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Marcus C, Muzahir S, Subramaniam RM. Quarter Century PET/Computed Tomography Transformation of Oncology: Neuroendocrine Tumors. PET Clin 2024; 19:187-196. [PMID: 38160070 DOI: 10.1016/j.cpet.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Significant improvement in molecular imaging and theranostics in the management of neuroendocrine tumors (NETs) has been made in the last few decades. Somatostatin receptor-targeted PET imaging outperforms conventional, planar, and single-photon emission computed tomography imaging and is indicated in the evaluation of these patients when available, resulting in a significant impact on staging, treatment response assessment, and restaging of these patients. Radionuclide therapy can have an impact on patient outcome in metastatic disease when not many treatment options are available.
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Affiliation(s)
- Charles Marcus
- Division of Nuclear Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, E163, Atlanta, GA 30322, USA.
| | - Saima Muzahir
- Division of Nuclear Medicine, Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Road Northeast, E163, Atlanta, GA 30322, USA
| | - Rathan M Subramaniam
- Faculty of Medicine, Nursing, Midwifery and Health Sciences, The University of Notre Dame Australia, 160 Oxford Street, Darlinghurst, New South Wales 2010, Australia; Department of Radiology, Duke University, Durham, NC, USA; Department of Medicine, Otago Medical School, The University of Otago, New Zealand
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2
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Wang J, Gao R, Cao S, Qin Z, Lin M, Huang Q, Yao Z. Production of medical isotope (68)Ge based on a novel chromatography separation technique and assembling of (68)Ge/(68)Ga generator. Appl Radiat Isot 2023; 192:110599. [PMID: 36476417 DOI: 10.1016/j.apradiso.2022.110599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/06/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022]
Abstract
A double-column chromatography separation technique was involved for isolation of 68Ge from a bombarded Ga-Ni alloy target. About 185 MBq 68Ge obtained was used for assembling SnO2-based 68Ge/68Ga generator. Approximately 70% of 68Ga in high radioactivity concentration was eluted from generator with excellent radionuclidic, radiochemical and chemical purity. 68Ga was quite adequate for radiolabeling with DOTATATE or PSMA-617 with a high labelling efficiency of >92%. The double-column chromatography technique possessed a potential application prospect of 68Ge/68Ga production, aiding the development of 68Ga in nuclear medicine.
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Koffas A, Giakoustidis A, Papaefthymiou A, Bangeas P, Giakoustidis D, Papadopoulos VN, Toumpanakis C. Diagnostic work-up and advancement in the diagnosis of gastroenteropancreatic neuroendocrine neoplasms. Front Surg 2023; 10:1064145. [PMID: 36950054 PMCID: PMC10025557 DOI: 10.3389/fsurg.2023.1064145] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 02/07/2023] [Indexed: 03/08/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of neoplasms ranging from well-differentiated, slowly growing tumors to poorly differentiated carcinomas. These tumors are generally characterized by indolent course and quite often absence of specific symptoms, thus eluding diagnosis until at an advanced stage. This underscores the importance of establishing a prompt and accurate diagnosis. The gold-standard remains histopathology. This should contain neuroendocrine-specific markers, such as chromogranin A; and also, an estimate of the proliferation by Ki-67 (or MIB-1), which is pivotal for treatment selection and prognostication. Initial work-up involves assessment of serum Chromogranin A and in selected patients gut peptide hormones. More recently, the measurement of multiple NEN-related transcripts, or the detection of circulating tumor cells enhanced our current diagnostic armamentarium and appears to supersede historical serum markers, such as Chromogranin A. Standard imaging procedures include cross-sectional imaging, either computed tomography or magnetic resonance, and are combined with somatostatin receptor scintigraphy. In particular, the advent of 111In-DTPA-octreotide and more recently PET/CT and 68Ga-DOTA-Octreotate scans revolutionized the diagnostic landscape of NENs. Likewise, FDG PET represents an invaluable asset in the management of high-grade neuroendocrine carcinomas. Lastly, endoscopy, either conventional, or more advanced modalities such as endoscopic ultrasound, capsule endoscopy and enteroscopy, are essential for the diagnosis and staging of gastroenteropancreatic neuroendocrine neoplasms and are routinely integrated in clinical practice. The complexity and variability of NENs necessitate the deep understanding of the current diagnostic strategies, which in turn assists in offering optimal patient-tailored treatment. The current review article presents the diagnostic work-up of GEP-NENs and all the recent advances in the field.
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Affiliation(s)
- Apostolos Koffas
- Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
- Correspondence: Apostolos Koffas
| | - Alexandros Giakoustidis
- 1st Department of Surgery, General Hospital Papageorgiou, School of Medicine, Faculty of Medical Sciences, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Apostolis Papaefthymiou
- Pancreaticobiliary Medicine Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Petros Bangeas
- 1st Department of Surgery, General Hospital Papageorgiou, School of Medicine, Faculty of Medical Sciences, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Giakoustidis
- 1st Department of Surgery, General Hospital Papageorgiou, School of Medicine, Faculty of Medical Sciences, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Vasileios N Papadopoulos
- 1st Department of Surgery, General Hospital Papageorgiou, School of Medicine, Faculty of Medical Sciences, Aristotle University Thessaloniki, Thessaloniki, Greece
| | - Christos Toumpanakis
- Centre for Gastroenterology, Neuroendocrine Tumour Unit, ENETS Centre of Excellence, Royal Free Hospital, London, United Kingdom
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Chen L, Jumai N, He Q, Liu M, Lin Y, Luo Y, Wang Y, Chen MH, Zeng Z, Zhang X, Zhang N. The role of quantitative tumor burden based on [ 68 Ga]Ga-DOTA-NOC PET/CT in well-differentiated neuroendocrine tumors: beyond prognosis. Eur J Nucl Med Mol Imaging 2023; 50:525-534. [PMID: 36181533 DOI: 10.1007/s00259-022-05971-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/15/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE We aimed to elucidate the role of quantitative tumor burden based on PET/CT of somatostatin receptors in well-differentiated neuroendocrine tumors (NETs). METHODS This study enrolled patients with [68 Ga]Ga-DOTA-NOC PET/CT-positive advanced NETs who did not receive medical treatment prior to PET/CT. Tumor burden was calculated using methods based on the background threshold and relative fixed threshold values (30%, 40%, and 50%). The prognostic value of the measured tumor burden in reference to overall survival (OS) and progression-free survival (PFS) on treatment with octreotide long-acting repeatable (LAR) was assessed using Cox regression analysis, Harrell's C-index, and survival analysis. A classification and regression tree (CART) was used to determine the optimal threshold for tumor burden. RESULTS A total of 204 patients were included. Somatostatin receptor-expressing tumor volume (SRETV) and liver SRETV derived from a relative fixed threshold of 30% (SRETV30 and liver SRETV30) were statistically significantly associated with OS (C-index: 0.802 [95% confidence interval (CI), 0.658-0.946] and 0.806 [95% CI, 0.664-0.948], respectively). Extrahepatic tumor burden was not correlated with OS (hazard ratio: 0.617, 95% CI: 0.241-1.574, P = 0.312). Among 155 patients with non-functional NETs with a ki-67 index of ≤ 10%, those with a high SRETV30 (P = 0.016) or high liver SRETV30 (P = 0.014) showed statistically significantly worse PFS on treatment with octreotide LAR. Patients receiving a higher dose of octreotide LAR normalized by SRETV30 or liver SRETV30 (a normalized dose or a liver normalized dose) showed prolonged PFS on treatment with octreotide LAR and a prolonged OS. CONCLUSION Quantitative tumor burden based on [68 Ga]Ga-DOTA-NOC PET/CT was correlated with OS and PFS in patients with non-functional NETs with a ki-67 index of ≤ 10% who received octreotide LAR. Calculating normalized and liver normalized doses may help in selecting the starting dose of octreotide LAR.
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Affiliation(s)
- Luohai Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Nuerailaguli Jumai
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qiao He
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Man Liu
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuan Lin
- Department of Pathology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yanji Luo
- Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yu Wang
- Department of Interventional Oncology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Min-Hu Chen
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhirong Zeng
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiangsong Zhang
- Department of Nuclear Medicine, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Ning Zhang
- Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
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Park J, Young BD, Miller EJ. Potential novel imaging targets of inflammation in cardiac sarcoidosis. J Nucl Cardiol 2022; 29:2171-2187. [PMID: 34734365 DOI: 10.1007/s12350-021-02838-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 09/26/2021] [Indexed: 10/19/2022]
Abstract
Cardiac sarcoidosis (CS) is an inflammatory disease with high morbidity and mortality, with a pathognomonic feature of non-caseating granulomatous inflammation. While 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality to image inflammation and diagnose CS, there are limitations to its specificity and reproducibility. Imaging focused on the molecular processes of inflammation including the receptors and cellular microenvironments present in sarcoid granulomas provides opportunities to improve upon FDG-PET imaging for CS. This review will highlight the current limitations of FDG-PET imaging for CS while discussing emerging new nuclear imaging molecular targets for the imaging of cardiac sarcoidosis.
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Affiliation(s)
- Jakob Park
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Bryan D Young
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
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6
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Solanki R, Singh H, Kumar R. Exceptional Visualization of the Gallbladder on 68Ga-DOTANOC PET/CT Imaging. Clin Nucl Med 2022; 47:e468-e469. [PMID: 35353720 DOI: 10.1097/rlu.0000000000004157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Neuroendocrine tumors (NETs) are rare tumors associated with the overexpression of somatostatin receptors owing to their origin from neural crest cells. The somatostatin receptor-based molecular imaging of NETs with 68Ga-DOTANOC is extensively used to diagnose primary and metastatic disease with high diagnostic accuracy. Unlike conventional octreotide imaging, physiological gallbladder uptake is not seen on 68Ga-DOTANOC PET/CT imaging. The present case report exhibits the rare physiological 68Ga-DOTANOC uptake in the gall bladder and bile duct.
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Affiliation(s)
- Ritanshu Solanki
- From the Department of Nuclear Medicine and PET/CT, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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7
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Ragab A, Wu J, Ding X, Clark A, Mischen B, Chauhan A, Oates ME, Anthony L, El Khouli R. 68Ga-DOTATATE PET/CT: The Optimum Standardized Uptake Value (SUV) Internal Reference. Acad Radiol 2022; 29:95-106. [PMID: 34756348 DOI: 10.1016/j.acra.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES Standardized Uptake Value (SUV) is an important semiquantitative measurement used in the clinical and research domains to assess radiopharmaceutical concentration in tumors versus normal organs, but is susceptible to many factors beyond the tumor biological environment. So, the aim of this study is to identify the optimum internal reference among organs with physiological uptake in 68Ga-DOTATATE PET/CT (DOTA PET/CT) scans. MATERIALS AND METHODS This HIPAA-compliant, IRB-approved study with waiver of consent included retrospective imaging review of 180 consecutive patients with neuroendocrine tumors presenting for DOTA PET/CT image acquisition: Ga-68 DOTATATE dose was reported as (0.054 mCi/Kg) scans between September 2018 and May 2019. Mean value of body weight normalized SUV (SUVbw) and lean body mass normalized SUV (SUL) of liver and spleen were measured. Information about the patients and scan characteristics were collected. The paired Grambsch test was used to compare variance among the measured SUVs. Spearman's rank correlation coefficient was used to assess correlation between SUVs and potential patient- and scan-specific confounding factors. RESULTS Variance of SUL was significantly lower than variance of SUVbw in both liver and spleen (p-value < 0.0001). Variances of liver SUVbw and SUL were significantly lower than the corresponding spleen SUVs. Liver SUL showed the lowest variance (3.69% ± 1.25%) among all measured SUVs. CONCLUSION SUL is a more reproducible, less variable, and therefore more reliable quantitative measure in DOTA PET/CT scans, compared SUVbw. Among the available organs with physiological uptake, liver SUL is the optimum internal reference given the liver's larger size and uniform SUL values resulting in lower variability and better reproducibility.
