Rationale:99m Tc-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) is a cost-effective and accurate means of characterizing indeterminate renal masses. This is scant literature on 99m Tc-sestamibi protocol optimization. Methods:We investigated the difference between modeled, quantitative 180-degree and 360-degree acquisitions for 99mTc-sestamibi SPECT/CT in a cohort of 50 patients who were prospectively enrolled on a scan-and-resect protocol. Two experienced, dual-boarded observers rated each renal mass for image quality (1-5 scale) and diagnosis (benign to malignant, 1-5 scale) in a blinded, randomized order. Ordinal logistic regression was used, incorporating random intercepts for patient and reader; inter-observer variability was assessed. Results:Image quality ratings were significantly higher for 360-degree acquisitions versus 180-degree (P<0.0001; odds ratio 0.22, 95% CI 0.12-0.39). The odds ratio was 0.22 (95% CI: 0.12, 0.39). There was insufficient evidence that the modeled angle of acquisition was associated with scan positivity (P=0.17). The odds ratio was 0.67 (95% CI: 0.37, 1.19). Diagnostic positivity ratings did not differ between reconstruction angles (P=0.17; odds ratio 0.67, 95% CI 0.37-1.19). Conclusions:Modeled 180-degree reconstructions of quantitative SPECT/CT are qualitatively inferior to quantitative reconstructions of 360-degree acquisitions, although there was no difference in the diagnostic accuracy between the reconstruction methods. These results suggest that 180-degree acquisitions are adequate for diagnosis.
Summary:This procedure guideline for SPECT examinations of striatal dopamine transporter availability is intended to support the planning, execution, quality control, interpretation and reporting of cerebral SPECT scans with [123I]ioflupane. It is an update and expansion built on the 2019 version of the procedure guideline. It was developed through an informal process as a consensus of the Neuroimaging Working Group of the German Society of Nuclear Medicine and in consultation with the German Neurological Society. It is intended for use by physicians and technical staff working in the field of nuclear medicine.
Aim:[18F]FDG positron-emission-tomography/computed tomography (PET/CT) is a crucial tool in paediatric oncology for staging, treatment response assessment, and follow-up imaging. Long axial field of view (LAFOV) PET/CT is more sensitive for the detection of annihilation events than short axial field of view (SAFOV) instrumentation, thus enabling lower radiation dose and/or briefer acquisition time. In consideration of the radiation sensitivity of children, we compared the performance of LAFOV and SAFOV PET/CT in paediatric oncology. Methods:Twenty-six paediatric oncology patients (mean age 13.7 ± 4.8 y), of whom half had diagnosis of lymphoma, underwent 37 [18F]FDG PET/CT scans (12 SAFOV, 25 LAFOV). The LAFOV acquisitions (1-3 MBq/kg) were numerically rescaled to simulate 0.5-3 MBq/kg, yielding 75 LAFOV studies. Four blinded readers rated image quality on a 5-point Likert scale, and recorded various imaging metrics, statistical comparison, and power calculations. Results:LAFOV at 2 and 3 MBq/kg achieved significantly higher Likert ratings than SAFOV. LAFOV at 1 MBq/kg yielded comparable ratings to SAFOV (p=0.13), while 0.5 MBq/kg was inferior to SAFOV (p=0.012). Hepatic background SD decreased and SNR increased dose-dependently with LAFOV (p<0.001), whereas lesion SUVmax and SUVmean remained stable across scanners. TBR was lower for LAFOV at higher doses, despite unchanged image quality. Inter-rater agreement was fair to moderate. Conclusion:LAFOV PET/CT supports [18F]FDG dose reduction without impairing image quality for lesion detection. 1 MBq/kg yielded diagnostic quality comparable to SAFOV, while 2-3 MBq/kg provided superior performance. These results support LAFOV PET/CT as a strategy to minimize radiation exposure in children.
Aim:[⁸⁹Zr]Zr-DFO-trastuzumab has emerged as a powerful tool to visualise non-invasively HER2 expression across metastatic lesions, complementing conventional pathological HER2 evaluation and helping to identify patients unlikely to benefit from therapy with trastuzumab-based therapies. This paper outlines the roadmap of the manufacturing implementation of [89Zr]Zr-DFO-trastuzumab at our centre in Germany. Methods:In this paper, we describe the key questions encountered during implementation of the manufacturing process for [89Zr]Zr-DFO-trastuzumab and how these were addressed through discussions between academia, hospital departments, teams experienced in the radiolabelling of antibodies and regulatory authorities. Results:Discussions with multiple institutions were essential for the implementation of the GMP-compliant radiosynthesis of [⁸⁹Zr]Zr-DFO-trastuzumab at our manufacturing site. Example decisions included shortening the shelf-life of [⁸⁹Zr]Zr-DFO-trastuzumab to 24 hours to mitigate container-closure integrity concerns and adoption of a bead-based method to determine the immunoreactive fraction. Conclusion:This work presents a practical overview of operational considerations relevant to the clinical implementation of [⁸⁹Zr]Zr-DFO-trastuzumab, with potential applicability to other ⁸⁹Zr-labelled high-molecular-weight radiotracers in Germany. By sharing these practical insights, we aim to support broader patient access to established radiopharmaceuticals and encourage dialogue around open regulatory and practical questions, particularly in anticipation of future clinical trials.
Abstract:This procedure guideline for brain perfusion SPECT is intended to support the planning, execution, quality control, evaluation and reporting of brain perfusion SPECT studies using the 99 mTc-labelled radiopharmaceuticals [99 mTc]Tc-HMPAO and [99 mTc]Tc-ECD. It is an update and expansion built on the 2019 version of the procedure guideline. It was developed through an informal process as a consensus of the Neuroimaging Working Group of the German Society of Nuclear Medicine. It is intended for use by physicians and physical-technical staff (technologists, physicists) working in nuclear medicine.
