Dynamic PET Studies Research Articles

Simultaneous water activation and glucose metabolic rate imaging with PET

A novel imaging and signal separation strategy is proposed to be able to separate [18F]FDG and multiple [15O]H2O signals from a simultaneously acquired dynamic PET acquisition of the two tracers. The technique is based on the fact that the dynamics of the two tracers are very distinct. By adopting an appropriate bolus injection strategy and by defining tailored sets of basis functions that model either the FDG or water component, it is possible to separate the FDG and water signal. The basis functions are inspired from the spectral analysis description of dynamic PET studies and are defined as the convolution of estimated generating functions (GFs) with a set of decaying exponential functions. The GFs are estimated from the overall measured head curve, while the decaying exponential functions are pre-determined. In this work, the time activity curves (TACs) are modelled post-reconstruction but the model can be incorporated in a global 4D reconstruction strategy. Extensive PET simulation studies are performed considering single [18F]FDG and 6 [15O]H2O bolus injections for a total acquisition time of 75 min. The proposed method is evaluated at multiple noise levels and different parameters were estimated such as [18F]FDG uptake and blood flow estimated from the [15O]H2O component, requiring a full dynamic analysis of the two components, static images of [18F]FDG and the water components as well as [15O]H2O activation. It is shown that the resulting images and parametric values in ROIs are comparable to images obtained from separate imaging, illustrating the feasibility of simultaneous imaging of [18F]FDG and [15O]H2O components.

Modeling of the Renal Kinetics of the AT1 Receptor Specific PET Radioligand [11C]KR31173

Purpose. The radioligand [11C]KR31173 has been introduced for PET imaging of the angiotensin II subtype 1 receptor (AT1R). The purpose of the present project was to employ and validate a compartmental model for quantification of the kinetics of this radioligand in a porcine model of renal ischemia followed by reperfusion (IR). Procedures. Ten domestic pigs were included in the study: five controls and five experimental animals with IR of the left kidney. To achieve IR, acute ischemia was created with a balloon inserted into the left renal artery and inflated for 60 minutes. Reperfusion was achieved by deflation and removal of the balloon. Blood chemistries, urine specific gravity and PH values, and circulating hormones of the renin angiotensin system were measured and PET imaging was performed one week after IR. Cortical time-activity curves obtained from a 90 min [11C]KR31173 dynamic PET study were processed with a compartmental model that included two tissue compartments connected in parallel. Radioligand binding quantified by radioligand retention (80 min value to maximum value ratio) was compared to the binding parameters derived from the compartmental model. A binding ratio was calculated as DVR = DVS/DVNS, where DVS and DVNS represented the distribution volumes of specific binding and nonspecific binding. Receptor binding was also determined by autoradiography in vitro. Results. Correlations between rate constants and binding parameters derived by the convolution and deconvolution curve fittings were significant (r > 0.9). Also significant was the correlation between the retention parameter derived from the tissue activity curve (Y ret) and the retention parameter derived from the impulse response function (f ret). Furthermore, significant correlations were found between these two retention parameters and DVR. Measurements with PET showed no significant changes in the radioligand binding parameters caused by IR, and these in vivo findings were confirmed by autoradiography performed in vitro. Conclusions. Correlations between various binding parameters support the concept of the parallel connectivity compartmental model. If an arterial input function cannot be obtained, simple radioligand retention may be adequate for estimation of in vivo radioligand binding.

Comparison of 2-amino-[3- 11C]isobutyric acid and 2-deoxy-2-[18F]fluoro-D-glucose in nude mice with xenografted tumors and acute inflammation

2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) accumulates in tumors and also during active inflammation, including therapy-related inflammation. Additional PET tracers that are less avid to inflammation could be useful in differentiating cancer from inflammation and could complement the limitation of [18F]FDG-PET. 2-Amino-[3-11C]isobutyric acid ([3-11C]AIB) is a potential PET tracer for this purpose. We compared [3-11C]AIB and [18F]FDG uptakes in tumors and acute inflammation in a mouse model. Acute inflammatory lesions were induced in the hind legs of tumor-bearing mice by intramuscular injection of turpentine, and we conducted biodistribution and dynamic PET studies on [3-11C]AIB and [18F]FDG. [3-11C]AIB tumor uptake increased with time and was statistically significantly higher than [18F]FDG uptake. In inflamed muscles, [3-11C]AIB uptake was statistically significantly lower than [18F]FDG uptake, and the tumor-to-inflammation ratio for [3-11C]AIB was statistically significantly higher than that for [18F]FDG. [3-11C]AIB accumulates more selectively in tumor tissue than does [18F]FDG and thus has the potential of discriminating between tumors and inflammatory lesions better and of complementing the limitation of [18F]FDG.

