Abstract
Pulmonary imaging using ventilation/perfusion (V/P) single-photon emission tomography (V/P scan) with Tc-99m-labeled radiotracers is a well-established diagnostic tool for clinically suspected pulmonary embolism (PE). Ga-68 aerosol (Galligas) and Ga-68-labeled macroaggregated albumin (MAA) are potential tracers for positron emission tomography (PET) lung V/P imaging and could display an advantage over conventional V/P scans in terms of sensitivity and specificity. After radiochemical and animal studies, the clinical applicability of Ga-68 aerosol (Galligas) and Ga-68-labeled MAA was investigated in an exploratory study in patients with clinical suspicion of PE. PET scans were acquired using a 16-slice Gemini TF positron emission tomography/computed tomography (PET/CT) scanner. The acquisition protocol included low-dose computed tomography (CT) for attenuation correction (AC). Dosimetry calculations and continuative phantom measurements were performed. Structural analyses showed no modification of the particles due to the labeling process. In addition, in vitro experiments showed stability of Ga-68 MAA in various media. As expected, Ga-68-labeled human serum albumin microspheres (HSAM) were completely retained in the lung of the animals. In clinical use, PET lung ventilation and perfusion imaging using Ga-68 aerosol (Galligas) and Ga-68-labeled MAA was successful in all cases. In one case a clinically suspected PE could be detected and verified. The administered activity of Ga-68 aerosol (Galligas) and Ga-68-labeled MAA may be reduced by more than 50%, resulting in comparable radiation exposure to conventional V/P scans. In conclusion, Ga-68 aerosol (Galligas) and Ga-68-labeled MAA are efficient substitutes for clinical use and could be an interesting alternative with high accuracy for lung V/P imaging with Tc-99m-labeled radiotracers, especially in times of Mo-99 shortages and increasing use and spread of PET/CT scanners and Ga-68 generators, respectively.
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Notes
- 1.
Operating Instructions GMP Produced 68Ga Generator iThemba LABS (Somerset West, South Africa), distributed by IDB Holland (Baarle-Nassau, The Netherlands).
Abbreviations
- AC:
-
Attenuation correction
- CT:
-
Computed tomography
- CTA:
-
Computed tomography angiography
- cGMP:
-
Current good manufacturing practice
- DLP:
-
Dose–length product
- DOTA:
-
1,4,7,10-Tetraazacyclododecane-1,4,7,10-tetraacetic acid (chelate)
- DVT:
-
Deep vein thrombosis
- EANM:
-
European Association of Nuclear Medicine
- HSA:
-
Human serum albumin
- HSAM:
-
Human serum albumin microspheres
- HU:
-
Hounsfield unit
- ICRP:
-
International Commission on Radiological Protection
- ITLC:
-
Instant thin-layer chromatography
- MAA:
-
Macroaggregated albumin
- NEC:
-
Noise-equivalent count
- OSEM:
-
Ordered-subsets expectation maximization (reconstruction)
- PE:
-
Pulmonary embolism
- PET:
-
Positron emission tomography
- PET/CT:
-
Positron emission tomography/computed tomography
- RNP:
-
Radionuclide purity
- ROI:
-
Region of interest
- rpm:
-
Revolutions per minute
- SEM:
-
Scanning electron microscopy
- SPECT:
-
Single-photon emission computed tomography
- SUV:
-
Standardized uptake value
- VOI:
-
Volumes of interest
- V/P:
-
Ventilation/perfusion
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Ament, S. et al. (2013). PET Lung Ventilation/Perfusion Imaging Using 68Ga Aerosol (Galligas) and 68Ga-Labeled Macroaggregated Albumin. In: Baum, R., Rösch, F. (eds) Theranostics, Gallium-68, and Other Radionuclides. Recent Results in Cancer Research, vol 194. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-27994-2_22
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