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Annals of Nuclear Medicine 32-3
Review Article
1. Paradigm shift in theranostics of neuroendocrine tumors: conceptual horizons of nanotechnology in nuclear medicine (pp151–164)
Geetanjali Arora & Gurupad Bandopadhyaya
Gurupad Bandopadhyaya (guru47@gmail.com)
Department of Nuclear Medicine All India Institute of Medical Sciences, New Delhi, India
Original Article
2. Pilot study of serial FLT and FDG-PET/CT imaging to monitor response to neoadjuvant chemoradiotherapy of esophageal adenocarcinoma: correlation with histopathologic response
(pp 165–174)
Victor H. Gerbaudo, Joseph H. Killoran, Chun K. Kim, Jason L. Hornick, Jonathan A. Nowak, Peter C. Enzinger & Harvey J. Mamon
Victor H. Gerbaudo (gerbaudo@bwh.harvard.edu)
Division of Nuclear Medicine and Molecular Imaging, Department of Radiology Brigham and Women’s Hospital, Harvard Medical School Boston, Massachusetts, US
3. Is 123I-metaiodobenzylguanidine heart-to-mediastinum ratio dependent on age? From Japanese Society of Nuclear Medicine normal database (pp 175–181)
Kenichi Nakajima, Koichi Okuda, Shinro Matsuo, Hiroshi Wakabayashi & Seigo Kinuya
Kenichi Nakajima (nakajima@med.kanazawa-u.ac.jp)
Department of Nuclear Medicine Kanazawa University Hospital, Kanazawa, Japan
4. Automated segmentation and detection of increased uptake regions in bone scintigraphy using SPECT/CT images (pp 182–190)
Masakazu Tsujimoto, Atsushi Teramoto, Seiichiro Ota, Hiroshi Toyama & Hiroshi Fujita
Masakazu Tsujimoto (mckz-t@fujita-hu.ac.jp)
Department of Radiology Fujita Health University Hospital, Toyoake, Japan
5. The influence of elevated hormone levels on physiologic accumulation of 68Ga-DOTATOC
(pp191-196)
Masao Watanabe, Yuji Nakamoto, Sho Koyasu, Takayoshi Ishimori, Akihiro Yasoda & Kaori Togashi
Yuji Nakamoto (ynakamo1@kuhp.kyoto-u.ac.jp)
Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine Kyoto University, Kyoto, Japan
6. Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries (pp 197–205)
Wei Dong, Jianan Li, Hongzhi Mi, Xiantao Song, Jian Jiao & Quan Li
Hongzhi Mi (hongzhim3256@sina.com)
Department of Nuclear Medicine, Beijing Anzhen Hospital Capital Medical University, Beijing, China
Xiantao Song (songxiantao@medmail.com.cn)
Department of Cardiology, Beijing Anzhen Hospital Capital Medical University, Beijing, China
7. 18F-FPYBF-2, a new F-18-labelled amyloid imaging PET tracer: first experience in 61 volunteers and 55 patients with dementia (pp 206–216)
Tatsuya Higashi, Ryuichi Nishii, Shinya Kagawa, Yoshihiko Kishibe, Masaaki Takahashi, Tomoko Okina, Norio Suzuki, Hiroshi Hasegawa, Yasuhiro Nagahama, Koichi Ishizu, Naoya Oishi, Hiroyuki Kimura, Hiroyuki Watanabe, Masahiro Ono, Hideo Saji & Hiroshi Yamauchi
Tatsuya Higashi (higashi.tatsuya@qst.go.jp)
Shiga Medical Center Research Institute Moriyama, Japan
Department of Molecular Imaging and Theranostics National Institute of Radiological Sciences (NIRS), National Institutes for Quantum and Radiological Science and Technology (QST)Chiba, Japan
Report
8. Manual on the proper use of lutetium-177-labeled somatostatin analogue (Lu-177-DOTA-TATE) injectable in radionuclide therapy (2nd ed.) (pp 217–235 )
Makoto Hosono, Hideharu Ikebuchi, Yoshihide Nakamura, Nobutaka Nakamura, Takahiro Yamada, Sachiko Yanagida, Asami Kitaoka, Kiyotaka Kojima, Hiroyasu Sugano, Seigo Kinuya, Tomio Inoue & Jun Hatazawa