Dynamic PET With FDG in Patients With Unresectable Aggressive Fibromatosis

Dynamic PET (dPET) studies with 18F-FDG were performed in patients with unresectable aggressive fibromatosis before imatinib therapy. The goal of the study was to evaluate the impact of regression-based parametric imaging on tumor diagnostics. A comparison between the regression-based quantitative data (slope and intercept values) with the compartmental data of FDG was performed. The evaluation includes 24 patients with recurrent disease (n = 14), residual tissue (n = 2), or primary disease (n = 8), who were scheduled for palliative treatment with imatinib. Parametric images were calculated based on the dPET data by fitting a linear regression function to the time-activity data and for each voxel. Images of the slope and the intercept of the time-activity data were calculated using a dedicated software. A volume-of-interest-based analysis was also performed by applying a 2-tissue compartment model to the dPET data. The resulting parameters of the FDG kinetics [blood volume (VB), k1-k4] were compared with the volume-of-interest-based slope and intercept data. The evaluation of the parametric images was performed visually and quantitatively. Twenty of 24 tumors could be visualized in the SUV images with a moderate uptake, in locations that were already known from the MR images. Most (16/24) of the tumors demonstrated a clear enhancement in the intercept images, whereas 4 of them showed an intermediate enhancement and only 4 did not show any enhancement in the intercept images. In contrast, only 10 of 24 tumors demonstrated a clearly enhanced slope, 3 of them revealed a slightly enhanced slope, and 11 of the 24 patients did not demonstrate any slope enhancement within the area of the known desmoid tumors. The comparison of slope revealed the highest correlation to the SUV (r = 0.56, P < 0.05), whereas the intercept values demonstrated the highest correlation to k1 (r = 0.794, P < 0.05), followed by the fractional VB (r = 0.709, P < 0.05), followed by SUV (r = 0.630, P < 0.05). The results indicate that slope images are related to the transport/phosphorylation-dependent part of FDG, whereas intercept images are related to the transport/perfusion part of FDG. These data demonstrate that the use of regression-based parametric imaging helps to differentiate between transport/perfusion- and transport/phosphorylation-dependent FDG uptake and demonstrate that the transport/phosphorylation rate is low in most of these tumors.

Radiosynthesis of a 18F-labeled 2,3-diarylsubstituted indole via McMurry coupling for functional characterization of cyclooxygenase-2 (COX-2) in vitro and in vivo

The radiosynthesis of 3-(4-[18F]fluorophenyl)-2-(4-methylsulfonylphenyl)-1H-indole [18F]-3 as potential PET radiotracer for functional characterization of cyclooxygenase-2 (COX-2) in vitro and in vivo is described. [18F]-3 was prepared by McMurry cyclization of a 18F-labeled intermediate with low valent titanium and zinc via a two-step procedure in a remote controlled synthesizer unit including HPLC purification and solid phase extraction. In this way [18F]-3 was synthesized in 80min synthesis time in 10% total decay corrected yield from [18F]fluoride in radiochemical purity >98% and a specific activity of 74–91GBq/μmol (EOS). [18F]-3 was evaluated in vitro using pro-inflammatory stimulated THP-1 and COX-2 expressing tumor cell lines (FaDu, A2058, HT-29), where the radiotracer uptake was shown to be consistent with up regulated COX-2 expression. The stability of [18F]-3 was determined by incubation in rat whole blood and plasma in vitro and by metabolite analysis of arterial blood samples in vivo, showing with 75% of original compound after 60min an acceptable high metabolic stability. However, no substantial tumor accumulation of [18F]-3 could be observed by dynamic small animal PET studies on HT-29 tumor-bearing mice in vivo. This may be due to the only moderate COX-1/COX-2 selectivity of 3 as demonstrated by both cellular and enzymatic cyclooxygenase inhibition assay in vitro. Nevertheless, the new approach first using McMurry cyclization in 18F-chemistry gives access to 18F-labeled diarylsubstituted heterocycles that hold promise as radiolabeled COX-2 inhibitors.

