Simulation studies of a full-ring, CZT SPECT system for whole-body imaging of 99m Tc and 177 Lu.

BACKGROUND: Single photon emission computed tomography (SPECT) is an imaging modality that has demonstrated its utility in a number of clinical indications. Despite this progress, a high sensitivity, high spatial resolution, multi-tracer SPECT with a large field of view suitable for whole-body imaging of a broad range of radiotracers for theranostics is not available. PURPOSE: With the goal of filling this technological gap, we have designed a cadmium zinc telluride (CZT) full-ring SPECT scanner instrumented with a broad-energy tungsten collimator. The final purpose is to provide a multi-tracer solution for brain and whole-body imaging. Our static SPECT does not rely on the dual- and the triple-head rotational SPECT standard paradigm, enabling a larger effective area in each scan to increase the sensitivity. We provide a demonstration of the performance of our design using a realistic model of our detector with simulated body-sized phantoms filled with 99m Tc and 177 Lu. METHODS: We create a realistic model of our detector by using a combination of a Geant4 Application for Tomographic Emission (GATE) Monte Carlo simulation and a finite element model for the CZT response, accounting for low-energy tail effects in CZT that affects the sensitivity and the scatter correction. We implement a modified dual-energy-window scatter correction adapted for CZT. Other corrections for attenuation, detector and collimator response, and detector gaps and edges are also included. The images are reconstructed using the maximum-likelihood expectation-maximization. Detector and reconstruction performance are characterized with point sources, Derenzo phantoms, and a body-sized National Electrical Manufacturers Association (NEMA) Image Quality (IQ) phantom for both 99m Tc and 177 Lu. RESULTS: Our SPECT design can resolve 7.9 mm rods for 99m Tc (140 keV) and 9.5 mm for 177 Lu (208 keV) in a hot-rod Derenzo phantom with a 3-min exposure and reach an image contrast of 78% for 99m Tc and 57% for 177 Lu using the NEMA IQ phantom with a 6-min exposure. Our modified scatter correction shows an improved contrast-recovery ratio compared to a standard correction. CONCLUSIONS: In this paper, we demonstrate the good performance of our design for whole-body imaging purposes. This adds to our previous demonstration of improved qualitative and quantitative 99m Tc imaging of brain perfusion and 123 I imaging of dopamine transport with respect to state-of-the-art NaI dual-head cameras. We show that our design provides similar IQ and contrast to the commercial full-ring SPECT VERITON for 99m Tc. Regarding 177 Lu imaging of the 208 keV emissions, our design provides similar contrast to that of other state-of-the-art SPECTs with a significant reduction in exposure. The high sensitivity and extended energy range up to 250 keV makes our SPECT design a promising alternative for clinical imaging and theranostics of emerging radionuclides.

Radioiodination, purification, and evaluation of antihuman tumor-derived immunoglobulin G light chain monoclonal antibody in tumor-bearing nude mice.

We report the synthesis and biological evaluation of 131 I-labeled antihuman tumor-derived immunoglobulin G (IgG) light chain monoclonal antibody (4E9) ([131 I]I-4E9) as a promising probe for tumor imaging. [131 I]I-4E9 was synthesized in radiochemical yield of 89.9 ± 4.7% with radiochemical purity of more than 99%. [131 I]I-4E9 showed high stability in normal saline and human serum. In cell uptake studies, [131 I]I-4E9 exhibited favorable binding affinity and high specificity in HeLa MR cells. In biodistribution studies, [131 I]I-4E9 showed high tumor uptake, high tumor/non-tumor ratios, and specific binding in BALB/c nu/nu mice bearing human HeLa MR xenografts. Single-photon emission computerized tomography (SPECT) imaging of [131 I]I-4E9 in the HeLa MR xenograft model demonstrated clear visualization of tumor after 48 h and confirmed specific binding in tumor. These findings suggest that [131 I]I-4E9 possesses favorable biological characteristics and warrants further investigation as a prospective probe for imaging and treatment of cancers.

Characterization of a Pixelated Cadmium Telluride Detector System Using a Polychromatic X-Ray Source and Gold Nanoparticle-Loaded Phantoms for Benchtop X-Ray Fluorescence Imaging.

