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Dubash S, Inglese M, Mauri F, Kozlowski K, Trivedi P, Arshad M, Challapalli A, Barwick T, Al-Nahhas A, Stanbridge R, Lewanski C, Berry M, Bowen F, Aboagye EO. Spatial heterogeneity of radiolabeled choline positron emission tomography in tumors of patients with non-small cell lung cancer: first-in-patient evaluation of [ 18F]fluoromethyl-(1,2- 2H 4)-choline. Theranostics 2020; 10:8677-8690. [PMID: 32754271 PMCID: PMC7392021 DOI: 10.7150/thno.47298] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose: The spatio-molecular distribution of choline and its metabolites in tumors is highly heterogeneous. Due to regulation of choline metabolism by hypoxic transcriptional signaling and other survival factors, we envisage that detection of such heterogeneity in patient tumors could provide the basis for advanced localized therapy. However, non-invasive methods to assess this phenomenon in patients are limited. We investigated such heterogeneity in Non-Small Cell Lung Cancer (NSCLC) with [18F]fluoromethyl-(1,2-2H4) choline ([18F]D4-FCH) and positron emission tomography/computed tomography (PET/CT). Experimental design: [18F]D4-FCH (300.5±72.9MBq [147.60-363.6MBq]) was administered intravenously to 17 newly diagnosed NSCLC patients. PET/CT scans were acquired concurrently with radioactive blood sampling to permit mathematical modelling of blood-tissue transcellular rate constants. Comparisons were made with biopsy-derived choline kinase-α (CHKα) expression and diagnostic [18F]fluorodeoxyglucose ([18F]FDG) scans. Results: Oxidation of [18F]D4-FCH to [18F]D4-fluorobetaine was suppressed (48.58±0.31% parent at 60 min) likely due to the deuterium isotope effect embodied within the design of the radiotracer. Early (5 min) and late (60 min) images showed specific uptake of tracer in all 51 lesions (tumors, lymph nodes and metastases) from 17 patients analyzed. [18F]D4-FCH-derived uptake (SUV60max) in index primary lesions (n=17) ranged between 2.87-10.13; lower than that of [18F]FDG PET [6.89-22.64]. Mathematical modelling demonstrated net irreversible uptake of [18F]D4-FCH at steady-state, and parametric mapping of the entire tumor showed large intratumorally heterogeneity in radiotracer retention, which is likely to have influenced correlations with biopsy-derived CHKα expression. Conclusions: [18F]D4-FCH is detectable in NSCLC with large intratumorally heterogeneity, which could be exploited in the future for targeting localized therapy.
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Affiliation(s)
- Suraiya Dubash
- Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Marianna Inglese
- Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Francesco Mauri
- Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Pritesh Trivedi
- Department of Surgery and Cancer, Imperial College London, United Kingdom
| | - Mubarik Arshad
- Department of Surgery and Cancer, Imperial College London, United Kingdom
- Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | | | - Tara Barwick
- Department of Surgery and Cancer, Imperial College London, United Kingdom
- Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Adil Al-Nahhas
- Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rex Stanbridge
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Conrad Lewanski
- Department of Surgery and Cancer, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Matthew Berry
- Department of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Frances Bowen
- Department of Medicine and Integrated Care, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Eric O. Aboagye
- Department of Surgery and Cancer, Imperial College London, United Kingdom
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Fahrni G, Karakatsanis NA, Di Domenicantonio G, Garibotto V, Zaidi H. Does whole-body Patlak 18F-FDG PET imaging improve lesion detectability in clinical oncology? Eur Radiol 2019; 29:4812-4821. [PMID: 30689031 DOI: 10.1007/s00330-018-5966-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/07/2018] [Accepted: 12/11/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Single-pass whole-body (WB) 18F-FDG PET/CT imaging is routinely employed for the clinical assessment of malignant, infectious, and inflammatory diseases. Our aim in this study is the systematic clinical assessment of lesion detectability in multi-pass WB parametric imaging enabling direct imaging of the highly quantitative 18F-FDG influx rate constant Ki, as a complement to standard-of-care standardized uptake value (SUV) imaging for a range of oncologic studies. METHODS We compared SUV and Ki images of 18 clinical studies of different oncologic indications (lesion characterization and staging) including standard-of-care SUV and dynamic WB PET protocols in a single session. The comparison involved both the visual assessment and the quantitative evaluation of SUVmean, SUVmax, Kimean, Kimax, tumor-to-background ratio (TBRSUV, TBRKi), and contrast-to-noise ratio (CNRSUV, CNRKi) quality metrics. RESULTS Overall, both