Magome Taiki, Froelich Jerry, Holtan Shernan G, Takahashi Yutaka, Verneris Michael R, Brown Keenan, Dusenbery Kathryn, Wong Jeffrey, Hui Susanta K
1 Department of Radiological Sciences, Faculty of Health Sciences, Komazawa University, Tokyo, Japan.
2 Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.
Mol Imaging. 2017 Jan-Dec;16:1536012117732203. doi: 10.1177/1536012117732203.
This report describes a multimodal whole-body 3'-deoxy-3'[(18)F]-fluorothymidine positron emission tomography (FLT-PET) and dual-energy computed tomography (DECT) method to identify leukemia distribution within the bone marrow environment (BME) and to develop disease- and/or BME-specific radiation strategies. A control participant and a newly diagnosed patient with acute myeloid leukemia prior to induction chemotherapy were scanned with FLT-PET and DECT. The red marrow (RM) and yellow marrow (YM) of the BME were segmented from DECT using a basis material decomposition method. Functional total marrow irradiation (fTMI) treatment planning simulations were performed combining FLT-PET and DECT imaging to differentially target irradiation to the leukemia niche and the rest of the skeleton. Leukemia colonized both RM and YM regions, adheres to the cortical bone in the spine, and has enhanced activity in the proximal/distal femur, suggesting a potential association of leukemia with the BME. The planning target volume was reduced significantly in fTMI compared with conventional TMI. The dose to active disease (standardized uptake value >4) was increased by 2-fold, while maintaining doses to critical organs similar to those in conventional TMI. In conclusion, a hybrid system of functional-anatomical-physiological imaging can identify the spatial distribution of leukemia and will be useful to both help understand the leukemia niche and develop targeted radiation strategies.
本报告描述了一种多模态全身3'-脱氧-3'[(18)F]-氟代胸腺嘧啶正电子发射断层扫描(FLT-PET)和双能计算机断层扫描(DECT)方法，用于识别骨髓环境(BME)内的白血病分布，并制定针对疾病和/或BME的放射治疗策略。对一名对照参与者和一名诱导化疗前新诊断的急性髓系白血病患者进行了FLT-PET和DECT扫描。使用基物质分解法从DECT中分割出BME的红骨髓(RM)和黄骨髓(YM)。结合FLT-PET和DECT成像进行了功能性全骨髓照射(fTMI)治疗计划模拟，以将照射差异靶向白血病龛和骨骼的其余部分。白血病定位于RM和YM区域，附着于脊柱的皮质骨，并在股骨近端/远端有增强的活性，提示白血病与BME之间可能存在关联。与传统TMI相比，fTMI中的计划靶体积显著减小。对活动性疾病(标准化摄取值>4)的剂量增加了2倍，同时保持对关键器官的剂量与传统TMI中的剂量相似。总之，功能-解剖-生理成像的混合系统可以识别白血病的空间分布，有助于理解白血病龛并制定靶向放射治疗策略。