Pixelated semi-conductor detectors providing high energy resolution enable parallel acquisition of x-ray fluorescence (XRF) signals, potentially leading to performance enhancement of benchtop XRF imaging or computed tomography (XFCT) systems utilizing ordinary polychromatic x-ray sources. However, little is currently known about the characteristics of such detectors under typical operating conditions of benchtop XRF imaging/XFCT. In this work, a commercially available pixelated cadmium telluride (CdTe) detector system, HEXITEC (High Energy X-ray Imaging Technology), was characterized to address this issue. Specifically, HEXITEC was deployed into our benchtop cone-beam XFCT system, and used to detect gold Kα XRF photons from gold nanoparticle (GNP)-loaded phantoms. To facilitate the detection of XRF photons, various parallel-hole stainless steel collimators were fabricated and coupled with HEXITEC. A pixel-by-pixel spectrum merging algorithm was introduced to obtain well-defined XRF + scatter spectra with parallel-hole collimators. The effect of charge sharing addition (CSA) and discrimination (CSD) algorithms was also investigated for pixel-level CS correction. Finally, the detector energy resolution, in terms of the full-width at half-maximum (FWHM) values at two gold Kα XRF peaks (~68 keV), was also determined. Under the current experimental conditions, CSD provided the best energy resolution of HEXITEC (~1.05 keV FWHM), compared with CSA and no CS correction. This FWHM value was larger (by up to ~0.35 keV) than those reported previously for HEXITEC (at ~60 keV Am-241 peak) and single-crystal CdTe detectors (at two gold Kα XRF peaks). This investigation highlighted characteristics of HEXITEC as well as the necessity for application-specific detector characterization.

Impact of selenium addition to the cadmium-zinc-telluride matrix for producing high energy resolution X-and gamma-ray detectors.

Both material quality and detector performance have been steadily improving over the past few years for the leading room temperature radiation detector material cadmium-zinc-telluride (CdZnTe). However, although tremendous progress being made, CdZnTe still suffers from high concentrations of performance-limiting defects, such as Te inclusions, networks of sub-grain boundaries and compositional inhomogeneity due to the higher segregation coefficient of Zn. Adding as low as 2% (atomic) Se into CdZnTe matrix was found to successfully mitigate many performance-limiting defects and provide improved compositional homogeneity. Here we report record-high performance of Virtual Frisch Grid (VFG) detector fabricated from as-grown Cd0.9Zn0.1Te0.98Se0.02 ingot grown by the Traveling Heater Method (THM). Benefiting from superior material quality, we achieved superb energy resolution of 0.77% at 662 keV (as-measured without charge-loss correction algorithms) registered at room temperature. The absence of residual thermal stress in the detector was revealed from white beam X-ray topographic images, which was also confirmed by Infra-Red (IR) transmission imaging under cross polarizers. Furthermore, neither sub-grain boundaries nor their networks were observed from the X-ray topographic image. However, large concentrations of extrinsic impurities were revealed in as-grown materials, suggesting a high likelihood for further reduction in the energy resolution after improved purification of the starting material.

Noninvasive evaluation of tumor immune microenvironment in patients with clear cell renal cell carcinoma using metabolic parameter from preoperative 2-[18F]FDG PET/CT.

PURPOSE: Nowadays, it is necessary to explore effective biomarkers associated with tumor immune microenvironment (TIME) noninvasively. Here, we investigated whether the metabolic parameter from preoperative 2-[18F]FDG PET/CT could provide information related to TIME in patients with clear cell renal cell carcinoma (ccRCC). METHODS: Ninety patients with newly diagnosed ccRCC who underwent 2-[18F]FDG PET/CT prior to surgery were retrospectively reviewed. The immunological features included tumor-infiltrating lymphocytes (TILs) density, programmed death-ligand 1 (PD-L1) expression, and tumor immune microenvironment types (TIMTs). TIMTs were classified as TIMT I (positive PD-L1 and high TILs), TIMT II (negative PD-L1 and low TILs), TIMT III (positive PD-L1 and low TILs), and TIMT IV (negative PD-L1 and high TILs). The relationship between maximum standardized uptake value (SUVmax) in the primary lesion from 2-[18F]FDG PET/CT and immunological features was analyzed. Cox proportional hazards analyses were performed to identify the prognostic factors for disease-free survival (DFS) after nephrectomy. RESULTS: Tumors with high TILs infiltration showed remarkable correlation with elevated SUVmax and aggressive clinicopathological characteristics, such as high World Health Organization/International Society of Urological Pathology (WHO/ISUP) grade. PD-L1 expression on tumor cells was positively associated with WHO/ISUP grade and negatively correlated with body mass index (BMI). However, no correlation was observed between SUVmax and PD-L1 expression, regardless of its spatial tissue distribution. SUVmax of TIMT I and IV was higher than that of TIMT II, but there was remarkable difference merely between TIMT II and IV. In multivariate analysis, SUVmax (P = 0.022, HR 3.120, 95% CI 1.175-8.284) and WHO/ISUP grade (P = 0.046, HR 2.613, 95% CI 1.017-6.710) were the significant prognostic factors for DFS. Six cases (16.2%) with normal SUVmax showed disease progression, while 25 cases (71.4%) with elevated SUVmax experienced disease progression. Conversely, the immunological features held no prognostic value. CONCLUSIONS: Our findings demonstrated that 2-[18F]FDG PET/CT could provide metabolic information of TIME for ccRCC patients and develop image-guided therapeutic strategies accordingly. Patients with elevated preoperative SUVmax should be seriously considered, and perioperative immunotherapy might be beneficial for them.

