-nicotine binding were associated with changes in the attention domain of cognition rather than episodic memory.
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Affiliation(s)
- A Kadir
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
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Forsberg A, Engler H, Almkvist O, Blomquist G, Hagman G, Wall A, Ringheim A, Långström B, Nordberg A. PET imaging of amyloid deposition in patients with mild cognitive impairment. Neurobiol Aging 2007; 29:1456-65. [PMID: 17499392 DOI: 10.1016/j.neurobiolaging.2007.03.029] [Citation(s) in RCA: 454] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 03/25/2007] [Accepted: 03/30/2007] [Indexed: 11/23/2022]
Abstract
It is of great clinical value to identify subjects at a high risk of developing AD. We previously found that the amyloid positron emission tomography (PET) tracer PIB showed a robust difference in retention in the brain between AD patients and healthy controls (HC). Twenty-one patients diagnosed with MCI (mean age 63.3+/-7.8 (S.D.) years) underwent PET studies with (11)C-PIB, and (18)F-fluoro-deoxy-glucose (FDG) to measure cerebral glucose metabolism, as well as assessment of cognitive function and CSF sampling. Reference group data from 27 AD patients and 6 healthy controls, respectively, were used for comparison. The mean cortical PIB retention for the MCI patients was intermediate compared to HC and AD. Seven MCI patients that later at clinical follow-up converted to AD (8.1+/-6.0 (S.D.) months) showed significant higher PIB retention compared to non-converting MCI patients and HC, respectively (ps<0.01). The PIB retention in MCI converters was comparable to AD patients (p>0.01). Correlations were observed in the MCI patients between PIB retention and CSF Abeta(1-42), total Tau and episodic memory, respectively.
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Affiliation(s)
- Anton Forsberg
- Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Stockholm, Sweden
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Engler H, Forsberg A, Almkvist O, Blomquist G, Larsson E, Savitcheva I, Wall A, Ringheim A, Långström B, Nordberg A. Two-year follow-up of amyloid deposition in patients with Alzheimer's disease. Brain 2006; 129:2856-66. [PMID: 16854944 DOI: 10.1093/brain/awl178] [Citation(s) in RCA: 467] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Beta amyloid is one of the major histopathological hallmarks of Alzheimer's disease. We recently reported in vivo imaging of amyloid in 16 Alzheimer patients, using the PET ligand N-methyl[11C]2-(4'-methylaminophenyl)-6-hydroxy-benzothiazole (PIB). In the present study we rescanned these 16 Alzheimer patients after 2.0 +/- 0.5 years and have described the interval change in amyloid deposition and regional cerebral metabolic rate for glucose (rCMRGlc) at follow-up. Sixteen patients with Alzheimer's disease were re-examined by means of PET, using PIB and 2-[18F]fluoro-2-deoxy-d-glucose (FDG) after 2.0 +/- 0.5 years. The patients were all on cholinesterase inhibitor treatment and five also on treatment with the N-methyl-d-aspartate (NMDA) antagonist memantine. In order to estimate the accuracy of the PET PIB measurements, four additional Alzheimer patients underwent repeated examinations with PIB within 20 days (test-retest). Relative PIB retention in cortical regions differed by 3-7% in the test-retest study. No significant difference in PIB retention was observed between baseline and follow-up while a significant (P < 0.01) 20% decrease in rCMRGlc was observed in cortical brain regions. A significant negative correlation between rCMRGlc and PIB retention was observed in the parietal cortex in the Alzheimer patients at follow-up (r = 0.67, P = 0.009). A non-significant decline in Mini-Mental State Examination (MMSE) score from 24.3 +/- 3.7 (mean +/- standard deviation) to 22.7 +/- 6.1 was measured at follow-up. Five of the Alzheimer patients showed a significant decline in MMSE score of >3 (21.4 +/- 3.5 to 15.6 +/- 3.9, P < 0.01) (AD-progressive) while the rest of the patients were cognitively more stable (MMSE score = 25.6 +/- 3.1 to 25.9 +/- 3.7) (AD-stable) compared with baseline. A positive correlation (P = 0.001) was observed in the parietal cortex between Rey Auditory Verbal Learning (RAVL) test score and rCMRGlc at follow-up while a negative correlation (P = 0.018) was observed between RAVL test and PIB retention in the parietal at follow-up. Relatively stable PIB retention after 2 years of follow-up in patients with mild Alzheimer's disease suggests that amyloid deposition in the brain reaches a plateau by the early clinical stages of Alzheimer's disease and therefore may precede a decline in rCMRGlc and cognition. It appears that anti-amyloid therapies will need to induce a significant decrease in amyloid load in order for PIB PET images to detect a drug effect in Alzheimer patients. FDG imaging may be able to detect a stabilization of cerebral metabolism caused by therapy administered to patients with a clinical diagnosis of Alzheimer's disease.
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Affiliation(s)
- Henry Engler
- Uppsala Imanet AB, Imanet, GE Healthcare Uppsala University, Uppsala
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Forsberg A, Engler H, Blomquist G, Wall A, Ringheim A, Långström B, Nordberg A. IC–P–050: Neuroimaging of amyloid depositions studied with statistical parametric mapping. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.2255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Gunnar Blomquist
- Department of Oncology, Radiology and Clinical ImmunologyUppsala UniversityUppsalaSweden
| | - Anders Wall
- Uppsala Imanet AB, Imanet GE HealthcareUppsalaSweden
| | - Anna Ringheim
- Uppsala Imanet AB, Imanet GE HealthcareUppsalaSweden
| | - Bengt Långström
- Department of Organic ChemistryUppsala UniversityUppsalaSweden
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Forsberg A, Engler H, Blomquist G, Almkvist O, Hagman G, Wall A, Ringheim A, Långström B, Nordberg A. P2–303: Amyloid depositions in MCI–patients studied with PIB–PET. Alzheimers Dement 2006. [DOI: 10.1016/j.jalz.2006.05.1143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | - Gunnar Blomquist
- Department of Oncology, Radiology and Clinical ImmunologyUppsala UniversityUppsalaSweden
| | - Ove Almkvist
- Karolinska InstitutetNeurotec DepartmentStockholmSweden
| | - Göran Hagman
- Department of Geriatric Medicine Karolinska University Hospital HuddingeStockholmSweden
| | - Anders Wall
- Uppsala Imanet AB, ImanetGE HealthcareUppsalaSweden
| | | | - Bengt Långström
- Department of Organic ChemistryUppsala UniversityUppsalaSweden
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