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Smith NJ, Green MA, Bahler CD, Tann M, Territo W, Smith AM, Hutchins GD. Comparison of tracer kinetic models for 68Ga-PSMA-11 PET in intermediate-risk primary prostate cancer patients. EJNMMI Res 2024; 14:6. [PMID: 38198060 PMCID: PMC10781928 DOI: 10.1186/s13550-023-01066-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND 68Ga-PSMA-11 positron emission tomography enables the detection of primary, recurrent, and metastatic prostate cancer. Regional radiopharmaceutical uptake is generally evaluated in static images and quantified as standard uptake values (SUVs) for clinical decision-making. However, analysis of dynamic images characterizing both tracer uptake and pharmacokinetics may offer added insights into the underlying tissue pathophysiology. This study was undertaken to evaluate the suitability of various kinetic models for 68Ga-PSMA-11 PET analysis. Twenty-three lesions in 18 patients were included in a retrospective kinetic evaluation of 55-min dynamic 68Ga-PSMA-11 pre-prostatectomy PET scans from patients with biopsy-demonstrated intermediate- to high-risk prostate cancer. Three kinetic models-a reversible one-tissue compartment model, an irreversible two-tissue compartment model, and a reversible two-tissue compartment model, were evaluated for their goodness of fit to lesion and normal reference prostate time-activity curves. Kinetic parameters obtained through graphical analysis and tracer kinetic modeling techniques were compared for reference prostate tissue and lesion regions of interest. RESULTS Supported by goodness of fit and information loss criteria, the irreversible two-tissue compartment model optimally fit the time-activity curves. Lesions exhibited significant differences in kinetic rate constants (K1, k2, k3, Ki) and semiquantitative measures (SUV and %ID/kg) when compared with reference prostatic tissue. The two-tissue irreversible tracer kinetic model was consistently appropriate across prostatic zones. CONCLUSIONS An irreversible tracer kinetic model is appropriate for dynamic analysis of 68Ga-PSMA-11 PET images. Kinetic parameters estimated by Patlak graphical analysis or full compartmental analysis can distinguish tumor from normal prostate tissue.
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Affiliation(s)
- Nathaniel J Smith
- Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, 46202, USA.
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| | - Mark A Green
- Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, 46202, USA
| | - Clinton D Bahler
- Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, 46202, USA
| | - Mark Tann
- Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, 46202, USA
| | - Wendy Territo
- Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, 46202, USA
| | - Anne M Smith
- Siemens Medical Solutions USA, Inc., Knoxville, TN, USA
| | - Gary D Hutchins
- Indiana University School of Medicine, 950 West Walnut Street, Indianapolis, IN, 46202, USA
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Lin R, Wang C, Chen S, Lin T, Cai H, Chen S, Yang Y, Zhang J, Xu F, Zhang J, Chen X, Zang J, Miao W. [ 68Ga]Ga‑LNC1007 PET/CT in the evaluation of renal cell carcinoma: comparison with 2-[ 18F]FDG/[ 68Ga]Ga-PSMA PET/CT. Eur J Nucl Med Mol Imaging 2024; 51:535-547. [PMID: 37728667 DOI: 10.1007/s00259-023-06436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
PURPOSE To compare the potential efficiency of [68Ga]Ga-LNC1007 with 2-[18F]FDG/[68Ga]Ga-PSMA PET/CT for detecting renal cell carcinoma (RCC) and to explore parameters derived from [68Ga]Ga-LNC1007 PET/CT for discriminating pathological characteristics in RCC. METHODS Twenty-five RCC patients confirmed by pathology were enrolled in this prospective study. The maximum standardized uptake value (SUVmax), mean SUV (SUVmean), gross tumor volume (GTV) and total lesion-tracer (TL-tracer) of lesions were calculated from the corresponding PET/CT images. Pathological characteristics included World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade and adverse pathological features (tumor necrosis or sarcomatoid or rhabdoid feature). RESULTS [68Ga]Ga-LNC1007 PET/CT showed a higher detection rate for primary lesions than 2-[18F]FDG and [68Ga]Ga-PSMA (LNC1007 vs. FDG: 13/17 vs. 4/17, P = 0.005; LNC1007 vs. PSMA: 9/11 vs. 6/11, P = 0.361). [68Ga]Ga-LNC1007 PET/CT showed higher SUVmax (6.6 vs. 3.7, P = 0.005), SUVmean (4.1 vs. 2.3, P = 0.001) and TBR (2.6 vs. 1.7, P = 0.011) compared with 2-[18F]FDG PET/CT, and it also showed higher TBR (2.9 vs. 0.5, P = 0.003), TBR-delay (2.8 vs. 0.3, P = 0.003), GTV (84.1 vs. 42.9, P = 0.003) and TL-tracer (442.7 vs. 235.8, P = 0.008) compared with [68Ga]Ga-PSMA PET/CT. SUVmax and TBR derived from [68Ga]Ga-LNC1007 PET/CT could effectively differentiate WHO/ISUP grade (3-4 vs. 1-2) and adverse pathological features (positive vs. negative) (SUVmax: AUC 0.81, P = 0.04; AUC 0.80, P = 0.033; TBR: AUC 0.84, P = 0.026; AUC 0.85, P = 0.014). The SUVmax was positively correlated with the FAP expression, integrin αvβ3 expression and the total expression of FAP and integrin αvβ3 (r = 0.577, P = 0.006, r = 0.701, P < 0.001, and r = 0.702, P < 0.001, respectively). CONCLUSION [68Ga]Ga-LNC1007 is a promising tracer for RCC imaging and can effectively identify aggressive pathological characteristics of RCC.
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Affiliation(s)
- Rong Lin
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China
| | - Chao Wang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China
| | - Shaohao Chen
- Department of Urology, Urology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Tingting Lin
- Department of Urology, Urology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Hai Cai
- Department of Urology, Urology Research Institute, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Shaoming Chen
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China
| | - Yun Yang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China
| | - Jiaying Zhang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China
| | - Fuqi Xu
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China
| | - Jingjing Zhang
- Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119074, Singapore.
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore.
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.
| | - Xiaoyuan Chen
- Departments of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119074, Singapore.
- Clinical Imaging Research Centre, Centre for Translational Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117599, Singapore.
- Nanomedicine Translational Research Program, NUS Center for Nanomedicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.