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Affiliation(s)
- Ahmed Ragab
- Yale New Haven Health - Bridgeport Hospital, Bridgeport, Connecticut
| | - Jianrong Wu
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Cancer Biostatistics, Lexington, Kentucky; University of Kentucky College of Medicine, Markey Cancer Center, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, Kentucky
| | - Xue Ding
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Cancer Biostatistics, Lexington, Kentucky
| | - Aurela Clark
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY
| | - Blaine Mischen
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY
| | - Aman Chauhan
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Medical Oncology, Lexington, Kentucky; University of Kentucky College of Medicine, Markey Cancer Center, Lexington, Kentucky
| | - M Elizabeth Oates
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY
| | - Lowell Anthony
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Medical Oncology, Lexington, Kentucky; University of Kentucky College of Medicine, Markey Cancer Center, Lexington, Kentucky
| | - Riham El Khouli
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY; University of Kentucky College of Medicine, Markey Cancer Center, Lexington, Kentucky.
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8
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Kumar R, Vankadari K, Mittal BR, Bansal D, Trehan A, Sahu JK, Sankhyan N. Diagnostic values of 68Ga-labelled DOTANOC PET/CT imaging in pediatric patients presenting with paraneoplastic opsoclonus myoclonus ataxia syndrome. Eur Radiol 2021; 31:4587-4594. [PMID: 33409780 DOI: 10.1007/s00330-020-07587-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/07/2020] [Accepted: 12/01/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Opsoclonus myoclonus ataxia (OMA) syndrome, also known as "Kinsbourne syndrome" or "dancing eye syndrome," is a rare, paraneoplastic entity which may be associated with pediatric neuroblastic tumors and carry a grave prognosis. We aimed to evaluate the role of 68Ga DOTANOC PET/CT for detecting neuroblastic tumors in patients with OMA syndrome. METHODS We retrospectively evaluated the 68Ga-DOTANOC PET/CT data of pediatric patients presenting with OMA syndrome from March 2012 to November 2018. A somatostatin receptor (SSTR)-expressing lesion with corresponding morphological change on CT image was considered PET-positive, while no abnormal SSTR expression or lesion was noticed in PET-negative patients. Histopathology and/or clinical/imaging follow-up (minimum one year) was considered a reference standard for comparing the PET/CT findings. The results of 68Ga-DOTANOC PET/CT were also compared with 131I MIBG whole-body scintigraphy, which was available in five patients. RESULTS Of 38 patients (13 males, 25 females, aged 3-96 months), 18 (47.3%) had SSTR-expressing lesions (PET-positive), and histopathology revealed neuroblastic tumors in 17/18 lesions (neuroblastoma 14, ganglioneuroblastoma 2, and ganglioneuroma 1) and reactive hyperplasia in 1/18. The remaining 20/38 (52.6%) patients did not demonstrate SSTR-expressing lesions (PET-negative) and had an uneventful follow-up. The average SUVmax of the PET-positive lesions was 10.3 (range 2.8-34.5). The PET/CT results revealed 17 true-positive, one false-positive, 20 true-negative, and zero false-negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 100%, 95.2%, 94.4%, 100%, and 97.3% respectively. CONCLUSIONS 68Ga-DOTANOC PET/CT identified neuroblastic tumors with a high diagnostic accuracy in our cohort compared to histology and follow-up. KEY POINTS • Opsoclonus myoclonus ataxia (OMA) syndrome or "dancing eye syndrome" is a rare paraneoplastic entity which may be associated with pediatric neuroblastic tumors with a grave prognosis. • 123I/131I MIBG imaging has a proven role for functional imaging in neuroblastoma or patients with OMA, but the role of 68Ga-DOTANOC PET/CT is not yet studied. • 68Ga-labelled DOTANOC PET/CT (SSTR) imaging, in our cohort, was able to positively identify neuroblastic tumors with high diagnostic accuracy when compared with histology.
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Affiliation(s)
- Rajender Kumar
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Kousik Vankadari
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Bhagwant Rai Mittal
- Department of Nuclear Medicine and PET/CT, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Deepak Bansal
- Department of Pediatric Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amita Trehan
- Department of Pediatric Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra K Sahu
- Department of Pediatric Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatric Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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9
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Viitanen R, Moisio O, Lankinen P, Li XG, Koivumäki M, Suilamo S, Tolvanen T, Taimen K, Mali M, Kohonen I, Koskivirta I, Oikonen V, Virtanen H, Santalahti K, Autio A, Saraste A, Pirilä L, Nuutila P, Knuuti J, Jalkanen S, Roivainen A. First-in-Humans Study of 68Ga-DOTA-Siglec-9, a PET Ligand Targeting Vascular Adhesion Protein 1. J Nucl Med 2020; 62:577-583. [PMID: 32817143 PMCID: PMC8049366 DOI: 10.2967/jnumed.120.250696] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/09/2020] [Indexed: 01/13/2023] Open
Abstract
Sialic acid–binding immunoglubulinlike lectin 9 (Siglec-9) is a ligand of vascular adhesion protein 1. A 68Ga-labeled peptide of Siglec-9, 68Ga-DOTA-Siglec-9, holds promise as a novel PET tracer for imaging of inflammation. This first-in-humans study investigated the safety, tolerability, biodistribution, and radiation dosimetry of this radiopharmaceutical. Methods: Six healthy men underwent dynamic whole-body PET/CT. Serial venous blood samples were drawn from 1 to 240 min after intravenous injection of 162 ± 4 MBq of 68Ga-DOTA-Siglec-9. In addition to γ-counting, the plasma samples were analyzed by high-performance liquid chromatography to detect intact tracer and radioactive metabolites. Radiation doses were calculated using the OLINDA/EXM software, version 2.2. In addition, a patient with early rheumatoid arthritis was studied with both 68Ga-DOTA-Siglec-9 and 18F-FDG PET/CT to determine the ability of the new tracer to detect arthritis. Results:68Ga-DOTA-Siglec-9 was well tolerated by all subjects. 68Ga-DOTA-Siglec-9 was rapidly cleared from the blood circulation, and several radioactive metabolites were detected. The organs with the highest absorbed doses were the urinary bladder wall (0.38 mSv/MBq) and kidneys (0.054 mSv/MBq). The mean effective dose was 0.022 mSv/MBq (range, 0.020–0.024 mSv/MBq). Most importantly, however, 68Ga-DOTA-Siglec-9 was comparable to 18F-FDG in detecting arthritis. Conclusion: Intravenous injection of 68Ga-DOTA-Siglec-9 was safe and biodistribution was favorable for testing of the tracer in larger group of patients with rheumatoid arthritis, as is planned for the next phase of clinical trials. The effective radiation dose of 68Ga-DOTA-Siglec-9 was within the same range as the effective radiation doses of other 68Ga-labeled tracers. Injection of 150 MBq of 68Ga-DOTA-Siglec-9 would expose a subject to 3.3 mSv. These findings support the possible repeated clinical use of 68Ga-DOTA-Siglec-9, such as in trials to elucidate the treatment efficacy of novel drug candidates.
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Affiliation(s)
| | - Olli Moisio
- Turku PET Centre, University of Turku, Turku, Finland
| | - Petteri Lankinen
- Department of Orthopaedics and Traumatology, Turku University Hospital and University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Xiang-Guo Li
- Turku PET Centre, University of Turku, Turku, Finland
| | | | - Sami Suilamo
- Department of Medical Physics, Turku University Hospital, Turku, Finland.,Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Tuula Tolvanen
- Turku PET Centre, Turku University Hospital, Turku, Finland.,Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Kirsi Taimen
- Department of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Markku Mali
- Department of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Ia Kohonen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Ilpo Koskivirta
- Department of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Vesa Oikonen
- Turku PET Centre, University of Turku, Turku, Finland
| | | | | | - Anu Autio
- Turku PET Centre, University of Turku, Turku, Finland.,MediCity Research Laboratory, University of Turku, Turku, Finland; and
| | - Antti Saraste
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland.,Heart Center, Turku University Hospital, Turku, Finland
| | - Laura Pirilä
- Department of Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Pirjo Nuutila
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, Turku, Finland.,Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Sirpa Jalkanen
- MediCity Research Laboratory, University of Turku, Turku, Finland; and
| | - Anne Roivainen
- Turku PET Centre, University of Turku, Turku, Finland .,Turku PET Centre, Turku University Hospital, Turku, Finland
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10
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Moisio O, Palani S, Virta J, Elo P, Liljenbäck H, Tolvanen T, Käkelä M, Miner MG, Herre EA, Marjamäki P, Örd T, Heinäniemi M, Kaikkonen MU, Zhang F, Srinivasarao M, Knuuti J, Low PS, Saraste A, Li XG, Roivainen A. Radiosynthesis and preclinical evaluation of [ 68Ga]Ga-NOTA-folate for PET imaging of folate receptor β-positive macrophages. Sci Rep 2020; 10:13593. [PMID: 32788595 DOI: 10.1038/s41598-020-70394-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/27/2020] [Indexed: 11/09/2022] Open
Abstract
Folate receptor β (FR-β), a marker expressed on macrophages, is a promising target for imaging of inflammation. Here, we report the radiosynthesis and preclinical evaluation of [68Ga]Ga-NOTA-folate (68Ga-FOL). After determining the affinity of 68Ga-FOL using cells expressing FR-β, we studied atherosclerotic mice with 68Ga-FOL and 18F-FDG PET/CT. In addition, we studied tracer distribution and co-localization with macrophages in aorta cryosections using autoradiography, histology, and immunostaining. The specificity of 68Ga-FOL was assessed in a blocking study with folate glucosamine. As a final step, human radiation doses were extrapolated from rat PET data. We were able to produce 68Ga-FOL with high radiochemical purity and moderate molar activity. Cell binding studies revealed that 68Ga-FOL had 5.1 nM affinity for FR-β. Myocardial uptake of 68Ga-FOL was 20-fold lower than that of 18F-FDG. Autoradiography and immunohistochemistry of the aorta revealed that 68Ga-FOL radioactivity co-localized with Mac-3–positive macrophage-rich atherosclerotic plaques. The plaque-to-healthy vessel wall ratio of 68Ga-FOL was significantly higher than that of 18F-FDG. Blocking studies verified that 68Ga-FOL was specific for FR. Based on estimations from rat data, the human effective dose was 0.0105 mSv/MBq. Together, these findings show that 68Ga-FOL represents a promising new FR-β–targeted tracer for imaging macrophage-associated inflammation.