Evaluation of a variable-aperture full-ring SPECT system using large-area pixelated CZT modules: A simulation study for brain SPECT applications.

PURPOSE: Single photon emission computed tomography (SPECT) scanners using cadmium zinc telluride (CZT) offer compact, lightweight, and improved imaging capability over conventional NaI(Tl)-based SPECT scanners. The main purpose in this study is to propose a full-ring SPECT system design with eight large-area CZT detectors that can be used for a broad spectrum of SPECT radiopharmaceuticals and demonstrate the performance of our system in comparison to the reference conventional NaI(Tl)-based two-head Anger cameras. METHODS: A newly designed full-ring SPECT system is composed of eight large-area CZT cameras (128 mm × 179.2 mm effective area) that can be independently swiveled around their own axes of rotation independently and can have radial motion for varying aperture sizes that can be adapted to different sizes of imaging volume. Extended projection data were generated by conjoining projections of two adjacent detectors to overcome the limited field-of-view (FOV) by each CZT camera. Using Monte Carlo simulations, we evaluated this new system design with digital phantoms including a Derenzo hot rod phantom and a Zubal brain phantom. Comparison of performance metrics such as spatial resolution, sensitivity, contrast-to-noise ratio (CNR), and contrast-recovery ratio was made between our design and conventional SPECT scanners having different pixel sizes and radii of rotation (one clinically well-known type and two arbitrary types matched to our proposed CZT-SPECT geometries). RESULTS: The proposed scanner could result in up to about three times faster in acquisition time over conventional scan time at same acquisition time per step. The spatial resolution improvement, or deterioration, of our proposed scanner compared to the clinical-type scanner was dependent upon the location of the point source. However, there were overall performance improvements over the three different setups of the conventional scanner particularly in volume sensitivity (approximately up to 1.7 times). Overall, we successfully reconstructed the phantom image for both 99m Tc-based perfusion and 123 I-based dopamine transporter (DaT) brain studies simulated for our new design. In particular, the striatal/background contrast-recovery ratio in 3-to-1 reference ratio was over 0.8 for the 123 I-based DaT study. CONCLUSIONS: We proposed a variable-aperture full-ring SPECT system using combined pixelated CZT and energy-optimized parallel-hole collimator modules and evaluated the performance of this scanner using relevant digital phantoms and MC simulations. Our studies demonstrated the potential of our new full-ring CZT-SPECT design, showing reduced acquisition time and improved sensitivity with acceptable CNR and spatial resolution.

2-[18F]FDG PET/CT parameters associated with WHO/ISUP grade in clear cell renal cell carcinoma.

