Radionuclide Cisternography with [⁶⁴Cu]Cu-DOTA

Area of Science:

• Nuclear Medicine
• Radiopharmaceutical Development
• Diagnostic Imaging

Background:

• Radionuclide cisternography (RNC) is used for imaging the cerebrospinal system and detecting cerebrospinal fluid (CSF) leaks.
• Conventional RNC utilizes agents for single-photon emission tomography (SPECT), which have limitations in image resolution and can yield false-negative results.
• Existing imaging methods like CT and MRI often require contrast agents with higher risks of adverse events.

Purpose of the Study:

• To investigate [64Cu]Cu-DOTA as a novel radiopharmaceutical for RNC, utilizing positron emission tomography (PET) for enhanced imaging.
• To compare the diagnostic efficacy of [64Cu]Cu-DOTA PET RNC against the established agent [111In]In-DTPA SPECT RNC in a patient with a suspected CSF leak.

Main Methods:

• A GMP-compliant formulation of [64Cu]Cu-DOTA was prepared for intrathecal administration.
• The study involved administering [64Cu]Cu-DOTA for PET RNC in a patient.
• The results were compared with those obtained using [111In]In-DTPA for scintigraphic RNC in the same patient.

Main Results:

• While [111In]In-DTPA SPECT RNC failed to detect any CSF leak, [64Cu]Cu-DOTA PET RNC successfully identified a posterolateral leak between vertebral bodies C1 and C2.
• In this specific case, PET RNC with [64Cu]Cu-DOTA demonstrated superior diagnostic performance over [111In]In-DTPA RNC.
• The radiopharmaceutical [64Cu]Cu-DOTA met the stringent requirements for intrathecal application.

Conclusions:

• PET RNC using [64Cu]Cu-DOTA represents a significant advancement over traditional SPECT-based RNC methods for diagnosing CSF leaks.
• The high resolution and sensitivity of PET imaging with [64Cu]Cu-DOTA offer improved diagnostic accuracy, potentially reducing false-negative outcomes.
• [64Cu]Cu-DOTA PET RNC is a promising, safer alternative to conventional scintigraphy and contrast-enhanced CT/MRI, due to the favorable safety profile of radiopharmaceuticals.