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Grosser OS, Wissel H, Klopfleisch M, Kupitz D, Paetzold N, Pech M, Kreissl MC. Time course and local distribution of skin exposure of hand and fingers from [68Ga]Ga-DOTA-NOC synthesis using a self-shielded module. Nuklearmedizin 2020; 59:308-315. [DOI: 10.1055/a-1134-4374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Abstract
Aim The study examined the local dose distribution as well as the time course of skin exposure of hand and fingers from [68Ga]Ga-DOTA-NOC synthesis using a self-shielded synthesis module.
Methods A compact calibrated electronic dosimeter (ED) with a miniaturized probe was used for real-time measurements of skin dose equivalent Hp (0.07) (reference point: left and right index finger). A time resolved assessment of exposure during radiotracer production was performed. Additionally, thermoluminescence dosimeters (TLD) were used to determine local dose distribution for five different positions (e. g. fingertips). Cumulated Hp (0.07) estimated by ED was analysed and correlated with the measurements obtained by a TLD positioned close to the ED.
Results The cumulative skin exposure from the production process measured by ED, was 74.7 ± 32.7 µSv/GBq and 40.1 ± 14.3 µSv/GBq for the right and left hand, respectively. The exposure recorded by the ED was in the average 19.4 % ± 40.0 % (median = 21.3 %) lower compared to the results from TLD. Highest exposure was recorded during synthesis (guided hand: 24.5 ± 12.2 µSv/GBq) and measuring of product yield including preparation of probes for quality control (guided hand: 36.1 ± 12.7 µSv/GBq). The highest local exposure was measured by a TLD close to the tip of the index finger of the guiding hand (range: 773–1257 µS/GBq).
Conclusion The chosen methodology using ED, proved to be a good concept for identifying procedure steps with an increased exposure level and to determine the time course of skin exposure and to identify procedure steps for further optimization of handling. Furthermore, miniaturized electronic dosimeters may be used for online surveillance of local exposure rates at hands and fingers.
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Affiliation(s)
- Oliver Stephan Grosser
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Heiko Wissel
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Maurice Klopfleisch
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Dennis Kupitz
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Nadine Paetzold
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
- Second Department of Radiology, Medical University of Gdansk, Gdansk, Poland
| | - Michael C. Kreissl
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg and Medical Faculty of Otto-von-Guericke University, Magdeburg, Germany
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Parihar AS, Sood A, Sood A, Gulati A, Mittal BR. Demonstration of focal physiologic in-vivo somatostatin receptor expression in the caput epididymis of the testes on 68Ga-DOTANOC PET/CT and 177Lu-DOTATATE post-therapy whole body scintigraphy. Asia Ocean J Nucl Med Biol 2020; 8:132-135. [PMID: 32715001 DOI: 10.22038/aojnmb.2020.44324.1297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We present the case of a 60-year-old man with metastatic neuroendocrine tumor of the ileum following ileal resection, being evaluated for 177Lu-based peptide receptor radionuclide therapy. 68Ga-DOTANOC PET/CT showed focal increased tracer uptake in the scrotal region without any morphologic changes on the corresponding CT images. Similar increased tracer uptake was seen on post-therapy whole-body imaging following 177Lu-DOTATATE therapy. An USG guided FNA revealed no malignant cells on cytopathologic examination. This case illustrates that focal testicular tracer uptake, may not always be pathological and can represent a normal physiologic variant, similar to the diffuse testicular somatostatin receptor expression as previously reported in literature.
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Affiliation(s)
- Ashwin Singh Parihar
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Apurva Sood
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Gulati
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant Rai Mittal
- Departments of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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13
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Lima M, Camacho M, Carvalheira JBC, Biggi A, de Lima ML, Ciampi J, Salis F, Silveira MB, Ferreira U, Etchebehere E. The current role of PET/CT in urological malignancies. Clin Transl Imaging 2020; 8:313-47. [DOI: 10.1007/s40336-020-00378-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Allott L, Dubash S, Aboagye EO. [ 18F]FET-βAG-TOCA: The Design, Evaluation and Clinical Translation of a Fluorinated Octreotide. Cancers (Basel) 2020; 12:cancers12040865. [PMID: 32252406 PMCID: PMC7226534 DOI: 10.3390/cancers12040865] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 01/17/2023] Open
Abstract
The success of Lutathera™ ([177Lu]Lu-DOTA-TATE) in the NETTER-1 clinical trial as a peptide receptor radionuclide therapy (PRRT) for somatostatin receptor expressing (SSTR) neuroendocrine tumours (NET) is likely to increase the demand for patient stratification by positron emission tomography (PET). The current gold standard of gallium-68 radiolabelled somatostatin analogues (e.g., [68Ga]Ga-DOTA-TATE) works effectively, but access is constrained by the limited availability and scalability of gallium-68 radiopharmaceutical production. The aim of this review is three-fold: firstly, we discuss the peptide library design, biological evaluation and clinical translation of [18F]fluoroethyltriazole-βAG-TOCA ([18F]FET-βAG-TOCA), our fluorine-18 radiolabelled octreotide; secondly, to exemplify the potential of the 2-[18F]fluoroethylazide prosthetic group and copper-catalysed azide-alkyne cycloaddition (CuAAC) chemistry in accessing good manufacturing practice (GMP) compatible radiopharmaceuticals; thirdly, we aim to illustrate a framework for the translation of similarly radiolabelled peptides, in which in vivo pharmacokinetics drives candidate selection, supported by robust radiochemistry methodology and a route to GMP production. It is hoped that this review will continue to inspire the development and translation of fluorine-18 radiolabelled peptides into clinical studies for the benefit of patients.
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15
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Berner AM, Pipinikas C, Ryan A, Dibra H, Moghul I, Webster A, Luong TV, Thirlwell C. Diagnostic Approaches to Neuroendocrine Neoplasms of Unknown Primary Site. Neuroendocrinology 2020; 110:563-573. [PMID: 31658461 DOI: 10.1159/000504370] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/26/2019] [Indexed: 12/18/2022]
Abstract
Neuroendocrine neoplasms (NENs) arise from cells of neuronal and endocrine differentiation. While they are a rare entity, an increasing proportion of patients with NEN present with metastatic disease and no evident primary site using routine imaging or histopathology. NENs of unknown primary site have a poorer prognosis, often due to the challenge of selecting appropriate evidence-based management. We review the available literature and guidelines for the management of NENs of unknown primary site including clinical features, biochemical tests, histopathology, imaging, surgical exploration and localised and systemic treatments. We also discuss novel molecular techniques currently under investigation to aid primary site identification.
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Affiliation(s)
- Alison May Berner
- Department of Tumour Biology, Barts Cancer Institute, London, United Kingdom,
- Research Department of Oncology, UCL Cancer Institute, London, United Kingdom,
| | | | - Anna Ryan
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom
| | | | - Ismail Moghul
- Research Department of Oncology, UCL Cancer Institute, London, United Kingdom
| | - Amy Webster
- Research Department of Oncology, UCL Cancer Institute, London, United Kingdom
| | - Tu Vinh Luong
- Royal Free Hospitals NHS Trust, London, United Kingdom
| | - Christina Thirlwell
- Research Department of Oncology, UCL Cancer Institute, London, United Kingdom
- University of Exeter School of Medicine and Health, RILD Building, Exeter, United Kingdom
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16
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Boss M, Buitinga M, Jansen TJP, Brom M, Visser EP, Gotthardt M. PET-Based Human Dosimetry of 68Ga-NODAGA-Exendin-4, a Tracer for β-Cell Imaging. J Nucl Med 2019; 61:112-116. [PMID: 31519801 PMCID: PMC6954461 DOI: 10.2967/jnumed.119.228627] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/03/2019] [Indexed: 11/22/2022] Open
Abstract
68Ga-NODAGA-exendin-4 is a promising tracer for β-cell imaging using PET/CT. Possible applications include preoperative visualization of insulinomas and discrimination between focal and diffuse forms of congenital hyperinsulinism. There is also a significant role for this tracer in extending our knowledge on the role of β-cell mass in the pathophysiology of type 1 and type 2 diabetes by enabling noninvasive quantification of tracer uptake as a measure for β-cell mass. Calculating radiation doses from this tracer is important to assess its safety for use in patients (including young children) with benign diseases and healthy individuals. Methods: Six patients with hyperinsulinemic hypoglycemia were included. After intravenous injection of 100 MBq of the tracer, 4 successive PET/CT scans were obtained at 30, 60, 120, and 240 min after injection. Tracer activity in the pancreas, kidneys, duodenum, and remainder of the body were determined, and time-integrated activity coefficients for the measured organs were calculated. OLINDA/EXM software, version 1.1, was applied to calculate radiation doses using the reference adult male and female models and to estimate radiation doses to children. Results: The mean total effective dose for adults was very low (0.71 ± 0.07 mSv for a standard injected dose of 100 MBq). The organ with the highest absorbed dose was the kidney (47.3 ± 10.2 mGy/100 MBq). The estimated effective dose was 2.32 ± 0.32 mSv for an injected dose of 20 MBq in newborns. This dose decreased to 0.77 ± 0.11 mSv/20 MBq for 1-y-old children and 0.59 ± 0.05 mSv for an injected dose of 30 MBq in 5-y-old children. Conclusion: Our human PET/CT-based dosimetric calculations show that the effective radiation doses from the novel tracer 68Ga-NODAGA-exendin-4 are very low for adults and children. The doses are lower than reported for other polypeptide tracers such as somatostatin analogs (2.1–2.6 mSv/100 MBq) and are beneficial for application as a research tool, especially when repeated examinations are needed.