PURPOSE: To explore the potential parameters from preoperative 2-[18F]FDG PET/CT that might associate with the World Health Organization/the International Society of Urological Pathology (WHO/ISUP) grade in clear cell renal cell carcinoma (ccRCC). METHODS: One hundred twenty-five patients with newly diagnosed ccRCC who underwent 2-[18F]FDG PET/CT prior to surgery or biopsy were retrospectively reviewed. The metabolic parameters and imaging features obtained from 2-[18F]FDG PET/CT examinations were analyzed in combination with clinical characteristics. Univariate and multivariate logistic regression analyses were performed to identify the predictive factors of WHO/ISUP grade. RESULTS: Metabolic parameters of primary tumor maximum standardized uptake value (SUVmax), tumor-to-liver SUV ratio (TLR), and tumor-to-kidney SUV ratio (TKR) were significantly different between any two of the four different WHO/ISUP grades, except those between the WHO/ISUP grade 3 and grade 4. The optimal cutoff values to predict high WHO/ISUP grade for SUVmax, TLR, and TKR were 4.15, 1.63, and 1.59, respectively. TLR (AUC: 0.841) was superior to TKR (AUC: 0.810) in distinguishing high and low WHO/ISUP grades (P = 0.0042). In univariate analysis, SUVmax, TLR, TKR, primary tumor size, tumor thrombus, distant metastases, and clinical symptoms could discriminate between the high and low WHO/ISUP grades (P < 0.05). In multivariate analysis, TLR (P < 0.001; OR: 1.732; 95%CI: 1.289-2.328) and tumor thrombus (P < 0.001; OR: 6.199; 95%CI: 2.499-15.375) were significant factors for differentiating WHO/ISUP grades. CONCLUSION: Elevated TLR (> 1.63) and presence of tumor thrombus from preoperative 2-[18F]FDG PET/CT can distinguish high WHO/ISUP grade ccRCC effectively. 2-[18F]FDG PET/CT may be a feasible method for noninvasive assessment of WHO/ISUP grade.

Theranostic supramolecular polymers formed by the self-assembly of a metal-chelating prodrug.

Therapeutic constructs with imaging modalities hold great promise for improving the treatment efficacy for cancer and many other diseases. We report here the design and synthesis of a self-assembling prodrug (SAPD) by the direct linkage of camptothecin (CPT), an anticancer drug, to a metal-chelating agent, DOTA. We found that under physiological conditions the DOTA-conjugated CPT prodrug can self-assemble into tubular supramolecular polymers (SPs) with a length of several micrometers. Our studies also suggest that the resultant assemblies were stable in biological environments and exhibited a fast drug release rate in the presence of intracellular glutathione. Furthermore, the SAPD exhibited remarkable in vitro efficacy against various cancer cell lines and effectively inhibited the growth of tumor spheroids. We believe that the design and optimization of self-assembling theranostic conjugates could provide a robust yet simple platform for the development of new imaging-guided drug delivery systems.

Elevated tumor-to-liver standardized uptake value ratio (TLR) from preoperative 18F-FDG PET/CT predicts poor prognosis of patients with clear cell renal cell carcinoma after nephrectomy.

AIM: To assess the potential of using preoperative 18F-FDG PET/CT to predict the prognosis of patients with clear cell renal cell carcinoma (ccRCC) after nephrectomy. METHODS: Sixty-nine patients with newly diagnosed ccRCC who underwent 18F-FDG PET/CT prior to surgery were retrospectively reviewed. The metabolic parameters of maximum standardized uptake value (SUVmax) and tumor-to-liver ratio (TLR) from 18F-FDG PET/CT were obtained. Clinicopathological characteristics, including the World Health Organization/the International Society of Urological Pathology (WHO/ISUP) grade, pathological tumor node metastasis (pTNM) stage, venous tumor thrombus, and so on, were acquired. Univariate and multivariate Cox proportional hazards analyses were performed to identify the prognostic factors for disease-free survival (DFS). RESULTS: Of the 69 patients, 25 patients (36.2%) experienced disease progression during the follow-up period. In univariate analysis, the primary tumor size (>4.85 cm), pTNM stage (Ⅲ/Ⅳ), WHO/ISUP grade (G3/4), venous tumor thrombus, adjuvant therapy, SUVmax (>3.55), and TLR (>1.66) were found to correlate with the incidence of decreased DFS (P < 0.05). In multivariate analysis, TLR (P = 0.007, HR: 5.489, 95%CI: 1.605-18.774) and pTNM stage (P = 0.024, HR: 10.385, 95%CI: 1.361-79.238) were revealed to serve as independent prognostic predictors for DFS after adjustment for other variables. Only 3 cases (8.3%) with normal TLR showed disease progression, while 22 cases (66.7%) with elevated TLR experienced disease progression. CONCLUSION: ccRCC patients with preoperatively elevated TLR (>1.66) and high pTNM stages (Ⅲ/Ⅳ) had significantly unfavorable survival outcomes. These patients should be carefully monitored to detect the possibility of disease progression after nephrectomy as early as possible.

