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Bone Marrow and NOT Bone Metastases is What 21st Century Diagnostic Imaging Must Focus upon when Looking for Skeletal Metastases.
Related Articles

Bone Marrow and NOT Bone Metastases is What 21st Century Diagnostic Imaging Must Focus upon when Looking for Skeletal Metastases.

J Nucl Med. 2017 Sep 15;:

Authors: Høilund-Carlsen PF, Hess S, Alavi A

PMID: 28916624 [PubMed - as supplied by publisher]




Efficacy of radioembolization with holmium-166 microspheres in salvage patients with liver metastases: a phase 2 study.
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Efficacy of radioembolization with holmium-166 microspheres in salvage patients with liver metastases: a phase 2 study.

J Nucl Med. 2017 Sep 15;:

Authors: Prince JF, van den Bosch MAAJ, Nijsen JFW, Smits MLJ, van den Hoven AF, Nikolakopoulos S, Wessels FJ, Bruijnen RCG, Braat M, Zonnenberg BA, Lam M

Abstract
Rationale: Radioembolization of liver malignancies with holmium-166 (166Ho) microspheres has been shown safe in a phase 1 dose-escalation study. The purpose of this study was to investigate the efficacy of 166Ho radioembolization. Methods: In this prospective single-arm study, 56 patients were enrolled, all with liver metastases refractory to systemic therapy and ineligible for surgical resection. Radioembolization was performed with a projected average absorbed dose of 60 Gy to the liver (equal to 3.8 GBq/kg liver tissue). The primary outcome was tumor response of two target lesions on triphasic liver CT scans, 3 months after therapy using RECIST 1.1 criteria. Secondary outcomes included overall tumor response, response on (18)F-FDG-PET/CT, time to imaging progression, overall survival, toxicity, quality of life, and quantification of the microspheres on SPECT and MRI. Results: Between May 2012 and March 2015, 38 eligible patients were treated, one of whom was not evaluable. In 27/37 (73%) patients, the target lesions showed complete response, partial response or stable disease (disease control) at three months (95% confidence interval [CI], 57 to 85%). Disease control in the whole liver was achieved in 18/37 (49%) of patients (95% CI, 33 to 64%). The median overall survival was 14.5 months (95% CI, 8.6 to 22.8 months). For colorectal cancer patients (n = 23), the median overall survival was 13.4 months (95% CI, 8.2 - 15.7 months). Grade 3 or 4 toxic events after treatment (according to CTCAE v4.03 criteria) included abdominal pain (in 18% of patients), nausea (8%), ascites (3%), fatigue (3%), gastric stenosis (3%), hepatic failure (3%), liver abscesses (3%), paroxysmal atrial tachycardia (3%), thoracic pain (3%), upper gastrointestinal hemorrhage (3%), and vomiting (3%). On SPECT/CT, 166Ho could be quantified with high accuracy and precision, with a mean overestimation of 9.3±7.1% in the liver. Conclusion: Radioembolization with 166Ho microspheres induced a tumor response with an acceptable toxicity profile in salvage patients with liver metastases.

PMID: 28916623 [PubMed - as supplied by publisher]




Quantification and Determination of Normal (123)I-Meta Iodobenzylguanidine Heart-to-Mediastinum Ratio (HMR) from Cardiac SPECT/CT and Correlation with Planar HMR.
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Quantification and Determination of Normal (123)I-Meta Iodobenzylguanidine Heart-to-Mediastinum Ratio (HMR) from Cardiac SPECT/CT and Correlation with Planar HMR.

J Nucl Med. 2017 Sep 15;:

Authors: Alvi R, Miller EJ, Hashemi Zonouz T, Sandoval V, Tariq N, Lampert R, Sinusas AJ, Liu YH