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Affiliation(s)
- Marti Boss
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mijke Buitinga
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tom J P Jansen
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Maarten Brom
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eric P Visser
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Martin Gotthardt
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Leisser A, Lukic K, Nejabat M, Wadsak W, Mitterhauser M, Mayerhöfer M, Karnaikas G, Raderer M, Hacker M, Haug A. Sex-differences in [68Ga]Ga-DOTANOC biodistribution. Nucl Med Biol 2019; 76-77:15-20. [DOI: 10.1016/j.nucmedbio.2019.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 12/22/2022]
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18
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Taïeb D, Hicks RJ, Hindié E, Guillet BA, Avram A, Ghedini P, Timmers HJ, Scott AT, Elojeimy S, Rubello D, Virgolini IJ, Fanti S, Balogova S, Pandit-Taskar N, Pacak K. European Association of Nuclear Medicine Practice Guideline/Society of Nuclear Medicine and Molecular Imaging Procedure Standard 2019 for radionuclide imaging of phaeochromocytoma and paraganglioma. Eur J Nucl Med Mol Imaging 2019; 46:2112-2137. [PMID: 31254038 PMCID: PMC7446938 DOI: 10.1007/s00259-019-04398-1] [Citation(s) in RCA: 183] [Impact Index Per Article: 36.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/10/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE Diverse radionuclide imaging techniques are available for the diagnosis, staging, and follow-up of phaeochromocytoma and paraganglioma (PPGL). Beyond their ability to detect and localise the disease, these imaging approaches variably characterise these tumours at the cellular and molecular levels and can guide therapy. Here we present updated guidelines jointly approved by the EANM and SNMMI for assisting nuclear medicine practitioners in not only the selection and performance of currently available single-photon emission computed tomography and positron emission tomography procedures, but also the interpretation and reporting of the results. METHODS Guidelines from related fields and relevant literature have been considered in consultation with leading experts involved in the management of PPGL. The provided information should be applied according to local laws and regulations as well as the availability of various radiopharmaceuticals. CONCLUSION Since the European Association of Nuclear Medicine 2012 guidelines, the excellent results obtained with gallium-68 (68Ga)-labelled somatostatin analogues (SSAs) in recent years have simplified the imaging approach for PPGL patients that can also be used for selecting patients for peptide receptor radionuclide therapy as a potential alternative or complement to the traditional theranostic approach with iodine-123 (123I)/iodine-131 (131I)-labelled meta-iodobenzylguanidine. Genomic characterisation of subgroups with differing risk of lesion development and subsequent metastatic spread is refining the use of molecular imaging in the personalised approach to hereditary PPGL patients for detection, staging, and follow-up surveillance.
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Affiliation(s)
- David Taïeb
- Department of Nuclear Medicine, La Timone University Hospital, CERIMED, Aix-Marseille University, 264 rue Saint-Pierre, 13005, Marseille Cedex 05, France
| | - Rodney J. Hicks
- Centre for Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Elif Hindié
- Department of Nuclear Medicine, Hôpital Haut-Lévêque, Bordeaux University Hospitals, Pessac, France
| | - Benjamin A. Guillet
- Department of Radiopharmacy, La Timone University Hospital, CERIMED, Aix-Marseille University, Marseille, France
| | - Anca Avram
- Nuclear Medicine/Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Pietro Ghedini
- Nuclear Medicine Unit, Medicina Nucleare Metropolitana, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Henri J. Timmers
- Department of Endocrinology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Saeed Elojeimy
- Department of Radiology, University of New Mexico, Albuquerque, NM, USA
| | - Domenico Rubello
- Department of Nuclear Medicine, Radiology, Neuroradiology, Medical Physics, Clinical Laboratory, Microbiology, Pathology, Transfusional Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | - Irène J. Virgolini
- Department of Nuclear Medicine, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Stefano Fanti
- Nuclear Medicine Unit, Medicina Nucleare Metropolitana, University Hospital S.Orsola-Malpighi, Bologna, Italy
| | - Sona Balogova
- Department of Nuclear Medicine, Comenius University and St. Elisabeth Oncology Institute, Heydukova 10, 81250 Bratislava, Slovakia,Department of Nuclear Medicine, Hôpital Tenon Assistance Publique-Hôpitaux de Paris and Sorbonne University, Paris, France
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Karel Pacak
- Eunice Kennedy Shriver National Institutes of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Anzola LK, Glaudemans AWJM, Dierckx RAJO, Martinez FA, Moreno S, Signore A. Somatostatin receptor imaging by SPECT and PET in patients with chronic inflammatory disorders: a systematic review. Eur J Nucl Med Mol Imaging 2019; 46:2496-513. [PMID: 31463594 DOI: 10.1007/s00259-019-04489-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the literature on the clinical application of radiolabeled somatostatin receptor scintigraphy (SRS) by SPECT and PET in adults with chronic inflammatory diseases. RESEARCH DESIGN Systematic review of published observational studies between 1993 and 2017. DATA COLLECTION AND ANALYSIS The Cochrane Central Register of Controlled Trials, MedLine, EMBASE, PubMed, Google Scholar, OVID, EBSCO, Scopus, and Web of Science were used to search for studies on the use of SRS in adults with chronic inflammatory diseases. A team of reviewers independently screened for eligible studies. Quality of evidence was assessed by QUADAS approach. RESULTS Eligible papers included 38 studies. Studied populations were heterogeneous, and patients were classified according to the diagnosed disease: endothelial inflammation, rheumatoid arthritis, cardiac allograft rejection, granulomatous diseases, small vessel vasculitis, idiopathic pulmonary fibrosis, sarcoidosis, and thyroid exophthalmopathy. Because of many quality differences between studies, it was not possible to pool data, and a narrative synthesis is reported. CONCLUSION Results highlight the value of SRS to detect active inflammation in several chronic inflammatory conditions, despite the bias related to the index test, showing lack of standardization of the scintigraphic technique and high variability of methods used to clinically evaluate inflammatory condition.
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20
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Coura-Filho GB, Hoff AAFO, Duarte PS, Buchpiguel CA, Josefsson A, Hobbs RF, Sgouros G, Sapienza MT. 68Ga-DOTATATE PET: temporal variation of maximum standardized uptake value in normal tissues and neuroendocrine tumours. Nucl Med Commun 2019; 40:920-6. [PMID: 31343614 DOI: 10.1097/MNM.0000000000001048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Higher affinity of Ga compounds to somatostatin receptors (SSTRs) and PET better image resolution increased interest in Ga-labelled somatostatin analogs in the management of neuroendocrine tumours (NETs). This study aimed to evaluate the maximum standardized uptake value (SUVmax) variation in sequential somatostatin analogs-PET in NET patients and identify optimal tumour detection and characterization imaging time. METHODS Patients with histological or biochemical NET diagnosis performed two to three PET/computed tomography (CT) scans after intravenous injection of Ga-DOTATATE: Early PET [EarlyPET: <15 minutes postinjection (p.i.)], diagnostic PET (DiagPET: 45-90 minutes p.i.) and delayed PET (DelayPE: 90-240 minutes p.i.). Up to five tumour sites and normal tissues had SUVmax determined. Time-SUVmax curves were created for the target lesions and normal organs. Ratios between tumour and liver SUVmax (SUVTU/Liver) and tumour/blood pool (SUVTU/BP) were also calculated. RESULTS Twenty-nine patients were included, 16 female, mean age of 46.5 ± 14.3 years. Average administered activity was 129.5 ± 29.6 MBq. Kidneys SUVmax was higher in EarlyPET compared with DiagPET (P = 0.04) and DelayPET showed higher SUVmax compared with DiagPET for normal liver, pancreas and kidneys (P = 0.02). No differences were noted between EarlyPET, DiagPET and DelayPET in tumour SUVmax (P > 0.05). SUVTU/Liver and SUVTU/BP did not change between EarlyPET and DiagPET, with a slight decrease in DelayPET. CONCLUSION Stability in tumour SUVmax values measured at different intervals independently of tumour location, as also in normal tissues as kidneys and liver suggest that a more flexible imaging protocol may be adopted.
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Muffatti F, Partelli S, Cirocchi R, Andreasi V, Mapelli P, Picchio M, Gianolli L, Falconi M. Combined 68Ga-DOTA-peptides and 18F-FDG PET in the diagnostic work-up of neuroendocrine neoplasms (NEN). Clin Transl Imaging 2019. [DOI: 10.1007/s40336-019-00328-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Signore A, Lauri C, Auletta S, Anzola K, Galli F, Casali M, Versari A, Glaudemans AWJM. Immuno-Imaging to Predict Treatment Response in Infection, Inflammation and Oncology. J Clin Med 2019; 8:E681. [PMID: 31091813 DOI: 10.3390/jcm8050681] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/14/2022] Open
Abstract
Background: Molecular nuclear medicine plays a pivotal role for diagnosis in a preclinical phase, in genetically susceptible patients, for radio-guided surgery, for disease relapse evaluation, and for therapy decision-making and follow-up. This is possible thanks to the development of new radiopharmaceuticals to target specific biomarkers of infection, inflammation and tumour immunology. Methods: In this review, we describe the use of specific radiopharmaceuticals for infectious and inflammatory diseases with the aim of fast and accurate diagnosis and treatment follow-up. Furthermore, we focus on specific oncological indications with an emphasis on tumour immunology and visualizing the tumour environment. Results: Molecular nuclear medicine imaging techniques get a foothold in the diagnosis of a variety of infectious and inflammatory diseases, such as bacterial and fungal infections, rheumatoid arthritis, and large vessel vasculitis, but also for treatment response in cancer immunotherapy. Conclusion: Several specific radiopharmaceuticals can be used to improve diagnosis and staging, but also for therapy decision-making and follow-up in infectious, inflammatory and oncological diseases where immune cells are involved. The identification of these cell subpopulations by nuclear medicine techniques would provide personalized medicine for these patients, avoiding side effects and improving therapeutic approaches.
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Abstract
Fibrosis, the progressive accumulation of connective tissue that occurs in response to injury, causes irreparable organ damage and may result in organ failure. The few available antifibrotic treatments modify the rate of fibrosis progression, but there are no available treatments to reverse established fibrosis. Thus, more effective therapies are urgently needed. Molecular imaging is a promising biomedical methodology that enables noninvasive visualization of cellular and subcellular processes. It provides a unique means to monitor and quantify dysregulated molecular fibrotic pathways in a noninvasive manner. Molecular imaging could be used for early detection, disease staging, and prognostication, as well as for assessing disease activity and treatment response. As fibrotic diseases are often molecularly heterogeneous, molecular imaging of a specific pathway could be used for patient stratification and cohort enrichment with the goal of improving clinical trial design and feasibility and increasing the ability to detect a definitive outcome for new therapies. Here we review currently available molecular imaging probes for detecting fibrosis and fibrogenesis, the active formation of new fibrous tissue, and their application to models of fibrosis across organ systems and fibrotic processes. We provide our opinion as to the potential roles of molecular imaging in human fibrotic diseases.
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Affiliation(s)
| | - Pauline Désogère
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging and.,Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bryan C Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Peter Caravan
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Athinoula A. Martinos Center for Biomedical Imaging and.,Institute for Innovation in Imaging, Massachusetts General Hospital, Boston, Massachusetts, USA
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Abstract
Theranostics and its principles: pre-treatment selection of patients who are most likely to benefit from treatment by the use of a related, specific diagnostic test are integral to the treatment of patients with neuroendocrine tumours (NETs). This is due to NETs' important, but variable, somatostatin receptor (SSTR) expression, their heterogeneity and variation in site of primary and rate of progression. Only patients whose tumours have sufficient expression of SSTRs will benefit from SSTR-based radionuclide therapy and demonstrating this expression prior to therapy is essential. This article provides a relevant overview of NETs and the multiple facets of SSTR based theranostics, including imaging and therapy radionuclides; clinical efficacy and toxicity; patient selection and treatment and finally emerging radiopharmaceuticals and newer clinical applications.