Relative Equilibrium Plot Improves Graphical Analysis and Allows Bias Correction of Standardized Uptake Value Ratio in Quantitative 11C-PiB PET Studies

Both the standardized uptake value ratio (SUVR) and the Logan plot result in biased distribution volume ratios (DVRs) in ligand-receptor dynamic PET studies. The objective of this study was to use a recently developed relative equilibrium-based graphical (RE) plot method to improve and simplify the 2 commonly used methods for quantification of (11)C-Pittsburgh compound B ((11)C-PiB) PET. The overestimation of DVR in SUVR was analyzed theoretically using the Logan and the RE plots. A bias-corrected SUVR (bcSUVR) was derived from the RE plot. Seventy-eight (11)C-PiB dynamic PET scans (66 from controls and 12 from participants with mild cognitive impaired [MCI] from the Baltimore Longitudinal Study of Aging) were acquired over 90 min. Regions of interest (ROIs) were defined on coregistered MR images. Both the ROI and the pixelwise time-activity curves were used to evaluate the estimates of DVR. DVRs obtained using the Logan plot applied to ROI time-activity curves were used as a reference for comparison of DVR estimates. Results from the theoretic analysis were confirmed by human studies. ROI estimates from the RE plot and the bcSUVR were nearly identical to those from the Logan plot with ROI time-activity curves. In contrast, ROI estimates from DVR images in frontal, temporal, parietal, and cingulate regions and the striatum were underestimated by the Logan plot (controls, 4%-12%; MCI, 9%-16%) and overestimated by the SUVR (controls, 8%-16%; MCI, 16%-24%). This bias was higher in the MCI group than in controls (P < 0.01) but was not present when data were analyzed using either the RE plot or the bcSUVR. The RE plot improves pixelwise quantification of (11)C-PiB dynamic PET, compared with the conventional Logan plot. The bcSUVR results in lower bias and higher consistency of DVR estimates than of SUVR. The RE plot and the bcSUVR are practical quantitative approaches that improve the analysis of (11)C-PiB studies.

Prediction of cognitive decline based on hemispheric cortical surface maps of FDDNP PET

A cross-sectional study to establish whether a subject's cognitive state can be predicted based on regional values obtained from brain cortical maps of FDDNP Distribution Volume Ratio (DVR), which shows the pattern of beta amyloid and neurofibrillary binding, along with those of early summed FDDNP PET images (reflecting the pattern of perfusion) was performed. Dynamic FDDNP PET studies were performed in a group of 23 subjects (8 control (NL), 8 Mild Cognitive Impairment (MCI) and 7 Alzheimer's Disease (AD) subjects). FDDNP DVR images were mapped to the MR derived hemispheric cortical surface map warped into a common space. A set of Regions of Interest (ROI) values of FDDNP DVR and early summed FDDNP PET (0-6 min post tracer injection), were thus calculated for each subject which along with the MMSE score were used to construct a linear mathematical model relating ROI values to MMSE. After the MMSE prediction models were developed, the models' predictive ability was tested in a non-overlapping set of 8 additional individuals, whose cognitive status was unknown to the investigators who constructed the predictive models. Among all possible subsets of ROIs, we found that the standard deviation of the predicted MMSE was 1.8 by using only DVR values from medial and lateral temporal and prefrontal regions plus the early summed FDDNP value in the posterior cingulate gyrus. The root mean square prediction error for the eight new subjects was 1.6. FDDNP scans reflect progressive neuropathology accumulation and can potentially be used to predict the cognitive state of an individual.

