Indian Journal of Nuclear Medicine

INTERESTING IMAGE
Year
: 2018  |  Volume : 33  |  Issue : 3  |  Page : 242--244

Multifarious Ga-68 labeled PET radiopharmaceuticals in imaging various malignancies


Rakhee Vatsa, Abhiram Gopalajois Ashwathanarayana, Jaya Shukla, Shashank Singh, Priya Bhusari, Rajender Kumar, Harmandeep Singh, Bhagwant Rai Mittal 
 Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh, Punjab and Haryana, India

Correspondence Address:
Bhagwant Rai Mittal
Department of Nuclear Medicine and PET, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012, Punjab and Haryana
India

Abstract

The gamut of gallium labeled radiopharmaceuticals contributes to augmented variety in molecular imaging approach for in vivo identification of tumor characteristics. The spectrum ranges from somatostatin receptor based target-specific imaging agents, to those used for tumor imaging based on specific receptor types extending into ones used for therapeutic monitoring. The versatility of gallium chemistry provides the needed advantage for imaging which is further exploited in clinical practice influences the specificity of tumor imaging. Ga-68 has revealed applicability in labeling compounds from nanoparticles to micro as well as macromolecules. We in this image, present variety of frequently and infrequently used gallium labeled radiopharmaceuticals, for imaging diverse malignancies other than conventional established tracers.



How to cite this article:
Vatsa R, Ashwathanarayana AG, Shukla J, Singh S, Bhusari P, Kumar R, Singh H, Mittal BR. Multifarious Ga-68 labeled PET radiopharmaceuticals in imaging various malignancies.Indian J Nucl Med 2018;33:242-244


How to cite this URL:
Vatsa R, Ashwathanarayana AG, Shukla J, Singh S, Bhusari P, Kumar R, Singh H, Mittal BR. Multifarious Ga-68 labeled PET radiopharmaceuticals in imaging various malignancies. Indian J Nucl Med [serial online] 2018 [cited 2022 Aug 13 ];33:242-244
Available from: https://www.ijnm.in/text.asp?2018/33/3/242/234122


Full Text



The use of Ga-68 in clinical practice has continually evolved owing to its notable flexibility in labeling properties with antibodies, peptides, and drug conjugates.[1],[2] We hereby depict a composite image of four cases showing the usefulness of 68-Ga radiopharmaceuticals for imaging diverse malignancies [Figure 1]. Integrin expression in lung carcinoma can be imaged by Ga-68-RGD which targets the αvβ3 integrin [3] as represented by maximum intensity projection (MIP) positron emission tomography image [Figure 1]a of a patient diagnosed to have squamous cell lung carcinoma, showing intense uptake of Ga-68-DOTA-RGD2 (SUVmax 7.8) in the left hemithorax corresponding to a heterogeneously enhancing pleural based soft-tissue mass on the transaxial images [Figure 1]b and [Figure 1]c in left lung with involvement of adjacent rib. Note is also made of mild tracer uptake in the left lower paratracheal and sub-cranial lymph nodes. Ga-68 RGD uptake correlates with the degree of angiogenesis, and therefore it may be a useful marker for identifying metastatic mediastinal lymph nodes in comparison to F-18 FDG. The identification of mediastinal lymph nodes noninvasively would guide mediastinoscopy in countries with an epidemic of infectious disease like tuberculosis. The Ga-68-NOTA-RGD was initially used in breast cancer [4] depicting the variability in integrin (αvβ3) expression with respect to estrogen dependent and independent tumors which can be further extended to other cancers like lung carcinoma.{Figure 1}

Glucagon-like peptide-1 receptor (GLP-1R) imaging using Ga-68-DOTA-Exendin-4 is a novel receptor-targeted imaging technique for benign insulinomas, but GLP-1R is also overexpressed in pancreatic neuroendocrine tumors [5] The MIP and transaxial images [Figure 1]d,[Figure 1]e,[Figure 1]f show uptake of Ga-68-DOTA-Exendin-4 (SUVmax 5.8) in a G1 neuroendocrine tumour (Ki index <2%) of the pancreas with metastasis to liver and left supraclavicular lymph node.

Prostate-specific membrane antigen (PSMA) expression is noted in solid malignancies other than prostate, namely, melanoma, NET, breast, and colon cancer.[6] PSMA expression in the cells of neovasculature is well documented and have been depicted on thyroid adenomas.[7] [Figure 1]g,[Figure 1]h,[Figure 1]i shows intense tracer uptake of 68Ga labeled HBED-CC-PSMA in the right tracheoesophageal groove (SUVmax 11.2) in a post total thyroidectomy patient of thyroglobulin elevated negative iodine scan differentiated thyroid carcinoma representing local recurrence in the neck, potentially opening the role for Lu-177 based PSMA therapy.

The chemokine receptors CXCR4 are expressed in either nucleus or cytoplasm and play a noticeable role in metastasis serves to predict poor survival.[8]68Ga-CPCR4 trifluoroacetate, a cyclic pentapeptide targeting the CXCR4 receptor, shows abnormal foci of tracer uptake in multiple ribs, cervico dorso lumbar vertebra (D9; SUVmax 22.42), sternum and multiple sites in the pelvis [Figure 1]j,[Figure 1]l. The targeted receptor may potentially serve as sites of the therapeutic target which may be further useful for assessing response to therapy. Thus, diverse Ga-68 labeled radiopharmaceuticals can be used to target-specific receptor sites leading to better identification and characterization of tumors.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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