Quantitative PET-Bildgebung für die Dosimetrie an Beispielen von ¹²⁴I, ⁸⁶Y, ⁶⁸Ga und ⁴⁴Sc

Zusammenfassung

Die prätherapeutische PET-Dosimetrie gewinnt insbesondere in der Radionuklidtherapie zur Behandlung von Krebserkrankungen immer mehr an Bedeutung. Im Vergleich zu anderen bildgebenden Verfahren der Nuklearmedizin ermöglicht sie eine genauere Bestimmung der Energiedosen pro applizierte Therapieaktivität in Tumoren und Risikoorganen. Zum Beispiel werden die Radionuklide ¹²⁴I, ⁸⁶Y und ⁶⁸Ga zur Optimierung der Radiojodtherapie von Schilddrüsenkarzinomen und zur Therapieplanung von Somatostatinrezeptor-positiven Tumoren eingesetzt. Das kürzlich eingeführte PET-Nuklid ⁴⁴Sc rückt immer mehr in den Fokus als Ersatz für ⁶⁸Ga, weil es auch Spätmessungen mit ausreichender Bildqualität erlaubt. Zur Abschätzung der Energiedosis ist eine genaue PET-Quantifizierung der räumlichen und zeitlichen Tracer-Aktivitätsverteilung im Tumor bzw. Organ notwendig. Im Vergleich zum Standard-Radionuklid ¹⁸F besitzen ¹²⁴I, ⁸⁶Y und ⁴⁴Sc ungünstige Zerfallseigenschaften. Die Quantifizierung ist dadurch beeinträchtigt. Außerdem werden die Aktivitäten von kleinen Tumoren durch den bekannten Partial-Volumen-Effekt beeinflusst. In dieser Arbeit werden die wesentlichen Faktoren zur PET-Quantifizierung beschrieben, die bei der Anwendung von ¹²⁴I, ⁸⁶Y, ⁶⁸Ga und ⁴⁴Sc bei der prätherapeutischen Dosimetrie zu berücksichtigen sind. Darüber hinaus werden klinische Dosimetrieprotokolle von ausgewählten Arbeiten und ihre Korrekturverfahren kurz präsentiert.

Abstract

Pretherapeutic PET dosimetry is becoming increasingly important, in particular in targeted radionuclide therapy for the treatment of cancer diseases. Compared to other nuclear imaging modalities, PET allows a more precise determination of absorbed radiation doses per unit administered therapeutic activity in tumours and organs at risks. For instance, the radionuclides ¹²⁴I, ⁸⁶Y, and ⁶⁸Ga are used to optimise radioiodine therapy of thyroid carcinomas and to plan therapy of somatostatin receptor-positive tumours. The novel PET nuclide ⁴⁴Sc is increasingly moving into focus as a possible substitute for ⁶⁸Ga because it allows late measurements with sufficient image quality. For estimating the absorbed radiation dose, an accurate PET quantification of the spatial and temporal tracer activity distribution within the tumour or organ at risk is necessary. Compared to the standard radionuclide ¹⁸F, ¹²⁴I, ⁸⁶Y, and ⁴⁴Sc exhibit unfavourable decay properties that affect quantification. In addition, the activities of small tumours are influenced by the well-known partial volume effect. In this work, the essential factors for PET quantification are described that have to be taken into account when using ¹²⁴I, ⁸⁶Y, ⁶⁸Ga, and ⁴⁴Sc for dosimetry purposes. Furthermore, clinical dosimetry protocols of selected studies and their correction approaches are shortly presented.

Schlüsselwörter

Positronen-Emissionstomografie - Radionuklidtherapie - Partial-Volumen-Effekt - Dosimetrie, prompte Gammastrahlung - ¹²⁴I - ⁸⁶Y - ⁶⁸Ga - ⁴⁴Sc

Keywords

positron emission tomography - radionuclide therapy - partial volume effect - dosimetry - prompt gamma radiation, ¹²⁴I, ⁸⁶Y, ⁶⁸Ga, ⁴⁴Sc

^* die beiden erstgenannten Autoren publizieren gleichwertig

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