Use of quantitative SPECT/CT reconstruction in 99mTc-sestamibi imaging of patients with renal masses

Krystyna M Jones; Lilja B Solnes; Steven P Rowe; Michael A Gorin; Sara Sheikhbahaei; George Fung; Eric C Frey; Mohamad E Allaf; Yong Du; Mehrbod S Javadi

doi:10.1007/s12149-017-1222-z

Use of quantitative SPECT/CT reconstruction in ^99mTc-sestamibi imaging of patients with renal masses

Ann Nucl Med. 2018 Feb;32(2):87-93. doi: 10.1007/s12149-017-1222-z. Epub 2017 Dec 6.

Authors

Affiliations

¹ The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N. Caroline St., Baltimore, MD, 21287, USA.
² The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, 600 N. Wolfe St., Baltimore, MD, 21287, USA.

PMID: 29214562
DOI: 10.1007/s12149-017-1222-z

Abstract

Objective: Technetium-99m (^99mTc)-sestamibi single-photon emission computed tomography/computed tomography (SPECT/CT) has previously been shown to allow for the accurate differentiation of benign renal oncocytomas and hybrid oncocytic/chromophobe tumors (HOCTs) apart from other malignant renal tumor histologies, with oncocytomas/HOCTs showing high uptake and renal cell carcinoma (RCC) showing low uptake based on uptake ratios from non-quantitative single-photon emission computed tomography (SPECT) reconstructions. However, in this study, several tumors fell close to the uptake ratio cutoff, likely due to limitations in conventional SPECT/CT reconstruction methods. We hypothesized that application of quantitative SPECT/CT (QSPECT) reconstruction methods developed by our group would provide more robust separation of hot and cold lesions, serving as an imaging framework on which quantitative biomarkers can be validated for evaluation of renal masses with ^99mTc-sestamibi.

Methods: Single-photon emission computed tomography data were reconstructed using the clinical Flash 3D reconstruction and QSPECT methods. Two blinded readers then characterized each tumor as hot or cold. Semi-quantitative uptake ratios were calculated by dividing lesion activity by background renal activity for both Flash 3D and QSPECT reconstructions.

Results: The difference between median (mean) hot and cold tumor uptake ratios measured 0.655 (0.73) with the QSPECT method and 0.624 (0.67) with the conventional method, resulting in increased separation between hot and cold tumors. Sub-analysis of 7 lesions near the separation point showed a higher absolute difference (0.16) between QPSECT and Flash 3D mean uptake ratios compared to the remaining lesions.

Conclusions: Our finding of improved separation between uptake ratios of hot and cold lesions using QSPECT reconstruction lays the foundation for additional quantitative SPECT techniques such as SPECT-UV in the setting of renal ^99mTc-sestamibi and other SPECT/CT exams. With robust quantitative image reconstruction and biomarker analysis, there may be an expanded role for SPECT/CT imaging in renal masses and other pathologic conditions.

Keywords: Oncocytoma; Quantitative; RCC; SPECT; Sestamibi.

MeSH terms

Adenoma, Oxyphilic / diagnostic imaging*
Adult
Aged
Aged, 80 and over
Diagnosis, Differential
Female
Humans
Imaging, Three-Dimensional*
Kidney Neoplasms / diagnostic imaging*
Male
Middle Aged
Single Photon Emission Computed Tomography Computed Tomography*
Technetium Tc 99m Sestamibi*

Substances

Technetium Tc 99m Sestamibi

Supplementary concepts

Oncocytoma, renal