FDG-PET-CT and whole-body MRI for triage in patients planned for radioembolisation therapy

Sorption Characteristics and Chromatographic Separation of 90Y3+ from 90Sr2+ from Aqueous Media by Chelex-100 (Anion Ion Exchange) Packed Column

There is growing demand for separation of 90Y carrier free from 90Sr coexisting to produce high purity 90Y essential for radiopharmaceutical uses. Thus, in this context the sorption profiles of Y3+ and Sr2+ from aqueous solutions containing diethylenetriaminepenta acetic acid (DTPA), ethylenediaminetetra-acetic acid (EDTA), acetic acid, citric acid, or NaCl onto Chelex-100 (anion ion exchange) solid sorbent were critically studied for developing an efficient and low-cost methodology for selective separation of Y3+ from Sr2+ ions (1.0 × 10-5 M). Batch experiments displayed relative chemical extraction percentage (98 ± 5.4%) of Y3+ from aqueous acetic acid solution onto Chelex-100 (anion ion exchanger), whereas Sr2+ species showed no sorption. Hence, a selective separation of Y3+ from its parent 90Sr2+ has been established based upon percolation of the aqueous solution of Y3+ and Sr2+ ions containing acetic acid at pH 1-2 through Chelex-100 sorbent packed column at a 2 mL min-1 flow rate. Y3+ species were retained quantitatively while Sr2+ ions were not sorbed and passed through the sorbent packed column without extraction. The sorbed Y3+ species were then recovered from the sorbent packed column with HNO3 (1.0 M) at a 1.0 mL min-1 flow rate. A dual extraction mechanism comprising absorption associated to "weak-base anion exchanger" and "solvent extraction" of Y3+ as (YCl6)3- and an extra part for "surface adsorption" of Y3+ by the sorbent is proposed. The established method was validated by measuring the radiochemical (99.2 ± 2 1%), radionuclide purity and retardation factor (Rf = 10.0 ± 0.1 cm) of 90Y3+ recovered in the eluate. Ultimately, the sorbent packed column also presented high stability for reusing 2-3 cycles without drop in its efficiency (±5%) towards Y3+ uptake and relative chemical recovery. A proposed flow sheet describing the analytical procedures for the separation of 90Y3+ from 90Sr2+ using chelating Chelex 100 (anion exchange) packed column is also included.

International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres

PURPOSE

A multidisciplinary expert panel convened to formulate state-of-the-art recommendations for optimisation of selective internal radiation therapy (SIRT) with yttrium-90 (90Y)-resin microspheres.

METHODS

A steering committee of 23 international experts representing all participating specialties formulated recommendations for SIRT with 90Y-resin microspheres activity prescription and post-treatment dosimetry, based on literature searches and the responses to a 61-question survey that was completed by 43 leading experts (including the steering committee members). The survey was validated by the steering committee and completed anonymously. In a face-to-face meeting, the results of the survey were presented and discussed. Recommendations were derived and level of agreement defined (strong agreement ≥ 80%, moderate agreement 50%-79%, no agreement ≤ 49%).

RESULTS

Forty-seven recommendations were established, including guidance such as a multidisciplinary team should define treatment strategy and therapeutic intent (strong agreement); 3D imaging with CT and an angiography with cone-beam-CT, if available, and 99mTc-MAA SPECT/CT are recommended for extrahepatic/intrahepatic deposition assessment, treatment field definition and calculation of the 90Y-resin microspheres activity needed (moderate/strong agreement). A personalised approach, using dosimetry (partition model and/or voxel-based) is recommended for activity prescription, when either whole liver or selective, non-ablative or ablative SIRT is planned (strong agreement). A mean absorbed dose to non-tumoural liver of 40 Gy or less is considered safe (strong agreement). A minimum mean target-absorbed dose to tumour of 100-120 Gy is recommended for hepatocellular carcinoma, liver metastatic colorectal cancer and cholangiocarcinoma (moderate/strong agreement). Post-SIRT imaging for treatment verification with 90Y-PET/CT is recommended (strong agreement). Post-SIRT dosimetry is also recommended (strong agreement).

CONCLUSION

Practitioners are encouraged to work towards adoption of these recommendations.

Whole Body MRI and oncology: recent major advances

MRI is a very attractive approach for tumour detection and oncological staging with its absence of ionizing radiation, high soft tissue contrast and spatial resolution. Less than 10 years ago the use of Whole Body MRI (WB-MRI) protocols was uncommon due to many limitations, such as the forbidding acquisition times and limited availability. This decade has marked substantial progress in WB-MRI protocols. This very promising technique is rapidly arising from the research world and is becoming a commonly used examination for tumour detection due to recent technological developments and validation of WB-MRI by multiple studies and consensus papers. As a result, WB-MRI is progressively proposed by radiologists as an efficient examination for an expanding range of indications. As the spectrum of its uses becomes wider, radiologists will soon be confronted with the challenges of this technique and be urged to be trained in order to accurately read and report these examinations. The aim of this review is to summarize the validated indications of WB-MRI and present an overview of its most recent advances. This paper will briefly discuss how this examination is performed and which are the recommended sequences along with the future perspectives in the field.