Makoto Hosono (hosono@med.kindai.ac.jp)
Faculty of Medicine Kindai University, Osaka-Sayama, Japan
Letter to the Editor
9. Open letter to journal editors on: International Consensus Radiochemistry Nomenclature Guidelines (pp 236–238)
Heinz H. Coenen, Antony D. Gee, Michael Adam, Gunnar Antoni, Cathy S. Cutler, Yasuhisa Fujibayashi, Jae Min Jeong, Robert H. Mach, Thomas L. Mindt, Victor W. Pike & Albert D. Windhorst
Antony D. Gee (antony.gee@kcl.ac.uk)
King’s College London, London, UK
1. Paradigm shift in theranostics of neuroendocrine tumors: conceptual horizons of nanotechnology in nuclear medicine
Geetanjali Arora & Gurupad Bandopadhyaya
Abstract
We present a comprehensive review of Neuroendocrine Tumors (NET) and the current and developing imaging and therapeutic modalities for NET with emphasis on Nuclear Medicine modalities. Subsequently, nanotechnology and its emerging role in cancer management, especially NET, are discussed. The article is both educative and informative. The objective is to provide an insight into the developments made in nuclear medicine and nanotechnology towards management of NET, individually as well as combined together.
Keywords
Neuroendocrine tumors, Nanoparticles, Radionuclide therapy, Drug delivery
2. Pilot study of serial FLT and FDG-PET/CT imaging to monitor response to neoadjuvant chemoradiotherapy of esophageal adenocarcinoma: correlation with histopathologic response
Victor H. Gerbaudo, Joseph H. Killoran, Chun K. Kim, Jason L. Hornick, Jonathan A. Nowak, Peter C. Enzinger & Harvey J. Mamon
Abstract
The aim of this prospective pilot study was to investigate the potential of serial FLT-PET/CT compared to FDG-PET/CT to provide an early indication of esophageal cancer response to concurrent neoadjuvant chemoradiation therapy.
Five patients with biopsy-proven esophageal adenocarcinomas underwent neoadjuvant chemoradiation (Tx) prior to minimally invasive esophagectomy. The presence of residual tumor was classified histologically using the Mandard et al. criteria, categorizing patients as pathologic responders and non-responders. Participants underwent PET/CT imaging 1 h after intravenous administration of FDG and of FLT on two separate days within 48 h of each other. Each patient underwent a total of 3 scan “pairs”: (1) pre-treatment, (2) during treatment, and (3) post-treatment. Image-based response to therapy was measured in terms of changes in SUVmax (ΔSUV) between pre- and post-therapeutic FLT- and FDG-PET scans. The PET imaging findings were correlated with the pathology results after surgery.
All tumors were FDG and FLT avid at baseline. Lesion FLT uptake was lower than with FDG. Neoadjuvant chemoradiation resulted in a reduction of tumor uptake of both radiotracers in pathological responders (n = 3) and non-responders (n = 2). While the difference in the reduction in mean tumor FLT uptake during Tx between responders (ΔSUV = − 55%) and non-responders (ΔSUV = − 29%) was significant (P = 0.007), for FDG it was not, [responders had a mean ΔSUV = − 39 vs. − 31% for non-responders (P = 0.74)]. The difference in the reduction in tumor FLT uptake at the end of treatment between responders (ΔSUV = − 62%) and non-responders (ΔSUV = − 57%) was not significant (P = 0.54), while for FDG there was a trend toward significance [ΔSUV of responders = − 74 vs. − 52% in non-responders (P = 0.06)].