Abstract
Assessment of cardiac (123)I-mIBG uptake relies on the heart-to-mediastinal ratio (HMR) derived from planar images. We have developed novel semi-automated quantitative methodologies for assessing HMR from single photon emission computed tomography (SPECT) images using a dedicated cardiac multi-pinhole SPECT/computerized tomography (CT) system and determined the lower limit of normal (LLN) SPECT-derived HMR and the correlation to planar-derived HMR. Methods: Twenty-one healthy volunteers were injected with (123)I-meta Iodobenzylguanidine ((123)I-mIBG) and imaged using two different cameras. Planar images were acquired using a conventional SPECT camera equipped with parallel hole collimators and hybrid SPECT/CT images were acquired using a dedicated cardiac SPECT system with 19 pinhole collimators interfaced with 64-slice CT. Planar HMR was calculated as per standard guidelines (manual traditional method), elliptical region of interest (Elip-ROI) and region growing (RG-ROI) techniques. SPECT HMR was quantified using a new method that incorporates various cardiac and mediastinal segmentation schemes in which upper and lower limits of the heart were determined from CT and the left ventricular ROI and mean counts were calculated using Elip-ROI and RG-ROI techniques. Mean counts in mediastinal ROI were computed from a fixed volume in three different regions: upper mediastinum (UM), lower mediastinum (LM), and contralateral lung (CL). HMRs were processed by two observers and reproducibility was assessed by intra-class correlation coefficient and Bland-Altman analysis. Results: Planar HMR calculated using RG-ROI method showed highest intra- and inter-observer levels of agreement compared to Elip-ROI and manual traditional methods. SPECT HMR calculated based on UM, LM and CL background regions showed excellent intra- and inter-observer agreement. SPECT HMR with UM resulted in highest correlation (R= 0.91) with planar HMR compared to that with LM (R= 0.74) and CL (R= 0.73). The LLN of SPECT HMR with UM and that of planar HMR was calculated as 5.5 and 1.6, respectively. The normal values of SPECT-derived HMR and planar-derived HMR were correlated linearly. Conclusion: We reconfirmed the previous planar HMR threshold and determined SPECT LLN HMR for SPECT. Planar HMR can be estimated from SPECT HMR via a simple linear regression equation, allowing use of the new cardiac-dedicated SPECT camera for (123)I-mIBG imaging.

PMID: 28916622 [PubMed - as supplied by publisher]




(64)Cu-Labeled Repebody Molecules for Imaging of Epidermal Growth Factor Receptor Expressing Tumors.
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(64)Cu-Labeled Repebody Molecules for Imaging of Epidermal Growth Factor Receptor Expressing Tumors.

J Nucl Med. 2017 Sep 15;:

Authors: Pyo A, Yun M, Kim HS, Kim TY, Lee JJ, Kim JY, Lee S, Kwon SY, Bom HS, Kim HS, Kim DY, Min JJ

Abstract
The epidermal growth factor receptor (EGFR) is a member of the erbB family of receptors and is overexpressed in many tumor types. A repebody is a newly designed non-antibody protein scaffold for tumor targeting that contains leucine-rich repeat modules. In this study, three (64)Cu-labeled anti-EGFR repebodies with different chelators were synthesized, and their biological characteristics were assessed in cultured cells and tumor-bearing mice. Methods: Repebodies (rEgAs) were synthesized with the chelators p-SCN-Bn-NOTA, DOTA-NHS ester, or p-SCN-Bn-DTPA in 1.0 M NaHCO3 buffer (pH 9.2) for 24 h. Purified NOTA-, DOTA-, and DTPA-conjugated rEgA were radiolabeled with (64)Cu in 0.1 M NH4OAc buffer (pH 5.5). To compare the EGFR-binding affinities of the repebodies, cellular uptake studies were performed with the human non-small cell lung cancer cell line H1650 (high expression of EGFR) and the human colon adenocarcinoma cell line SW620 (low expression of EGFR). Biodistribution and microPET imaging studies were performed using H1650 tumor-bearing mice. Results: Radiochemical yields of the (64)Cu-labeled rEgAs were approximately 70-80%. Cellular uptake of the NOTA-, DOTA-, and DTPA- rEgAs was over 4-fold higher in H1650 cells than in SW620 cells at 1 h. The three rEgAs had accumulated specifically in H1650 tumor-bearing nude mice by 1 h after intravenous injection and were retained for over 24 h, as measured by the percent injected dose per gram of tissue (%ID/g). Tumor uptake of all repebodies increased from 1 h to 6 h (at 1 h, 6.28, 8.46, and 6.91 %ID/g for NOTA-, DOTA-, and DTPA-rEgA, respectively; at 6 h, 9.4, 8.28, and 10.1 %ID/g, respectively). H1650 tumors were clearly visible after injection of each repebody, with high tumor-to-background ratios (at 1 h, 3.43, 4.89, and 2.38 for NOTA-, DOTA-, and DTPA-rEgA, respectively; at 6 h, 3.05, 4.36, and 2.08; at 24 h, 3.81, 4.58, and 2.86). Conclusion: The three (64)Cu-rEgA complexes demonstrated specific and rapid uptake in EGFR-expressing tumors within 1 h and may have potential as novel EGFR imaging agents for PET.

PMID: 28916621 [PubMed - as supplied by publisher]