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Affiliation(s)
- Deborah Pencharz
- 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust , Brighton , UK
| | - Gopinath Gnanasegaran
- 2 Department of Nuclear Medicine, Royal Free London NHS Foundation Trust , London , UK
| | - Shaunak Navalkissoor
- 2 Department of Nuclear Medicine, Royal Free London NHS Foundation Trust , London , UK
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25
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Stéen EJL, Edem PE, Nørregaard K, Jørgensen JT, Shalgunov V, Kjaer A, Herth MM. Pretargeting in nuclear imaging and radionuclide therapy: Improving efficacy of theranostics and nanomedicines. Biomaterials 2018; 179:209-245. [PMID: 30007471 DOI: 10.1016/j.biomaterials.2018.06.021] [Citation(s) in RCA: 99] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/13/2018] [Accepted: 06/14/2018] [Indexed: 01/18/2023]
Abstract
Pretargeted nuclear imaging and radiotherapy have recently attracted increasing attention for diagnosis and treatment of cancer with nanomedicines. This is because it conceptually offers better imaging contrast and therapeutic efficiency while reducing the dose to radiosensitive tissues compared to conventional strategies. In conventional imaging and radiotherapy, a directly radiolabeled nano-sized vector is administered and allowed to accumulate in the tumor, typically on a timescale of several days. In contrast, pretargeting is based on a two-step approach. First, a tumor-accumulating vector carrying a tag is administered followed by injection of a fast clearing radiolabeled agent that rapidly recognizes the tag of the tumor-bound vector in vivo. Therefore, pretargeting circumvents the use of long-lived radionuclides that is a necessity for sufficient tumor accumulation and target-to-background ratios using conventional approaches. In this review, we give an overview of recent advances in pretargeted imaging strategies. We will critically reflect on the advantages and disadvantages of current state-of-the-art conventional imaging approaches and compare them to pretargeted strategies. We will discuss the pretargeted imaging concept and the involved chemistry. Finally, we will discuss the steps forward in respect to clinical translation, and how pretargeted strategies could be applied to improve state-of-the-art radiotherapeutic approaches.
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Affiliation(s)
- E Johanna L Stéen
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Patricia E Edem
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Kamilla Nørregaard
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Jesper T Jørgensen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Vladimir Shalgunov
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark; Cluster for Molecular Imaging, Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2100 Copenhagen, Denmark
| | - Matthias M Herth
- Department of Drug Design and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Jagtvej 160, DK-2100 Copenhagen, Denmark; Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.
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Sarikaya I, Elgazzar AH, Sarikaya A, Alnafisi N, Alenezi S. Can 68Ga-DOTA Peptides Be Potential Radiotracers for PET Imaging of the Spleen? J Nucl Med Technol 2018; 46:133-135. [PMID: 29599400 DOI: 10.2967/jnmt.117.203448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/06/2018] [Indexed: 11/16/2022] Open
Abstract
On radionuclide somatostatin receptor imaging studies, the spleen shows high physiologic uptake. Reducing the intensity of the image settings helps to better assess the distribution of radiotracer in the spleen. In our routine studies, we incidentally recognized that 68Ga-DOTANOC PET provides higher-resolution splenic images than 111In-octreotide SPECT. Autoradiography and immunohistochemistry studies have shown that somatostatin receptors are located mainly in the red pulp of the spleen. The distribution of 68Ga-DOTANOC in the spleen appears to correlate with the distribution of red pulp. In this article, we present 68Ga-DOTANOC PET/CT spleen images of our patients.
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Affiliation(s)
- Ismet Sarikaya
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
| | - Abdelhamid H Elgazzar
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
| | - Ali Sarikaya
- Department of Nuclear Medicine, Trakya University Faculty of Medicine, Edirne, Turkey and
| | - Naheel Alnafisi
- Department of Nuclear Medicine, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Saud Alenezi
- Department of Nuclear Medicine, Kuwait University Faculty of Medicine, Safat, Kuwait
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Velikyan I. Prospective of 68Ga Radionuclide Contribution to the Development of Imaging Agents for Infection and Inflammation. Contrast Media Mol Imaging 2018; 2018:9713691. [PMID: 29531507 DOI: 10.1155/2018/9713691] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
During the last decade, the utilization of 68Ga for the development of imaging agents has increased considerably with the leading position in the oncology. The imaging of infection and inflammation is lagging despite strong unmet medical needs. This review presents the potential routes for the development of 68Ga-based agents for the imaging and quantification of infection and inflammation in various diseases and connection of the diagnosis to the treatment for the individualized patient management.
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Virtanen H, Silvola JMU, Autio A, Li XG, Liljenbäck H, Hellberg S, Siitonen R, Ståhle M, Käkelä M, Airaksinen AJ, Helariutta K, Tolvanen T, Veres TZ, Saraste A, Knuuti J, Jalkanen S, Roivainen A. Comparison of 68Ga-DOTA-Siglec-9 and 18F-Fluorodeoxyribose-Siglec-9: Inflammation Imaging and Radiation Dosimetry. Contrast Media Mol Imaging 2017; 2017:7645070. [PMID: 29463960 DOI: 10.1155/2017/7645070] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/13/2017] [Indexed: 11/17/2022]
Abstract
Sialic acid-binding immunoglobulin-like lectin 9 (Siglec-9) is a ligand of inflammation-inducible vascular adhesion protein-1 (VAP-1). We compared 68Ga-DOTA- and 18F-fluorodeoxyribose- (FDR-) labeled Siglec-9 motif peptides for PET imaging of inflammation. Methods. Firstly, we examined 68Ga-DOTA-Siglec-9 and 18F-FDR-Siglec-9 in rats with skin/muscle inflammation. We then studied 18F-FDR-Siglec-9 for the detection of inflamed atherosclerotic plaques in mice and compared it with previous 68Ga-DOTA-Siglec-9 results. Lastly, we estimated human radiation dosimetry from the rat data. Results. In rats, 68Ga-DOTA-Siglec-9 (SUV, 0.88 ± 0.087) and 18F-FDR-Siglec-9 (SUV, 0.77 ± 0.22) showed comparable (P = 0.29) imaging of inflammation. In atherosclerotic mice, 18F-FDR-Siglec-9 detected inflamed plaques with a target-to-background ratio (1.6 ± 0.078) similar to previously tested 68Ga-DOTA-Siglec-9 (P = 0.35). Human effective dose estimates for 68Ga-DOTA-Siglec-9 and 18F-FDR-Siglec-9 were 0.024 and 0.022 mSv/MBq, respectively. Conclusion. Both tracers are suitable for PET imaging of inflammation. The easier production and lower cost of 68Ga-DOTA-Siglec-9 present advantages over 18F-FDR-Siglec-9, indicating it as a primary choice for clinical studies.
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Nicolas GP, Beykan S, Bouterfa H, Kaufmann J, Bauman A, Lassmann M, Reubi JC, Rivier JE, Maecke HR, Fani M, Wild D. Safety, Biodistribution, and Radiation Dosimetry of 68Ga-OPS202 in Patients with Gastroenteropancreatic Neuroendocrine Tumors: A Prospective Phase I Imaging Study. J Nucl Med 2017; 59:909-914. [DOI: 10.2967/jnumed.117.199737] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/30/2017] [Indexed: 12/24/2022] Open
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Abstract
This article discusses the important role of nuclear medicine imaging and therapy in the management of neuroendocrine tumours (NETs). Somatostatin receptor scintigraphy has a high impact on patient management versus conventional imaging. Molecular radiotherapy is an important part of the management of patients with NETs. Selection of patients for molecular radiotherapy in NETs is based on uptake on their radionuclide imaging study. The imaging agent has the same mechanism of uptake as the therapeutic agent. Thus, the imaging study preselects patients that are likely to concentrate radiation within their tumours.
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Affiliation(s)
| | - Glenn Flux
- Royal Marsden Hospital & Institute of Cancer Research, London, UK
| | - Jamshed Bomanji
- University College London Hospitals NHS Foundation Trust, London, UK
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Bruinsma TJ, Johnson DR, Fang P, Senjem M, Josephs KA, Whitwell JL, Boeve BF, Pandey MK, Kantarci K, Jones DT, Vemuri P, Murray M, Graff-Radford J, Schwarz CG, Knopman DS, Petersen RC, Jack CR, Lowe VJ. Uptake of AV-1451 in meningiomas. Ann Nucl Med 2017; 31:736-743. [PMID: 28887599 DOI: 10.1007/s12149-017-1205-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 08/31/2017] [Indexed: 01/25/2023]
Abstract
AIM AV-1451 is an imaging agent labeled with the positron-emitting radiolabel Fluorine-18. 18F-AV-1451 binds paired helical filament tau (PHF-tau), a pathology related to Alzheimer's disease. In our study of AV-1451 uptake in the brains of cognitively normal subjects, we noted a case of a meningioma with visually significant uptake of AV-1451. OBJECTIVE We initiated the present retrospective study to further examine cases of meningioma that underwent AV-1451 imaging. METHODS We searched the patient records of 650 patients who had undergone AV-1451 at our institution for the keyword "meningioma" to identify potential cases. PET/CT and MRI results were visually reviewed and semi-quantitative analysis of PET was performed. A paired student's t test was run between background and tumor standard uptake values. Fisher's exact test was used to examine the association between AV-1451 uptake and presence of calcifications on CT. RESULTS We identified 12 cases of meningioma, 58% (7/12) of which demonstrated uptake greater than background using both visual analysis and tumor-to-normal cortex ratios (T/N + 1.90 ± 0.83). The paired student's t test revealed no statistically significant difference between background and tumor standard uptake values (p = 0.09); however, cases with a T/N ratio greater than one showed statistically higher uptake in tumor tissue (p = 0.01). A significant association was noted between AV-1451 uptake and presence of calcifications (p = 0.01). CONCLUSION AV-1451 PET imaging should be reviewed concurrently with anatomic imaging to prevent misleading interpretations of PHF-tau distribution due to meningiomas.
