Radionuclides and radiopharmaceuticals for single-photon emission tomography, positron emission tomography and radiotherapy in Russia.

The current status of the manufacture of radiopharmaceuticals for diagnostic and therapeutic application in Russia is discussed, consideration being given to various aspects of the production and distribution of radionuclides, radioisotope generators and kits as well as individual radiopharmaceuticals in different regions of the country. The major focus is on the recent developments in production technologies for therapeutic and single-photon emission tomography radionuclides, technetium chemistry and synthetic approaches for the labelling of compounds with short-lived positron emitters. The status of positron emission tomography and its application are considered. The major factors restricting the expansion of nuclear imaging techniques and radiotherapy in Russia are also discussed.     

Radionuclides and radiopharmaceuticals for single-photon emission tomography, positron emission tomography and radiotherapy in Russia

The current status of the manufacture of radiopharmaceuticals for diagnostic and therapeutic application in Russia is discussed, consideration being given to various aspects of the production and distribution of radionuclides, radioisotope generators and kits as well as individual radiopharmaceuticals in different regions of the country. The major focus is on the recent developments in production technologies for therapeutic and single-photon emission tomography radionuclides, technetium chemistry and synthetic approaches for the labelling of compounds with short-lived positron emitters. The status of positron emission tomography and its application are considered. The major factors restricting the expansion of nuclear imaging techniques and radiotherapy in Russia are also discussed.     

Copper radionuclides and radiopharmaceuticals in nuclear medicine

The chemistry, radiochemistry, radiobiology, and radiopharmacology of radiopharmaceuticals containing copper radionuclides are reviewed. Copper radionuclides offer application in positron emission tomography, targeted radiotherapy, and single photon imaging. The chemistry of copper is relatively simple and well-suited to radiopharmaceutical application. Current radiopharmaceuticals include biomolecules labelled via bifunctional chelators primarily based on cyclic polyaminocarboxylates and polyamines, and pyruvaldehyde-bis(N⁴-methylthiosemicarbazone) (PTSM) and its analogues. The chemistry of copper, of which only a fraction has yet been exploited, is likely to be applied more fully in the future.     

Performance characteristics of a 511-keV collimator for imaging positron emitters with a standard gamma-camera.

Line-source experiments were conducted to assess the performance of a gamma-camera equipped with a specially designed 511-keV collimator for the planar imaging of positron emitters. The results were compared with the camera performance with routinely used collimators and radionuclides (thallium-201, technetium-99m and gallium-67). With positron emitters, scatter contributed less to the widening of the line spread function than with radionuclides emitting lower photon energies. These observations can be explained by the relative deterioration in the discrimination power of the gamma-camera to reject scattered radiation at low energies. Planar 511-keV imaging may provide relevant clinical information, as we showed by fluorodeoxyglucose studies in a patient with a myocardial infarction and in a patient with a malignant lymphoma. It is concluded that positron emitters can be effectively applied for planar imaging with the generally available gamma-cameras. This study implies that radiotracers developed for positron emission tomography may find a place in the practice of conventional nuclear medicine.     

Cyclotrons and positron emission tomography radiopharmaceuticals for clinical imaging

Positron emission tomography (PET) requires positron-emitting radionuclides that emit 511-keV photons detectable by PET imagers. Positron-emitting radionuclides are commonly produced in charged particle accelerators, eg, linear accelerators or cyclotrons. The most widely available radiopharmaceuticals for PET imaging are carbon-11-, nitrogen-13-, and oxygen-15-labeled compounds, many of which, either in their normal state or incorporated in other compounds, serve as physiological tracers. Other useful PET radiopharmaceuticals include fluorine-18-, bromine-75-, gallium-68 (68Ga)-, rubidium-82 (82Rb)-, and copper-62 (62Cu)-labeled compounds. Many positron emitters have short half-lives and thus require on-site cyclotrons for application, and others (68Ga, 82Rb, and 62Cu) are available from radionuclides generators using relatively long-lived parent radionuclides. This review is divided into two sections: cyclotrons and PET radiopharmaceuticals for clinical imaging. In the cyclotron section, the principle of operation of the cyclotron, types of cyclotrons, medical cyclotrons, and production of radionuclides are discussed. In the section on PET radiopharmaceuticals, the synthesis and clinical use of PET radiopharmaceuticals are described.     

