Abstract
Purpose
To evaluate the feasibility of using the StarGuide (General Electric Healthcare, Haifa, Israel), a new generation multi-detector cadmium-zinc-telluride (CZT)-based SPECT/CT, for whole-body imaging in the setting of post-therapy imaging of 177Lu-labeled radiopharmaceuticals.
Methods
Thirty-one patients (34–89 years old; mean ± SD, 65.5 ± 12.1) who were treated with either 177Lu-DOTATATE (n=17) or 177Lu-PSMA617 (n=14) as part of standard of care were scanned post-therapy with the StarGuide; some were also scanned with the standard GE Discovery 670 Pro SPECT/CT. All patients had either 64Cu-DOTATATE or 18F-DCFPyL PET/CT prior to first cycle of therapy for eligibility check. The detection/targeting rate (lesion uptake greater than blood pool uptake) of large lesions meeting RECIST 1.1 size criteria on post-therapy StarGuide SPECT/CT was evaluated and compared to the standard design GE Discovery 670 Pro SPECT/CT (when available) and pre-therapy PET by two nuclear medicine physicians with consensus read.
Results
This retrospective analysis identified a total of 50 post-therapy scans performed with the new imaging protocol from November 2021 to August 2022. The StarGuide system acquired vertex to mid-thighs post-therapy SPECT/CT scans with 4 bed positions, 3 min/bed and a total scan time of 12 min. In comparison, the standard GE Discovery 670 Pro SPECT/CT system typically acquires images in 2 bed positions covering the chest, abdomen, and pelvis with a total scan time of 32 min. The pre-therapy 64Cu-DOTATATE PET takes 20 min with 4 bed positions on GE Discovery MI PET/CT, and 18F-DCFPyL PET takes 8–10 min with 4–5 bed positions on GE Discovery MI PET/CT. This preliminary evaluation showed that the post-therapy scans acquired with faster scanning time using StarGuide system had comparable detection/targeting rate compared to the Discovery 670 Pro SPECT/CT system and detected large lesions defined by RECIST criteria on the pre-therapy PET scans.
Conclusion
Fast acquisition of whole-body post-therapy SPECT/CT is feasible with the new StarGuide system. Short scanning time improves the patients’ clinical experience and compliance which may lead to increased adoption of post-therapy SPECT. This opens the possibility to offer imaged-based treatment response assessment and personalized dosimetry to patients referred for targeted radionuclide therapies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Yes.
Code availability
Yes.
References
Israel O, Pellet O, Biassoni L, De Palma D, Estrada-Lobato E, Gnanasegaran G, et al. Two decades of SPECT/CT - the coming of age of a technology: an updated review of literature evidence. Eur J Nucl Med Mol Imaging. 2019;46:1990–2012.
Cherry SRS, James A, Phelps ME. Hybrid imaging: SPECT/CT and PET/CT: W.B: Saunders; 2012.
Seo Y, Mari C, Hasegawa BH. Technological development and advances in single-photon emission computed tomography/computed tomography. Semin Nucl Med. 2008;38:177–98.
IAEA. IMAGINE - IAEA Medical imAGIng and Nuclear mEdicine global resources database https://humanhealthiaeaorg/HHW/DBStatistics/IMAGINEhtml. Accessed 1 Oct 2022
Grubmuller B, Rasul S, Baltzer P, Fajkovic H, D'Andrea D, Berndl F, et al. Response assessment using [(68) Ga]Ga-PSMA ligand PET in patients undergoing systemic therapy for metastatic castration-resistant prostate cancer. Prostate. 2020;80:74–82.
Gafita A, Rauscher I, Weber M, Hadaschik B, Wang H, Armstrong WR, et al. Novel framework for treatment response evaluation using PSMA PET/CT in patients with metastatic castration-resistant prostate cancer (RECIP 1.0): an international multicenter study. J Nucl Med. 2022;63:1651–8.
Ljungberg M, Pretorius PH. SPECT/CT: an update on technological developments and clinical applications. Br J Radiol. 2018;91:20160402.
Ritt P. Recent developments in SPECT/CT. Semin Nucl Med. 2022;52:276–85.
Gambhir SS, Berman DS, Ziffer J, Nagler M, Sandler M, Patton J, et al. A novel high-sensitivity rapid-acquisition single-photon cardiac imaging camera. J Nucl Med. 2009;50:635–43.
Dorbala S, Ananthasubramaniam K, Armstrong IS, Chareonthaitawee P, DePuey EG, Einstein AJ, et al. Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol. 2018;25:1784–846.
Wacholz CH, Carrie ; OConnor, and Michael. Veriton multi-CZT detector SPECT/CT system acceptance testing. J Nucl Med 2020;61:3003.
Desmonts C, Bouthiba MA, Enilorac B, Nganoa C, Agostini D, Aide N. Evaluation of a new multipurpose whole-body CzT-based camera: comparison with a dual-head Anger camera and first clinical images. EJNMMI Phys. 2020;7:18.
Imbert L, Chevalier E, Claudin M, Karcher G, Verger A, Paycha F, Marie PY. A one-shot whole-body bone SPECT may be recorded in less than 20 minutes with the high-sensitivity Veriton® CZT-camera. J Nucl Med. 2019;60:1288.
Sartor O, de Bono J, Chi KN, Fizazi K, Herrmann K, Rahbar K, et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med. 2021;385:1091–103.
Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 trial of (177) Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376:125–35.
Sgouros G, Dewaraja YK, Escorcia F, Graves SA, Hope TA, Iravani A, et al. Tumor response to radiopharmaceutical therapies: the knowns and the unknowns. J Nucl Med. 2021;62:12S–22S.
Pandit-Taskar N, Iravani A, Lee D, Jacene H, Pryma D, Hope T, et al. Dosimetry in clinical radiopharmaceutical therapy of cancer: practicality versus perfection in current practice. J Nucl Med. 2021;62:60S–72S.
GE Medical Systems Israel FI, GE Healthcare. FDA 510(k) premarket notification submission - StarGuide. https://www.accessdatafdagov/cdrh_docs/pdf21/K210173pdf. 2021:5-6. Accessed 1 Oct 2022
Teoh EJ, McGowan DR, Macpherson RE, Bradley KM, Gleeson FV. Phantom and Clinical evaluation of the Bayesian penalized likelihood reconstruction algorithm Q.Clear on an LYSO PET/CT system. J Nucl Med. 2015;56:1447–52.
Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.
Benabdallah N, Scheve W, Dunn N, Silvestros D, Schelker P, Abou D, et al. Practical considerations for quantitative clinical SPECT/CT imaging of alpha particle emitting radioisotopes. Theranostics. 2021;11:9721–37.
Esquinas PL, Rodriguez-Rodriguez C, Esposito TVF, Harboe J, Bergamo M, Celler A, et al. Dual SPECT imaging of (111) In and (67) Ga to simultaneously determine in vivo the pharmacokinetics of different radiopharmaceuticals: a quantitative tool in pre-clinical research. Phys Med Biol. 2018;63:235029.
Erdi YE. Limits of tumor detectability in nuclear medicine and PET. Mol Imaging Radionucl Ther. 2012;21:23–8.
Ito T, Matsusaka Y, Onoguchi M, Ichikawa H, Okuda K, Shibutani T, et al. Experimental evaluation of the GE NM/CT 870 CZT clinical SPECT system equipped with WEHR and MEHRS collimator. J Appl Clin Med Phys. 2021;22:165–77.
Lebtahi R, Cadiot G, Sarda L, Daou D, Faraggi M, Petegnief Y, et al. Clinical impact of somatostatin receptor scintigraphy in the management of patients with neuroendocrine gastroenteropancreatic tumors. J Nucl Med. 1997;38:853–8.
Le Rouzic G, Zananiri R. First performance measurements of a new multi-detector CZT-Based SPECT/CT system: GE StarGuide. J Nucl Med. 2021;62:1125.
Uribe C, Peterson A, Van B, Fedrigo R, Carlson J, Sunderland J, et al. An international study of factors affecting variability of dosimetry calculations, part 1: design and early results of the SNMMI dosimetry challenge. J Nucl Med. 2021;62:36S–47S.
Capala J, Graves SA, Scott A, Sgouros G, James SS, Zanzonico P, et al. Dosimetry for radiopharmaceutical therapy: current practices and commercial resources. J Nucl Med. 2021;62:3S–11S.
Violet J, Jackson P, Ferdinandus J, Sandhu S, Akhurst T, Iravani A, et al. Dosimetry of (177) Lu-PSMA-617 in metastatic castration-resistant prostate cancer: correlations between pretherapeutic imaging and whole-body tumor dosimetry with treatment outcomes. J Nucl Med. 2019;60:517–23.
Fendler WP, Reinhardt S, Ilhan H, Delker A, Boning G, Gildehaus FJ, et al. Preliminary experience with dosimetry, response and patient reported outcome after 177Lu-PSMA-617 therapy for metastatic castration-resistant prostate cancer. Oncotarget. 2017;8:3581–90.
Pathmanandavel S, Crumbaker M, Ho B, Yam AO, Wilson P, Niman R, et al. Evaluation of (177) Lu-PSMA SPECT quantitation as a response biomarker within a prospective (177) Lu-PSMA-617 and NOX66 combination trial (LuPIN). J Nucl Med. 2022;64:221–6.
Author information
Authors and Affiliations
Contributions
HS: content planning, data analyses, manuscript writing and editing. VF: data analyses, manuscript editing. HD: data analyses, manuscript editing. CMA: manuscript editing. GD: manuscript editing. BLF: manuscript editing. FM: data analyses, manuscript editing. JN: manuscript editing. JS: manuscript editing. AI: content planning, data analyses, manuscript editing.
Corresponding author
Ethics declarations
Ethics approval
Yes.
Consent to participate
Yes.
Consent for publication
Yes.
Competing interests
AI is an unpaid consultant to GE Healthcare. Hong Song, Valentina Ferri, Heying Duan, Carina Mari Aparici, Guido Davidzon, Benjamin L. Franc, Farshad Moradi, Judy Nguyen, and Jagruti Shah declare that they have no conflict or competing of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Theragnostic.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Song, H., Ferri, V., Duan, H. et al. SPECT at the speed of PET: a feasibility study of CZT-based whole-body SPECT/CT in the post 177Lu-DOTATATE and 177Lu-PSMA617 setting. Eur J Nucl Med Mol Imaging 50, 2250–2257 (2023). https://doi.org/10.1007/s00259-023-06176-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-023-06176-6