Impact of residual 18 F-fluoride in 18 F-FDOPA for the diagnosis of neuroblastoma
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ORIGINAL ARTICLE
Impact of residual of neuroblastoma
18
F-fluoride in
18
F-FDOPA for the diagnosis
Ya-Yao Huang1 • Kai-Yuan Tzen1,2 • Yen-Lin Liu3,4 • Ching-Hong Chiu1 • Chia-Ling Tsai1 • Hsiang-Ping Wen1 • Kuang-Hua Tang1 • Chien-Chu Liu1 Chyng-Yann Shiue1,2,5
•
Received: 19 January 2015 / Accepted: 30 March 2015 Ó The Japanese Society of Nuclear Medicine 2015
Abstract Objective PET imaging with 18F-FDOPA has been successfully applied in the diagnosis and surveillance of neuroblastoma (NB) by targeting the overexpression of aromatic L-amino acid decarboxylase. This study aims to assess the impact of residual 18F-fluoride on 18F-FDOPA PET in NB and to implement a method to maintain low 18 F-fluoride content in future studies. Methods Automatic synthesis of 18F-FDOPA was based on the electrophilic method using TRACERlab FXFE module. Radio-TLC was employed to determine residual 18 F-fluoride levels. We analyzed the impact of residual 18 F-fluoride on the images of 35 patients undergoing 18FFDOPA PET at initial diagnosis and/or follow-ups of NB. Results In 35 batches of 18F-FDOPA products from 9/28/ 2010 to 07/27/2011, the mean residual 18F-fluoride level was 4.4 % (range 0.2–19.1 %). Residual 18F-fluoride level C4.0 % was associated with dense uptake in the growth
plates, skull, and pelvis on PET scans, which may interfere with the interpretation of 18F-FDOPA imaging in NB. By applying stringent restraints in 18F-FDOPA production, including regular renewal of reagents, exclusive use of NH4OH, and timely replacement of HPLC column, the incidence of 18F-FDOPA batches with residual 18F-fluoride level C4.0 % was reduced from 33 to 4 % (P \ 0.0001) during 7/30/2011–4/29/2013. Conclusion By monitoring residual 18F-fluoride levels and keeping stringent restraint procedures, low 18F-fluoride content was achieved in most batches of 18F-FDOPA, which diminished false-positive skeletal uptake. An appropriate upper limit of 18F-fluoride level is suggested to be included in the criteria of routine quality control of 18FFDOPA productions.
& Kai-Yuan Tzen [email protected]
Introduction
1
PET Center, Department of Nuclear Medicine, National Taiwan University Hospital, 7 Chung-Shan S. Rd., Taipei 100, Taiwan
2
Molecular Imaging Center, National Taiwan University, No. 81, Changxing St., Taipei 106, Taiwan
3
Department of Pediatrics, Taipei Medical University Hospital, 252 Wuxing St., Xinyi District, Taipei 110, Taiwan
4
PhD of Translational Medicine Program, National Taiwan University and Academia Sinica, 1 Jen Ai Rd. Sec. 1, Taipei 100, Taiwan
5
PET Center, Department of Nuclear Medicine, Tri-Service General Hospital, 325 Sec. 2, Cheng-Kung Rd., Taipei 114, Taiwan
Keywords 18F-FDOPA PET Neuroblastoma Metastasis
18
F-Fluoride
Neuroblastoma (NB) is a pediatric malignancy responsible for approximately 15 % of childhood cancer deaths [1]. The tumor behavior of NB is highly variable that ranges from spontaneous regression to aggressive progression with distant spreads [2]. The most common sites of metastasi
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