Mapping of treatment-induced apoptosis in normal structures: 99mTc-Hynic-rh-annexin V SPECT and CT image fusion.
OBJECTIVE
The purpose of this study was to map treatment-induced (99m)Tc-Hynic-rh-annexin V uptake in normal tissues using co-registration of SPECT and CT.


METHODS
Nineteen patients (11 male, 8 female, mean age 57 years) with various malignant tumours (12 lymphomas, four non-small cell lung cancers and three head and neck squamous cell carcinomas) underwent (99m)Tc-Hynic-rh-annexin V scintigraphy and CT before and within 48 h after the start of anticancer therapy. SPECT and CT were performed separately, with the patient in a reproducible position. Volume-based automated and manual methods were used to match functional and anatomical data. SPECT/CT co-registration was used to evaluate treatment-induced changes in the normal structures.


RESULTS
A significant radiation field-related increase in early post-treatment (99m)Tc-Hynic-rh-annexin V uptake in salivary glands and bone marrow was detected in eight of nine patients. Radiation field-related increase in bone marrow activity above the baseline value was detected in all 13 irradiated patients. A minimal, symmetrical increase in activity in the salivary glands was detected after the initial course of platinum-based chemotherapy, and a diffuse prominent increase in (99m)Tc-Hynic-rh-annexin V in the bone marrow was detected in all cases. Precise delineation between the tumour and normal tissue tracer accumulation was accomplished in all cases using SPECT/CT co-registered volumes, enhanced by the "colourwash" technique.


CONCLUSIONS
Mapping of early treatment-related changes in annexin V uptake by SPECT/CT co-registration permits accurate evaluation of tracer distribution in normal structures and precise delineation from tumour uptake. The associations between tracer distribution in the normal tissues and treatment regimen found in this study may contribute to the evaluation of dose-effect relations in various treatment schedules.
Department of Nuclear Medicine, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066, CX Amsterdam, The Netherlands. r.valdes@nki.nl
Marina S
MS
Kartachova
Renato A
RA
Valdés Olmos
Rick L M
RL
Haas
Frank J P
FJ
Hoebers
Michiel W
MW
van den Brekel
Nico
N
van Zandwijk
Marcel van
Mv
Herk
Marcel
M
Verheij
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017304:Annexin A5 / Q000493:pharmacokinetics*; D017209:Apoptosis; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis* / Q000378:metabolism* / Q000628:therapy; D015609:Organotechnetium Compounds / Q000493:pharmacokinetics*; D011379:Prognosis; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D013382:Subtraction Technique; D014018:Tissue Distribution; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
D017304:Annexin A5; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C117287:technetium Tc 99m HYNIC annexin V