- Departments of Chemical and Biomolecular Engineering, and Biomedical Engineering, Faculty of Engineering, National University of Singapore, Singapore, 117597, Singapore.
| | - Jie Zang
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China.
| | - Weibing Miao
- Department of Nuclear Medicine, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
- Department of Nuclear Medicine, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Changle District, No. 999 Huashan Road, Fuzhou, 350212, China.
- Fujian Key Laboratory of Precision Medicine for Cancer, the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, Fujian Province, China.
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Houshmand S, Lawhn-Heath C, Behr S. PSMA PET imaging in the diagnosis and management of prostate cancer. Abdom Radiol (NY) 2023; 48:3610-3623. [PMID: 37493837 PMCID: PMC10682054 DOI: 10.1007/s00261-023-04002-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/27/2023]
Abstract
Prostate cancer is the second leading cause of cancer-related deaths in men in the United States. Imaging techniques such as CT, MRI, and bone scans have traditionally been used for diagnosis and staging. Molecular imaging modalities targeting the prostate-specific membrane antigen (PSMA) have recently gained attention due to their high affinity and accuracy. PSMA PET has been combined with other modalities such as multiparametric MRI for better diagnostic and prognostic performance. PSMA imaging has been studied at different clinical settings with a wide range of disease aggressiveness. In this review we will explore the role of PSMA PET in high-risk prostate cancer staging, biochemical recurrence, and castration-resistant prostate cancer. The primary focus of this review article is to examine the latest developments in the use of PSMA imaging and emphasize the clinical situations where its effectiveness has been demonstrated to significantly impact the treatment of prostate cancer. In addition, we will touch upon the potential future advancements of PSMA PET imaging and its evolving significance in the management of prostate cancer.
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Affiliation(s)
- Sina Houshmand
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA.
| | - Courtney Lawhn-Heath
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
| | - Spencer Behr
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California, USA
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Nilsson E, Sandgren K, Grefve J, Jonsson J, Axelsson J, Lindberg AK, Söderkvist K, Karlsson CT, Widmark A, Blomqvist L, Strandberg S, Riklund K, Bergh A, Nyholm T. The grade of individual prostate cancer lesions predicted by magnetic resonance imaging and positron emission tomography. COMMUNICATIONS MEDICINE 2023; 3:164. [PMID: 37945817 PMCID: PMC10636013 DOI: 10.1038/s43856-023-00394-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Multiparametric magnetic resonance imaging (mpMRI) and positron emission tomography (PET) are widely used for the management of prostate cancer (PCa). However, how these modalities complement each other in PCa risk stratification is still largely unknown. We aim to provide insights into the potential of mpMRI and PET for PCa risk stratification. METHODS We analyzed data from 55 consecutive patients with elevated prostate-specific antigen and biopsy-proven PCa enrolled in a prospective study between December 2016 and December 2019. [68Ga]PSMA-11 PET (PSMA-PET), [11C]Acetate PET (Acetate-PET) and mpMRI were co-registered with whole-mount histopathology. Lower- and higher-grade lesions were defined by International Society of Urological Pathology (ISUP) grade groups (IGG). We used PET and mpMRI data to differentiate between grades in two cases: IGG 3 vs. IGG 2 (case 1) and IGG ≥ 3 vs. IGG ≤ 2 (case 2). The performance was evaluated by receiver operating characteristic (ROC) analysis. RESULTS We find that the maximum standardized uptake value (SUVmax) for PSMA-PET achieves the highest area under the ROC curve (AUC), with AUCs of 0.72 (case 1) and 0.79 (case 2). Combining the volume transfer constant, apparent diffusion coefficient and T2-weighted images (each normalized to non-malignant prostatic tissue) results in AUCs of 0.70 (case 1) and 0.70 (case 2). Adding PSMA-SUVmax increases the AUCs by 0.09 (p < 0.01) and 0.12 (p < 0.01), respectively. CONCLUSIONS By co-registering whole-mount histopathology and in-vivo imaging we show that mpMRI and PET can distinguish between lower- and higher-grade prostate cancer, using partially discriminative cut-off values.
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Affiliation(s)
- Erik Nilsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden.
| | - Kristina Sandgren
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Josefine Grefve
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Joakim Jonsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | - Jan Axelsson
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
| | | | - Karin Söderkvist
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | | | - Anders Widmark
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Lennart Blomqvist
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Solna, Sweden
| | - Sara Strandberg
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Katrine Riklund
- Department of Radiation Sciences, Diagnostic Radiology, Umeå University, Umeå, Sweden
| | - Anders Bergh
- Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
| | - Tufve Nyholm
- Department of Radiation Sciences, Radiation Physics, Umeå University, Umeå, Sweden
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5
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Smith NJ, Green MA, Bahler CD, Tann M, Territo W, Smith AM, Hutchins GD. Comparison of Tracer Kinetic Models for 68Ga-PSMA-11 PET in Intermediate Risk Primary Prostate Cancer Patients. RESEARCH SQUARE 2023:rs.3.rs-3420161. [PMID: 37961116 PMCID: PMC10635384 DOI: 10.21203/rs.3.rs-3420161/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND 68Ga-PSMA-11 positron emission tomography enables the detection of primary, recurrent, and metastatic prostate cancer. Regional radiopharmaceutical uptake is generally evaluated in static images and quantified as standard uptake values (SUV) for clinical decision-making. However, analysis of dynamic images characterizing both tracer uptake and pharmacokinetics may offer added insights into the underlying tissue pathophysiology. This study was undertaken to evaluate the suitability of various kinetic models for 68Ga-PSMA-11 PET analysis. Twenty-three lesions in 18 patients were included in a retrospective kinetic evaluation of 55-minute dynamic 68Ga-PSMA-11 pre-prostatectomy PET scans from patients with biopsy-demonstrated intermediate to high-risk prostate cancer. A reversible one-tissue compartment model, irreversible two-tissue compartment model, and a reversible two-tissue compartment model were evaluated for their goodness-of-fit to lesion and normal reference prostate time-activity curves. Kinetic parameters obtained through graphical analysis and tracer kinetic modeling techniques were compared for reference prostate tissue and lesion regions of interest. RESULTS Supported by goodness-of-fit and information loss criteria, the irreversible two-tissue compartment model was selected as optimally fitting the time-activity curves. Lesions exhibited significant differences in kinetic rate constants (K1, k2, k3, Ki) and semiquantitative measures (SUV) when compared with reference prostatic tissue. The two-tissue irreversible tracer kinetic model was consistently appropriate across prostatic zones. CONCLUSIONS An irreversible tracer kinetic model is appropriate for dynamic analysis of 68Ga-PSMA-11 PET images. Kinetic parameters estimated by Patlak graphical analysis or full compartmental analysis can distinguish tumor from normal prostate tissue.