Primary metabolic tumor volume from 18F-FDG PET/CT associated with epidermal growth factor receptor mutation in lung adenocarcinoma patients.

PURPOSE: To explore the potential parameters from F-FDG PET/CT that might be associated with the epidermal growth factor receptor (EGFR) gene mutation status in lung adenocarcinoma (ADC) patients. METHODS: Data of the test cohort of 191 patients and the validation cohort of 55 patients with newly diagnosed ADC were retrospectively reviewed. All patients underwent F-FDG PET/CT scans and EGFR mutation tests prior to treatment. The metabolic parameters obtained from F-FDG PET/CT combining with clinical characteristics were analyzed by using univariate and multivariate logistic regression analyses. Then two cohorts were enrolled to validate the predictive model by area under the receiver-operating characteristic curve (AUC), respectively. RESULTS: EGFR mutation-positive was seen of 33.0% (63/191) and 32.7% (18/55) in two cohorts, respectively. In univariate analysis, female, nonsmokers, metabolic parameters of primary tumor [mean standardized uptake value, metabolic tumor volume (pMTV), and total lesion glycolysis], non-necrosis of primary tumor, and serum tumor markers [carbohydrate antigen 19-9, squamous cell carcinoma antigen, and precursor of gastrin releasing peptide (proGRP)] were significantly relevant with EGFR mutation. In multivariate analysis with adjustment of age and TNM stage, pMTV (<8.13 cm), proGRP (≥38.44 pg/ml) and women were independent significant predictors for EGFR mutation. The AUC for the predictive value of these factors was 0.739 [95% confidence interval (CI) 0.665-0.813] in the cohort of 191 patients and 0.716 (95% CI 0.567-0.865) in the cohort of 55 patients, respectively. CONCLUSION: Low pMTV (<8.13 cm) was an independent predictor and could be integrated with women and high proGRP (≥38.44 pg/ml) to enhance the discriminability on the EGFR mutation status in ADC patients.

Evaluation of CdZnTeSe as a high-quality gamma-ray spectroscopic material with better compositional homogeneity and reduced defects.

X- and gamma-ray detectors have broad applications ranging from medical imaging to security, non-proliferation, high-energy physics and astrophysics. Detectors with high energy resolution, e.g. less than 1.5% resolution at 662 keV at room temperature, are critically important in most uses. The efficacy of adding selenium to the cadmium zinc telluride (CdZnTe) matrix for radiation detector applications has been studied. In this paper, the growth of a new quaternary compound Cd0.9Zn0.1Te0.98Se0.02 by the Traveling Heater Method (THM) is reported. The crystals possess a very high compositional homogeneity with less extended defects, such as secondary phases and sub-grain boundary networks. Virtual Frisch-grid detectors fabricated from as-grown ingots revealed ~0.87-1.5% energy resolution for 662-keV gamma rays. The superior material quality with a very low density of defects and very high compositional homogeneity heightens the likelihood that Cd0.9Zn0.1Te0.98Se0.02 will be the next generation room-temperature detector material.

Peptide-based nanoprobes for molecular imaging and disease diagnostics.

Pathological changes in a diseased site are often accompanied by abnormal activities of various biomolecules in and around the involved cells. Identifying the location and expression levels of these biomolecules could enable early-stage diagnosis of the related disease, the design of an appropriate treatment strategy, and the accurate assessment of the treatment outcomes. Over the past two decades, a great diversity of peptide-based nanoprobes (PBNs) have been developed, aiming to improve the in vitro and in vivo performances of water-soluble molecular probes through engineering of their primary chemical structures as well as the physicochemical properties of their resultant assemblies. In this review, we introduce strategies and approaches adopted for the identification of functional peptides in the context of molecular imaging and disease diagnostics, and then focus our discussion on the design and construction of PBNs capable of navigating through physiological barriers for targeted delivery and improved specificity and sensitivity in recognizing target biomolecules. We highlight the biological and structural roles that low-molecular-weight peptides play in PBN design and provide our perspectives on the future development of PBNs for clinical translation.

[Metabolic activity measured by ¹8F-FDG PET/CT in newly diagnosed patients with non-Hodgkin lymphoma: correlation with immunophenotype].