Direct 4D parametric imaging for linearized models of reversibly binding PET tracers using generalized AB-EM reconstruction

Due to high noise levels in the voxel kinetics, development of reliable parametric imaging algorithms remains one of most active areas in dynamic brain PET imaging, which in the vast majority of cases involves receptor/transporter studies with reversibly binding tracers. As such, the focus of this work has been to develop a novel direct 4D parametric image reconstruction scheme for such tracers. Based on a relative equilibrium (RE) graphical analysis formulation (Zhou et al 2009b Neuroimage 44 661–70), we developed a closed-form 4D EM algorithm to directly reconstruct distribution volume (DV) parametric images within a plasma input model, as well as DV ratio (DVR) images within a reference tissue model scheme (wherein an initial reconstruction was used to estimate the reference tissue time–activity curves). A particular challenge with the direct 4D EM formulation is that the intercept parameters in graphical (linearized) analysis of reversible tracers (e.g. Logan or RE analysis) are commonly negative (unlike for irreversible tracers, e.g. using Patlak analysis). Subsequently, we focused our attention on the AB-EM algorithm, derived by Byrne (1998, Inverse Problems 14 1455–67) to allow inclusion of prior information about the lower (A) and upper (B) bounds for image values. We then generalized this algorithm to the 4D EM framework, thus allowing negative intercept parameters. Furthermore, our 4D AB-EM algorithm incorporated and emphasized the use of spatially varying lower bounds to achieve enhanced performance. As validation, the means of parameters estimated from 55 human 11C-raclopride dynamic PET studies were used for extensive simulations using a mathematical brain phantom. Images were reconstructed using conventional indirect as well as proposed direct parametric imaging methods. Noise versus bias quantitative measurements were performed in various regions of the brain. Direct 4D EM reconstruction resulted in notable qualitative and quantitative accuracy improvements (over 35% noise reduction, with matched bias, in both plasma and reference-tissue input models). Similar improvements were also observed in the coefficient of variation of the estimated DV and DVR values even for relatively low uptake cortical regions, suggesting the enhanced ability for robust parameter estimation. The method was also tested on a 90 min 11C-raclopride patient study performed on the high-resolution research tomograph wherein the proposed method was shown across a variety of regions to outperform the conventional method in the sense that for a given DVR value, improved noise levels were observed.

Preparation and Characterization of l-[5-11C]-Glutamine for Metabolic Imaging of Tumors

Recently, there has been a renewed interest in the study of tumor metabolism above and beyond the Warburg effect. Studies on cancer cell metabolism have provided evidence that tumor-specific activation of signaling pathways, such as the upregulation of the oncogene myc, can regulate glutamine uptake and its metabolism through glutaminolysis to provide the cancer cell with a replacement of energy source. We report a convenient procedure to prepare l-[5-(11)C]-glutamine. The tracer was evaluated in 9L and SF188 tumor cells (glioma and astrocytoma cell lines). The biodistribution of l-[5-(11)C]-glutamine in rodent tumor models was investigated by dissection and PET. By reacting (11)C-cyanide ion with protected 4-iodo-2-amino-butanoic ester, the key intermediate was obtained in good yield. After hydrolysis with trifluoroacetic and sulfonic acids, the desired optically pure l-[5-(11)C]-glutamine was obtained (radiochemical yield, 5% at the end of synthesis; radiochemical purity, >95%). Tumor cell uptake studies showed maximum uptake of l-[5-(11)C]-glutamine reached 17.9% and 22.5% per 100 μg of protein, respectively, at 60 min in 9L and SF188 tumor cells. At 30 min after incubation, more than 30% of the activity appeared to be incorporated into cellular protein. Biodistribution in normal mice showed that l-[5-(11)C]-glutamine had significant pancreas uptake (7.37 percentage injected dose per gram at 15 min), most likely due to the exocrine function and high protein turnover within the pancreas. Heart uptake was rapid, and there was 3.34 percentage injected dose per gram remaining at 60 min after injection. Dynamic small-animal PET studies in rats bearing xenografted 9L tumors and in transgenic mice bearing spontaneous mammary gland tumors showed a prominent tumor uptake and retention. The data demonstrated that this tracer was favorably taken up in the tumor models. The results suggest that l-[5-(11)C]-glutamine might be useful for probing in vivo tumor metabolism in glutaminolytic tumors.

