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Lawal IO, Abubakar SO, Ndlovu H, Mokoala KMG, More SS, Sathekge MM. Advances in Radioligand Theranostics in Oncology. Mol Diagn Ther 2024; 28:265-289. [PMID: 38555542 DOI: 10.1007/s40291-024-00702-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/02/2024]
Abstract
Theranostics with radioligands (radiotheranostics) has played a pivotal role in oncology. Radiotheranostics explores the molecular targets expressed on tumor cells to target them for imaging and therapy. In this way, radiotheranostics entails non-invasive demonstration of the in vivo expression of a molecular target of interest through imaging followed by the administration of therapeutic radioligand targeting the tumor-expressed molecular target. Therefore, radiotheranostics ensures that only patients with a high likelihood of response are treated with a particular radiotheranostic agent, ensuring the delivery of personalized care to cancer patients. Within the last decades, a couple of radiotheranostics agents, including Lutetium-177 DOTATATE (177Lu-DOTATATE) and Lutetium-177 prostate-specific membrane antigen (177Lu-PSMA), were shown to prolong the survival of cancer patients compared to the current standard of care leading to the regulatory approval of these agents for routine use in oncology care. This recent string of successful approvals has broadened the interest in the development of different radiotheranostic agents and their investigation for clinical translation. In this work, we present an updated appraisal of the literature, reviewing the recent advances in the use of established radiotheranostic agents such as radioiodine for differentiated thyroid carcinoma and Iodine-131-labeled meta-iodobenzylguanidine therapy of tumors of the sympathoadrenal axis as well as the recently approved 177Lu-DOTATATE and 177Lu-PSMA for differentiated neuroendocrine tumors and advanced prostate cancer, respectively. We also discuss the radiotheranostic agents that have been comprehensively characterized in preclinical studies and have shown some clinical evidence supporting their safety and efficacy, especially those targeting fibroblast activation protein (FAP) and chemokine receptor 4 (CXCR4) and those still being investigated in preclinical studies such as those targeting poly (ADP-ribose) polymerase (PARP) and epidermal growth factor receptor 2.
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Affiliation(s)
- Ismaheel O Lawal
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University, 1364 Clifton Road, NE, Atlanta, GA, 30322, USA.
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa.
| | - Sofiullah O Abubakar
- Department of Radiology and Nuclear Medicine, Sultan Qaboos Comprehensive Cancer Care and Research Center, Muscat, Oman
| | - Honest Ndlovu
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, 0001, South Africa
| | - Kgomotso M G Mokoala
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, 0001, South Africa
| | - Stuart S More
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa
- Division of Nuclear Medicine, Department of Radiation Medicine, University of Cape Town, Cape Town, 7700, South Africa
| | - Mike M Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, 0001, South Africa
- Nuclear Medicine Research Infrastructure (NuMeRI), Steve Biko Academic Hospital, Pretoria, 0001, South Africa
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Grafe H, Lindemann ME, Weber M, Kirchner J, Binse I, Umutlu L, Herrmann K, Quick HH. Intra-Individual Comparison of 124I-PET/CT and 124I-PET/MR Hybrid Imaging of Patients with Resected Differentiated Thyroid Carcinoma: Aspects of Attenuation Correction. Cancers (Basel) 2022; 14:cancers14133040. [PMID: 35804811 PMCID: PMC9264885 DOI: 10.3390/cancers14133040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/03/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary This study evaluates the qualitative and quantitative differences between 124-iodine PET/CT and PET/MR in oncologic patients with differentiated thyroid carcinoma after thyroidectomy. The impact of improved MR-based attenuation correction (AC) using a bone atlas was analysed in PET/MR data. Despite different patient positioning and AC methods PET/CT and PET/MR provide overall comparable results in a clinical setting. The overall number of detected 124I-active lesions and the measured average SUVmean values for congruent lesions were higher for PET/MR when compared to PET/CT. The addition of bone to the MR-based AC in PET/MR slightly increased the SUVmean values for all detected lesions. Abstract