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Physiological 68Ga-RM2 uptake in patients with biochemically recurrent prostate cancer: an atlas of semi-quantitative measurements

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Aim

68Ga-RM2 is a bombesin (BBN) analog that targets the gastrin releasing peptide receptors (GRPR) overexpressed in many cancer cells, including prostate cancer (PC). It has been reported to successfully detect primary and recurrent PC. Here, we describe the distribution and range of physiological uptake of 68Ga-RM2 in 95 patients with biochemically recurrent (BCR) PC.

Materials and methods

Ninety-five participants had simultaneous PET/MRI for BCR PC and were prospectively enrolled in this study. Maximum standardized uptake value (SUVmax) and mean standardized uptake value (SUVmean) were measured in 24 normal anatomical structures for each participant. Three readers evaluated the images independently. Uptake in various normal tissues was classified into 4 different categories: no significant uptake if SUVmean was less than SUVmean of the aortic arch (AA); mild if SUVmean was less or equal to 2.5, but higher than SUVmean of the AA; moderate if SUVmean was higher than 2.5, but less or equal to 5; intense if SUVmean was higher than 5.

Results

The most intense uptake was observed in the urinary bladder, due to excretion of the radiotracer. No significant uptake was seen in the brain, salivary glands, lungs, myocardium, skeleton, muscles, and fat. Liver, spleen, and adrenal glands had mostly no significant uptake; the gastrointestinal tract had intense physiological uptake, with pancreas being the organ with the highest SUVmax measurements (average SUVmax 64.91). Mild and moderate uptake was measured in the esophagus (average SUVmax 3.99), while the stomach wall, duodenum, and rectum had mild uptake (average SUVmax 2.49, 3.42, and 3.58, respectively).

Conclusions

68Ga-RM2 has been mostly evaluated for PC detection, but it can be used for other tumors overexpressing GRPR such as breast cancer. This atlas of normal biodistribution and SUV measurements in healthy tissues will help physicians distinguish between physiological vs. pathological uptake, as well as potentially assist with planning future studies using GRPR targeting radiopharmaceuticals.

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Acknowledgments

Life MI provided the precursor for synthesis of 68Ga-RM2.

Funding

This study was partially funded by the Department of Defense through an Impact Award (W81XWH-16-1-0604).

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Author notes

  1. Lucia Baratto, Heying Duan and Riccardo Laudicella contributed equally to this work.

Authors and Affiliations

  1. Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Stanford University Medical Center, Stanford, CA, 94305, USA

    Lucia Baratto, Heying Duan, Akira Toriihara, Negin Hatami, Valentina Ferri & Andrei Iagaru

  2. Department of Biomedical and Dental Sciences and Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy

    Riccardo Laudicella

Authors
  1. Lucia Baratto
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  2. Heying Duan
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  3. Riccardo Laudicella
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  4. Akira Toriihara
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  5. Negin Hatami
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  7. Andrei Iagaru
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Corresponding author

Correspondence to Andrei Iagaru.

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Conflict of interest

Lucia Baratto declares that she has no conflict of interest.

Heying Duan declares that she has no conflict of interest.

Riccardo Laudicella declares that he has no conflict of interest.

Akira Toriihara declares that she has no conflict of interest.

Negin Hatami declares that she has no conflict of interest.

Valentina Ferri declares that she has no conflict of interest.

Andrei Iagaru receives institutional research support from GE Healthcare, Advanced Accelerator Applications and Progenics Pharmaceuticals.

Ethical approval

All procedures performed in our study 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.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Oncology – Genitourinary

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Baratto, L., Duan, H., Laudicella, R. et al. Physiological 68Ga-RM2 uptake in patients with biochemically recurrent prostate cancer: an atlas of semi-quantitative measurements. Eur J Nucl Med Mol Imaging 47, 115–122 (2020). https://doi.org/10.1007/s00259-019-04503-4

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  • DOI: https://doi.org/10.1007/s00259-019-04503-4

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