OBJECTIVE: To compare the metabolic activity by ¹8F-fluorodeoxyglucose (¹8F-FDG) uptake across the various histologic subtypes of non-Hodgkin lymphoma (NHL) and to investigate the relationship between metabolic activity and immunophenotype. METHODS: Positron emission tomography/computed tomography (PET/CT) studies of patients with newly diagnosed NHL from Jul 2010 to Mar 2012 were retrospectively reviewed, 82 patients were enrolled in our study according to the inclusion and exclusion criteria. The maximum standardized uptake value (SUVmax) of each patient reflecting the metabolic activity was recorded. Mean SUVmax of aggressive B-cell NHL, indolent B-cell NHL and T-cell NHL were compared. Pearson and Spearman test were used to analyze the relationship between SUVmax and immunophenotype. RESULTS: The SUVmax of various subtypes of lymphoma revealed a wide range from 0.9 to 40.3, but lesions of 79 patients in this study showed obviously FDG uptake. SUVmax of indolent B-cell NHL (4.5 ± 2.4) was significantly lower than that of aggressive B-cell NHL (13.1 ± 7.6) (P = 0.000), T-cell NHL (8.0 ± 3.8) (P = 0.03). SUVmax of aggressive B-cell NHL was significantly higher than that of indolent B-cell NHL, T-cell NHL (P = 0.000, P = 0.005). SUVmax of B-cell NHL had positive correlation with Ki-67 expression (r = 0.493, P = 0.001) and negative correlation with CD138 (r = -0.654, P = 0.008). While SUVmax of T-cell NHL had no correlation with Ki-67 expression (P = 0.213), but had negative correlation with CD56 (r = -0.545, P = 0.044). CONCLUSIONS: Different subtype of NHL manifests markedly different intensity of FDG uptake, but most lesions of lymphoma are FDG avid. Metabolic activity is lower in indolent B-cell NHL than in aggressive B-cell NHL and T-cell lymphoma, which is concordant with its aggressiveness. SUVmax of B-cell NHL correlates with expression of Ki-67 and CD138. SUVmax of T-cell NHL is associated with the expression of CD56, no correlation is detected between SUVmax of T-cell NHL and Ki-67 proliferation.

Detection and localization of carcinoma within the prostate using high resolution transrectal gamma imaging (TRGI) of monoclonal antibody directed at prostate specific membrane antigen (PSMA)--proof of concept and initial imaging results.

PURPOSE: Molecular imaging methods may identify primary prostate cancer foci and potentially guide biopsy and optimal management approaches. In this exploratory study, safety and first human imaging experience of a novel solid state endocavity transrectal gamma-imaging (TRGI) device was evaluated. METHODS: Twelve patients received 5 ± 0.5 mCi In-111 capromab pendetide (ProstaScint) intravenously and the prostate of each was imaged 4 days later transrectally using an endoluminal cadmium zinc telluride (CZT)-based compact gamma camera (ProxiScan™, Hybridyne Imaging Technologies, Inc.). Immediate and 5-7-day post imaging safety assessments were performed. In those patients with a prostate cancer diagnosis (N=10), single photon emission computed tomography (SPECT-CT) and magnetic resonance imaging (MRI) of the pelvis were also acquired. Images were reviewed and sites of suspected cancer were localized by prostate quadrant by consensus of two nuclear medicine physicians. Pathology from TRUS biopsy, or surgical pathology following prostatectomy (N=3) when available, served as the gold standard. RESULTS: There were no serious adverse events associated with TRGI. No focal signal was detected in patients without a diagnosis of prostate cancer (N=2). Of 40 quadrants evaluated in the cancer cohort (N=10), 22 contained malignancy. In 8 of these 10 patients, the most focal site of uptake on TRGI corresponded to a prostatic quadrant with biopsy-proven malignancy. In 6 cancer-containing quadrants, TRGI was positive where SPECT-CT was negative; MRI showed a detectable abnormality in only 1 of these 6 quadrants. Qualitative image review of the planar TRGI images for prostate cancer localization was severely limited in some cases by scatter artifact within the vicinity of the prostate gland arising from physiologic urine and blood pool activity from nearby structures. CONCLUSIONS: TRGI is a safe imaging method that can potentially detect radiopharmaceutical uptake of primary prostate cancer and facilitate prostatic quadrant - localization of cancer. Further investigation of this technology is warranted.