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Affiliation(s)
| | | | | | - Mark Tann
- Indiana University School of Medicine
| | | | - Anne M Smith
- Siemens Medical Solutions USA Inc: Siemens Healthcare USA
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Gondry O, Xavier C, Raes L, Heemskerk J, Devoogdt N, Everaert H, Breckpot K, Lecocq Q, Decoster L, Fontaine C, Schallier D, Aspeslagh S, Vaneycken I, Raes G, Van Ginderachter JA, Lahoutte T, Caveliers V, Keyaerts M. Phase I Study of [ 68Ga]Ga-Anti-CD206-sdAb for PET/CT Assessment of Protumorigenic Macrophage Presence in Solid Tumors (MMR Phase I). J Nucl Med 2023; 64:1378-1384. [PMID: 37474271 PMCID: PMC10478821 DOI: 10.2967/jnumed.122.264853] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/05/2023] [Indexed: 07/22/2023] Open
Abstract
Macrophages play an important role throughout the body. Antiinflammatory macrophages expressing the macrophage mannose receptor (MMR, CD206) are involved in disease development, ranging from oncology to atherosclerosis and rheumatoid arthritis. [68Ga]Ga-NOTA-anti-CD206 single-domain antibody (sdAb) is a PET tracer targeting CD206. This first-in-human study, as its primary objective, evaluated the safety, biodistribution, and dosimetry of this tracer. The secondary objective was to assess its tumor uptake. Methods: Seven patients with a solid tumor of at least 10 mm, an Eastern Cooperative Oncology Group score of 0 or 1, and good renal and hepatic function were included. Safety was evaluated using clinical examination and blood sampling before and after injection. For biodistribution and dosimetry, PET/CT was performed at 11, 90, and 150 min after injection; organs showing tracer uptake were delineated, and dosimetry was evaluated. Blood samples were obtained at selected time points for blood clearance. Metabolites in blood and urine were assessed. Results: Seven patients were injected with, on average, 191 MBq of [68Ga]Ga-NOTA-anti-CD206-sdAb. Only 1 transient adverse event of mild severity was considered to be possibly, although unlikely, related to the study drug (headache, Common Terminology Criteria for Adverse Events grade 1). The blood clearance was fast, with less than 20% of the injected activity remaining after 80 min. There was uptake in the liver, kidneys, spleen, adrenals, and red bone marrow. The average effective dose from the radiopharmaceutical was 4.2 mSv for males and 5.2 mSv for females. No metabolites were detected. Preliminary data of tumor uptake in cancer lesions showed higher uptake in the 3 patients who subsequently progressed than in the 3 patients without progression. One patient could not be evaluated because of technical failure. Conclusion: [68Ga]Ga-NOTA-anti-CD206-sdAb is safe and well tolerated. It shows rapid blood clearance and renal excretion, enabling high contrast-to-noise imaging at 90 min after injection. The radiation dose is comparable to that of routinely used PET tracers. These findings and the preliminary results in cancer patients warrant further investigation of this tracer in phase II clinical trials.
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Affiliation(s)
- Odrade Gondry
- MIMA, Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium;
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Catarina Xavier
- MIMA, Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
| | - Laurens Raes
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Johannes Heemskerk
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Nick Devoogdt
- MIMA, Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
| | - Hendrik Everaert
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Karine Breckpot
- Laboratory for Molecular and Cellular Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Quentin Lecocq
- Laboratory for Molecular and Cellular Therapy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lore Decoster
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Christel Fontaine
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Denis Schallier
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Sandrine Aspeslagh
- Department of Medical Oncology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ilse Vaneycken
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Geert Raes
- Cellular and Molecular Immunology, Lab of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium; and
- Myeloid Cell Immunology Lab, VIB Center for Inflammation Research, Brussels, Belgium
| | - Jo A Van Ginderachter
- Cellular and Molecular Immunology, Lab of Cellular and Molecular Immunology, Vrije Universiteit Brussel, Brussels, Belgium; and
- Myeloid Cell Immunology Lab, VIB Center for Inflammation Research, Brussels, Belgium
| | - Tony Lahoutte
- MIMA, Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Vicky Caveliers
- MIMA, Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Marleen Keyaerts
- MIMA, Department of Medical Imaging, Vrije Universiteit Brussel, Brussels, Belgium
- Nuclear Medicine Department, Universitair Ziekenhuis Brussel, Brussels, Belgium
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7
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Winkens T, Berger FP, Foller S, Greiser J, Groeber S, Grimm MO, Freesmeyer M, Kuehnel C. 67 Ga-PSMA I&T for Radioguided Surgery of Lymph Node Metastases in Patients With Biochemical Recurrence of Prostate Cancer. Clin Nucl Med 2023; 48:600-607. [PMID: 37145416 DOI: 10.1097/rlu.0000000000004668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
PURPOSE Radioguided lymph node dissection in patients with prostate cancer, and suffering from biochemical recurrence has been described thoroughly during the past few years. Several prostate-specific membrane antigen (PSMA)-directed ligands labeled with 111 In, 99m Tc, and 68 Ga have been published; however, limitations regarding availability, short half-life, high costs, and unfavorable high energy might restrict frequent use. This study aims at introducing 67 Ga as a promising radionuclide for radioguided surgery. METHODS Retrospective analysis was performed on 6 patients with 7 PSMA-positive lymph node metastases. 67 Ga-PSMA I&T (imaging and therapy) was synthesized in-house and intravenously applied according to §13 2b of the German Medicinal Products Act. Radioguided surgery was performed 24 hours after injection of 67 Ga-PSMA I&T using a gamma probe. Patient urine samples were collected. Occupational and waste dosimetry was performed to describe hazards arising from radiation. RESULTS 67 Ga-PSMA application was tolerated without adverse effects. Five of 7 lymph nodes were detected on 22-hour SPECT/CT in 4 of 6 patients. During surgery, all 7 lymph node metastases were identified by positive gamma probe signal. Relevant accumulation of 67 Ga was observed in lymph node metastases (32.1 ± 15.1 kBq). Histology analysis of near-field lymph node dissection revealed more lymph node metastases than PET/CT (and gamma probe measurements) identified. Waste produced during inpatient stay required decay time of up to 11 days before reaching exemption limits according to German regulations. CONCLUSIONS Radioguided surgery using 67 Ga-PSMA I&T is a safe and feasible option for patients suffering from biochemical recurrence of prostate cancer. 67 Ga-PSMA I&T was successfully synthesized according to Good Manufacturing Practice guidelines. Radioguided surgery with 67 Ga-PSMA I&T does not lead to relevant radiation burden to urology surgeons and represents a novel interdisciplinary approach in nuclear medicine and urology.