Performance characteristics of a 511-keV collimator for imaging positron emitters with a standard gamma-camera

Line-source experiments were conducted to assess the performance of a gamma-camera equipped with a specially designed 511-keV collimator for the planar imaging of positron emitters. The results were compared with the camera performance with routinely used collimators and radionuclides (thallium-201, technetium-99m and gallium-67). With positron emitters, scatter contributed less to the widening of the line spread function than with radionuclides emitting lower photon energies. These observations can be explained by the relative deterioration in the discrimination power of the gamma-camera to reject scattered radiation at low energies. Planar 511-keV imaging may provide relevant clinical information, as we showed by fluorodeoxyglucose studies in a patient with a myocardial infarction and in a patient with a malignant lymphoma. It is concluded that positron emitters can be effectively applied for planar imaging with the generally available gamma-cameras. This study implies that radiotracers developed for positron emission tomography may find a place in the practice of conventional nuclear medicine. Offprint requests to: A. van Lingen     

Quantitative studies of bone with the use of 18F-fluoride and 99mTc-methylene diphosphonate

This article discusses methods for quantifying bone turnover based on tracer kinetic studies of the short-lived radiopharmaceuticals 99mTc-MDP and 18F-fluoride. Measurements of skeletal clearance obtained by using these tracers reflect the combined effects of skeletal blood flow and osteoblastic activity. The pharmacokinetics of each tracer is described, together with some of the quantitative tests of skeletal function that have been described in the literature. The physiologic interpretation of quantitative measurements of bone obtained with the use of short half-life radionuclides is discussed, and the advantages and limitations of 99mTc-MDP and 18F-fluoride are compared and contrasted. Currently, 18F-fluoride dynamic positron emission tomography (PET) is the technique of choice for physiologically precise quantitative studies of bone. However, comparable data could probably be obtained by using 99mTc-MDP if methods for single photon emission computed tomography (SPECT) quantitation were improved.     

Tracer kinetic modeling in nuclear cardiology

The introduction of tracer kinetic modeling techniques in conjunction with nuclear imaging has allowed the assessment of physiologic processes in the myocardium in a noninvasive and quantitative manner. Alongside the development of novel radiopharmaceuticals for both positron emission tomography and single photon emission computed tomography is the clarification of their pharmacology, pharmacokinetics, and modeling strategies for assessment of physiologic rates from imaging data. Image analysis and tracer kinetic modeling techniques used in nuclear cardiology must address unique considerations related to the heart. The most commonly used tracers and modeling techniques are presently discussed, with particular attention given to methods that allow absolute quantitation of physiologic processes. The applications of these techniques are obvious in research protocols and may find more use in future clinical studies.     

Radiobromine-labelled tracers for positron emission tomography: possibilities and pitfalls

The use of positron emission tomography (PET) for radionuclide imaging provides better sensitivity, better spatial and temporal resolution and better quantification accuracy in comparison with single photon emission computed tomography (SPECT). One limitation of PET is the predominant use of short-lived (with half-life up to 2 h) radionuclides. Extension of PET utility might be achieved by the use of more long-lived, "non-conventional" positron emitters. Two positron-emitting isotopes of bromine, 75Br (T1/2 = 96.7 min) and 76Br (T1/2 = 16.2 h), can be considered as labels for targeting proteins and peptides, and for small molecules, which have an optimal imaging time outside the time frame provided by conventional biogenic positron emitters. Variety of tracers might be labelled by electrophilic bromination of activated phenolic rings, electrophilic bromodestannylation and halogen exchange. A major problem is that in vivo metabolism of tracers might lead to formation of radiobromide as a main radiocatabolite. Radiobromide is very slowly excreted, and is distributed in the extracellular space creating high background. Careful tracer design optimisation is required to avoid this obstacle in the introduction of bromine isotopes into PET practice.     

Brain radioligands--state of the art and new trends.

Non-invasive radioligand imaging methods for brain receptor studies use either short-lived positron-emitting radionuclides such as 11C and 18F for positron emission tomography (PET) or single photon-emitting radionuclides such as 123I for single photon emission computed tomography (SPECT). PET and SPECT use radioligands which are injected intravenously into experimental animals, human volunteers or patients. The main applications of radioligands in brain research concern human neuropsychopharmacology and the discovery and development of novel drugs to be used in thetherapy of neurological and psychiatric disorders. A basic problem in PET and SPECT brain receptor studies is the lack of useful radioligands with appropriate binding characteristics. Prerequisite criteria need to be satisfied for a radioligand to reveal target binding sites in vivo. This section will discuss these important criteria and also review recent examples in neuroreceptor radioligand development such as selective radioligands for brain monoamine transporters.     

Positron emission tomography: a technical introduction for clinicians

Up to a few years ago, positron emission tomography (PET) was known as a very expensive research tool using positron emitting radiopharmaceuticals to study metabolic processes in vivo. Recent developments in detector technology enabled the detection of the distribution of positron emitting radionuclides inside the human body through dual-headed gamma camera systems. These much cheaper cameras did move the focus of PET from research to clinical applications. The improved availability of [(18)F]fluorodeoxyglucose has promoted clinical PET. Ongoing developments in detector and image reconstruction technology may lead to even more accurate imaging in the clinical setting. New applications in diagnosing and staging of cancer patients came across and more will arise. In this paper, we present a short historical overview and a technical introduction of PET.     

