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Hofman MS, Binns D, Thompson M, Johnson V, Eu P, Hicks RJ

Nephrourology 68 Ga EDTA PET/CT for better assessment of renal function: early results with comparison to 51 Cr EDTA. Hofman MS, Binns D, Thompson M, Johnson V, Eu P, Hicks RJ Molecular Imaging, Centre for Cancer Imaging Peter MacCallum Cancer Centre / The University of Melbourne

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Hofman MS, Binns D, Thompson M, Johnson V, Eu P, Hicks RJ

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  1. Nephrourology 68Ga EDTA PET/CT for better assessment of renal function: early results with comparison to 51Cr EDTA Hofman MS, Binns D, Thompson M, Johnson V, EuP, Hicks RJ Molecular Imaging, Centre for Cancer Imaging Peter MacCallum Cancer Centre / The University of Melbourne michael.hofman@petermac.org

  2. Disclosure • No Conflicts of Interest or Disclosure to Declare

  3. Background 51Cr-EDTA GFR estimation • Glomerular filtration rate (GFR) can be accurately determined using 51Cr-EDTA plasma clearance counting • Wide variety of indications • Disadvantages • time consuming • dependent on collection accuracy • requires a well counter • cannot imaging • no split or regional renal function EDTA: ethylenediaminetetraacetic acid

  4. 68Ga-EDTA: new light to old tracer

  5. 68Ga-EDTA renal imaging PET-CT images demonstrating rapid glomerular filtration of 68Ga-EDTA by kidneys following injection into the tail vein

  6. High resolution imaging with clinical PET/CT

  7. Background & Aim Background • 68Ga-EDTA is readily available using an onsite generator • PET/CT enables tomographic dynamic imaging and accurate camera-based quantitation Aims • Primary aim: to assess agreement between 68Ga-EDTA (GaGFR) and 51Cr-EDTA studies (CrGFR), using serial plasma sampling and PET/CT imaging. • Secondary aim: to assess utility in assessing differential renal function by assessing agreement with 99mTc-DMSA planar and SPECT/CT imaging

  8. Methods Protocol

  9. Methods Data collection & analysis • PET analysis • Plasma analysis • Clearance using 3 time points: • Excretion @ 10-19 mins • Early renal excretion 2-10 minutes • Renal cortical activity @ 2 minutes • MARVN Software • 68Ga counting(Biodex 950 well counter) • 51Cr counting after positron decay(WallacWizard 1470) • Level of agreement • Bland-Altman plot • Pearsons correlation coefficient (PCC)

  10. Methods 68Ge/68Ga generator 68Ga eluted from onsite generator (IBD Holland) 68Ga-EDTA: quick, easy, cheap

  11. Methods PET acquisition Dynamic acquisition of kidneys (1 bed step)   10 min. 3 min. 3 min. 3 min. • Kidney to bladder(3 bed steps) • Kidney to bladder (3 bed steps) Kidney to bladder (3 bed steps)

  12. Methods PET acquisition Dynamic acquisition of kidneys (1 bed step)   10 min. 3 min. 3 min. 3 min. • Kidney to bladder(3 bed steps) • Kidney to bladder (3 bed steps) Kidney to bladder (3 bed steps)

  13. Methods PET acquisition Dynamic acquisition of kidneys (1 bed step)   10 min. 3 min. 3 min. 3 min. • Kidney to bladder(3 bed steps) • Kidney to bladder (3 bed steps) Kidney to bladder (3 bed steps)

  14. Methods PET acquisition Dynamic acquisition of kidneys (1 bed step)   10 min. 3 min. 3 min. 3 min. %ID excreted • Kidney to bladder(3 bed steps) • Kidney to bladder (3 bed steps) Kidney to bladder (3 bed steps)

  15. Results Patient characteristics & results NET: neuroendocrine tumour, RCC: renal cell carcinoma eGFR: simplified Modification of Diet in Renal Disease (MDRD) formula (absolute) <30mls/min: 1 | 30-60: 4 | 60-90: 7 | >90: 3

  16. Results Plasma sampling: CrEDTA & GaEDTA agreement • CrGFR ranged from 10 – 220 mls/min (mean 90) • Near perfect exponential fit of the 3 plasma samples r2 of CrGFR= 0.98, GaGFR = 0.99 • Good agreement between GaGFR and CrGFR using serial plasma sampling, Bland-Altman bias of -11 ± 22mls/min for GaGFR, PCC 0.95.

  17. Results %ID excreted: highest correlate with plasma sampling GaGFR versus %ID excreted

  18. Results Split renal function Rt Anterior Lt Lt Posterior Rt large Rt renal cell carcinoma CrGFR=50, GaGFR=54

  19. Results Split renal function DMSA planar DMSA SPECT/CT Rt Anterior Lt Lt Posterior Rt

  20. Results Split renal function DMSA planar DMSA SPECT/CT 68Ga-EDTA PET/CT Rt Anterior Lt Lt Posterior Rt

  21. Results Split renal function (4 patients) poor-to-modest agreement between DMSA planar and SPECT-CT

  22. Results Split renal function Near perfect agreement between DMSA SPECT/CT and 68Ga-EDTA

  23. Discussion Advantages of 68Ga-EDTA 99mTc-DTPA, MAG3, DMSA 51Cr-EDTA • Cannot image • Multiple plasma samples (several hours for patient) • Labor intensive plasma counting 68Ga-EDTA PET/CT

  24. Discussion 68Ga-EDTA vs. 99mTc-DTPA/MAG3 Hicks RJ, Hofman MS, Nat Rev ClinOncol. 2012 Dec;9(12):712-20. WebLink

  25. Discussion Clinical use of 68Ga-EDTA • 8yo girl • Ongoing incontinence • Normal conventional imaging workup 1 sec 30 sec 5 min 15 min Serial maximum intensity projection (MIP) images

  26. Discussion Advantage of 3D dynamic imaging 3D Dynamic Imaging is a Major Advantage of 68Ga-EDTA PET/CT

  27. 68Ga-EDTA GFR Conclusions

  28. Thank-you. Questions? michael.hofman@petermac.org Thank-you

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