Background: This study evaluates the quantitative differences between 124-iodine (I) positron emission tomography/computed tomography (PET/CT) and PET/magnetic resonance imaging (PET/MR) in patients with resected differentiated thyroid carcinoma (DTC). Methods: N = 43 124I PET/CT and PET/MR exams were included. CT-based attenuation correction (AC) in PET/CT and MR-based AC in PET/MR with bone atlas were compared concerning bone AC in the head-neck region. AC-map artifacts (e.g., dentures) were noted. Standardized uptake values (SUV) were measured in lesions in each PET data reconstruction. Relative differences in SUVmean were calculated between PET/CT and PET/MR with bone atlas. Results: Overall, n = 111 124I-avid lesions were detected in all PET/CT, while n = 132 lesions were detected in PET/MR. The median in SUVmean for n = 98 congruent lesions measured in PET/CT was 12.3. In PET/MR, the median in SUVmean was 16.6 with bone in MR-based AC. Conclusions: 124I-PET/CT and 124I-PET/MR hybrid imaging of patients with DTC after thyroidectomy provides overall comparable quantitative results in a clinical setting despite different patient positioning and AC methods. The overall number of detected 124I-avid lesions was higher for PET/MR compared to PET/CT. The measured average SUVmean values for congruent lesions were higher for PET/MR.
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Affiliation(s)
- Hong Grafe
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.W.); (I.B.); (K.H.)
- Correspondence: ; Tel.: +49-201-723-2033
| | - Maike E. Lindemann
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.E.L.); (H.H.Q.)
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.W.); (I.B.); (K.H.)
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital Dusseldorf, 40225 Dusseldorf, Germany;
| | - Ina Binse
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.W.); (I.B.); (K.H.)
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany;
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45147 Essen, Germany; (M.W.); (I.B.); (K.H.)
| | - Harald H. Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University Duisburg-Essen, 45147 Essen, Germany; (M.E.L.); (H.H.Q.)
- Erwin L. Hahn Institute for Magnetic Resonance Imaging, University Duisburg-Essen, 45141 Essen, Germany
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Kersting D, Jentzen W, Sraieb M, Costa PF, Conti M, Umutlu L, Antoch G, Nader M, Herrmann K, Fendler WP, Rischpler C, Weber M. Comparing lesion detection efficacy and image quality across different PET system generations to optimize the iodine-124 PET protocol for recurrent thyroid cancer. EJNMMI Phys 2021; 8:14. [PMID: 33587222 PMCID: PMC7884562 DOI: 10.1186/s40658-021-00361-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background In recurrent differentiated thyroid cancer patients, detectability in 124I PET is limited for lesions with low radioiodine uptake. We assess the improvements in lesion detectability and image quality between three generations of PET scanners with different detector technologies. The results are used to suggest an optimized protocol. Methods Datasets of 10 patients with low increasing thyroglobulin or thyroglobulin antibody levels after total thyroidectomy and radioiodine therapies were included. PET data were acquired and reconstructed on a Biograph mCT PET/CT (whole-body, 4-min acquisition time per bed position; OSEM, OSEM-TOF, OSEM-TOF+PSF), a non-TOF Biograph mMR PET/MR (neck region, 4 min and 20 min; OSEM), and a new generation Biograph Vision PET/CT (whole-body, 4 min; OSEM, OSEM-TOF, OSEM-TOF+PSF). The 20-min image on the mMR was used as reference to calculate the detection efficacy in the neck region. Image quality was rated on a 5-point scale. Results All detected lesions were in the neck region. Detection efficacy was 8/9 (Vision OSEM-TOF and OSEM-TOF+PSF), 4/9 (Vision OSEM), 3/9 (mMR OSEM and mCT OSEM-TOF+PSF), and 2/9 (mCT OSEM and OSEM-TOF). Median image quality was 4 (Vision OSEM-TOF and OSEM-TOF+PSF), 3 (Vision OSEM, mCT OSEM-TOF+PSF, and mMR OSEM 20-min), 2 (mCT OSEM-TOF), 1.5 (mCT OSEM), and 1 (mMR OSEM 4 min). Conclusion At a clinical standard acquisition time of 4 min per bed position, the new generation Biograph Vision using a TOF-based image reconstruction demonstrated the highest detectability and image quality and should, if available, be preferably used for imaging of low-uptake lesions. A prolonged acquisition time for the mostly affected neck region can be useful. Supplementary Information The online version contains supplementary material available at 10.1186/s40658-021-00361-y.
