Assessment of [177Lu]Lu-DOTATATE Dosimetry from High-Speed Whole-Body Recordings Provided by a 360° Cadmium–Zinc–Telluride Camera Compared with Results from a Conventional Anger-Camera Protocol

Timothée Zaragori, Elodie Chevalier, Quentin Citerne, Véronique Roch, Gabriela Hossu, Pierre-Yves Marie, Caroline Boursier, Laetitia Imbert
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Abstract

Absorbed doses (ADs) may be calculated through serial conventional SPECT imaging after therapeutic [177Lu]Lu-DOTATATE injection but with recording times too long for clinical routine. The aim of this study was to determine whether activity concentrations and ADs calculated from a high-speed whole-body 360° cadmium–zinc–telluride (CZT) SPECT camera are comparable to those provided by conventional SPECT. Methods: Fifteen patients referred for [177Lu]Lu-DOTATATE treatment were enrolled and underwent, at 24, 96, and 168 h after [177Lu]Lu-DOTATATE injection, 32 min of thoracoabdominopelvic conventional SPECT recording and 18 min of whole-body CZT SPECT recording. The order of device procedure (conventional or CZT SPECT) was randomly selected to avoid bias. The kidneys, bone marrow, liver, and spleen were automatically segmented by an artificial intelligence–based tool on CT images, whereas the largest tumor was segmented manually on CT or MR images. Time-integrated activity curves were computed using activity concentrations from the kidneys, bone marrow, liver, spleen, and tumor and convolved by the voxel S-value kernel to calculate AD values. The partial-volume effect was corrected by fitting the recovery coefficients of 1- to 113-mL spheres. Activity concentrations (in Bq/mL) and ADs (in Gy/GBq) were expressed as median (minimum to maximum) and compared between the 2 cameras with Wilcoxon tests. Results: Activity concentrations and ADs were not significantly different between conventional and CZT SPECT, respectively, for the kidneys (337.3 [203.3–622.4] vs. 342.7 [218.2–547.8] kBq/mL at 24 h and 0.45 [0.26–0.79] vs. 0.47 [0.25–0.79] Gy/GBq), spleen (340.3 [171.8–703.1] vs. 277.7 [215.6–640.8] kBq/mL at 24 h and 0.48 [0.31–1.41] vs. 0.50 [0.35–1.15] Gy/GBq), bone marrow (32.7 [13.9–662.9] vs. 41.1 [12.4–509.6] kBq/mL at 24 h and 0.09 [0.04–1.96] vs. 0.13 [0.06–0.87] Gy/GBq), and largest tumor (826.8 [376.4–4,459.0] vs. 1,116.7 [447.0–6,043.3] kBq/mL at 24 h and 1.8 [0.9–5.7] vs. 2.0 [1.0–7.3] Gy/GBq). However, significant, albeit small, differences were observed for the liver (126.2 [42.7–335.9] vs. 113.5 [35.1–293.4] kBq/mL at 24 h and 0.23 [0.07–0.72] vs. 0.21 [0.05–0.64] Gy/GBq, both P < 0.01). Conclusion: Activity concentrations and absorbed doses calculated from the 360° CZT SPECT/CT system after [177Lu]Lu-DOTATATE injection are globally comparable to those obtained from a conventional SPECT/CT system. However, CZT SPECT/CT is more appropriate for clinical routine, with shorter recording times and actual whole-body coverage.

360°镉锌碲化相机提供的高速全身记录对[177Lu]Lu-DOTATATE剂量测定的评估与传统Anger-Camera协议结果的比较
治疗性[177Lu]注射Lu-DOTATATE后,可通过连续常规SPECT成像计算吸收剂量(ADs),但记录时间太长,不适合临床常规。本研究的目的是确定从高速全身360°镉锌碲化(CZT) SPECT相机计算的活性浓度和ADs是否与传统SPECT提供的结果相当。方法:选取15例[177Lu]Lu-DOTATATE治疗的患者,分别于注射后24、96、168 h,胸腹骨盆常规SPECT记录32 min,全身CZT SPECT记录18 min。装置程序的顺序(常规或CZT SPECT)随机选择以避免偏差。通过基于人工智能的工具在CT图像上自动分割肾脏、骨髓、肝脏和脾脏,而在CT或MR图像上手动分割最大的肿瘤。利用肾脏、骨髓、肝脏、脾脏和肿瘤的活性浓度计算时间积分活性曲线,并通过体素s值核卷积计算AD值。通过拟合1 ~ 113 ml球的回收率系数,修正了部分体积效应。活性浓度(以Bq/mL表示)和ADs(以Gy/GBq表示)以中位数(从最小值到最大值)表示,并通过Wilcoxon试验比较2台相机之间的差异。结果:肾脏(24小时337.3 [203.3-622.4]vs. 342.7 [218.2-547.8] kBq/mL, 0.45 [0.26-0.79] vs. 0.47 [0.25-0.79] Gy/GBq)、脾脏(24小时340.3 [171.8-703.1]vs. 277.7 [215.6-640.8] kBq/mL, 0.48 [0.31-1.41] vs. 0.50 [0.35-1.15] Gy/GBq)、骨髓(24小时32.7 [13.9-662.9]vs. 41.1 [12.4-509.6] kBq/mL, 0.09 [0.04-1.96] vs. 0.13 [0.06-0.87] Gy/GBq)的活性浓度和ADs在常规SPECT和CZT SPECT之间无显著差异。最大肿瘤(24h 826.8 [376.4-4,459.0] vs. 1,116.7 [447.0-6,043.3] kBq/mL, 1.8 [0.9-5.7] vs. 2.0 [1.0-7.3] Gy/GBq)。然而,肝脏的差异虽然很小,但也很显著(24小时126.2 [42.7-335.9]vs. 113.5 [35.1-293.4] kBq/mL, 0.23 [0.07-0.72] vs. 0.21 [0.05-0.64] Gy/GBq, P <;0.01)。结论:注射[177Lu]Lu-DOTATATE后,360°CZT SPECT/CT系统计算的活性浓度和吸收剂量与传统SPECT/CT系统计算的活性浓度和吸收剂量在全球范围内相当。然而,CZT SPECT/CT更适合临床常规,记录时间更短,实际覆盖全身。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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