methods provided good-quality images suitable for visual interpretation. A total of 118 lesions were detected, including 40 malignant (proven) and 78 malignant (unproven) lesions. Of those, 111 were detected on SUV and 108 on Ki images. One proven malignant lesion was detected only on Ki images whereas none of the proven malignant lesions was visible only on SUV images. The proven malignant lesions had overall higher Ki TBR and CNR scores. One unproven lesion, which was later confirmed as benign, was detected only on the SUV images (false-positive). Overall, our results from 40 proven malignant lesions suggested improved sensitivity (from 92.5 to 95%) and accuracy (from 90.24 to 95.12%) and potentially enhanced specificity with Ki over SUV imaging. CONCLUSION Oncologic WB Patlak Ki imaging may achieve equivalent or superior lesion detectability with reduced false-positive rates when complementing standard-of-care SUV imaging. KEY POINTS • The whole-body spatio-temporal distribution of 18 F-FDG uptake may reveal clinically useful information on oncologic diseases to complement the standard-of-care SUV metric. • Parametric imaging resulted in less false-positive indications of non-specific 18 F-FDG uptake relative to SUV. • Parametric imaging may achieve equivalent or superior 18 F-FDG lesion detectability than standard-of-care SUV imaging in oncology.
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Affiliation(s)
- Guillaume Fahrni
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Nicolas A Karakatsanis
- Division of Radiopharmaceutical Sciences, Department of Radiology, Weill Cornell Medical College of Cornell University, New York, NY, 10021, USA.
| | - Giulia Di Domenicantonio
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, 1205, Geneva, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland. .,Geneva University Neurocenter, University of Geneva, 1205, Geneva, Switzerland. .,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, 9700 RB, Groningen, Netherlands. .,Department of Nuclear Medicine, University of Southern Denmark, DK-500, Odense, Denmark.
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Scussolini M, Garbarino S, Piana M, Sambuceti G, Caviglia G. Reference Tissue Models for FDG-PET Data: Identifiability and Solvability. IEEE TRANSACTIONS ON RADIATION AND PLASMA MEDICAL SCIENCES 2018. [DOI: 10.1109/trpms.2018.2801029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Spectral Analysis of Dynamic PET Studies: A Review of 20 Years of Method Developments and Applications. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2016; 2016:7187541. [PMID: 28050197 PMCID: PMC5165231 DOI: 10.1155/2016/7187541] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022]
Abstract
In Positron Emission Tomography (PET), spectral analysis (SA) allows the quantification of dynamic data by relating the radioactivity measured by the scanner in time to the underlying physiological processes of the system under investigation. Among the different approaches for the quantification of PET data, SA is based on the linear solution of the Laplace transform inversion whereas the measured arterial and tissue time-activity curves of a radiotracer are used to calculate the input response function of the tissue. In the recent years SA has been used with a large number of PET tracers in brain and nonbrain applications, demonstrating that it is a very flexible and robust method for PET data analysis. Differently from the most common PET quantification approaches that adopt standard nonlinear estimation of compartmental models or some linear simplifications, SA can be applied without defining any specific model configuration and has demonstrated very good sensitivity to the underlying kinetics. This characteristic makes it useful as an investigative tool especially for the analysis of novel PET tracers. The purpose of this work is to offer an overview of SA, to discuss advantages and limitations of the methodology, and to inform about its applications in the PET field.
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Abstract
Positron emission tomography (PET) is an extraordinarily sensitive clinical imaging modality for interrogating tumor metabolism. Radiolabeled PET substrates can be traced at subphysiological concentrations, allowing noninvasive imaging of metabolism and intratumoral heterogeneity in systems ranging from advanced cancer models to patients in the clinic. There are a wide range of novel and more established PET radiotracers, which can be used to investigate various aspects of the tumor, including carbohydrate, amino acid, and fatty acid metabolism. In this review, we briefly discuss the more established metabolic tracers and describe recent work on the development of new tracers. Some of the unanswered questions in tumor metabolism are considered alongside new technical developments, such as combined PET/magnetic resonance imaging scanners, which could provide new imaging solutions to some of the outstanding diagnostic challenges facing modern cancer medicine.