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Affiliation(s)
| | | | | | - Julia Greiser
- Experimental Radiopharmacy, Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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8
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Kesler M, Cohen D, Levine C, Sarid D, Keizman D, Yossepowitch O, Even-Sapir E. Staging Prostate Cancer with 68Ga-PSMA-11 PET/CT in the Elderly: Is Preimaging Biopsy Imperative? J Nucl Med 2023:jnumed.122.265371. [PMID: 37116912 DOI: 10.2967/jnumed.122.265371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/16/2023] [Indexed: 04/30/2023] Open
Abstract
Although prostate-specific membrane antigen (PSMA) PET/CT has been shown valuable for staging biopsy-proven [B(+)] high-risk prostate cancer, elderly patients are occasionally referred for PSMA PET/CT without a preimaging confirming biopsy [B(-)]. The current study evaluated the rate, clinical characteristics, and PET-based stage of elderly B(-) patients and explored whether biopsy status affects therapeutic approach. Methods: One hundred consecutive patients at least 80 y old who underwent staging 68Ga-PSMA-11 PET/CT were included. For each patient, we documented whether preimaging biopsy was performed, the clinical parameters, the PET-based staging parameters, and the primary therapy received. Results: Thirty-four (34%) of the elderly patients included in the study had no preimaging biopsy. Compared with B(+) patients, B(-) patients were older (median age, 87 vs. 82 y; P < 0.01), with worse performance status (P < 0.01) and higher prostate-specific antigen (PSA) levels (median, 57 vs. 15.4 ng/mL; P < 0.01). On 68Ga-PSMA-11 PET/CT, all B(-) patients had avid disease, with trends toward higher rates of bone metastases (47.1% vs. 28.8%) and overall advanced disease (50% vs. 33.3%) than in B(+) patients. Among patients with localized (n = 36) or locally advanced (n = 25) disease, B(-) patients were less commonly referred than B(+) patients for definitive therapies (P < 0.01). However, higher age, Eastern Cooperative Oncology Group performance status, and PSA were other probable factors determining their therapeutic approach. Among 39 patients with advanced disease, 38 received hormonal therapy irrespective of their biopsy status. Among B(-) patients with advanced disease who were referred for hormonal therapy, 12 of 13 with follow-up data showed a biochemical or imaging-based response. Conclusion: Real-life experience with 68Ga-PSMA-11 PET/CT indicates that around one third of elderly patients are referred for imaging without a preimaging confirming biopsy. These patients are likely to be older, with a worse clinical status and higher PSA levels. Advanced disease might be more likely to be identified on their 68Ga-PSMA-11 PET/CT images, and if it is, their biopsy status does not preclude them from receiving hormonal therapy.
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Affiliation(s)
- Mikhail Kesler
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Dan Cohen
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Charles Levine
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Sarid
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; and
| | - Daniel Keizman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Oncology, Tel-Aviv Sourasky Medical Center, Tel Aviv, Israel; and
| | - Ofer Yossepowitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Urology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Cook GJ, Wong WL, Sanghera B, Mangar S, Challapalli A, Bahl A, Bassett P, Leaning D, Schmidkonz C. Eligibility for 177Lu-PSMA Therapy Depends on the Choice of Companion Diagnostic Tracer: A Comparison of 68Ga-PSMA-11 and 99mTc-MIP-1404 in Metastatic Castration-Resistant Prostate Cancer. J Nucl Med 2023; 64:227-231. [PMID: 36302657 PMCID: PMC9902859 DOI: 10.2967/jnumed.122.264296] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/11/2022] [Accepted: 08/11/2022] [Indexed: 02/04/2023] Open
Abstract
177Lu-prostate-specific membrane antigen-617 (177Lu-PSMA-617) is an effective therapy for metastatic castration-resistant prostate cancer (mCRPC), with evidence of improved survival over standard care. The VISION trial inclusion criteria required a metastatic lesion-to-liver ratio of greater than 1 on 68Ga-PSMA-11 PET scans. We aimed to determine whether an equivalent ratio is suitable for a SPECT tracer, 99mTc-MIP-1404, and to compare lesion and lesion-to-normal-organ ratios between the 2 radiotracers. Methods: Two cohorts of patients with mCRPC matched for age, prostate-specific antigen level, and total Gleason score, with either 99mTc-MIP-1404 SPECT/CT (n = 25) or 68Ga-PSMA-11 PET/CT (n = 25) scans, were included for analysis. Up to 3 lesions in each site (prostate/prostate bed, lymph nodes, bone and soft-tissue metastases) as well as normal liver, parotid gland, spleen, and mediastinal blood-pool SUVmax were measured. Results: 99mTc-MIP-1404 SPECT lesion SUVmax was not significantly different from 68Ga-PSMA-11 PET (median, 18.2 vs. 17.3; P = 0.93). However, 99mTc-MIP-1404 liver SUVmax was higher (median, 8.5 vs. 5.8; P = 0.002) and lesion-to-liver ratios were lower (median, 2.7 vs. 3.5; P = 0.009). There was no significant difference in parotid gland or splenic SUVmax or lesion-to-parotid gland ratios between the 2 tracers although there was a small difference in lesion-to-spleen ratios (P = 0.034). Conclusion: There are differences in biodistribution and, in particular, liver activity, between 68Ga-PSMA-11 and 99mTc-MIP-1404. Therefore, if 99mTc-MIP-1404 is used to assess eligibility for 177Lu-PSMA-617 therapy, a lower adjusted lesion-to-liver ratio should be used.