PET Imaging of Glutaminolysis in Tumors by 18F-(2S,4R)4-Fluoroglutamine

Changes in gene expression, metabolism, and energy requirements are hallmarks of cancer growth and self-sufficiency. Upregulation of the PI3K/Akt/mTor pathway in tumor cells has been shown to stimulate aerobic glycolysis, which has enabled (18)F-FDG PET tumor imaging. However, of the millions of (18)F-FDG PET scans conducted per year, a significant number of malignant tumors are (18)F-FDG PET-negative. Recent studies suggest that several tumors may use glutamine as the key nutrient for survival. As an alternative metabolic tracer for tumors, (18)F-(2S,4R)4-fluoroglutamine was developed as a PET tracer for mapping glutaminolytic tumors. A series of in vitro cell uptake and in vivo animal studies were performed to demonstrate tumor cell addiction to glutamine. Cell uptake studies of this tracer were performed in SF188 and 9L glioblastoma tumor cells. Dynamic small-animal PET studies of (18)F-(2S,4R)4-fluoroglutamine were conducted in 2 animal models: xenografts produced in F344 rats by subcutaneous injection of 9L tumor cells and transgenic mice with M/tomND spontaneous mammary gland tumors. In vitro studies showed that both transformed 9L and SF188 tumor cells displayed a high rate of glutamine uptake (maximum uptake, ≈ 16% dose/100 μg of protein). The cell uptake of (18)F-(2S,4R)4-fluoroglutamine by SF188 cells is comparable to that of (3)H-L-glutamine but higher than that of (18)F-FDG. The tumor cell uptake can be selectively blocked. Biodistribution and PET studies showed that (18)F-(2S,4R)4-fluoroglutamine localized in tumors with a higher uptake than in surrounding muscle and liver tissues. Data suggest that certain tumor cells may use glutamine for energy production. The results support that (18)F-(2S,4R)4-fluoroglutamine is selectively taken up and trapped by tumor cells. It may be useful as a novel metabolic tracer for tumor imaging.

PET of CXCR4 Expression by a 68Ga-Labeled Highly Specific Targeted Contrast Agent

The overexpression of the chemokine receptor CXCR4 plays an important role in oncology, since together with its endogenous ligand, the stromal cell-derived factor (SDF1-α), CXCR4 is involved in tumor development, growth, and organ-specific metastasis. As part of our ongoing efforts to develop highly specific CXCR4-targeted imaging probes and with the aim to assess the suitability of this ligand for first proof-of-concept studies in humans, we further evaluated the new (68)Ga-labeled high-affinity cyclic CXCR4 ligand, (68)Ga-CPCR4-2 (cyclo(D-Tyr(1)-[NMe]-D-Orn(2)-[4-(aminomethyl) benzoic acid,(68)Ga-DOTA]-Arg(3)-2-Nal(4)-Gly(5))). Additional biodistribution and competitions studies in vivo, dynamic PET studies, and investigations on the metabolic stability and plasma protein binding were performed in nude mice bearing metastasizing OH1 human small cell lung cancer xenografts. CXCR4 expression on OH1 tumor sections was determined by immunohistochemical staining. (nat)Ga-CPCR4-2 exhibits high CXCR4 affinity with a half maximum inhibitory concentration of 4.99 ± 0.72 nM. (68)Ga-CPCR4-2 showed high in vivo stability and high and specific tumor accumulation, which was reduced by approximately 80% in competition studies with AMD3100. High CXCR4 expression in tumors was confirmed by immunohistochemical staining. (68)Ga-CPCR4-2 showed low uptake in nontumor tissue and particularly low kidney accumulation despite predominant renal excretion, leading to high-contrast delineation of tumors in small-animal PET studies. The small and optimized cyclic peptide CPCR4-2 labeled with (68)Ga is a suitable tracer for targeting and imaging of human CXCR4 receptor expression in vivo. The high affinity for CXCR4, its in vivo stability, and the excellent pharmacokinetics recommend the further evaluation of (68)Ga-CPCR4-2 in a proof-of-concept study in humans.

Development of a 4D Digital Phantom for Tracer Kinetic Modeling and Analysis of Dynamic Perfusion PET and SPECT Simulation Studies.