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Affiliation(s)
- Tyler J Bruinsma
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Derek R Johnson
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Ping Fang
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Matthew Senjem
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Information Technology, Mayo Clinic, Rochester, MN, USA
| | | | - Jennifer L Whitwell
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Mukesh K Pandey
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kejal Kantarci
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - David T Jones
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Prashanthi Vemuri
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Melissa Murray
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Christopher G Schwarz
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | | | - Clifford R Jack
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Val J Lowe
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Bozkurt MF, Virgolini I, Balogova S, Beheshti M, Rubello D, Decristoforo C, Ambrosini V, Kjaer A, Delgado-bolton R, Kunikowska J, Oyen WJG, Chiti A, Giammarile F, Fanti S. Guideline for PET/CT imaging of neuroendocrine neoplasms with 68Ga-DOTA-conjugated somatostatin receptor targeting peptides and 18F–DOPA. Eur J Nucl Med Mol Imaging 2017; 44:1588-601. [DOI: 10.1007/s00259-017-3728-y] [Citation(s) in RCA: 150] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 05/09/2017] [Indexed: 12/15/2022]
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Kaewput C, Vinjamuri S. Comparison of renal uptake of 68Ga-DOTANOC PET/CT and estimated glomerular filtration rate before and after peptide receptor radionuclide therapy in patients with metastatic neuroendocrine tumours. Nucl Med Commun 2016; 37:1325-32. [PMID: 27612032 DOI: 10.1097/MNM.0000000000000591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ga-DOTA-conjugated peptide PET/CT is used widely for diagnosis and treatment planning in patients with neuroendocrine tumours. As nephrotoxicity is a major limiting factor during peptide receptor radionuclide therapy (PRRT), it is important to evaluate renal function before, during and after treatment. The aim of our study is to compare renal uptake of Ga-DOTANOC and estimated glomerular filtration rate (eGFR) before and after PRRT and to identify any surrogate indicators of renal toxicity. MATERIALS AND METHODS We included 64 Ga-DOTANOC PET/CT examinations in 32 patients with metastatic neuroendocrine tumours who underwent Y-DOTATATE therapy between May 2013 and April 2016. An amino acid infusion was used routinely for renal protection. Renal uptake was quantified as mean standardized uptake value (SUVmean) of both kidneys after background subtraction. eGFR was calculated using standard software. The values were compared and evaluation of correlation and agreement between the two parameters was performed. RESULTS Our study showed fair agreement between SUVmean of the kidneys on Ga-DOTANOC PET/CT and eGFR (r=0.33) before PRRT and poor agreement between SUVmean of the kidneys and eGFR (r=0.16) after PRRT. As expected, there was a statistically significant difference in eGFR before and after PRRT (mean difference=4.41±9.24 ml/min/1.73 m, P=0.01). On comparison of renal uptake before and after PRRT, the post-PRRT scans showed a statistically significant increase in uptake (SUVmean=-1.25±3.17, P=0.03). CONCLUSION Renal quantitative analysis on Ga-DOTANOC PET/CT before and after PRRT showed no significant correlation with the eGFR. However, there was a statistically significant increase in the renal uptake of Ga-DOTANOC, with a higher uptake after PRRT. As a result of this pilot study, we suggest that the higher renal uptake in the post-PRRT scans could be an indicator of early renal dysfunction and could have implications for further cycles of PRRT. Further longitudinal studies and further evaluation of such data across multiple centres are suggested.
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Panagiotidis E, Alshammari A, Michopoulou S, Skoura E, Naik K, Maragkoudakis E, Mohmaduvesh M, Al-Harbi M, Belda M, Caplin ME, Toumpanakis C, Bomanji J. Comparison of the Impact of 68Ga-DOTATATE and 18F-FDG PET/CT on Clinical Management in Patients with Neuroendocrine Tumors. J Nucl Med 2016; 58:91-96. [DOI: 10.2967/jnumed.116.178095] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 06/30/2016] [Indexed: 12/20/2022] Open
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Dubash SR, Keat N, Mapelli P, Twyman F, Carroll L, Kozlowski K, Al-Nahhas A, Saleem A, Huiban M, Janisch R, Frilling A, Sharma R, Aboagye EO. Clinical Translation of a Click-Labeled 18F-Octreotate Radioligand for Imaging Neuroendocrine Tumors. J Nucl Med 2016; 57:1207-13. [PMID: 27173162 DOI: 10.2967/jnumed.115.169532] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 01/29/2016] [Indexed: 02/06/2023] Open
Abstract
UNLABELLED We conducted the first-in-human study of (18)F-fluoroethyl triazole [Tyr(3)] octreotate ((18)F-FET-βAG-TOCA) in patients with neuroendocrine tumors (NETs) to evaluate biodistribution, dosimetry, and safety. Despite advances in clinical imaging, detection and quantification of NET activity remains a challenge, with no universally accepted imaging standard. METHODS Nine patients were enrolled. Eight patients had sporadic NETs, and 1 had multiple endocrine neoplasia type 1 syndrome. Patients received 137-163 MBq (mean ± SD, 155.7 ± 8 MBq) of (18)F-FET-βAG-TOCA. Safety data were obtained during and 24 h after radioligand administration. Patients underwent detailed whole-body PET/CT multibed scanning over 4 h with sampling of venous bloods for radioactivity and radioactive metabolite quantification. Regions of interest were defined to derive individual and mean organ residence times; effective dose was calculated with OLINDA 1.1. RESULTS All patients tolerated (18)F-FET-βAG-TOCA with no adverse events. Over 60% parent radioligand was present in plasma at 60 min. High tumor (primary and metastases)-to-background contrast images were observed. Physiologic distribution was seen in the pituitary, salivary glands, thyroid, and spleen, with low background distribution in the liver, an organ in which metastases commonly occur. The organs receiving highest absorbed dose were the gallbladder, spleen, stomach, liver, kidneys, and bladder. The calculated effective dose over all subjects (mean ± SD) was 0.029 ± 0.004 mSv/MBq. CONCLUSION The favorable safety, imaging, and dosimetric profile makes (18)F-FET-βAG-TOCA a promising candidate radioligand for staging and management of NETs. Clinical studies in an expanded cohort are ongoing to clinically qualify this agent.
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Affiliation(s)
- Suraiya R Dubash
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Nicholas Keat
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Paola Mapelli
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Frazer Twyman
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Laurence Carroll
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Kasia Kozlowski
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Adil Al-Nahhas
- Department of Radiology/Nuclear Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom; and
| | - Azeem Saleem
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Mickael Huiban
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Ryan Janisch
- Imanova Centre for Imaging Sciences, London, United Kingdom
| | - Andrea Frilling
- Department of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Rohini Sharma
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Eric O Aboagye
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
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Green MA, Mathias CJ, Fletcher JW. Experience in production of (68)Ga-DOTA-NOC for clinical use under an Expanded Access IND. Appl Radiat Isot 2016; 116:63-8. [PMID: 27501136 DOI: 10.1016/j.apradiso.2016.07.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/11/2016] [Indexed: 01/08/2023]
Abstract
[(68)Ga]Ga-DOTA-NOC was produced under an Expanded Access IND for 174 clinical PET/CT studies to evaluate patients with neuroendocrine tumors. Production employed either the TiO2-based Eckert & Ziegler (EZAG) (68)Ge/(68)Ga-generator (with fractionated elution), or the SiO2-based ITG (68)Ge/(68)Ga-generator. In both cases, [(68)Ga]Ga-DOTA-NOC was reliably produced, without pre-synthesis purification of the(68)Ga generator eluate, using readily-implemented manual synthesis procedures. [(68)Ga]Ga-DOTA-NOC radiochemical purity averaged 99.2±0.4%. Administered (68)Ga dose averaged 181±22 MBq, and administered peptide mass averaged 43.2±5.2µg (n=47) and 23.9±5.7µg (n=127), respectively, using the EZAG and ITG generators. At dose expiration, (68)Ge breakthrough in the final product averaged 2.7×10(-7)% and 5.4×10(-5%) using the EZAG and ITG generators, respectively.
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Affiliation(s)
- Mark A Green
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202 United States.
| | - Carla J Mathias
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202 United States
| | - James W Fletcher
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, 46202 United States
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Xie T, Zaidi H. Development of computational pregnant female and fetus models and assessment of radiation dose from positron-emitting tracers. Eur J Nucl Med Mol Imaging 2016; 43:2290-2300. [PMID: 27349243 DOI: 10.1007/s00259-016-3448-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/16/2016] [Indexed: 01/20/2023]
Abstract
PURPOSE Molecular imaging using PET and hybrid (PET/CT and PET/MR) modalities nowadays plays a pivotal role in the clinical setting for diagnosis and staging, treatment response monitoring, and radiation therapy treatment planning of a wide range of oncologic malignancies. The developing embryo/fetus presents a high sensitivity to ionizing radiation. Therefore, estimation of the radiation dose delivered to the embryo/fetus and pregnant patients from PET examinations to assess potential radiation risks is highly praised. METHODS We constructed eight embryo/fetus models at various gestation periods with 25 identified tissues according to reference data recommended by the ICRP publication 89 representing the anatomy of the developing embryo/fetus. The developed embryo/fetus models were integrated into realistic anthropomorphic computational phantoms of the pregnant female and used for estimating, using Monte Carlo calculations, S-values of common positron-emitting radionuclides, organ absorbed dose, and effective dose of a number of positron-emitting labeled radiotracers. RESULTS The absorbed dose is nonuniformly distributed in the fetus. The absorbed dose of the kidney and liver of the 8-week-old fetus are about 47.45 % and 44.76 % higher than the average absorbed dose of the fetal total body for all investigated radiotracers. For 18F-FDG, the fetal effective doses are 2.90E-02, 3.09E-02, 1.79E-02, 1.59E-02, 1.47E-02, 1.40E-02, 1.37E-02, and 1.27E-02 mSv/MBq at the 8th, 10th, 15th, 20th, 25th, 30th, 35th, and 38th weeks of gestation, respectively. CONCLUSION The developed pregnant female/fetus models matching the ICRP reference data can be exploited by dedicated software packages for internal and external dose calculations. The generated S-values will be useful to produce new standardized dose estimates to pregnant patients and embryo/fetus from a variety of positron-emitting labeled radiotracers.
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Affiliation(s)
- Tianwu Xie
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland. .,Geneva Neuroscience Center, Geneva University, Geneva, Switzerland. .,Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. .,Department of Nuclear Medicine, University of Southern Denmark, DK-500, Odense, Denmark.
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Sharma P, Mukherjee A, Karunanithi S, Naswa N, Kumar R, Ammini AC, Bal C. Accuracy of 68Ga DOTANOC PET/CT Imaging in Patients With Multiple Endocrine Neoplasia Syndromes. Clin Nucl Med 2015; 40:e351-6. [PMID: 25783509 DOI: 10.1097/RLU.0000000000000775] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the role of ⁶⁸Ga DOTANOC PET/CT imaging in patients with multiple endocrine neoplasia (MEN) syndromes. PATIENTS AND METHODS Data of 33 patients (age, 33.5 [13.8] years; male 14/female 19) with MEN syndromes (MEN 1, 9; MEN 2A, 19; MEN 2B, 5) who underwent 41 ⁶⁸Ga DOTANOC PET/CT studies were retrospectively analyzed. Twenty PET/CTs were done for staging and 21 for restating. PET/CT images were evaluated in consensus by 2 nuclear medicine physicians, qualitatively and semiquantitatively (SUV(max)). A combination of histopathology, clinical, and biomarker follow-up was taken as reference standard. RESULTS Of the total 41 ⁶⁸Ga DOTANOC PET/CTs, 34 were interpreted as positive for neuroendocrine tumors (NETs) and 7 as negative. The patientwise sensitivity of PET/CT was 94% (95% confidence interval [CI], 80-99), specificity was 71% (95% CI, 29-96), positive predictive value was 94% (95% CI, 80-99), negative predictive value was 71% (95% CI, 29-96), and accuracy was 90%. A total of 74 disease sites were demonstrated on PET/CT, including 41 primary NETs (pancreas, 10; stomach, 2; pheochromocytoma, 10; medullary thyroid carcinoma, 19), 31 metastatic sites (lymph node, 15; liver, 10; bone, 4; lung, 1; breast, 1), and 2 parathyroid adenomas. Lesionwise sensitivity, positive predictive value, and accuracy of PET/CT were 93%, 96%, and 90% overall, 89%, 95%, and 85% for primary tumors, and 100%, 97%, and 97% for metastasis, respectively. Among primary tumors, the SUV(max) of medullary thyroid carcinoma was significantly lower than gastro pancreatic NETs (P = 0.003) and pheochromocytomas (P = 0.003). No site-specific difference was seen in SUV(max) of metastatic lesions. CONCLUSIONS ⁶⁸Ga DOTANOC PET/CT shows high diagnostic accuracy in MEN syndrome and can demonstrate both primary and metastatic NETs in these patients.
