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Use of quantitative SPECT/CT reconstruction in 99mTc-sestamibi imaging of patients with renal masses

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Abstract

Objective

Technetium-99m (99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has previously been shown to allow for the accurate differentiation of benign renal oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) apart from other malignant renal tumor histologies, with oncocytomas/HOCTs showing high uptake and renal cell carcinoma (RCC) showing low uptake based on uptake ratios from non-quantitative single-photon emission computed tomography (SPECT) reconstructions. However, in this study, several tumors fell close to the uptake ratio cutoff, likely due to limitations in conventional SPECT/CT reconstruction methods. We hypothesized that application of quantitative SPECT/CT (QSPECT) reconstruction methods developed by our group would provide more robust separation of hot and cold lesions, serving as an imaging framework on which quantitative biomarkers can be validated for evaluation of renal masses with 99mTc-sestamibi.

Methods

Single-photon emission computed tomography data were reconstructed using the clinical Flash 3D reconstruction and QSPECT methods. Two blinded readers then characterized each tumor as hot or cold. Semi-quantitative uptake ratios were calculated by dividing lesion activity by background renal activity for both Flash 3D and QSPECT reconstructions.

Results

The difference between median (mean) hot and cold tumor uptake ratios measured 0.655 (0.73) with the QSPECT method and 0.624 (0.67) with the conventional method, resulting in increased separation between hot and cold tumors. Sub-analysis of 7 lesions near the separation point showed a higher absolute difference (0.16) between QPSECT and Flash 3D mean uptake ratios compared to the remaining lesions.

Conclusions

Our finding of improved separation between uptake ratios of hot and cold lesions using QSPECT reconstruction lays the foundation for additional quantitative SPECT techniques such as SPECT-UV in the setting of renal 99mTc-sestamibi and other SPECT/CT exams. With robust quantitative image reconstruction and biomarker analysis, there may be an expanded role for SPECT/CT imaging in renal masses and other pathologic conditions.

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Abbreviations

99mTc-sestamibi:

Technetium-99m sestamibi

SPECT/CT:

Single photon emission computed tomography/computed tomography

HOCTs:

Hybrid oncocytic/chromophobe tumors

RCC:

Renal cell carcinoma

SPECT:

Single-photon emission computed tomography

QSPECT:

Quantitative SPECT/CT

CT:

Computed tomography

MRI:

Magnetic resonance imaging

OSEM:

Ordered subset expectation maximization

ICC:

Intra-class correlation coefficient

PET/CT:

Proton emission computed tomography/computed tomography

ROC:

Receiver operator curve

SPECT-UV:

SPECT-uptake value

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA

    Krystyna M. Jones, Lilja B. Solnes, Steven P. Rowe, Michael A. Gorin, Sara Sheikhbahaei, George Fung, Eric C. Frey, Yong Du & Mehrbod S. Javadi

  2. The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA

    Steven P. Rowe, Michael A. Gorin & Mohamad E. Allaf

Authors
  1. Krystyna M. Jones
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  2. Lilja B. Solnes
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  3. Steven P. Rowe
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  4. Michael A. Gorin
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  5. Sara Sheikhbahaei
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  6. George Fung
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  7. Eric C. Frey
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  8. Mohamad E. Allaf
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  9. Yong Du
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  10. Mehrbod S. Javadi
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Contributions

KMJ study conceptualization/design, data collection/analysis, drafting of manuscript, revision of manuscript; LBS study conceptualization/design, data collection/analysis, revision of manuscript; SPR study conceptualization/design, data collection/analysis, revision of manuscript; MAG study conceptualization/design, patient recruitment, data collection, revision of manuscript; SS study conceptualization/design, data collection/analysis, revision of manuscript; GF study conceptualization/design, data analysis, revision of manuscript; ECF study conceptualization/design, data analysis, revision of manuscript; MEA study conceptualization/design, data collection, patient recruitment; YD study conceptualization/design, data analysis, revision of manuscript; MSJ study conceptualization/design, data collection/analysis, revision of manuscript.

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Funding

No funding was received.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

IRB approval

The study was approved by the Johns Hopkins University Institutional Review Board.

Informed consent

Informed consent was obtained from all individual participants.

Conflict of interest

Author ECF receives royalties from software licensed to General Electric. Author KMJ declares that he/she has no conflict of interest. Author LBS declares that he/she has no conflict of interest. Author SPR declares that he/she has no conflict of interest. Author MAG declares that he/she has no conflict of interest. Author SS declares that he/she has no conflict of interest. Author GF declares that he/she has no conflict of interest. Author MEA declares that he/she has no conflict of interest. Author YD declares that he/she has no conflict of interest. Author MSJ declares that he/she has no conflict of interest.

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Jones, K.M., Solnes, L.B., Rowe, S.P. et al. Use of quantitative SPECT/CT reconstruction in 99mTc-sestamibi imaging of patients with renal masses. Ann Nucl Med 32, 87–93 (2018). https://doi.org/10.1007/s12149-017-1222-z

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  • DOI: https://doi.org/10.1007/s12149-017-1222-z

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