Abstract

BackgroundTechnetium-99m-hydrazinonicotinamide-Tyr3-octreotide (99mTc-HYNIC-TOC) is recognized as a promising radiopharmaceutical for diagnosing neuroendocrine tumors (NETs). However, 99mTc-HYNIC-TOC dosimetry has been investigated only for adults. As pediatric radionuclide therapies become increasingly common, similar dosimetric studies for children are urgently needed. The aim of this study is to report personalized image-based biodistributions and dosimetry evaluations for children studies performed using 99mTc-HYNIC-TOC and to compare them with those from adult subjects.Eleven children/teenage patients with suspected or diagnosed NETs were enrolled. Patient imaging included a series of 2–3 whole-body planar scans and SPECT/CT performed over 2–24 h after the 99mTc-HYNIC-TOC injections. The time-integrated activity coefficients (TIACs) were obtained from the hybrid planar/SPECT technique. Patient-specific doses were calculated using both the voxel-level and the organ-level approaches. Estimated children doses were compared with adults’ dosimetry.ResultsPathologic uptake was observed in five patients. TIACs for normal organs with significant uptakes, i.e., kidneys, spleen, and liver, were similar to adults’ TIACs. Using the voxel-level approach, the average organ doses for children were 0.024 ± 0.009, 0.032 ± 0.017, and 0.017 ± 0.007 mGy/MBq for the kidneys, spleen, and liver, respectively, which were 30% larger than adults’ doses. Similar values were obtained from the organ-level dosimetry when using OLINDA with adapted organ masses. Tumor doses were 0.010–0.024 mGy/MBq. However, cross-organ contributions were much larger in children than in adults, comprising about 15–40% of the total organ/tumor doses. No statistical differences were found between mean doses and dose distributions in patients with and without pathologic uptakes.ConclusionAlthough the children TIACs were similar to those in adults, their doses were about 30% higher. No significant correlation was found between the children’s doses and their ages. However, substantial inter-patient variability in radiotracer uptake, indicating disparity in expression of somatostatin receptor between different patients, emphasizes the importance and necessity of patient-specific dosimetry for clinical studies.

Highlights

  • Technetium-99m-hydrazinonicotinamide-Tyr3-octreotide (99mTc-HYNIC-TOC) is recognized as a promising radiopharmaceutical for diagnosing neuroendocrine tumors (NETs)

  • The most popular tracers used for NETs diagnosis are 99mTc-hydrazinonicotinamide-Tyr3-octreotide (99mTc-HYNIC-TOC) and 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide for SPECT [1, 3, 4] and 68Ga-DOTA-conjugated peptides for PET [5,6,7,8,9]

  • Labeling with technetium makes this tracer more readily available and less expensive than tracers labeled with 68Ga

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Summary

Introduction

Technetium-99m-hydrazinonicotinamide-Tyr3-octreotide (99mTc-HYNIC-TOC) is recognized as a promising radiopharmaceutical for diagnosing neuroendocrine tumors (NETs). The aim of this study is to report personalized image-based biodistributions and dosimetry evaluations for children studies performed using 99mTc-HYNIC-TOC and to compare them with those from adult subjects. Patient imaging included a series of 2–3 whole-body planar scans and SPECT/CT performed over 2–24 h after the 99mTc-HYNIC-TOC injections. The most popular tracers used for NETs diagnosis are 99mTc-hydrazinonicotinamide-Tyr3-octreotide (99mTc-HYNIC-TOC) and 111In-diethylenetriaminepentaacetic acid (DTPA)-octreotide for SPECT [1, 3, 4] and 68Ga-DOTA-conjugated peptides for PET [5,6,7,8,9]. Considering the SPECT tracers mentioned above, 99mTc-HYNIC-TOC results in better image quality and lower radiation dose than 111In-labeled pharmaceuticals [10, 12, 13]. Labeling with technetium makes this tracer more readily available and less expensive than tracers labeled with 68Ga

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