Jiraporn Sriprapaporn, M.D.

Nuclear Medicine

Siriraj Hospital

Mahidol University September 2015

Non-PET Oncologic Imaging_Jiraporn

Non-PET Oncologic Imaging_Jiraporn

Nature of Radionuclide Oncologic Imaging

• Requires cellular viability & avidity function,

– NOT all viable tumors can take up the

radiopharmaceutical.

– Should confirm avidity prior use of NM imaging modality

(preRx imaging)

– PreRx NM imaging is so helpful for F/U (evaluate

treatment response)

• Each radiopharmaceutical has its own normal physiologic

distribution.

– Learn to know to be able to DDx physiologic & pathologic.

• After Rx Functional or metabolic changes occurs prior to

anatomical change Early response evaluation.

Non-PET Oncologic Imaging_Jiraporn

Objectives of Radionuclide Oncologic Imaging

• Guide for biopsy

• Staging

• Monitoring treatment

• Post treatment evaluation

– Differentiate post-therapy tissue necrosis or

fibrosis from residual tumor

• Restaging detect tumor recurrence

Non-PET Oncologic Imaging_Jiraporn

Disease Applications

Essentials NM, 6th Ed.

Nuclear Oncologic Applications

Non-PET Oncologic Imaging_Jiraporn

Radiopharmaceuticals for Non-PET Oncologic Applications

Nonspecific

• Ga-67 citrate:

– Lymphoma

• Tl-201 chloride:

– Bone sarcomas

– Brain tumors

– Thyroid cancer

• Tc-99m sestamibi:

– Breast cancer

– Parathyroid adenomas

– Thyroid cancer

• Tc-99m tetrofosmin: Similar to sestamibi

Tumor-Type Specific

• I-131: Diff thyroid cancer (PTC, FTC)

• I-131 MIBG: Neural crest tumors (adrenal medullary imaging)

• Radiolabeled peptides: Somatostatin receptors (SSTR)

– In-111 pentetreotide (OctreoScan): Neuroendocrine tumors [NETs]

– Tc-99m HYNIC-TOC: NETs

– Tc-99m depreotide*: Lung cancer

• Radiolabeled monoclonal antibodies:

– Tc-99m arcitumomab (CEA-Scan)*: Colorectal cancer

– In-111 capromab pendetide (ProstaScint): Prostate cancer

– In-111 ibritumomab tiuxetan (Zevalin): Lymphoma

– I-131 tositumomab (Bexxar): Lymphoma

REF : modified from The Requisites

Non-PET Oncologic Imaging_Jiraporn

Physical Characteristics of Common Radionuclides Used for Tumor Imaging Agents

Radiotracer Physical T1/2 (hr)

Decay

Photopeaks

Injected dose mCi (MBq)

Organ receiving

highest dose rad/ mCi

(mGy/MBq)

Effective dose

rem/mCi (mSv/MBq)

keV Abundance

(%)

Ga-67* 78 EC

93 185 300 394

41 23 18 4

10 (370) Colon

0.74 (0.2) 0.44 (0.12)

Tl-201* 73 EC 69-83 94 3 (111) Kidneys

1.7 (0.46) 0.85 (0.23)

In-111* 67 EC 171 245

90 94

6 (222) Spleen

2.1 (0.57) 0.20 (0.054)

Tc-99m sestamibi

6 IT 140 88 20 (740) Gallbladder 0.14 (0.039)

0.033 (0.009)

modified from The Requisites, 4th Ed. SNM Guidelines

* Cyclotron-produced

Non-PET Oncologic Imaging_Jiraporn

Suggestion

• Ga-67 citrate imaging

• Tl-201 chloride imaging

• Tc-99m sestamibi imaging

• I-131 MIBG or adrenal medullary imaging

• Radiolabeled peptides: Somatostatin receptors (SSTR)

imaging

Please find more information on the above non-PET oncologic imaging from another different files.