Vol 25, No 1 (2022)
Research paper
Published online: 2022-01-31

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Optimized method for normal range estimation of standardized uptake values (SUVmax, SUVmean) in liver SPECT/CT images with somatostatin analog [99mTc]-HYNIC-TOC (Tektrotyd)

Hanna Piwowarska-Bilska1, Sara Kurkowska1, Bozena Birkenfeld1
Pubmed: 35137936
Nucl. Med. Rev 2022;25(1):37-46.


Background: 99mTc-hydrazinonicotinyl-Tyr3-octreotide ([99mTc]-HYNIC-TOC [Tektrotyd]) is a radiopharmaceutical used for the diagnosis of lesions with overexpression of somatostatin receptors. The purpose of this study was to optimize the method and estimate normal ranges for standardized uptake values of Tektrotyd in healthy livers.
Material and methods: An analysis of standardized uptake value (SUVs) normal ranges was performed for images acquired in a selected “healthy group” of 42 patients evaluated for neuroendocrin tumors. The “pathological group” comprised 20 patients with liver lesions detected by scintigraphic imaging. Normal ranges for radiopharmaceutical uptake values were estimated based on the quantitative analysis of images acquired with a GE Healthcare NM/CT 850 gamma camera.
Results: The method for healthy liver segmentation in single photon emission computed tomography/computed tomography (SPECT/CT) was optimized. The normal range of SUVs for the liver was: standardized uptake value body weight (SUVbw) max [5.2–14.0] g/mL and standardized uptake value lean body mass (SUVlbm) [3.5–9.5] g/mL. The relative standard error (relative SE) of activity concentration estimated in the phantom study for the largest hot spheres was: ϕ = 37 mm — 5.9%, ϕ = 28 mm
— 7.1%, ϕ = 22 mm — 11.4%, and ϕ = 17 mm — 22%.
Conclusions: Segmentation in the mid-coronal computed tomography (CT) image, at one-fourth of the height of the liver measured from the top, with a medium-sized volume of interest (VOI) outlined on a given transverse SPECT slice was regarded as the optimal method for estimating normal ranges for standardized uptake values. It is necessary to standardize quantification methods in the SPECT/CT studies. Our work is a step forward in obtaining standardization of SPECT/CT SUV calculation
methods. Calculations for radiopharmaceutical uptake in tumors with volumes smaller than 5 mL are biased with a significant measurement error.

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  1. Schillaci O, Spanu A, Palumbo B, et al. SPECT/CT in neuroendocrine tumours. Clin Transl Imaging. 2014; 2(6): 477–489.
  2. Sharma P, Singh H, Bal C, et al. PET/CT imaging of neuroendocrine tumors with (68)Gallium-labeled somatostatin analogues: An overview and single institutional experience from India. Indian J Nucl Med. 2014; 29(1): 2–12.
  3. Gabriel M, Decristoforo C, Donnemiller E, et al. An intrapatient comparison of 99m Tc-EDDA/HYNIC-TOC with 111 In-DTPA-octreotide for diagnosis of soma-tostatin receptor-expressing tumors. J Nucl Med. 2003; 44(5): 708–16.
  4. Briganti V, Cuccurullo V, Berti V, et al. Tc-EDDA/HYNIC-TOC is a New Opportunity in Neuroendocrine Tumors of the Lung (and in other Malignant and Benign Pulmonary Diseases). Curr Radiopharm. 2020; 13(3): 166–176.
  5. Artiko V, Sobic-Saranovic D, Pavlovic S, et al. The clinical value of scintigraphy of neuroendocrine tumors using (99m)Tc-HYNIC-TOC. J BUON. 2012; 17(3): 537–542.
  6. Trogrlic M, Težak S. Incremental value of Tc-HYNIC-TOC SPECT/CT over whole-body planar scintigraphy and SPECT in patients with neuroendocrine tumours. Nuklearmedizin. 2017; 56(3): 97–107.
  7. Yamaga LY, Neto GC, da Cunha ML, et al. 99mTc-HYNIC-TOC increased uptake can mimic malignancy in the pancreas uncinate process at somatostatin receptor SPECT/CT. Radiol Med. 2016; 121(3): 225–228.
  8. Boellaard R, O'Doherty MJ, Weber WA, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010; 37(1): 181–200.
  9. European Medicines Agency. Assesment report. SomaKit TOC International non-proprietary name: edotreotide Procedure No. EMEA/H/C/004140/0000. EMA/734748/2016 Committee for Medicinal Products for Human Use (CHMP). 2016.
  10. Krenning EP, Bakker WH, Breeman WA, et al. Localisation of endocrine-related tumours with radioiodinated analogue of somatostatin. Lancet. 1989; 1(8632): 242–244.
  11. Hope TA, Calais J, Zhang Li, et al. 111 In-Pentetreotide Scintigraphy Versus Ga-DOTATATE PET: Impact on Krenning Scores and Effect of Tumor Burden. J Nucl Med. 2019; 60(9): 1266–1269.
  12. Beck M, Sanders JC, Ritt P, et al. Longitudinal analysis of bone metabolism using SPECT/CT and (99m)Tc-diphosphono-propanedicarboxylic acid: comparison of visual and quantitative analysis. EJNMMI Res. 2016; 6(1): 60.
  13. NM Quantification. Q.Metrix for SPECT/CT Package. White Paper, DOC1951185, GE Healthcare 2017.
  14. Kim CK, Gupta NC, Chandramouli B, et al. Standardized uptake values of FDG: body surface area correction is preferable to body weight correction. J Nucl Med. 1994; 35(1): 164–167.
  15. Sugawara Y, Zasadny KR, Neuhoff AW, et al. Reevaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology. 1999; 213(2): 521–525.
  16. Zeintl J, Vija AH, Yahil A, et al. Quantitative accuracy of clinical 99mTc SPECT/CT using ordered-subset expectation maximization with 3-dimensional resolution recovery, attenuation, and scatter correction. J Nucl Med. 2010; 51(6): 921–928.
  17. Vandervoort E, Celler A, Harrop R. Implementation of an iterative scatter correction, the influence of attenuation map quality and their effect on absolute quantitation in SPECT. Phys Med Biol. 2007; 52(5): 1527–1545.
  18. Willowson K, Bailey DL, Baldock C. Quantitative SPECT reconstruction using CT-derived corrections. Phys Med Biol. 2008; 53(12): 3099–3112.
  19. Shcherbinin S, Celler A, Belhocine T, et al. Accuracy of quantitative reconstructions in SPECT/CT imaging. Phys Med Biol. 2008; 53(17): 4595–4604.
  20. Huang SC. Anatomy of SUV. Standardized uptake value. Nucl Med Biol. 2000; 27(7): 643–646.
  21. Peters SMB, van der Werf NR, Segbers M, et al. Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study. EJNMMI Phys. 2019; 6(1): 29.
  22. Gnesin S, Leite Ferreira P, Malterre J, et al. Phantom Validation of Tc-99m Absolute Quantification in a SPECT/CT Commercial Device. Comput Math Methods Med. 2016; 2016: 4360371.
  23. Collarino A, Pereira Arias-Bouda LM, Valdés Olmos RA, et al. Experimental validation of absolute SPECT/CT quantification for response monitoring in breast cancer. Med Phys. 2018; 45(5): 2143–2153.