The goal is to develop a 4D digital perfusion cardiac-torso (PCAT) phantom, a tracer kinetic extension of the XCAT phantom, by modeling the time activity curves (TACs) of individual organ regions in the phantom for dynamic perfusion PET and SPECT simulation studies. The PCAT phantom is based on a generalized compartmental model, which accepts the blood input function, multiple series or parallel compartments, the bidirectional rate constants between the compartments, the blood volume in the tissue, the extraction curves, and other properties of a specific tracer. Based on the kinetic differential equations of the compartmental model, the TACs of the targeted organ regions were determined. For a specific time point, a voxelized anatomical realistic phantom, which with or without the cardiac and respiratory motions, was generated and the activity concentrations in the organ regions were assigned according to the corresponding TACs. According to the dynamic scanning protocol, multiple phantoms at different acquisition time points, which could have uniform or non-uniform time intervals, were generated. When combining the dynamic phantoms with realistic projection simulator, realistic dynamic projection data could be generated by easily adopting to various scanning protocols and imaging systems. With the availability of the "known truth", the activity map of the targeted organ regions, the TACs, the estimated rate constants and other kinetic parameters, from the projection data and the reconstructed images could be quantitatively evaluated. We demonstrate the usefulness of the 4D PCAT phantom in initial simulation studies in dynamic myocardial perfusion PET imaging with different tracers. The PCAT phantom was found to be an important bridge between the creation of TACs and the generation of simulated projection data. It is a useful simulation tool to study different kinetic analysis methods, acquisition protocols, reconstruction methods, and imaging parameter settings.

SU-E-I-180: Simulation of Arterial First Pass and Recirculation Input Functions Using a Series of Related Gamma Variate Function

Purpose: Any tracer kinetic analysis requires an arterial input function (AIF) when the analysis is performed for quantitative measurements of concerned variables such as blood flow (BF) or blood volume (BV) as in the case of dynamic CT, PET or MR perfusion studies. The AIF is often measured at the middle cerebral artery (MCA) or only the first pass AIF is modeled using a single gamma variate function. However, the recirculating input, which is sometimes disregarded for the computational convenience or sometime modeled using too simplistic function (e.g. straight line), has not well been formulated. Here, a full AIF including recirculating input is modeled using a series of gamma variate functions that have related parameters, and the feasibility was tested by a computer simulation. Methods: The simulation was performed using an in‐house program developed in MATLAB. The shape of a gamma variate function was defined using two parameters (&#945;,&#61538;, reference). In addition, recirculation time (T) and fraction (f), i.e. the first arrival time and fraction after leaving the brain, were included in the simulation. A single recirculation was described as a related gamma variate function (reference), and the total recirculation was described as the sum of all related gamma variate functions. Results: The arterial input function, including the first pass and recirculating inputs, can be modeled using the sum of a series of related gamma variate functions. Conclusions: The arterial input function in its complete form can be modeled using a series of related gamma variate functions. From this modeling, the AIF can be described as its complete form, which might benefit the quantitative measurements of BF, BV or mean transit time (MTT) in those dynamic contrast based perfusion imaging technique such as in CT, PET or MRI.

Parametric Images in Assessing Bone Grafts Using Dynamic18F-Fluoride PET

The early identification of graft failure would improve patient management. 18F-fluoride is a suitable tracer for quantifying bone metabolism. Performance of parametric images constructed by Patlak graphical analysis (PGA) with various time periods was evaluated in the analysis of dynamic 18F-fluoride PET studies of eight patients with fibula bone grafts after limb salvage surgery. The PGA parametric image approach tended to underestimate influx rate. The linear portion of PGA analysis was found to be from 10 to 50 min. It shows promise in providing a quantitative assessment of the viability of bone grafts.