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Affiliation(s)
- David Kersting
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany. .,West German Cancer Center (WTZ), Essen, Germany. .,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany.
| | - Walter Jentzen
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | - Miriam Sraieb
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | - Pedro Fragoso Costa
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | | | - Lale Umutlu
- West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany.,Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, 45147, Essen, Germany
| | - Gerald Antoch
- German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany.,Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Michael Nader
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
| | - Manuel Weber
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany.,West German Cancer Center (WTZ), Essen, Germany.,German Cancer Consortium (DKTK), Essen and Dusseldorf, Germany
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Weber M, Binse I, Nagarajah J, Bockisch A, Herrmann K, Jentzen W. The role of 124I PET/CT lesion dosimetry in differentiated thyroid cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 63:235-252. [DOI: 10.23736/s1824-4785.19.03201-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Impact of prompt gamma coincidence correction on absorbed dose estimation in differentiated thyroid cancer using 124I PET/CT imaging. Nucl Med Commun 2018; 39:1156-1164. [PMID: 30204643 DOI: 10.1097/mnm.0000000000000911] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Iodine-124 positron emission tomography/computed tomography (I PET/CT) is increasingly being used in the absorbed dose estimation in the radioiodine treatment of differentiated thyroid cancer (DTC). However, the produced prompt gamma coincidences (PGCs) associated with the I decay result in a bias in the absorbed dose estimation. The impact of a sinogram-based PGC correction approach on the absorbed dose estimation in I PET/CT DTC imaging is investigated. METHODS I phantom and patient measurements were performed on a Siemens Biograph mCT PET/CT system. All images were reconstructed with (PGCon) and without PGC correction (PGCoff). The phantom contained seven spheres (diameters: 6.6-37 mm). The spheres and background compartment were filled with a I solution, resulting in a low (9.4 : 1) and a high sphere-to-background activity concentration ratio (750 : 1). Sphere recovery coefficient (RC) values were determined. In addition, the impact of PGC correction on measured lesion uptake and calculated lesion-absorbed dose was assessed for 66 lesions identified in 24 DTC patients. RESULTS PGC correction systematically increased sphere RC values up to 71% for the smallest spheres. For the patient data, PGC correction significantly increased both the measured I uptake (P<0.005) and the calculated lesion-absorbed dose (P=0.008) by ∼3%. The percentage difference in the calculated lesion-absorbed dose ranged from -19% to 50%, showing that PGC correction had a variable and large impact for a few lesions. CONCLUSION PGC correction resulted in significantly higher sphere RC values, I lesion uptake values and estimated lesion-absorbed doses.
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Hong CM, Ahn BC. Factors Associated with Dose Determination of Radioactive Iodine Therapy for Differentiated Thyroid Cancer. Nucl Med Mol Imaging 2018; 52:247-253. [PMID: 30100937 PMCID: PMC6066487 DOI: 10.1007/s13139-018-0522-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 04/11/2018] [Accepted: 04/12/2018] [Indexed: 12/25/2022] Open
Abstract
Radioactive iodine (RAI) therapy for differentiated thyroid cancer has been successfully used for more than 70 years. However, there is still plenty of controversy surrounding the use and doses of radioiodine. There is insufficient evidence to answer the questions. Recent American Thyroid Association (ATA) guidelines seem to favor low-dose RAI, based on recent clinical trials and meta-analyses. However, long-term follow-up data remains limited, and there are additional factors we should consider that might affect the efficacy of RAI therapy. Therefore, until sufficient data are available, it is necessary to remain cautious about determining RAI doses by considering multiple patient-specific variables.