The results of this prospective pilot study suggest that early changes in tumor FLT uptake may be better than FDG in predicting response of esophageal adenocarcinomas to neoadjuvant chemoradiation. These preliminary results support the need to corroborate the value of FLT-PET/CT in a larger cohort.
Keywords
FDG, FLT, PET/CT, Esophageal cancer, Radiation therapy, Response to treatment, Neoadjuvant chemoradiotherapy
3. Is 123I-metaiodobenzylguanidine heart-to-mediastinum ratio dependent on age? From Japanese Society of Nuclear Medicine normal database
Kenichi Nakajima, Koichi Okuda, Shinro Matsuo, Hiroshi Wakabayashi & Seigo Kinuya
Abstract
Heart-to-mediastinum ratios (HMRs) of 123I-metaiodobenzylguanidine (MIBG) have usually been applied to prognostic evaluations of heart failure and Lewy body disease. However, whether these ratios depend on patient age has not yet been clarified using normal databases.
We analyzed 62 patients (average age 57 ± 19 years, male 45%) derived from a normal database of the Japanese Society of Nuclear Medicine working group. The HMR was calculated from early (15 min) and delayed (3–4 h) anterior planar 123I-MIBG images. All HMRs were standardized to medium-energy general purpose (MEGP) collimator equivalent conditions using conversion coefficients for the collimator types. Washout rates (WR) were also calculated, and we analyzed whether early and late HMR, and WR are associated with age.
Before standardization of HMR to MEGP collimator conditions, HMR and age did not significantly correlate. However, late HMR significantly correlated with age after standardization: late HMR = − 0.0071 × age + 3.69 (r2 = 0.078, p = 0.028), indicating that a 14-year increase in age corresponded to a decrease in HMR of 0.1. Whereas the lower limit (2.5% quantile) of late HMR was 2.3 for all patients, it was 2.5 and 2.0 for those aged ≤ 63 and > 63 years, respectively. Early HMR tended to be lower in subjects with the higher age (p = 0.076), whereas WR was not affected by age.
While late HMR was slightly decreased in elderly patients, the lower limit of 2.2–2.3 can still be used to determine both early and late HMR.
Keywords
Scintigraphy, Sympathetic imaging, Quantitation, Aging, Standardization
4. Automated segmentation and detection of increased uptake regions in bone scintigraphy using SPECT/CT images
Masakazu Tsujimoto, Atsushi Teramoto, Seiichiro Ota, Hiroshi Toyama & Hiroshi Fujita
Abstract
To develop a method for automated detection of highly integrated sites in SPECT images using bone information obtained from CT images in bone scintigraphy.
Bone regions on CT images were first extracted, and bones were identified by segmenting multiple regions. Next, regions corresponding to the bone regions on SPECT images were extracted based on the bone regions on CT images. Subsequently, increased uptake regions were extracted from the SPECT image using thresholding and three-dimensional labeling. Last, the ratio of increased uptake regions to all bone regions was calculated and expressed as a quantitative index. To verify the efficacy of this method, a basic assessment was performed using phantom and clinical data.
The results of this analytical method using phantoms created by changing the radioactive concentrations indicated that regions of increased uptake were detected regardless of the radioactive concentration. Assessments using clinical data indicated that detection sensitivity for increased uptake regions was 71% and that the correlation between manual measurements and automated measurements was significant (correlation coefficient 0.868).
These results suggested that automated detection of increased uptake regions on SPECT images using bone information obtained from CT images would be possible.
