Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently [1, 2], which offer numerous advantages . One important advantage of using LAFOV PET/CT for imaging 89Zr-labelled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement for immunoPET with Biograph Vision Quadra™ (VQ) LAFOV PET/CT (Siemens Healthineers, Knoxville, TN, USA).
Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq [89Zr]trastuzumab in order to assist clinical decision-making [4, 5]. Patients were scanned 4 days postinjection with a Biograph™ mCT PET/CT (patient A) or a Biograph Vision™ PET/CT (patient B) (Siemens Healthineers, Knoxville, TN, USA), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with VQ. For VQ, we choose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with EARL1, whilst for LAFOV, we also applied clinically (CLIN) recommended settings (Table 1) [6, 7].
PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom rows (i-p). The same intensity scale, SUV range 0–10, applies for all images, except the fused images (e, m). Additional reconstructions of the Vision Quadra data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.
As can be appreciated from these first human immunoPET images on a LAFOV system, the image quality improvement (f) is most spectacular when compared with the mCT (a). For example, in patient A, an additional small bone lesion was visualized with VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this image quality was improved even in the 10 min image compared with the 30–45 min acquisition needed for SAFOV systems.
Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred overall scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the overall scan duration with still very acceptable image quality, even for 89Zr-labelled mAb PET/CT studies.
Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.
Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.
Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.
Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, De Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.
Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.
Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.
Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.
Ethics approval and consent to participate
The medical Ethics Review Board of the University Medical Center Groningen waived the need for formal ethical review of the validation protocol of the Vision Quadra PET/CT system (waiver number METc2020/554). Both patients were informed about the study aims, procedures (one additional PET/CT scan on the same day with the planned PET/CT), and the need to acquire an additional low-dose CT scan. Informed consent was obtained before the start of the second acquisition on the LAFOV PET/CT system.
Consent for publication
Both patients gave written informed consent to anonymously use their clinical and imaging data for publication.
Conflict of interest
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
This article is part of the Topical Collection on Image of the month
About this article
Cite this article
Brouwers, A.H., van Sluis, J., van Snick, J.H. et al. First-time imaging of [89Zr]trastuzumab in breast cancer using a long axial field-of-view PET/CT scanner. Eur J Nucl Med Mol Imaging 49, 3593–3595 (2022). https://doi.org/10.1007/s00259-022-05777-x