Whole Body MRI and oncology: recent major advances

MRI is a very attractive approach for tumour detection and oncological staging with its absence of ionizing radiation, high soft tissue contrast and spatial resolution. Less than 10 years ago the use of Whole Body MRI (WB-MRI) protocols was uncommon due to many limitations, such as the forbidding acquisition times and limited availability. This decade has marked substantial progress in WB-MRI protocols. This very promising technique is rapidly arising from the research world and is becoming a commonly used examination for tumour detection due to recent technological developments and validation of WB-MRI by multiple studies and consensus papers. As a result, WB-MRI is progressively proposed by radiologists as an efficient examination for an expanding range of indications. As the spectrum of its uses becomes wider, radiologists will soon be confronted with the challenges of this technique and be urged to be trained in order to accurately read and report these examinations. The aim of this review is to summarize the validated indications of WB-MRI and present an overview of its most recent advances. This paper will briefly discuss how this examination is performed and which are the recommended sequences along with the future perspectives in the field.

The role of 18F-FDG-PET and PET/CT in patients with colorectal liver metastases undergoing selective internal radiation therapy with yttrium-90: a first evidence-based review

PURPOSE

To provide a first evidence-based review of the literature on the role of fluorine-18-fluorodeoxyglucose positron emission tomography and positron emission tomography/computed tomography (FDG-PET and PET/CT) in patients with colorectal liver metastases (CRLM) undergoing selective internal radiation therapy (SIRT) with yttrium-90 ((90)Y) microspheres.

METHODS

A comprehensive computer literature search was conducted to find relevant published articles on whole-body FDG-PET or PET/CT in patients with CRLM undergoing SIRT.

RESULTS

We identified 19 studies including 833 patients with CRLM undergoing SIRT. The role of FDG-PET or PET/CT was analysed in treatment planning, treatment response evaluation, and as prognostic tool.

CONCLUSION

FDG-PET and PET/CT provide additional information in treatment evaluation of CRLM patients treated with SIRT and may have a role in treatment planning and patient selection. FDG-PET/CT is emerging as good prognostic tool in these patients.

Improved short tau inversion recovery (iSTIR) for increased tumor conspicuity in the abdomen

OBJECT

To develop an improved short tau inversion recovery (iSTIR) technique with simultaneous suppression of fat, blood vessels and fluid to increase tumor conspicuity in the abdomen for cancer screening.

MATERIALS AND METHODS

An adiabatic spectrally selective inversion pulse was used for fat suppression to overcome the reduced signal to noise ratio associated with chemically non-selective inversion pulse of STIR. A motion-sensitizing driven equilibrium was used for blood vessel suppression and a dual-echo single-shot fast spin echo acquisition was used for fluid suppression. The technique was optimized on four normal subjects and later tested on five patients referred for metastatic tumor evaluation.

RESULTS

A velocity encoding of 2 cm/s achieved effective blood suppression even in small vessels. Subtraction of two images (one with 60 ms and the other with 280 ms echo time) acquired in the same echo train achieved excellent fluid suppression (>70% reduction). Simultaneous suppression of fat, blood vessels and fluid improved the tumor conspicuity compared to corresponding fat-suppressed (STIR) image.

CONCLUSION

This technique generated two complementary images from a single scan: one that is equivalent to a STIR image and the other that qualitatively resembles a diffusion-weighted image and may have potential for magnetic resonance imaging cancer screening.

Comparison between whole-body MRI and Fluorine-18-Fluorodeoxyglucose PET or PET/CT in oncology: a systematic review

BACKGROUND

The aim of the article is to systematically review published data about the comparison between positron emission tomography (PET) or PET/computed tomography (PET/CT) using Fluorine-18-Fluorodeoxyglucose (FDG) and whole-body magnetic resonance imaging (WB-MRI) in patients with different tumours.

METHODS

A comprehensive literature search of studies published in PubMed/MEDLINE, Scopus and Embase databases through April 2012 and regarding the comparison between FDG-PET or PET/CT and WB-MRI in patients with various tumours was carried out.

RESULTS

Forty-four articles comprising 2287 patients were retrieved in full-text version, included and discussed in this systematic review. Several articles evaluated mixed tumours with both diagnostic methods. Concerning the specific tumour types, more evidence exists for lymphomas, bone tumours, head and neck tumours and lung tumours, whereas there is less evidence for other tumour types.

CONCLUSIONS

Overall, based on the literature findings, WB-MRI seems to be a valid alternative method compared to PET/CT in oncology. Further larger prospective studies and in particular cost-effectiveness analysis comparing these two whole-body imaging techniques are needed to better assess the role of WB-MRI compared to FDG-PET or PET/CT in specific tumour types.