Keywords
Bone scintigraphy, SPECT/CT, Image processing, Bone metastasis
5. The influence of elevated hormone levels on physiologic accumulation of 68Ga-DOTATOC Masao Watanabe, Yuji Nakamoto, Sho Koyasu, Takayoshi Ishimori, Akihiro Yasoda & Kaori Togashi
Abstract
PET/CT imaging with 68Ga-1,4,7,10-tetraazacyclododecane-N,N′,N″,N‴-tetraacetic acid-D-Phe1-Tyr3-octreotide (DOTATOC) is useful in patients with neuroendocrine tumors (NETs). Functioning NETs by definition secrete abnormal levels of hormones, causing clinical symptoms. It is known that physiologic accumulation can be seen in some organs, but it remains unknown whether elevated hormone levels can affect the physiologic accumulation pattern of 68Ga-DOTATOC. We aimed to investigate the influence of higher hormone levels on physiologic accumulation of 68Ga-DOTATOC.
A total of 167 patients with known or suspected NET lesions were enrolled in this study. The numbers of patients with elevations of ACTH, gastrin, insulin, and no elevation were 10, 25, 7, and 125, respectively. We compared the maximum standardized uptake value (SUVmax) in various organs of each group.
In the group with elevated ACTH levels, SUVmax in the pituitary gland, the uncinate process of the pancreas and adrenal glands was lower than those in the group with no elevation (5.7 ± 1.9 vs. 8.4 ± 3.1, P = 0.015; 4.7 ± 3.5 vs. 6.4 ± 2.8, P = 0.037; 10.8 ± 4.8 vs. 13.9 ± 4.7, P = 0.020, respectively). There were no differences in physiologic uptake of 68Ga-DOTATOC in the thyroid gland, the pancreatic body, the liver, the spleen, the bowel, or the kidney.
In NET patients with elevated ACTH levels, physiologic uptake of 68Ga-DOTATOC in the pituitary gland, the uncinate process of the pancreas and adrenal glands was significantly decreased. Other organs were unaffected.
Keywords
68Ga-DOTATOC, SUVmax, Physiologic accumulation, ACTH, Pituitary gland
6. Relationship between collateral circulation and myocardial viability of 18F-FDG PET/CT subtended by chronic total occluded coronary arteries
Wei Dong, Jianan Li, Hongzhi Mi, Xiantao Song, Jian Jiao & Quan Li
Abstract
To analyze the relationship between the collateral flow of coronary chronic total occlusion (CTO) and myocardial viability detected by 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging.
A prospective analysis of 104 patients diagnosed by coronary angiography. All patients underwent resting myocardial perfusion imaging and PET/CT within 1 week. The collateral circulation was graded with Rentrop classification as no or poor collateral circulation in 16 CTO vessels, moderate collateral circulation in 34 CTO vessels, and good collateral circulation in 69 CTO vessels. Myocardial viability was determined with myocardial perfusion imaging and PET. The patterns were interpreted as mismatch, match and normal perfusion and 18F-FDG uptake.
There was no significant correlation between the severity and extent of perfusion defect, myocardial viability and collateral circulation grade. The myocardial viability was normal in mild and moderate hypokinetic regions and decreased in severe hypokinetic and akinesis–dyskinesis regions. The presence of collateral circulation was a sensitive (89%) but not a specific (31%) sign of myocardial viability.
In patients with CTO, collateral circulation does not seem to be an effective way for predicting myocardial viability. Further analysis of PET patterns of viable myocardium is needed to guide further revascularization and predict functional improvement and survival benefit.
Keywords
18F-fluorodeoxyglucose, Chronic total occlusion, Positron emission tomography, Collateral circulation, Myocardial viability
7. 18F-FPYBF-2, a new F-18-labelled amyloid imaging PET tracer: first experience in 61 volunteers and 55 patients with dementia
Tatsuya Higashi, Ryuichi Nishii, Shinya Kagawa, Yoshihiko Kishibe, Masaaki Takahashi, Tomoko Okina, Norio Suzuki, Hiroshi Hasegawa, Yasuhiro Nagahama, Koichi Ishizu, Naoya Oishi, Hiroyuki Kimura, Hiroyuki Watanabe, Masahiro Ono, Hideo Saji & Hiroshi Yamauchi
Abstract
Recently, we developed a benzofuran derivative for the imaging of β-amyloid plaques, 5-(5-(2-(2-(2-18F-fluoroethoxy)ethoxy)ethoxy)benzofuran-2-yl)-N-methylpyridin-2-amine (18F-FPYBF-2) (Ono et al., J Med Chem 54:2971–9, 2011). The aim of this study was to assess the feasibility of 18F-FPYBF-2 as an amyloid imaging PET tracer in a first clinical study with healthy volunteers and patients with various dementia and in comparative dual tracer study using 11C-Pittsburgh Compound B (11C-PiB).
