Single-Photon Emission Computed Tomography/Computed Tomography in Lung Cancer and Malignant Lymphoma

https://doi.org/10.1053/j.semnuclmed.2006.05.003Get rights and content

In nuclear oncology, despite the fast-growing diffusion of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), single-photon emission computed tomography (SPECT) studies can still play an useful clinical role in several applications. The main limitation of SPECT imaging with tumor-seeking agents is the lack of the structural delineation of the pathologic processes they detect; this drawback sometimes renders SPECT interpretation difficult and can diminish its diagnostic accuracy. Fusion with morphological studies can overcome this limitation by giving an anatomical map to scintigraphic data. In the past, software-based fusion of independently performed SPECT and CT images proved to be time-consuming and impractical for routine use. The recent development of dual-modality integrated imaging systems that provide functional (SPECT) and anatomical (CT) images in the same scanning session, with the acquired images coregistered by means of the hardware, has opened a new era in this field. The first reports indicate that SPECT/CT is very useful in cancer imaging because it is able to provide further information of clinical value in several cases. In SPECT, studies of lung cancer and malignant lymphomas using different radiopharmaceutical, hybrid images are of value in providing the correct localization of tumor sites, with a precise detection of the involved organs, and the definition of their functional status, and in allowing the exclusion of disease in sites of physiologic tracer uptake. Therefore, in lung cancer and lymphomas, hybrid SPECT/CT can play a role in the diagnosis of the primary tumor, in the staging of the disease, in the follow-up, in the monitoring of therapy, in the detection of recurrence, and in dosimetric estimations for target radionuclide therapy.

Section snippets

Radiopharmaceuticals

This section analyzes the uptake mechanisms of the currently most used single photon radiopharmaceuticals for lung cancer and malignant lymphomas imaging. Tc-99m sestamibi (SM) and tetrofosmin (TF) are 2 small cationic complexes of technetium introduced for myocardial perfusion imaging, which then were proposed as tumor-avid agents.5 SM uptake and retention in cancer cells depend on several factors, such as regional blood flow, plasma and mithocondrial membrane potentials, metabolic activity,

Imaging Fusion of SPECT Studies

It is well known that SPECT imaging demonstrates function, rather than anatomy, and it is very useful for early diagnosing various disorders because of its ability to detect changes before there are identifiable anatomical correlates and clinical manifestations. Nevertheless, the anatomical landmarks provided by SPECT studies are usually limited, and, especially in cancer imaging, this drawback is not trivial because it could be important to precisely identify and differentiate the sites of

Lung Cancer

The first data on SPECT/CT fusion in lung cancer imaging were reported in clinical trials using radiolabeled antibodies, both in nonsmall cell lung cancer (NSCLC) and SCLC patients.

A group of 14 patients with NSCLC (from stage IIa to stage IV) were studied after the intravenous administration of 99mTc-labeled IMMU-4 anti-CEA Fab’ antibody fragment to evaluate the potential role of immunoscintigraphy SPECT fusion with CT in NSCLC staging.42 Chest SPECT acquisitions were performed either at 5 to

Malignant Lymphoma

67Ga demonstrated useful in evaluating lymphoma patients: however, its accuracy depends on several factors, including the proper technical protocol of imaging.15 It is well known that SPECT should be always performed to improve the sensitivity of planar scans and to better localize the abnormal sites of tracer uptake.75 Nonetheless, the precise anatomical localization of malignant lesions can remain difficult despite optimal technical conditions and careful visual correlation with morphological

Dosimetry Estimations for Radionuclide Therapy

Another possible application of hybrid imaging is to use the structural information obtained from the CT data for an accurate activity quantification in SPECT studies. In a phantom model (ie, a cylinder containing 6 hot spherical inserts in a warm background), Erlandsson and coworkers86 have reported that a SPECT/CT acquisition shows an improvement in image contrast and in the measurement of SPECT activity concentration. This aspect is particularly important in RIT applications, where the exact

Conclusions

In the era of FDG-PET, SPECT imaging with several different radiopharmaceuticals still can play an important clinical role in the workup of patients with lung cancer and malignant lymphomas. The combination of scintigraphic data with anatomical images, such as CT, adds structure to function and helps in overcoming some intrinsic limitations of SPECT studies. The introduction of hybrid systems in the clinical practice has rendered the fusion of SPECT and CT images of routine availability. The

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