Standardisation of 11C.

The increasing use of positron emission tomography for medical imaging and the availability of short-lived positron emitters has raised concerns about the accuracy of calibration of secondary standard measurement systems and the viability of using a single long-lived positron emitter as a reference calibration source for all positron emitters. Potential problems arise because the 511 keV quanta arising from positron annihilation are not generally produced at the same point as the original disintegration. In addition, the secondary standard may also be responsive to the associated bremsstrahlung radiation. The magnitude of both effects depends on the positron end-point energy. In order to resolve these problems, it is necessary to produce absolute standards of these positron-emitting radionuclides and the work presented here details the results of such work with 11C.     

Conventional radionuclide brain imaging in the era of transmission and emission tomography

The clinical applications for conventional radionuclide brain imaging have declined considerably since the introduction of newer imaging modalities (computerized cranial tomography [CCT], nuclear magnetic resonance [NMR]). Currently, conventional brain imaging primarily serves as a complementary test when CCT is negative or equivocal and strong clinical suspicion remains. Selected areas in which radionuclide imaging may be the preferred modality include evaluation of cerebral perfusion in assessment of brain death, detection of early viral encephalitis, evaluation of major venous sinus patency, external marking for localization of intracranial tumor, and in selected cases of suspected subdural hematoma, brain tumor, and cerebrovascular disease. The concept of conventional radionuclide brain imaging will likely undergo considerable change in the near future as newer radiopharmaceuticals are introduced and wider application is made of single photon emission computerized tomography (SPECT) and positron emission tomography (PET) imaging.     

Alternative positron emission tomography with non-conventional positron emitters: effects of their physical properties on image quality and potential clinical applications

The increasing amount of clinically relevant information obtained by positron emission tomography (PET), primarily with fluorine-18 labelled 2-deoxy-2-fluoro-d-glucose, has generated a demand for new routes for the widespread and cost-efficient use of positron-emitting radiopharmaceuticals. New dual-head single-photon emission tomography (SPET) cameras are being developed which offer coincidence detection with camera heads lacking a collimator or SPET imaging with specially designed collimators and additional photon shielding. Thus, not only satellite PET imaging units but also nuclear medicine units investing in these new SPET/PET systems need to examine all available alternatives for rational radionuclide supplies from host cyclotrons. This article examines 25 ”alternative” positron-emitting radionuclides, discusses the impact of their decay properties on image quality and reviews methods for their production as well as for their application in imaging techniques.     

The search for consistency in the manufacture of PET radiopharmaceuticals

Nuclear Medicine is the specialty of medical imaging, which utilizes a variety of radionuclides incorporated into specific compounds for diagnostic imaging and therapeutic applications. During recent years, research efforts in this discipline have concentrated on the decay characteristics of particular radionuclides and the design of unique radiolabeled tracers necessary to achieve time-dependent molecular images. Various oncology applications have utilized specific PET and SPECT radiopharmaceuticals, which have allowed an extension from functional process imaging in tissue to pathologic processes and nuclide directed treatments. One of the most widely recognized advantages of positron emission tomography (PET) is its use of the attractive, positron-emitting biologic radiotracers that mimic natural substrates. However, a major disadvantage is that these substances are relatively short-lived and unable to be transported great distances. At this time, economic considerations and regulatory guidelines associated with the creation of a PET facility, as well as the operational costs of maintaining both the facility and the necessary procedural documentation, continue to create interesting strategic dilemmas. This commentary will focus on the current approach and anticipated impact of pending regulations, which relate to the manufacture and formulation of a variety of PET radiopharmaceuticals used in clinical research and patient management at Memorial Hospital.     

The role of hybrid cameras in oncology

The rapid advances in imaging technologies are a challenge for nuclear medicine physicians, radiologists, and clinicians who must integrate these technologies for optimal patient care and outcome at minimal cost. Multiple indications for functional imaging using F-18-fluorodeoxyglucose (FDG) are now well accepted in the field of oncology, including differentiation of benign from malignant lesions, staging malignant lesions, detection of malignant recurrence, and monitoring therapy. The use of FDG imaging was first shown using dedicated positron emission tomography (PET) with multiple full rings of bismuth germanate detectors. Most manufacturers now have available hybrid gamma cameras capable of imaging conventional single-photon emitters, as well as positron emitters such as FDG. This new technology was developed to make FDG imaging more widely accessible, first using single photon emission computed tomography (SPECT) with high-energy collimators, and then using dualhead coincidence (DHC) detection with multihead gamma cameras that improved spatial resolution. Most hybrid gamma cameras are now equipped with thicker NaI(TI) crystals to improve sensitivity. Technical developments are still evolving with correction for attenuation and new iterative reconstruction algorithms to improve the quality of the images. Users need to be familiar with the rapid developments of the technology as well as its limitations. Currently, one model of hybrid gamma camera is equipped with an integrated x-ray transmission system for attenuation correction, anatomic mapping, and image fusion. This powerful tool has promising clinical applications including intensity-modulated radiation therapy.     