Parametric images via dynamic 18F-fluorodeoxyglucose positron emission tomographic data acquisition in predicting midterm outcome of liver metastases secondary to gastrointestinal stromal tumours

(18)F-Fluorodeoxyglucose positron emission tomography (FDG PET) may underestimate viable tumour tissue in patients with gastrointestinal stromal tumours (GIST) treated with molecular targeted agents. The aim of the present study was to investigate the value of parametric images generated after dynamic data acquisition for the detection of active liver metastases. The analysis included 65 dynamic FDG PET studies in 34 patients with liver metastases from GIST who were treated with imatinib or sunitinib. Parametric images of intercept and slope were calculated by dedicated software using a voxel-based linear regression of time-activity data. Intercept images represent the tracer's distribution volume and the slope its overall metabolic turnover. All images were assessed visually and semi-quantitatively. Liver disease status was established 12 months after each PET study. Dichotomous variables of visual interpretation and various quantitative parameters were entered in a statistical model of linear discriminant analysis. Visual analysis of slope images was more sensitive than the standard 1-h FDG uptake evaluation (70.6 vs 51.0%, p = 0.016) in detecting cases with liver disease progression (n = 51). Specificity did not differ. Combination of all variables in the discriminant analysis model correctly classified 87.7% of cases as progressive or non-progressive disease. Sensitivity was raised to 88.2%. Parametric images of intercept and slope add a new dimension to the interpretation of FDG PET studies, by isolating visually and quantifying the perfusion and phosphorylation-dependent part of tracer uptake. In treated GIST patients, integration of this information with the 1-h uptake data achieves better characterization of hepatic lesions with respect to disease activity.

Pharmacokinetic Studies of 68Ga-Labeled Bombesin (68Ga-BZH3) and F-18 FDG PET in Patients With Recurrent Gliomas and Comparison to Grading

Dynamic PET studies with a ⁶⁸Ga-Bombesin analog, the ⁶⁸Ga-BZH₃, were performed in patients with highly suspected recurrent gliomas to investigate the effect of the receptor scintigraphy on tumor grading. Furthermore, dynamic F-18 Fluorodeoxyglucose (FDG) studies were performed for comparison.The study consisted of 15 patients with histologically confirmed recurrent gliomas. Dynamic PET scans using ⁶⁸Ga-BZH₃ and FDG were obtained on 2 different days within 1 week. Multivariate analysis was used for the evaluation of the kinetic data. Standardized uptake values were calculated and a compartment (2-tissue) as well as a noncompartment model was used for data evaluation of both tracers.The evaluation includes 6 patients with a WHO II, 6 patients with a WHO III, and 3 patients with a WHO IV recurrent gliomas. Of the 15 patients, 10 patients demonstrated an increased ⁶⁸Ga-BZH₃ uptake visually, 3 of them with a WHO II, 4 with a WHO III, and 3 with a WHO IV tumor. Of the 15 patients, 6 patients revealed an enhanced FDG metabolism visually, 3 of them with a WHO II, and 3 with a WHO III. None of the 3 patients with WHO IV tumor demonstrated an enhanced FDG-uptake. Discriminant analysis based on a combination of FDG influx and binding potential of ⁶⁸Ga-BZH₃ best discriminated between low- and high-grade gliomas with a correct classification rate of 100%.⁶⁸Ga-BZH₃ seems to be helpful in patients with recurrent gliomas for the differentiation between low- and high-grade gliomas. Overall, the quantitative evaluation was superior to the visual analysis and the parameters of the ⁶⁸Ga-BZH₃ kinetics were more helpful than those of FDG for the differentiation between low- and high-grade gliomas.

Copper-free click chemistry with the short-lived positron emitter fluorine-18

The copper-free strain-promoted click chemistry between (18)F-labeled aza-dibenzocyclooctyne [(18)F]FB-DBCO and various azides is described. [(18)F]FB-DBCO was prepared in 85% isolated radiochemical yield (decay-corrected) through acylation of amino aza-dibenzocyclooctyne 1 with N-succinimidyl 4-[(18)F]fluorobenzoate ([(18)F]SFB). [(18)F]FB-DBCO showed promising radiopharmacological profil with fast blood clearance as assessed with dynamic small animal PET studies. Metabolic stability of [(18)F]FB-DBCO was 60% of intact compound after 60 min post injection in normal Balb/C mice and blood clearance half-life was determined to be 53 s based on the time-activity-curve (TAC). Copper-free click chemistry was performed with various azides at low concentrations (1-2 μM) which differed in their structural complexity in different solvents (methanol, water, phosphate buffer and in bovine serum albumin (BSA) solution). Reaction proceeded best in methanol (>95% yield after 15 min at room temperature), whereas reaction in BSA required longer reaction times of 60 min and 40 °C upon completion.