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Affiliation(s)
- Chae Moon Hong
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
| | - Byeong-Cheol Ahn
- Department of Nuclear Medicine, School of Medicine, Kyungpook National University, 680, Gukchaebosang-ro, Jung-gu, Daegu, 41944 Republic of Korea
- Department of Nuclear Medicine, Kyungpook National University Hospital, 130 Dongdeok-ro, Jung-gu, Daegu, 41944 Republic of Korea
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Jentzen W, Phaosricharoen J, Gomez B, Hetkamp P, Stebner V, Binse I, Kinner S, Herrmann K, Sabet A, Nagarajah J. Quantitative performance of 124I PET/MR of neck lesions in thyroid cancer patients using 124I PET/CT as reference. EJNMMI Phys 2018; 5:13. [PMID: 30022353 PMCID: PMC6051951 DOI: 10.1186/s40658-018-0214-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/17/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In patients with differentiated thyroid cancer (DTC), serial 124I PET/CT imaging is, for instance, used to assess the absorbed (radiation) dose to lesions. Frequently, the lesions are located in the neck and they are close to or surrounded by different tissue types. In contrast to PET/CT, MR-based attenuation correction in PET/MR may be therefore challenging in the neck region. The aim of this retrospective study was to assess the quantitative performance of 124I PET/MRI of neck lesions by comparing the MR-based and CT-based 124I activity concentrations (ACs). Sixteen DTC patients underwent PET/CT scans at 24 and 120 h after administration of about 25 MBq 124I. Approximately 1 h before or after PET/CT examination, each patient additionally received a 24-h PET/MR scan and sometimes a 120-h PET/MR scan. PET images were reconstructed using the respective attenuation correction approach. Appropriate reconstruction parameters and corrections were used to harmonize the reconstructed PET images to provide, for instance, similar spatial resolution. For each lesion, two types of ACs were ascertained: the maximum AC (max-AC) and an average AC (avg-AC). The avg-AC is the average activity concentration obtained within a spherical volume of interest with a diameter of 7 mm, equaling the PET scanner resolution. For each type of AC, the percentage AC difference between MR-based and CT-based ACs was determined and Lin's concordance correlation analysis was applied. Quantitative performance was considered acceptable if the standard deviation was ± 25% (precision), and the mean value was within ± 10% (accuracy). RESULTS The avg-ACs (max-ACs within parentheses) of 74 lesions ranged from 0.20 (0.33) to 657 (733) kBq/mL. Excluding two lesions with ACs of approximately 1 kBq/mL, the mean (median) ± standard deviation (range) was - 4% (- 5%) ± 14% (- 28 to 29%) for the avg-AC and - 9% (- 11%) ± 14% (- 33 to 33%) for the max-AC. Lin's concordance correlation coefficients were ≥ 0.97, indicating substantial AC agreement. CONCLUSIONS Quantification of lesions in the neck region using 124I PET/MR showed acceptable quantitation performance to 124I PET/CT for AC above 1 kBq/mL. The PET/MRI-based 124I ACs in the neck region can be therefore reliably used in pre-therapy dosimetry planning.
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Affiliation(s)
- Walter Jentzen
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Jinda Phaosricharoen
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Benedikt Gomez
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Philipp Hetkamp
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Vanessa Stebner
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Ina Binse
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Sonja Kinner
- Department of Radiology, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany
| | - Amir Sabet
- Department of Nuclear Medicine, University Hospital Frankfurt, Frankfurt, Germany
| | - James Nagarajah
- Department of Nuclear Medicine, University of Duisburg-Essen, Hufelandstrasse 55, D-45122, Essen, Germany.
- Radboudumc, Department of Radiology and Nuclear Medicine, Nijmegen, The Netherlands.
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