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Abstract
Detection of gastroenteropancreatic neuroendocrine tumours (GEP-NETs) and monitoring of treatment response relies mainly on morphological imaging such as computed tomography (CT) and magnetic resonance imaging (MRI). Molecular imaging techniques also in combination with CT (hybrid imaging) greatly benefit patient management, including better localization of occult tumours and better staging. Somatostatin receptor scintigraphy (SRS) and somatostatin receptor (SSTR) positron emission tomography (PET) play a central role in the diagnostic work-up of patients with well-differentiated GEP-NETs. SSTR PET/CT is superior to SRS and should be used whenever available. (18)F-DOPA and (18)F-FDG PET/CT is inferior to SSTR PET/CT at least in patients with well-differentiated GEP-NETs. Both SSTR PET/CT and SRS have limitations, such as relatively low detection rate of benign insulinomas, poorly differentiated GEP-NETs and liver metastases. New innovations such as SSTR PET/MRI, radiolabelled SSTR antagonists and glucagon-like peptide-1 receptor (GLP-1R) agonists might further improve imaging of GEP-NETs.
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Affiliation(s)
- Tobias Baumann
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland
| | - Christof Rottenburger
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland; Center of Neuroendocrine and Endocrine Tumors, University of Basel Hospital, Basel, Switzerland
| | - Guillaume Nicolas
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland; Neuroendocrine Tumour Unit, Royal Free Hospital, London, UK
| | - Damian Wild
- Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Basel, Switzerland; Center of Neuroendocrine and Endocrine Tumors, University of Basel Hospital, Basel, Switzerland.
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Zhou Y, Chen H, Ambalavanan N, Liu G, Antony VB, Ding Q, Nath H, Eary JF, Thannickal VJ. Noninvasive imaging of experimental lung fibrosis. Am J Respir Cell Mol Biol 2015; 53:8-13. [PMID: 25679265 DOI: 10.1165/rcmb.2015-0032tr] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Small animal models of lung fibrosis are essential for unraveling the molecular mechanisms underlying human fibrotic lung diseases; additionally, they are useful for preclinical testing of candidate antifibrotic agents. The current end-point measures of experimental lung fibrosis involve labor-intensive histological and biochemical analyses. These measures fail to account for dynamic changes in the disease process in individual animals and are limited by the need for large numbers of animals for longitudinal studies. The emergence of noninvasive imaging technologies provides exciting opportunities to image lung fibrosis in live animals as often as needed and to longitudinally track the efficacy of novel antifibrotic compounds. Data obtained by noninvasive imaging provide complementary information to histological and biochemical measurements. In addition, the use of noninvasive imaging in animal studies reduces animal usage, thus satisfying animal welfare concerns. In this article, we review these new imaging modalities with the potential for evaluation of lung fibrosis in small animal models. Such techniques include micro-computed tomography (micro-CT), magnetic resonance imaging, positron emission tomography (PET), single photon emission computed tomography (SPECT), and multimodal imaging systems including PET/CT and SPECT/CT. It is anticipated that noninvasive imaging will be increasingly used in animal models of fibrosis to gain insights into disease pathogenesis and as preclinical tools to assess drug efficacy.
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Affiliation(s)
- Yong Zhou
- 1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and
| | - Huaping Chen
- 1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and
| | | | - Gang Liu
- 1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and
| | - Veena B Antony
- 1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and
| | - Qiang Ding
- 1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and
| | - Hrudaya Nath
- 3 Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Janet F Eary
- 3 Radiology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Victor J Thannickal
- 1 Department of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine and
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Kunikowska J, Pawlak D, Kolasa A, Mikołajczak R, Królicki L. A frequency and semiquantitative analysis of pathological 68Ga DOTATATE PET/CT uptake by primary site-dependent neuroendocrine tumor metastasis. Clin Nucl Med 2014; 39:855-61. [PMID: 25072928 DOI: 10.1097/RLU.0000000000000533] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED The aim of this study was to define the frequency of neuroendocrine neoplasia (NEN) metastasis sites based on the primary lesion and create a database of SUVmax as a marker of human SSTR (somatostatin receptors) expression by semiquantitative analysis in vivo Ga DOTATATE PET/CT. PATIENTS AND METHODS Two hundred forty-five patients, 89 men and 156 women (mean [SD] age, 56.1 [12.8]), were imaged 60 to 70 minutes after 120 to 200 MBq (3.2-5.4 mCi) Ga DOTATATE injection using a Siemens Medical Solutions Biograph 64 PET/CT TruePoint. Visual assessments were made using a multimodality workstation, and sites of increased uptake were recorded. Pathological Ga DOTATATE uptake was quantified using semiquantitative analysis (SUVmax). RESULTS In patients with unknown primary tumors, Ga DOTATATE PET/CT revealed primary location in 92% (pancreas, 47%; intestines, 28%; and lung, 17%).Metastases, with respect to the primary sites, were predominantly in the liver (33% vs 49% vs 40%), lymph nodes (24% vs 34% vs 25%), and bone (10% vs 20% vs 30%). The SUVmax of metastases (mean [SD]) was highest in the liver (28.7 [23.5]), followed by the adrenal glands (24.7 [9.7]), bone (24.1 [36.8]), lymph nodes (22.5 [24.5]), pancreas (24.9 [28.1]), peritoneum (21.9 [24]), and the brain (4.6 [2.9]). CONCLUSIONS Ga DOTATATE PET/CT is very useful in the localization of NEN primary tumors. Ga DOTATATE PET/CT allows for visualizations of bone and lymph node metastases, not detected by any other modalities, which provides better staging and changes the clinical decision in approximately one third of patients.Our study shows that pancreatic NEN presented statistically a significantly lower frequency of bone metastases in comparison to lung and intestinal NEN. No significant frequency of metastases in the liver and lymph nodes based on primary tumors was observed.
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Johnbeck CB, Knigge U, Kjær A. PET tracers for somatostatin receptor imaging of neuroendocrine tumors: current status and review of the literature. Future Oncol 2015; 10:2259-77. [PMID: 25471038 DOI: 10.2217/fon.14.139] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Neuroendocrine tumors have shown rising incidence mainly due to higher clinical awareness and better diagnostic tools over the last 30 years. Functional imaging of neuroendocrine tumors with PET tracers is an evolving field that is continuously refining the affinity of new tracers in the search for the perfect neuroendocrine tumor imaging tracer. (68)Ga-labeled tracers coupled to synthetic somatostatin analogs with differences in affinity for the five somatostatin receptor subtypes are now widely applied in Europe. Comparison of sensitivity between the most used tracers - (68)Ga-DOTA-Tyr3-octreotide, (68)Ga-DOTA-Tyr3-octreotate and (68)Ga-DOTA-l-Nal3-octreotide - shows little difference and expertise on the specific tracer used, and knowledge regarding physiological uptake might be more important than in vitro-proven differences in affinity. Using isotopes such as (18)F or (64)Cu might improve these PET tracers further.
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Affiliation(s)
- Camilla Bardram Johnbeck
- Department of Clinical Physiology, Nuclear Medicine & PET & Cluster for Molecular Imaging, Rigshospitalet & University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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Savelli G, Muni A, Falchi R, Zaniboni A, Barbieri R, Valmadre G, Minari C, Casi C, Rossini P. Somatostatin receptors over-expression in castration resistant prostate cancer detected by PET/CT: preliminary report of in six patients. Ann Transl Med 2015. [PMID: 26207238 DOI: 10.3978/j.issn.2305-5839.2015.06.10] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Prostate cancer (PC) is usually characterized by an excellent prognosis, largely due to little biological aggressiveness and the power of hormonal deprivation therapy. In spite of these favorable characteristics, however, a significant quota of patients does not respond to androgen deprivation therapy (ADT) and develop a progressive disease. Castration-resistant prostate cancer (CRPC) is defined by disease progression in spite of ADT. This progression may show any combination of a rise in serum prostate-specific antigen (PSA), clinical and radiological progression of pre-existing disease, and appearance of new metastases. This event is a striking change in the clinical scenario, since the power of treatment for CRPC patients with distant metastases is very limited. Somatostatin is a hormone produced by neuroendocrine cells. Its distant effects are mediated by the binding to five specific receptors, which are the most striking parameter for neuroendocrine. Various synthetic somatostatin agonists able to bind to the receptors have been synthesized during the past two decades for diagnostic and therapeutic purposes. Octreotide, the most popular of these, is widely used to treat patients affected by neuroendocrine tumors. A number of researches carried out in the past evaluated the possible neuroendocrine differentiation (NED) of PC cells in the castration resistant phase. If proved, the presence of a specific class of receptor on cell's surfaces should give a potentially biological target to be used for therapy. However, these studies led to contradictory results. Aim of our phase III diagnostic trial was to study "in vivo" the over-expression of somatostatin receptors (SSTRs) in CRPC patients by PET/CT after the administration of the somatostatin analog [(68)Ga-DOTANOC,1-Nal(3)]-octreotide labeled with (68)Ga. Every area of increased uptake corresponding to a metastasis detected with other methods was considered as SSTRs expressing. False positivity to SSTRs expression was considered those localizations with a suspicious uptake not confirmed by other radiologic procedures. On the other hand, metastatic lesions lacking the radiopharmaceutical's uptake were considered not SSTRs expressing metastases. The preliminary results in 6 of the 67 patients scheduled by our phase III trial showed metastases with a variable SSTRs expression in 2 patients.