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Affiliation(s)
- David Y. Lewis
- Cancer Research UK - Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Dmitry Soloviev
- Cancer Research UK - Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
| | - Kevin M. Brindle
- Cancer Research UK - Cambridge Institute, University of Cambridge, Li Ka Shing Centre, Cambridge, UK
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Kotasidis FA, Tsoumpas C, Rahmim A. Advanced kinetic modelling strategies: towards adoption in clinical PET imaging. Clin Transl Imaging 2014. [DOI: 10.1007/s40336-014-0069-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Frings V, Yaqub M, Hoyng LL, Golla SSV, Windhorst AD, Schuit RC, Lammertsma AA, Hoekstra OS, Smit EF, Boellaard R. Assessment of simplified methods to measure 18F-FLT uptake changes in EGFR-mutated non-small cell lung cancer patients undergoing EGFR tyrosine kinase inhibitor treatment. J Nucl Med 2014; 55:1417-23. [PMID: 24970910 DOI: 10.2967/jnumed.114.140913] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) PET/CT provides a noninvasive assessment of proliferation and, as such, could be a valuable imaging biomarker in oncology. The aim of the present study was to assess the validity of simplified quantitative parameters of (18)F-FLT uptake in non-small cell lung cancer (NSCLC) patients before and after the start of treatment with a tyrosine kinase inhibitor (TKI). METHODS Ten patients with metastatic NSCLC harboring an activating epidermal growth factor receptor mutation were included in this prospective observational study. Patients underwent (15)O-H2O and (18)F-FLT PET/CT scanning on 3 separate occasions: within 7 d before treatment, and 7 and 28 d after the first therapeutic dose of a TKI (gefitinib or erlotinib). Dynamic scans were acquired and venous blood samples were collected during the (18)F-FLT scan to measure parent fraction and plasma and whole-blood radioactivity concentrations. Simplified measures (standardized uptake value [SUV] and tumor-to-blood ratio [TBR]) were correlated with fully quantitative measures derived from kinetic modeling. RESULTS Twenty-nine of thirty (18)F-FLT PET/CT scans were evaluable. According to the Akaike criterion, a reversible 2-tissue model with 4 rate constants and blood volume parameter was preferred in 84% of cases. Relative therapy-induced changes in SUV and TBR correlated with those derived from kinetic analyses (r(2) = 0.83-0.97, P < 0.001, slope = 0.72-1.12). (18)F-FLT uptake significantly decreased at 7 and 28 d after the start of treatment compared with baseline (P < 0.01). Changes in (18)F-FLT uptake were not correlated with changes in perfusion, as measured using (15)O-H2O. CONCLUSION SUV and TBR could both be used as surrogate simplified measures to assess changes in (18)F-FLT uptake in NSCLC patients treated with a TKI, at the cost of a small underestimation in uptake changes or the need for a blood sample and metabolite measurement, respectively.
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Affiliation(s)
- Virginie Frings
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Maqsood Yaqub
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Lieke L Hoyng
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Sandeep S V Golla
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Robert C Schuit
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
| | - Egbert F Smit
- Department of Pulmonology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands; and
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Garbarino S, Caviglia G, Sambuceti G, Benvenuto F, Piana M. A novel description of FDG excretion in the renal system: application to metformin-treated models. Phys Med Biol 2014; 59:2469-84. [PMID: 24778350 DOI: 10.1088/0031-9155/59/10/2469] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper introduces a novel compartmental model describing the excretion of 18F-fluoro-deoxyglucose (FDG) in the renal system and a numerical method based on the maximum likelihood for its reduction. This approach accounts for variations in FDG concentration due to water re-absorption in renal tubules and the increase of the bladder's volume during the FDG excretion process. From the computational viewpoint, the reconstruction of the tracer kinetic parameters is obtained by solving the maximum likelihood problem iteratively, using a non-stationary, steepest descent approach that explicitly accounts for the Poisson nature of nuclear medicine data. The reliability of the method is validated against two sets of synthetic data realized according to realistic conditions. Finally we applied this model to describe FDG excretion in the case of animal models treated with metformin. In particular we show that our approach allows the quantitative estimation of the reduction of FDG de-phosphorylation induced by metformin.