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Affiliation(s)
- Gary J.R. Cook
- Cancer Imaging Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Wai-Lup Wong
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Northwood, United Kingdom
| | - Bal Sanghera
- Paul Strickland Scanner Centre, Mount Vernon Hospital, Northwood, Northwood, United Kingdom
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Amarnath Challapalli
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom
| | - Amit Bahl
- Department of Clinical Oncology, Bristol Cancer Institute, Bristol, United Kingdom
| | | | - Darren Leaning
- Department of Clinical Oncology, James Cook University Hospital, South Tees NHS Trust, Middlesbrough, United Kingdom
| | - Christian Schmidkonz
- Department of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany; and,Department of Industrial Engineering and Health, Technical University of Applied Sciences Amberg-Weiden, Weiden, Germany
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10
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Boekestijn I, van Oosterom MN, Dell'Oglio P, van Velden FHP, Pool M, Maurer T, Rietbergen DDD, Buckle T, van Leeuwen FWB. The current status and future prospects for molecular imaging-guided precision surgery. Cancer Imaging 2022; 22:48. [PMID: 36068619 PMCID: PMC9446692 DOI: 10.1186/s40644-022-00482-2] [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: 12/17/2021] [Accepted: 08/21/2022] [Indexed: 01/19/2023] Open
Abstract
Molecular imaging technologies are increasingly used to diagnose, monitor, and guide treatment of i.e., cancer. In this review, the current status and future prospects of the use of molecular imaging as an instrument to help realize precision surgery is addressed with focus on the main components that form the conceptual basis of intraoperative molecular imaging. Paramount for successful interventions is the relevance and accessibility of surgical targets. In addition, selection of the correct combination of imaging agents and modalities is critical to visualize both microscopic and bulk disease sites with high affinity and specificity. In this context developments within engineering/imaging physics continue to drive the growth of image-guided surgery. Particularly important herein is enhancement of sensitivity through improved contrast and spatial resolution, features that are critical if sites of cancer involvement are not to be overlooked during surgery. By facilitating the connection between surgical planning and surgical execution, digital surgery technologies such as computer-aided visualization nicely complement these technologies. The complexity of image guidance, combined with the plurality of technologies that are becoming available, also drives the need for evaluation mechanisms that can objectively score the impact that technologies exert on the performance of healthcare professionals and outcome improvement for patients.
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Affiliation(s)
- Imke Boekestijn
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Matthias N van Oosterom
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Paolo Dell'Oglio
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Floris H P van Velden
- Medical Physics, Department of Radiology , Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Pool
- Department of Clinical Farmacy and Toxicology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Centre Hamburg, Hamburg, Germany
| | - Daphne D D Rietbergen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.,Section of Nuclear Medicine, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tessa Buckle
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Fijs W B van Leeuwen
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands.
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11
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Zhang J, Lin Z, Zhang X, Lin R, Cui M, Miao W, Yao S. 68Ga-DOTA-DiPSMA PET/CT Imaging: Biodistribution, Dosimetry, and Preliminary Application in Prostate Cancer. Front Bioeng Biotechnol 2022; 9:811972. [PMID: 35155411 PMCID: PMC8831372 DOI: 10.3389/fbioe.2021.811972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 12/17/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose: This prospective trial aimed to evaluate the safety, dosimetry, and biodistribution of a novel theranostic probe 68Ga-DOTA-DiPSMA. Also, we have performed the first preliminary application with 68Ga-DOTA-DiPSMA in prostate cancer (PCa) patients. Methods: Five healthy volunteers and ten PCa patients were injected with an intravenous bolus of 68Ga-DOTA-DiPSMA. They received serial whole-body PET scans from the time of injection up to 60 min post-injection, with a second PET/CT scanning at 120 min post-injection. In PCa patients, low-dose CT scan and whole-body PET were performed with 2 min per bed position in 40 min post-injection. Absorbed organ doses and effective doses were calculated using OLINDA/EXM. Normal organ uptake and tumor lesion uptake were measured. A lesion-by-lesion analysis was performed. Results: 68Ga-DOTA-DiPSMA administration was safe and well-tolerated. The kidneys received the highest absorbed dose (114.46 ± 29.28 μSv/MBq), followed by the urinary bladder wall (100.82 ± 46.22 μSv/MBq) in accordance with the expected Prostate-Specific Membrane Antigen (PSMA) renal excretion of the tracer. The mean effective dose was 19.46 ± 1.73 μSv/MBq. The SUVmax of 68Ga-DOTA-DiPSMA PET/CT for PCa lesions, bone metastases, and lymph node metastases was 4.41 ± 2.72, 2.95 ± 1.11, and 3.26 ± 1.20, respectively. Conclusion: Injection of 68Ga-DOTA-DiPSMA is safe and associated with low absorbed and effective doses. 68Ga-DOTA-DiPSMA shows favorable kinetics and imaging characteristics in patients who warrant further head-to-head comparison to validate 68Ga-DOTA-DiPSMA as an alternative for gallium-68-labeled PSMA clinical PET. Low nonspecific uptake in normal organs of 68Ga-DOTA-DiPSMA indicates potential radioligand therapy (RLT) application when labeled with 177Lu, 90Y, or 225Ac.
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Affiliation(s)
- Jiaying Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zefang Lin
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Xiaojun Zhang
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, Beijing Normal University, Beijing, China
| | - Rong Lin
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Mengchao Cui
- Key Laboratory of Radiopharmaceuticals, Ministry of Education, Beijing Normal University, Beijing, China
| | - Weibing Miao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shaobo Yao
- Department of Nuclear Medicine, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Fujian Provincial Key Laboratory of Precision Medicine for Cancer, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Shaobo Yao,
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12
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Deva K, Rana N, Kumar R, Mittal BR. Evaluation of Radiation Exposure to the Patients Undergoing Positron Emission Tomography/Computed Tomography-Guided Biopsies. Indian J Nucl Med 2022; 37:23-28. [PMID: 35478672 PMCID: PMC9037880 DOI: 10.4103/ijnm.ijnm_112_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/04/2022] Open
Abstract
Purpose We aimed to evaluate the radiation exposure to patients undergoing positron emission tomography/computed tomography (PET/CT)-guided biopsies. Materials and Methods Patients undergoing PET/CT-guided biopsy were recruited prospectively from October 2019 to April 2020. PET/CT-guided biopsy from a tracer avid site was done using an automated-robotic-arm 1 h after intravenous injection of F-18-fluorodeoxyglucose (FDG) (2-5 mCi) or Ga-68-PSMA (1-4 mCi). Regional CT-images were acquired for biopsy planning and confirmation of needle placement. The internal radiation exposure due to the PET component was estimated using the value of activity injected and dose-coefficient for FDG and PSMA. The external radiation exposure due to the CT component was estimated using the value of dose length product and organ coefficients conversion factor. The total effective dose during the procedure was calculated by adding exposure due to both CT and PET components. Percentage contribution from CT and PET component to total effective dose was compared using a paired t-test. Results A total of 101 patients (76 males) were recruited for PET/CT-guided biopsy using FDG (n = 79) and PSMA (n = 22). The mean effective-dose due to PET and CT components and total effective-dose was 2.49 ± 1.02 mSv, 2.35 ± 1.03 mSv and 4.83 ± 1.90 mSv, respectively, for FDG-guided procedures and 1.60 ± 0.57 mSv, 3.06 ± 1.36 mSv, and 4.66 ± 1.37 mSv for Ga-68-PSMA-guided procedures. The percentage contribution of PET and CT in total effective-dose was comparable in F-18-FDG and Ga-68-PSMA PET/CT-guided biopsy procedures; however, for Ga-68-PSMA PET/CT-biopsies, CT contributed a higher radiation dose than PET component. Conclusion PET/CT-guided biopsy is a safe interventional procedure, and radiation exposure to the patients was less than routine whole-body PET/CT-imaging.