61 healthy volunteers (age: 53.7 ± 13.1 years old; 19 male and 42 female; age range 24–79) and 55 patients with suspected dementia [Alzheimer’s Disease (AD); early AD: n = 19 and moderate stage AD: n = 8, other dementia: n = 9, mild cognitive impairment (MCI): n = 16, cognitively normal: n = 3] for first clinical study underwent static head PET/CT scan using 18 F − FPYBF-2 at 50–70 min after injection. 13 volunteers and 14 patients also underwent dynamic PET scan at 0–50 min at the same instant. 16 subjects (volunteers: n = 5, patients with dementia: n = 11) (age: 66.3 ± 14.2 years old; 10 males and 6 females) were evaluated for comparative study (50–70 min after injection) using 18F-FPYBF-2 and 11C-PiB on separate days, respectively. Quantitative analysis of mean cortical uptake was calculated using Mean Cortical Index of SUVR (standardized uptake value ratio) based on the established method for 11C-PiB analysis using cerebellar cortex as control.
Studies with healthy volunteers showed that 18F-FPYBF-2 uptake was mainly observed in cerebral white matter and that average Mean Cortical Index at 50–70 min was low and stable (1.066 ± 0.069) basically independent from age or gender. In patients with AD, 18F-FPYBF-2 uptake was observed both in cerebral white and gray matter, and Mean Cortical Index was significantly higher (early AD: 1.288 ± 0.134, moderate AD: 1.342 ± 0.191) than those of volunteers and other dementia (1.018 ± 0.057). In comparative study, the results of 18F-FPYBF-2 PET/CT were comparable with those of 11C-PiB, and the Mean Cortical Index (18F-FPYBF-2: 1.173 ± 0.215; 11C-PiB: 1.435 ± 0.474) showed direct proportional relationship with each other (p < 0.0001).
Our first clinical study suggest that 18F-FPYBF-2 is a useful PET tracer for the evaluation of β-amyloid deposition and that quantitative analysis of Mean Cortical Index of SUVR is a reliable diagnostic tool for the diagnosis of AD.
Keywords
Alzheimer disease, Amyloid imaging, Healthy volunteers, Positron emission tomography
8. Manual on the proper use of lutetium-177-labeled somatostatin analogue (Lu-177-DOTA-TATE) injectable in radionuclide therapy (2nd ed.)
Makoto Hosono, Hideharu Ikebuchi, Yoshihide Nakamura, Nobutaka Nakamura, Takahiro Yamada, Sachiko Yanagida, Asami Kitaoka, Kiyotaka Kojima, Hiroyasu Sugano, Seigo Kinuya, Tomio Inoue & Jun Hatazawa
Abstract
Here we present the guideline for the treatment of neuroendocrine tumors using Lu-177-DOTA-TATE on the basis of radiation safety aspects in Japan. This guideline was prepared by a study supported by Ministry of Health, Labour, and Welfare, and approved by Japanese Society of Nuclear Medicine. Lu-177-DOTA-TATE treatment in Japan should be carried out according to this guideline. Although this guideline is applied in Japan, the issues for radiation protection shown in this guideline are considered internationally useful as well. Only the original Japanese version is the formal document.
Keywords
Lu-177-DOTA-TATE, Radionuclide therapy, Neuroendocrine tumor