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Affiliation(s)
- S Garbarino
- Dipartimento di Matematica, Università di Genova, via Dodecaneso 35, I-16146 Genova, Italy. CNR - SPIN Genova, via Dodecaneso 33, I-16146 Genova, Italy
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Veronese M, Rizzo G, Turkheimer FE, Bertoldo A. SAKE: a new quantification tool for positron emission tomography studies. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 111:199-213. [PMID: 23611334 DOI: 10.1016/j.cmpb.2013.03.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 03/18/2013] [Accepted: 03/23/2013] [Indexed: 06/02/2023]
Abstract
In dynamic positron emission tomography (PET) studies, spectral analysis (SA) refers to a data-driven quantification method, based on a single-input single-output model for which the transfer function is described by a sum of exponential terms. SA allows to quantify numerosities, amplitudes and eigenvalues of the transfer function allowing, in this way, to separate kinetic components of the tissue tracer activity with minimal model assumptions. The SA model can be solved with a linear estimator alone or with numerical filters, resulting in different types of SA approaches. Once estimated the number, amplitudes and eigenvalues of the transfer function, one can distinguish the presence in the system of irreversible and/or reversible components as well as derive parameters of physiological significance. These characteristics make it an appealing alternative method to compartmental models which are widely used for the quantitative analysis of dynamic studies acquired with PET. However, despite its applicability to a large number of PET tracers, its implementation is not straightforward and its utilization in the nuclear medicine community has been limited especially by the lack of an user-friendly software application. In this paper we proposed SAKE, a computer program for the quantitative analysis of PET data through the main SA methods. SAKE offers a unified pipeline of analysis usable also by people with limited computer knowledge but with high interest in SA.
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Affiliation(s)
- Mattia Veronese
- Department of Information Engineering, University of Padova, Padova, Italy
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Introduction to the analysis of PET data in oncology. J Pharmacokinet Pharmacodyn 2013; 40:419-36. [PMID: 23443280 DOI: 10.1007/s10928-013-9307-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Accepted: 02/13/2013] [Indexed: 12/22/2022]
Abstract
Several reviews on specific topics related to positron emission tomography (PET) ranging in complexity from introductory to highly technical have already been published. This introduction to the analysis of PET data was written as a simple guide of the different phases of analysis of a given PET dataset, from acquisition to preprocessing, to the final data analysis. Although sometimes issues specific to PET in neuroimaging will be mentioned for comparison, most of the examples and applications provided will refer to oncology. Due to the limitations of space we couldn't address each issue comprehensively but, rather, we provided a general overview of each topic together with the references that the interested reader should consult. We will assume a familiarity with the basic principles of PET imaging.
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Abstract
The driving force in the research and development of new hybrid PET-CT/MR imaging scanners is the production of images with optimum quality, accuracy, and resolution. However, the acquisition process is limited by several factors. Key issues are the respiratory and cardiac motion artifacts that occur during an imaging session. In this article the necessary tools for modeling and simulation of realistic high-resolution four-dimensional PET-CT and PET-MR imaging data are described. Beyond the need for four-dimensional simulations, accurate modeling of the acquisition process can be included within the reconstruction algorithms assisting in the improvement of image quality and accuracy of estimation of physiologic parameters from four-dimensional hybrid PET imaging.
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PET imaging: implications for the future of therapy monitoring with PET/CT in oncology. Curr Opin Pharmacol 2012; 12:569-75. [PMID: 22901680 DOI: 10.1016/j.coph.2012.07.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 07/15/2012] [Accepted: 07/23/2012] [Indexed: 12/22/2022]
Abstract
Among the methods based on molecular imaging, the measure of the tracer uptake variation between a baseline and follow-up scan with the SUV and [(18)F]FDG-PET/CT is a very powerful tool for assessing response to treatment in oncology. However, the development of new targeted therapeutics and tissue pharmacokinetic evaluation of existing ones are increasingly requiring therapy monitoring with alternative tracers and indicators. In parallel, the potential predictive and prognostic value of other image-derived parameters, such as tumour volume and textural features, relating to tumoral heterogeneity, has recently emerged from several works.
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