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Affiliation(s)
- Krishnapriya Deva
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nivedita Rana
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence: Dr. Rajender Kumar, Department is Nuclear Medicine and PET/CT, Institute is Post Graduate Institute of Medical Education and Research, Chandigarh - 160 012, India. E-mail:
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Viry A, Bize J, Trueb PR, Ott B, Racine D, Verdun FR, LeCoultre R. ANNUAL EXPOSURE OF THE SWISS POPULATION FROM MEDICAL IMAGING IN 2018. RADIATION PROTECTION DOSIMETRY 2021; 195:289-295. [PMID: 33647105 PMCID: PMC8507460 DOI: 10.1093/rpd/ncab012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/18/2020] [Accepted: 01/12/2021] [Indexed: 06/12/2023]
Abstract
Nationwide surveys on radiation dose to the population from medical imaging are recommended in order to follow trends in population exposure. The goal of the 2018 survey was to investigate the current exposure. The invoice coding information was collected in five university hospitals and large clinics. To improve the estimation of the effective dose delivered in computed tomography (CT), we collected dose data from different Dose Archiving Communication Systems. On average, we found that 1.2 radiological examinations per year and per inhabitant were performed. Dental radiography was the most frequent examination (48% of all the X-ray examinations), followed by conventional radiography (36%) and CT (11%). The average annual effective dose was estimated to be 1.48 mSv per inhabitant, with CT representing 64% of that dose. Our results show that the exposure of the Swiss population from medical imaging has remained stable since 2013, despite a 15% increase in the number of CT examinations.
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Affiliation(s)
| | - Julie Bize
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | - Philipp R Trueb
- Radiation Protection Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Barbara Ott
- Radiation Protection Division, Swiss Federal Office of Public Health, Bern, Switzerland
| | - Damien Racine
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | - Francis R Verdun
- Institute of Radiation Physics (IRA), Lausanne University Hospital, Lausanne, Switzerland
| | - Régis LeCoultre
- University of Health Sciences (HESAV), University of Applied Sciences Western Switzerland (HES-SO), Lausanne, Switzerland
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14
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[ 68Ga]Ga-PSMA-11 PET imaging as a predictor for absorbed doses in organs at risk and small lesions in [ 177Lu]Lu-PSMA-617 treatment. Eur J Nucl Med Mol Imaging 2021; 49:1101-1112. [PMID: 34623453 PMCID: PMC8921092 DOI: 10.1007/s00259-021-05538-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022]
Abstract
Introduction
Patient eligibility for [177Lu]Lu-PSMA therapy remains a challenge, with only 40–60% response rate when patient selection is done based on the lesion uptake (SUV) on [68Ga]Ga-PSMA-PET/CT. Prediction of absorbed dose based on this pre-treatment scan could improve patient selection and help to individualize treatment by maximizing the absorbed dose to target lesions while adhering to the threshold doses for the organs at risk (kidneys, salivary glands, and liver). Methods Ten patients with low-volume hormone-sensitive prostate cancer received a pre-therapeutic [68Ga]Ga-PSMA-11 PET/CT, followed by 3 GBq [177Lu]Lu-PSMA-617 therapy. Intra-therapeutically, SPECT/CT was acquired at 1, 24, 48, 72, and 168 h. Absorbed dose in organs and lesions (n = 22) was determined according to the MIRD scheme. Absorbed dose prediction based on [68Ga]Ga-PSMA-PET/CT was performed using tracer uptake at 1 h post-injection and the mean tissue effective half-life on SPECT. Predicted PET/actual SPECT absorbed dose ratios were determined for each target volume. Results PET/SPECT absorbed dose ratio was 1.01 ± 0.21, 1.10 ± 0.15, 1.20 ± 0.34, and 1.11 ± 0.29 for kidneys (using a 2.2 scaling factor), liver, submandibular, and parotid glands, respectively. While a large inter-patient variation in lesion kinetics was observed, PET/SPECT absorbed dose ratio was 1.3 ± 0.7 (range: 0.4–2.7, correlation coefficient r = 0.69, p < 0.01). Conclusion A single time point [68Ga]Ga-PSMA-PET scan can be used to predict the absorbed dose of [177Lu]Lu-PSMA therapy to organs, and (to a limited extent) to lesions. This strategy facilitates in treatment management and could increase the personalization of [177Lu]Lu-PSMA therapy. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05538-2.
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15
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Sarikaya I, Alqallaf A, Sarikaya A, Baqer A, Kazem N. Renal Cortical Scarring: 68Ga-PSMA-11 PET versus 99mTc-DMSA Scan in a Case with Pyelonephritis. J Nucl Med Technol 2021; 50:49-53. [PMID: 34330812 DOI: 10.2967/jnmt.121.262415] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
We previously reported 68Ga-prostate‑specific membrane antigen (PSMA)-11 and 99mTcdimercaptosuccinic acid (DMSA) images of the 1st case of our prospective research comparing renal PSMA PET to DMSA scan in adult patients with pyelonephritis. Here, we present renal cortical PSMA PET and DMSA images of our 2nd patient with chronic recurring pyelonephritis which demonstrated renal parenchymal defects secondary to scarring in the kidney.