Spatiotemporal Clustering Method for Automatic Estimation of the FDG Input Function for Small-Animal PET

The plasma time-activity curve is often required as the input function for dynamic quantitative FDG PET studies to estimate the metabolic rate of glucose. The invasive gold standard arterial blood sampling has been suggested, however, it has many inconveniences and challenges in clinical and pre-clinical settings. Thus, the image-derived input function has been proposed to obtain the input function from dynamic images non-invasively. This method often needs a manual drawing of one or two regions of interest (ROIs), which is an operator-dependent and time-consuming task. The aim of the presented study was to capture the spatial and temporal patterns of dynamic PET images for automatic ROI extraction. Our proposed approach tries to overcome the main limitation of image clustering methods: the loss of temporal information for dynamic PET ROI definition. The experiments showed that the proposed automatic ROI method can be used for dynamic PET parameter estimation.

Dynamic PET Denoising with HYPR Processing

HighlY constrained backPRojection (HYPR) is a promising image-processing strategy with widespread application in time-resolved MRI that is also well suited for PET applications requiring time series data. The HYPR technique involves the creation of a composite image from the entire time series. The individual time frames then provide the basis for weighting matrices of the composite. The signal-to-noise ratio (SNR) of the individual time frames can be dramatically improved using the high SNR of the composite image. In this study, we introduced the modified HYPR algorithm (the HYPR method constraining the backprojections to local regions of interest [HYPR-LR]) for the processing of dynamic PET studies. We demonstrated the performance of HYPR-LR in phantom, small-animal, and human studies using qualitative, semiquantitative, and quantitative comparisons. The results demonstrate that significant improvements in SNR can be realized in the PET time series, particularly for voxel-based analysis, without sacrificing spatial resolution. HYPR-LR processing holds great potential in nuclear medicine imaging for all applications with low SNR in dynamic scans, including for the generation of voxel-based parametric images and visualization of rapid radiotracer uptake and distribution.

541 IMPAIRED NEUTROPHIL PHAGOCYTIC CAPACITY IN PATIENTS WITH ADVANCED CIRRHOSIS IS RELATED TO THE DEVELOPMENT OF AMMONIA-INDUCED NEUTROPHIL SWELLING

Background and Aims: Hyperammonemia is considered a major causative factor for the development of hepatic encephalopathy, HE, in liver disease. Tissue specific ammonia metabolism in e.g. brain, liver and muscle can be assessed by dynamic Nammonia PET based on kinetic modeling of metabolic pathways and measurements of N-ammonia and N-metabolites in arterial blood. In 1990, Rosenspire et al. (J Nucl Med 1990;31:163) introduced a solid phase extraction procedure for the fractionation of N-radioactivity in blood into N-ammonia, N-urea, Nglutamine and N-glutamate following an i.v. injection of Nammonia. However, due to the radioactive half-life for N of only 10 minutes, the procedure is not suitable for blood samples taken later than 5–7 minutes after tracer injection and the method is hence unsuitable for studies of steady-state ammonia metabolism. Methods: By modifying Rosenspire’s method, we established a method enabling analysis of up to 10 blood samples taken in the time course of a 30 min dynamic N-ammonia PET study. The modified procedure was validated by radio-HPLC and showed good reproducibility in humans examined by duplicate N-ammonia injections. Results: Blood measurements from a dynamic N-ammonia PET study showed: (1) time courses of N-ammonia fractions could be described adequately by double-exponential functions; (2) wholebody clearance of N-ammonia to N-metabolites was in the order: healthy subjects (n = 5) > cirrhotic patients without HE (n =7) > cirrhotic patients with overt HE (n =8); (3) kinetics of initial tracer distribution can be assessed by using total Nconcentration in blood as input function, whereas assessment of parameters for metabolic processes (i.e. steady-state metabolism) requires determination of N-ammonia and N-metabolites. Conclusions: The study underlines the importance of using Nmetabolite-corrected blood input curves when assessing wholebody and/or organ steady-state ammonia metabolism using Nammonia PET. Patients with HE have a slower whole-body clearance of injected N-ammonia than patients without HE and healthy controls.