Dynamic whole-body [¹⁸F]FES PET/CT increases lesion visibility in patients with metastatic breast cancer.

IF 3.1 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

EJNMMI Research Pub Date : 2024-03-04 DOI:10.1186/s13550-024-01080-y

Mette A Pedersen, Ole L Munk, André H Dias, Johanne H Steffensen, Anders L Møller, Anna Lyhne Johnsson, Kim Vang Hansen, Dirk Bender, Steen Jakobsen, Morten Busk, Lars C Gormsen, Trine Tramm, Signe Borgquist, Mikkel H Vendelbo

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引用次数: 0

Abstract

Background: Correct classification of estrogen receptor (ER) status is essential for prognosis and treatment planning in patients with breast cancer (BC). Therefore, it is recommended to sample tumor tissue from an accessible metastasis. However, ER expression can show intra- and intertumoral heterogeneity. 16α-[¹⁸F]fluoroestradiol ([¹⁸F]FES) Positron Emission Tomography/Computed Tomography (PET/CT) allows noninvasive whole-body (WB) identification of ER distribution and is usually performed as a single static image 60 min after radiotracer injection. Using dynamic whole-body (D-WB) PET imaging, we examine [¹⁸F]FES kinetics and explore whether Patlak parametric images ( $K_{i}$ ) are quantitative and improve lesion visibility.

Results: This prospective study included eight patients with metastatic ER-positive BC scanned using a D-WB PET acquisition protocol. The kinetics of [¹⁸F]FES were best characterized by the irreversible two-tissue compartment model in tumor lesions and in the majority of organ tissues. $K_{i}$ values from Patlak parametric images correlated with $K_{i}$ values from the full kinetic analysis, r² = 0.77, and with the semiquantitative mean standardized uptake value (SUV_mean), r² = 0.91. Furthermore, parametric $K_{i}$ images had the highest target-to-background ratio (TBR) in 162/164 metastatic lesions and the highest contrast-to-noise ratio (CNR) in 99/164 lesions compared to conventional SUV images. TBR was 2.45 (95% confidence interval (CI): 2.25-2.68) and CNR 1.17 (95% CI: 1.08-1.26) times higher in $K_{i}$ images compared to SUV images. These quantitative differences were seen as reduced background activity in the $K_{i}$ images.

Conclusion: [¹⁸F]FES uptake is best described by an irreversible two-tissue compartment model. D-WB [¹⁸F]FES PET/CT scans can be used for direct reconstruction of parametric $K_{i}$ images, with superior lesion visibility and $K_{i}$ values comparable to $K_{i}$ values found from full kinetic analyses. This may aid correct ER classification and treatment decisions. Trial registration ClinicalTrials.gov: NCT04150731, https://clinicaltrials.gov/study/NCT04150731.

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动态全身[18F]FES PET/CT 提高了转移性乳腺癌患者的病灶可见度。

背景：雌激素受体（ER）状态的正确分类对乳腺癌（BC）患者的预后和治疗计划至关重要。因此，建议从可触及的转移灶取样肿瘤组织。然而，ER的表达在瘤内和瘤间存在异质性。16α-[18F]氟雌二醇（[18F]FES）正电子发射断层扫描/计算机断层扫描（PET/CT）可对ER的分布进行无创全身（WB）鉴定，通常在放射性示踪剂注射后60分钟进行单次静态成像。利用动态全身（D-WB）PET 成像，我们检查了[18F]FES 动力学，并探讨了 Patlak 参数图像 ( K i ) 是否可以定量并提高病灶可见度：这项前瞻性研究纳入了八名转移性ER阳性BC患者，采用D-WB PET采集方案进行扫描。在肿瘤病灶和大多数器官组织中，[18F]FES 的动力学以不可逆的双组织分区模型为最佳特征。Patlak 参数图像的 K i 值与全动力学分析的 K i 值相关（r2 = 0.77），与半定量平均标准化摄取值（SUVmean）相关（r2 = 0.91）。此外，与传统 SUV 图像相比，参数 K i 图像在 162/164 个转移病灶中具有最高的靶-背景比（TBR），在 99/164 个病灶中具有最高的对比-噪声比（CNR）。与 SUV 图像相比，K i 图像的 TBR 高 2.45 倍（95% 置信区间：2.25-2.68），CNR 高 1.17 倍（95% 置信区间：1.08-1.26）。结论：[18F]FES摄取量与SUV图像相比增加了1.17倍（95 CI：1.08-1.26倍）：结论：[18F]FES 摄取最适合用不可逆的双组织分区模型来描述。D-WB[18F]FES PET/CT 扫描可用于直接重建参数 K i 图像，病变可见度更高，K i 值与全动力学分析得出的 K i 值相当。这可能有助于正确的 ER 分类和治疗决策。试验注册 ClinicalTrials.gov：NCT04150731，https://clinicaltrials.gov/study/NCT04150731。

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来源期刊

EJNMMI Research RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING&nb-

CiteScore

5.90

自引率

3.10%

发文量

审稿时长

13 weeks

期刊介绍： EJNMMI Research publishes new basic, translational and clinical research in the field of nuclear medicine and molecular imaging. Regular features include original research articles, rapid communication of preliminary data on innovative research, interesting case reports, editorials, and letters to the editor. Educational articles on basic sciences, fundamental aspects and controversy related to pre-clinical and clinical research or ethical aspects of research are also welcome. Timely reviews provide updates on current applications, issues in imaging research and translational aspects of nuclear medicine and molecular imaging technologies. The main emphasis is placed on the development of targeted imaging with radiopharmaceuticals within the broader context of molecular probes to enhance understanding and characterisation of the complex biological processes underlying disease and to develop, test and guide new treatment modalities, including radionuclide therapy.