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16
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[ 68Ga]Ga-P16-093 as a PSMA-Targeted PET Radiopharmaceutical for Detection of Cancer: Initial Evaluation and Comparison with [ 68Ga]Ga-PSMA-11 in Prostate Cancer Patients Presenting with Biochemical Recurrence. Mol Imaging Biol 2021; 22:752-763. [PMID: 31429050 DOI: 10.1007/s11307-019-01421-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study was undertaken to evaluate radiation dosimetry for the prostate-specific membrane antigen targeted [68Ga]Ga-P16-093 radiopharmaceutical, and to initially assess agent performance in positron emission tomography (PET) detection of the site of disease in prostate cancer patients presenting with biochemical recurrence. PROCEDURES Under IND 133,222 and an IRB-approved research protocol, we evaluated the biodistribution and pharmacokinetics of [68Ga]Ga-P16-093 with serial PET imaging following intravenous administration to ten prostate cancer patients with biochemical recurrence. The recruited subjects were all patients in whom a recent [68Ga]Ga-PSMA-11 PET/X-ray computed tomography (CT) exam had been independently performed under IND 131,806 to assist in decision-making with regard to their clinical care. Voided urine was collected from each subject at ~ 60 min and ~ 140 min post-[68Ga]Ga-P16-093 injection and assayed for Ga-68 content. Following image segmentation to extract tissue time-activity curves and corresponding cumulated activity values, radiation dosimetry estimates were calculated using IDAC Dose 2.1. The prior [68Ga]Ga-PSMA-11 PET/CT exam (whole-body PET imaging at 60 min post-injection, performed with contrast-enhanced diagnostic CT) served as a reference scan for comparison to the [68Ga]Ga-P16-093 findings. RESULTS [68Ga]Ga-P16-093 PET images at 60 min post-injection provided diagnostic information that appeared equivalent to the subject's prior [68Ga]Ga-PSMA-11 scan. With both radiopharmaceuticals, sites of tumor recurrence were found in eight of the ten patients, identifying 16 lesions. The site of recurrence was not detected with either agent for the other two subjects. Bladder activity was consistently lower with [68Ga]Ga-P16-093 than [68Ga]Ga-PSMA-11. The kidneys, spleen, salivary glands, and liver receive the highest radiation exposure from [68Ga]Ga-P16-093, with estimated doses of 1.7 × 10-1, 6.7 × 10-2, 6.5 × 10-2, and 5.6 × 10-2 mGy/MBq, respectively. The corresponding effective dose from [68Ga]Ga-P16-093 is 2.3 × 10-2 mSv/MBq. CONCLUSIONS [68Ga]Ga-P16-093 provided diagnostic information that appeared equivalent to [68Ga]Ga-PSMA-11 in this limited series of ten prostate cancer patients presenting with biochemical recurrence, with the kidneys found to be the critical organ. Diminished tracer appearance in the urine represents a potential advantage of [68Ga]Ga-P16-093 over [68Ga]Ga-PSMA-11 for detection of lesions in the pelvis.
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17
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Rivera-Bravo B, Ramírez-Nava G, Mendoza-Figueroa MJ, Ocampo-García B, Ferro-Flores G, Ávila-Rodríguez MA, Santos-Cuevas C. [ 68Ga]Ga-iPSMA-Lys 3-Bombesin: Biokinetics, dosimetry and first patient PET/CT imaging. Nucl Med Biol 2021; 96-97:54-60. [PMID: 33831746 DOI: 10.1016/j.nucmedbio.2021.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/19/2021] [Accepted: 03/20/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND The prostate-specific membrane antigen (PSMA) and the gastrin-releasing peptide receptor (GRPR) are overexpressed in prostate cancer (PCa). In preclinical studies, the iPSMA-Lys3-Bombesin (iPSMA-BN) heterodimeric ligand has shown a suitable affinity for PSMA and GRPR. This research aimed to assess the biokinetics and radiation dosimetry of [68Ga]Ga-iPSMA-BN in four healthy volunteers based on biodistribution data obtained from whole-body PET/CT studies, as well as to visualize the [68Ga]Ga-iPSMA-BN tumor uptake in a patient with PCa. METHODS PET/CT images acquired at 5 min, 0.5, 1, and 2 h after radiotracer administration (124.5 ± 2.1 MBq) were corrected for attenuation, scattering, dead-time, and decay. The activity in the segmented volumes of interest (VOIs) in each source organ at different times was adjusted to mono- and bi-exponential biokinetic models (A(t)VOI), from which the total disintegrations (N) were calculated to assess the internal radiation doses by using the OLINDA V1.1 code. RESULTS Images from the patient showed an evident uptake by the metastasis (SUVmax of 4.7) and by the organs expressing GRPR (pancreas) and PSMA (salivary glands). The average effective dose was 2.70 ± 0.05 mSv, which was like those known for most of the 68Ga studies, making [68Ga]Ga-iPSMA-BN a promising dual-target PET imaging radiotracer for PCa. CONCLUSIONS [68Ga]Ga-iPSMA-BN, capable of detecting both PSMA and GRPR with suitable biokinetics and dosimetric patterns, could be a potential complementary diagnostic tool for the improvement of prostate cancer PET imaging.
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Affiliation(s)
- Belén Rivera-Bravo
- Unidad PET/CT, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Gerardo Ramírez-Nava
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac 52750, Mexico State, Mexico; Departamento de Posgrado, UPIBI-Instituto Politécnico Nacional, Mexico City 07340, Mexico
| | - Mónica J Mendoza-Figueroa
- Unidad de Radiofarmacia-Ciclotrón, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico
| | - Blanca Ocampo-García
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac 52750, Mexico State, Mexico
| | - Guillermina Ferro-Flores
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac 52750, Mexico State, Mexico.
| | - Miguel A Ávila-Rodríguez
- Unidad de Radiofarmacia-Ciclotrón, División de Investigación, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City 04510, Mexico.
| | - Clara Santos-Cuevas
- Departamento de Materiales Radiactivos, Instituto Nacional de Investigaciones Nucleares, Ocoyoacac 52750, Mexico State, Mexico.
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Gühne F, Drescher R, Seifert P, Freesmeyer M. Supplemental minimal-activity PET/CT to validate ambiguous findings with less than 1 mSv: Proof of concept. J Med Imaging Radiat Oncol 2021; 65:201-207. [PMID: 33606349 DOI: 10.1111/1754-9485.13164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/02/2021] [Indexed: 11/30/2022]
Abstract
Short-term follow-up examinations could verify ambiguous findings in PET/CT diagnostics, but are often avoided due to radiation and financial burdens. We demonstrate the feasibility of a focused, minimal-activity PET protocol as a supplemental examination for uncertain findings after standard PET/CT. After changing conditions, e.g. patient positioning, preparation and bypassing an interval as well as a targeted tracer change, an additional examination with less than 1 mSv of additional radiation exposure was performed. Lowered administered activity of radiopharmaceuticals could be compensated by prolonged acquisition time, which was made possible by the limitation to a single body region. A sufficient visual and quantitative image quality of scans could be achieved. In all cases, the ambiguous finding could be clarified, so further diagnostic procedures or unnecessary interventions were avoided.
