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European Journal of Nuclear Medicine and Molecular Imaging

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Open Access 12-04-2022 | Scintigraphy | Original Article

First experiences with dynamic renal [⁶⁸Ga]Ga-DOTA PET/CT: a comparison to renal scintigraphy and compartmental modelling to non-invasively estimate the glomerular filtration rate

Authors: David Kersting, Miriam Sraieb, Robert Seifert, Pedro Fragoso Costa, Sandra Kazek, Lukas Kessler, Lale Umutlu, Wolfgang Peter Fendler, Walter Jentzen, Ken Herrmann, Florian Büther, Michael Nader, Christoph Rischpler

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 10/2022

Abstract

Purpose

The determination of the glomerular filtration rate (GFR) is decisive for a variety of clinical issues, for example, to monitor the renal function in radionuclide therapy patients. Renal scintigraphy using glomerularly filtered tracers allows combined acquisition of renograms and GFR estimation but requires repeated blood sampling for several hours. In contrast, dynamic PET imaging using the glomerularly filtered tracer [⁶⁸Ga]Ga-DOTA bears the potential to non-invasively estimate the GFR by compartmental kinetic modelling. Here, we report the, to our knowledge, first comparison of human renal dynamic [⁶⁸Ga]Ga-DOTA PET imaging in comparison to renal scintigraphy and compare PET-derived to serum creatinine-derived GFR measurements.

Methods

Dynamic [⁶⁸Ga]Ga-DOTA PET data were acquired for 30 min immediately after tracer injection in 12 patients. PET and renal scintigraphy images were visually interpreted in a consensus read by three nuclear medicine physicians. The functional renal cortex was segmented to obtain time-activity curves. The arterial input function was estimated from the PET signal in the abdominal aorta. Single-compartmental tracer kinetic modelling was performed to calculate the GFR using complete 30-min (GFR_PET-30) and reduced 15-min PET data sets (GFR_PET-15) to evaluate whether a shorter acquisition time is sufficient for an accurate GFR estimation. A modified approach excluding minutes 2 to 10 was applied to reduce urinary spill-over effects. Serum creatinine-derived GFR_CKD (CKD-EPI-formula) was used as reference standard.

Results

PET image interpretation revealed the same findings as conventional scintigraphy (2/12 patients with both- and 1/12 patients with right-sided urinary obstruction). Model fit functions were substantially improved for the modified approach to exclude spill-over. Depending on the modelling approach, GFR_CKD and both GFR_PET-30 and GFR_PET-15 were well correlated with interclass correlation coefficients (ICCs) from 0.74 to 0.80 and Pearson’s correlation coefficients (PCCs) from 0.74 to 0.81. For a subgroup of patients with undisturbed urinary efflux (n = 9), correlations were good to excellent (ICCs from 0.82 to 0.95 and PCCs from 0.83 to 0.95). Overall, GFR_PET-30 and GFR_PET-15 were excellently correlated (ICCs from 0.96 to 0.99 and PCCs from 0.96 to 0.99).

Conclusion

Renal [⁶⁸Ga]Ga-DOTA PET can be a suitable alternative to conventional scintigraphy. Visual assessment of PET images and conventional renograms revealed comparable results. GFR values derived by non-invasive single-compartmental-modelling of PET data show a good correlation to serum creatinine-derived GFR values. In patients with undisturbed urinary efflux, the correlation was excellent. Dynamic PET data acquisition for 15 min is sufficient for visual evaluation and GFR derivation.

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Title: First experiences with dynamic renal [68Ga]Ga-DOTA PET/CT: a comparison to renal scintigraphy and compartmental modelling to non-invasively estimate the glomerular filtration rate
Authors: David Kersting
Miriam Sraieb
Robert Seifert
Pedro Fragoso Costa
Sandra Kazek
Lukas Kessler
Lale Umutlu
Wolfgang Peter Fendler
Walter Jentzen
Ken Herrmann
Florian Büther
Michael Nader
Christoph Rischpler
Publication date: 12-04-2022
Publisher: Springer Berlin Heidelberg
Keyword: Scintigraphy
Published in: European Journal of Nuclear Medicine and Molecular Imaging / Issue 10/2022
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-022-05781-1

At a glance: The STEP trials

Springer Medicine

First experiences with dynamic renal [⁶⁸Ga]Ga-DOTA PET/CT: a comparison to renal scintigraphy and compartmental modelling to non-invasively estimate the glomerular filtration rate

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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