The future of SPECT in a time of PET

As positron emission tomography (PET) imaging is becoming more prevalent in clinical practice, it is reasonable to ask if there will be a role for single photon emission computed tomography (SPECT) in the future. This article considers that question, focusing on areas where SPECT can differentiate itself from PET for fundamental reasons: breadth of available radionuclides, simultaneous imaging of multiple agents, cost-effectiveness and adaptability to specific imaging situations. The conclusion is that SPECT will continue to evolve and exist alongside PET and will grow the field of molecular imaging with improved efficiency and patient workflow.     

Nitroimidazole radiopharmaceuticals in bioimaging: part I: synthesis and imaging applications

The paper is review on synthesis of nitroimidazole radiosensitizers useful in imaging of tumor cells. Nitroimidazole compounds are radiolabeled probes for specific use in imaging such as 18F for positron emission tomography; 99mTc for single photon emission computed tomography; 123I, or 131I for computer assisted tomography and 19F for magnetic resonance imaging. In synthesis of radiopharmaceutical compounds, parent nitroimidazole is modified to thiopyranosyl nucleosides, neuraminic acid derivatives followed by nitro group deprotection-substitution and radiolabeling by specific isotopes. Commercial attempts have been made to radiolabel the nitroimidazole by [18F]fluorine, [131I or 123I]iodine, [99mTc]technicium and [64Cu]copper on modified side chain of nitroimidazole compounds to design multimodal and multifunctional imaging techniques to detect and monitor the tumor hypoxia by measuring distribution of radiatiolabel or radiation. Nitroimidazole initially showed poor diffusion and poor stability in tissues with neurotoxicity concern limited its use as radiosensitizer. In last decade, several nitroimidazole derivatives were developed as potent less toxic and highly stable radiopharmaceuticals with optimized radiolabel concentration with high detectability of tumor oxygen or hypoxia. Currently, nitroimidazole based radiopharmaceuticals have emerged as multimodal and multifunctional hypoxia reporters with antitumor, anti-ischemic, anti-inflammatory and tumor targeting properties. In conclusion, nitroimidazole based radiopharmaceuticals are a new generation hypoxia biosensors for localized theradiagnostic utility in clinical medicine.     

Nuclear medicine applications in molecular imaging

With the emergence of the new field of molecular imaging, there is an increasing demand for development of sensitive and safe novel imaging agents that can be rapidly translated from small animal models into patients. Nuclear medicine and positron emission tomography (PET) techniques have the ability to detect and serially monitor a variety of biologic and pathophysiologic processes, usually with tracer quantities of radiolabeled peptides, drugs, and other molecules at doses free of pharmacologic side effects, unlike the current generation of intravenous agents required for magnetic resonance (MR) and computed tomography (CT) scanning. In this article, we will review a representative sampling of the wide array of radiopharmaceuticals developed specifically for nuclear medicine radionuclide imaging that have been approved for clinical use, and those in pre-clinical trials. We will also review the existing strategies used to select the appropriate biologic markers and targets for radionuclide labeling that have been employed in the development of novel radiotracers and the imaging of small animals with new microSPECT (single photon emission computed tomography) technologies.     

New horizons in cardiac innervation imaging: introduction of novel <Superscript>18</Superscript>F-labeled PET tracers

Cardiac sympathetic nervous activity can be uniquely visualized by non-invasive radionuclide imaging techniques due to the fast growing and widespread application of nuclear cardiology in the last few years. The norepinephrine analogue ¹²³I–meta-iodobenzylguanidine (¹²³I–MIBG) is a single photon emission computed tomography (SPECT) tracer for the clinical implementation of sympathetic nervous imaging for both diagnosis and prognosis of heart failure. Meanwhile, positron emission tomography (PET) imaging has become increasingly attractive because of its higher spatial and temporal resolution compared to SPECT, which allows regional functional and dynamic kinetic analysis. Nevertheless, wider use of cardiac sympathetic nervous PET imaging is still limited mainly due to the demand of costly on-site cyclotrons, which are required for the production of conventional ¹¹C-labeled (radiological half-life, 20 min) PET tracers. Most recently, more promising ¹⁸F-labeled (half-life, 110 min) PET radiopharmaceuticals targeting sympathetic nervous system have been introduced. These tracers optimize PET imaging and, by using delivery networks, cost less to produce. In this article, the latest advances of sympathetic nervous imaging using ¹⁸F-labeled radiotracers along with their possible applications are reviewed.