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Affiliation(s)
- Falk Gühne
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Robert Drescher
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Philipp Seifert
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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19
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Bois F, Noirot C, Dietemann S, Mainta IC, Zilli T, Garibotto V, Walter MA. [ 68Ga]Ga-PSMA-11 in prostate cancer: a comprehensive review. AMERICAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 2020; 10:349-374. [PMID: 33329937 PMCID: PMC7724278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
Imaging of the prostate-specific membrane antigen (PSMA) has become an important tool for managing patients with recurrent prostate cancer, and one of the most frequently employed radiopharmaceuticals is [68Ga]Ga-PSMA-11. Herein, we summarize the preclinical development and the clinical applications of [68Ga]Ga-PSMA-11 and present side-by-side comparisons with other radiopharmaceuticals or imaging modalities, in order to assist imagers and clinicians in recommending, performing, and interpreting the results of [68Ga]Ga-PSMA-11 PET scans in patients with prostate cancer.
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Affiliation(s)
- Frédéric Bois
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Camille Noirot
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Sébastien Dietemann
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Ismini C Mainta
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
| | - Thomas Zilli
- Division of Radiation Oncology, Oncology Department, University Hospital of GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
| | - Valentina Garibotto
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
| | - Martin A Walter
- Division of Nuclear Medicine, Diagnostic Department, University Hospital of GenevaGeneva, Switzerland
- Faculty of Medicine, University of GenevaGeneva, Switzerland
- Center for Biomedical Imaging (CIBM)Lausanne, Switzerland
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20
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Jackson IM, Lee SJ, Sowa AR, Rodnick ME, Bruton L, Clark M, Preshlock S, Rothley J, Rogers VE, Botti LE, Henderson BD, Hockley BG, Torres J, Raffel DM, Brooks AF, Frey KA, Kilbourn MR, Koeppe RA, Shao X, Scott PJH. Use of 55 PET radiotracers under approval of a Radioactive Drug Research Committee (RDRC). EJNMMI Radiopharm Chem 2020; 5:24. [PMID: 33175263 PMCID: PMC7658275 DOI: 10.1186/s41181-020-00110-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/19/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In the US, EU and elsewhere, basic clinical research studies with positron emission tomography (PET) radiotracers that are generally recognized as safe and effective (GRASE) can often be conducted under institutional approval. For example, in the United States, such research is conducted under the oversight of a Radioactive Drug Research Committee (RDRC) as long as certain requirements are met. Firstly, the research must be for basic science and cannot be intended for immediate therapeutic or diagnostic purposes, or to determine the safety and effectiveness of the PET radiotracer. Secondly, the PET radiotracer must be generally recognized as safe and effective. Specifically, the mass dose to be administered must not cause any clinically detectable pharmacological effect in humans, and the radiation dose to be administered must be the smallest dose practical to perform the study and not exceed regulatory dose limits within a 1-year period. In our experience, the main barrier to using a PET radiotracer under RDRC approval is accessing the required information about mass and radioactive dosing. RESULTS The University of Michigan (UM) has a long history of using PET radiotracers in clinical research studies. Herein we provide dosing information for 55 radiotracers that will enable other PET Centers to use them under the approval of their own RDRC committees. CONCLUSIONS The data provided herein will streamline future RDRC approval, and facilitate further basic science investigation of 55 PET radiotracers that target functionally relevant biomarkers in high impact disease states.
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Affiliation(s)
- Isaac M Jackson
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
- Present Address: Stanford University, Stanford, CA, USA
| | - So Jeong Lee
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
- Present Address: Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexandra R Sowa
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Melissa E Rodnick
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Laura Bruton
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Mara Clark
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Sean Preshlock
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Jill Rothley
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Virginia E Rogers
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Leslie E Botti
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Bradford D Henderson
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Brian G Hockley
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Jovany Torres
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - David M Raffel
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Allen F Brooks
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Kirk A Frey
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Michael R Kilbourn
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Robert A Koeppe
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Xia Shao
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA
| | - Peter J H Scott
- Department of Radiology, University of Michigan, 2276 Medical Science Bldg I, SPC 5610, Ann Arbor, MI, 48109, USA.
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21
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Sarikaya I, Alqallaf A, Sarikaya A. Renal Cortical 68Ga-PSMA-11 PET and 99mTc-DMSA Images. J Nucl Med Technol 2020; 49:30-33. [PMID: 32887764 DOI: 10.2967/jnmt.120.248922] [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: 05/04/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022] Open
Abstract
68Ga-prostate-specific membrane antigen (PSMA) ligands are novel PET radiotracers for prostate cancer. These radiotracers also localize in the normal renal cortex to a high degree and can demonstrate parenchymal defects. We recently started a prospective research study to compare 68Ga-PSMA-11 PET/CT with 99mTc-dimercaptosuccinic acid (DMSA) scan in adults with pyelonephritis. Here, we present a side-by-side comparison of renal cortical PSMA PET/CT and DMSA images of an adult patient with chronic recurring pyelonephritis. Methods: Our prospective study was approved by the Ethical Committees. DMSA images (multiple planar and SPECT) were obtained 3 h after intravenous injection of 111 MBq (3 mCi) of 99mTc-DMSA. On a separate day, we obtained PET/CT images of the kidneys 60 min after intravenous injection of 74 MBq (2 mCi) of 68Ga-PSMA-11 after the patient provided written informed consent. Results: The patient was a 46-y-old woman with history of chronic recurring pyelonephritis. Both DMSA scan and PSMA PET/CT demonstrated slight cortical thinning with mildly reduced uptake in the upper pole of the right kidney, with no significant cortical defects. There was an excellent distribution of activity in the renal cortex and better image resolution with PSMA PET than with DMSA scan. Non-attenuation-corrected PSMA PET images also showed the same findings, with reasonable image quality. Conclusion: In our first case, 68Ga-PSMA-11 PET imaging provided promising results in an adult patient with pyelonephritis. The results of our prospective study on a larger number of adult patients will provide a more accurate comparison of 68Ga-PSMA-11 PET to 99mTc-DMSA scanning in pyelonephritis.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Ahmed Alqallaf
- Department of Medicine, Division of Nephrology, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait; and
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey
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