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Affiliation(s)
- Giordano Savelli
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Alfredo Muni
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Roberta Falchi
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Alberto Zaniboni
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Roberto Barbieri
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Giuseppe Valmadre
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Chiara Minari
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Camilla Casi
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
| | - Pierluigi Rossini
- 1 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 2 Nuclear Medicine Division, SS. Antonio e Biagio e C.Arrigo City Hospital, Alessandria, Italy ; 3 Nuclear Medicine Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 4 Medical Oncology Division, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy ; 5 Oncology Unit, "Carlo Poma" Hospital, Mantua, Italy ; 6 Medical Oncology Division, Presidio Ospedaliero E. Morelli AOVV, Sondrio, Italy ; 7 Medical Physiscs Division, "Carlo Poma" Hospital, Mantua, Italy ; 8 Medical Oncology Division, Medical Oncology Department, Val d'Elsa Hospital, Siena, Italy ; 9 Nuclear Medicine Division, "Carlo Poma" Hospital, Mantua, Italy
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Autio A, Virtanen H, Tolvanen T, Liljenbäck H, Oikonen V, Saanijoki T, Siitonen R, Käkelä M, Schüssele A, Teräs M, Roivainen A. Absorption, distribution and excretion of intravenously injected (68)Ge/ (68)Ga generator eluate in healthy rats, and estimation of human radiation dosimetry. EJNMMI Res 2015; 5:117. [PMID: 26183032 PMCID: PMC4504870 DOI: 10.1186/s13550-015-0117-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/06/2015] [Indexed: 11/17/2022] Open
Abstract
Background This study evaluated the absorption, distribution, and excretion of Gallium-68 (68Ga) radionuclide after a single intravenous (i.v.) injection of 68Ge/68Ga generator eluate in healthy rats. Additionally, human radiation doses were estimated from the rat data. Methods Twenty-one female and 21 male Sprague-Dawley rats were i.v. injected with 47 ± 4 MBq of 68Ge/68Ga generator eluate, and the radioactivity of excised organs was measured using a gamma counter at 5, 30, 60, 120, or 180 min afterwards (n = 3–7 for each time point). The radioactivity concentration and plasma pharmacokinetic parameters were calculated. Subsequently, the estimates for human radiation dosimetry were determined. Additionally, 4 female and 5 male rats were positron emission tomography (PET) imaged for in vivo visualization of biodistribution. Results 68Ga radioactivity was cleared relatively slowly from blood circulation and excreted into the urine, with some retention in the liver and spleen. Notably, the 68Ga radioactivity in female genital organs, i.e., the uterus and ovaries, was considerable higher compared with male genitals. Extrapolating from the female and male rat 68Ga data, the estimated effective dose was 0.0308 mSv/MBq for a 57-kg woman and 0.0191 mSv/MBq for a 70-kg man. Conclusions The estimated human radiation burden of the 68Ge/68Ga generator eluate was slightly higher for females and similar for males as compared with somatostatin receptor ligands 68Ga-DOTANOC, 68Ga-DOTATOC, and 68Ga-DOTATATE, which is probably due to the retention in the liver and spleen. Our results revealed some differences between female and male rat data, which, at least in part, may be explained by the small sample size.
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Affiliation(s)
- Anu Autio
- Turku PET Centre, Turku University Hospital, University of Turku, FI-20521, Turku, Finland,
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Kagna O, Pirmisashvili N, Tshori S, Freedman N, Israel O, Krausz Y. Neuroendocrine tumor imaging with 68Ga-DOTA-NOC: physiologic and benign variants. AJR Am J Roentgenol 2014; 203:1317-23. [PMID: 25415711 DOI: 10.2214/AJR.14.12588] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Imaging with (68)Ga-labeled 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid (DOTA)-octreotide analogs has become an important modality in patients with neuroendocrine tumors (NETs). In addition to high uptake in NET lesions, prominent physiologic radiotracer activity has been reported in the pituitary gland, pancreas, adrenal glands, liver, and spleen, and faint activity has been reported in the thyroid and gastrointestinal tract. This article describes previously unknown sites of 68Ga-DOTA-1-NaI3-octreotide (NOC) uptake unrelated to NETs. MATERIALS AND METHODS One hundred eighty-two patients (96 female and 86 male patients; age range, 4-89 years) with documented (n=156) or suspected (n=26) NETs underwent 207 68Ga-DOTA-NOC PET/CT studies. Studies were retrospectively reviewed for the presence, intensity, and localization of foci of increased uptake that were further correlated with findings on additional imaging studies and clinical follow-up for a period of 4-32 months. RESULTS Uptake of 68Ga-DOTA-NOC not identified as NET or known physiologic activity was detected in 297 sites with confirmation in 149 of 207 studies (72%). The most common location of non-NET-related 68Ga-DOTA-NOC-avid sites was in small lymph nodes, followed by prostate, uterus, breasts, lungs, brown fat, musculoskeletal system, and other sites, including oropharynx, pineal body, thymus, aortic plaque, genitalia, surgical bed, and subcutaneous granuloma. Intensity of uptake in non-NET-related 68Ga-DOTA-NOC-avid sites ranged in maximum standardized uptake value from 0.8 to 10.5. CONCLUSION Previously unreported benign sites of 68Ga-DOTA-NOC uptake were found in the majority of studies, suggesting the presence of somatostatin receptors in physiologic variants or processes with no evidence of tumor. Knowledge of increased tracer uptake in non-NET-related sites is important for accurate interpretation and for avoiding potential pitfalls of 68Ga-DOTA-NOC PET/CT.
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Herrmann K, Lapa C, Wester HJ, Schottelius M, Schiepers C, Eberlein U, Bluemel C, Keller U, Knop S, Kropf S, Schirbel A, Buck AK, Lassmann M. Biodistribution and Radiation Dosimetry for the Chemokine Receptor CXCR4-Targeting Probe 68Ga-Pentixafor. J Nucl Med 2015; 56:410-6. [DOI: 10.2967/jnumed.114.151647] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Czepczyński R, Matysiak-Grześ M, Gryczyńska M, Bączyk M, Wyszomirska A, Stajgis M, Ruchała M. Peptide receptor radionuclide therapy of differentiated thyroid cancer: efficacy and toxicity. Arch Immunol Ther Exp (Warsz) 2014; 63:147-54. [PMID: 25403743 PMCID: PMC4359293 DOI: 10.1007/s00005-014-0318-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/01/2014] [Indexed: 11/24/2022]
Abstract
In rare cases of differentiated thyroid carcinoma (DTC), radioiodine treatment is no longer effective due to cell dedifferentiation. Targeting somatostatin receptors in DTC cells by radiolabelled somatostatin analogues could provide an alternative therapy option. The aim of this study was to evaluate safety and efficacy of peptide receptor radionuclide therapy (PRRT) in patients with advanced, non-iodine avid DTC. Eleven patients aged 47–81 years (median: 65 years) with a history of several courses of radioiodine therapy, increasing thyroglobulin (Tg) and negative whole body scan, were qualified to the study. After confirming receptor expression by somatostatin receptor scintigraphy, PRRT with yttrium-90 labelled analogue was initiated. Fractionated treatment protocol was used with four doses of 90Y-DOTA-TOC in 12-week intervals. Activity of each dose was 3.7 GBq (100 mCi). Of 11 patients, 5 died before receiving the fourth course of PRRT. In the remaining six patients, morphological response, evaluated 3 months after the last course using RECIST criteria showed partial remission (PR) in one patient, stable disease (SD) in two patients and progressive disease (PD) in three patients. Biochemical response based on Tg measurements before and after PRRT showed PR in one patient, SD in four patients and PD in one patient. Median survival was 21 months from the first course of PRRT. Only minor and transient hematological toxicity was observed in some patients. We conclude that PRRT is generally well-tolerated and may be a valuable option for some patients with radioiodine-refractory DTC.
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Affiliation(s)
- Rafał Czepczyński
- Department of Endocrinology, Poznan University of Medical Sciences, Przybyszewskiego 49, 60-355, Poznań, Poland,
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Kratochwil C, Giesel FL, Bruchertseifer F, Mier W, Apostolidis C, Boll R, Murphy K, Haberkorn U, Morgenstern A. ²¹³Bi-DOTATOC receptor-targeted alpha-radionuclide therapy induces remission in neuroendocrine tumours refractory to beta radiation: a first-in-human experience. Eur J Nucl Med Mol Imaging 2014; 41:2106-19. [PMID: 25070685 PMCID: PMC4525192 DOI: 10.1007/s00259-014-2857-9] [Citation(s) in RCA: 259] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 07/03/2014] [Indexed: 11/28/2022]
Abstract
Purpose Radiopeptide therapy using a somatostatin analogue labelled with a beta emitter such as 90Y/177Lu-DOTATOC is a new therapeutic option in neuroendocrine cancer. Alternative treatments for patients with refractory disease are rare. Here we report the first-in-human experience with 213Bi-DOTATOC targeted alpha therapy (TAT) in patients pretreated with beta emitters. Methods Seven patients with progressive advanced neuroendocrine liver metastases refractory to treatment with 90Y/177Lu-DOTATOC were treated with an intraarterial infusion of 213Bi-DOTATOC, and one patient with bone marrow carcinosis was treated with a systemic infusion of 213Bi-DOTATOC. Haematological, kidney and endocrine toxicities were assessed according to CTCAE criteria. Radiological response was assessed with contrast-enhanced MRI and 68Ga-DOTATOC-PET/CT. More than 2 years of follow-up were available in seven patients. Results The biodistribution of 213Bi-DOTATOC was evaluable with 440 keV gamma emission scans, and demonstrated specific tumour binding. Enduring responses were observed in all treated patients. Chronic kidney toxicity was moderate. Acute haematotoxicity was even less pronounced than with the preceding beta therapies. Conclusion TAT can induce remission of tumours refractory to beta radiation with favourable acute and mid-term toxicity at therapeutic effective doses. Electronic supplementary material The online version of this article (doi:10.1007/s00259-014-2857-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany,
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Hartmann H, Freudenberg R, Oehme L, Zöphel K, Schottelius M, Wester HJ, Wunderlich G, Kotzerke J, Brogsitter C. Dosimetric measurements of (68)Ga-high affinity DOTATATE: twins in spirit - part III. Nuklearmedizin 2014; 53:211-6. [PMID: 25029274 DOI: 10.3413/nukmed-0667-14-05] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/07/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE 68Ga-labelled compounds are increasingly used for somatostatin-receptor scintigraphy because of their favourable biokinetic properties, a higher tumour-to-background contrast and higher diagnostic accuracy compared to the gamma-emitting tracer 111In-DTPA-octreotide. Recently, we have introduced the new tracer 68Ga-DOTA-3-iodo-Tyr3-Thr8-octreotide (68Ga-HA-DOTATATE). The present study demonstrates the biodistribution and radiation dosimetry of this tracer in humans. PATIENTS, METHODS Seven men were enrolled in this analysis. Every patient underwent a 20 min dynamic PET scan after intravenous injection of about 114 ± 9 MBq of 68Ga-HA-DOTATATE. This was followed by two whole-body scans at 30 min p. i. and 120 min p. i. Blood radioactivity concentration was determined non-invasively from a ROI drawn over the aorta. Urine was collected until the time of the last scan. Liver, spleen, kidneys and urinary bladder wall were included in the dosimetric estimation that was carried out with the software package OLINDA 1.0. RESULTS Physiological 68Ga-HA-DOTATATE uptake was observed in the pituitary gland, thyroid, salivary glands, liver, spleen, kidneys, urinary bladder, adrenals and intestine. Organs with the highest absorbed dose were spleen (0.26 ± 0.11 mSv/MBq), kidneys (0.14 ± 0.03 mSv/MBq) and liver (0.12 ± 0.02 mSv/MBq).The estimated effective dose was 0.024 ± 0.001 mSv/MBq. CONCLUSION Our study demonstrates biokinetics and radiation exposure of the 68Ga-labelled tracer HA-DOTATATE to be comparable to other 68Ga-labelled SSR analogues in clinical use.
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Affiliation(s)
- H Hartmann
- Holger Hartmann, Fetscherstr. 74, 01307 Dresden, Germany Tel. +49/(0)351/45 81 54 83, Fax +49/(0)351/458 53 47, E-mail:
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