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Research ArticleTheranostics

Can 177Lu-DOTATATE Kidney Absorbed Doses be Predicted from Pretherapy SSTR PET? Findings from Multicenter Data

Azadeh Akhavanallaf, Zhonglin Lu, Avery B. Peterson, Johan Blakkisrud, Sara Kurkowska, Surekha Yadav, Chang Wang, Carlos Uribe, Caroline Stokke, Arman Rahmim, Ka Kit Wong, Jean-Mathieu Beauregard, Thomas A. Hope, Katarina Sjögreen Gleisner and Yuni K. Dewaraja
Journal of Nuclear Medicine May 2025, jnumed.124.269098; DOI: https://doi.org/10.2967/jnumed.124.269098
Azadeh Akhavanallaf
1Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan;
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Zhonglin Lu
1Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan;
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Avery B. Peterson
1Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan;
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Johan Blakkisrud
2Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway;
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Sara Kurkowska
3Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada;
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Surekha Yadav
4Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
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Chang Wang
5Department of Biostatistics, University of Michigan, Ann Arbor, Michigan;
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Carlos Uribe
3Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada;
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Caroline Stokke
2Department of Physics and Computational Radiology, Oslo University Hospital, Oslo, Norway;
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Arman Rahmim
3Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada;
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Ka Kit Wong
1Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan;
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Jean-Mathieu Beauregard
6Nuclear Medicine, Department of Medical Imaging, CHU de Québec-Université Laval, Quebec City, Quebec, Canada; and
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Thomas A. Hope
4Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, California;
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Katarina Sjögreen Gleisner
7Medical Radiation Physics, Clinical Sciences Lund, Lund University, Lund, Sweden
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Yuni K. Dewaraja
1Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan;
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Abstract

Before performing 177Lu-DOTATATE therapy for neuroendocrine tumors, somatostatin receptor (SSTR) PET imaging is currently used to confirm sufficient tumor SSTR expression, but it also has potential to be used to personalize treatment by predicting absorbed doses to critical organs. This study aims to validate the predictive capability of SSTR PET in anticipating renal absorbed dose in the first cycle of 177Lu-DOTATATE using a multicenter dataset to analyze and derive insights from a broader patient population. Methods: Retrospective data from 5 centers were included in this study: 1 in Canada (n = 25), 1 in Norway (n = 75), 1 in Sweden (n = 18), and 2 in the United States (n = 36 and n = 26). At each center, pretherapy SSTR PET/CT imaging and postcycle 1 177Lu imaging–based dosimetry were performed according to site-specific protocols. The mixed-effects model treating centers as random effects was developed using baseline SSTR PET renal uptake values to predict renal absorbed dose from 177Lu-DOTATATE. Additionally, leave-one-center-out cross-validation and leave-one-sample-out cross-validation were implemented for external and internal validation, respectively, measuring mean absolute error and mean relative absolute error. Results: Across all participating centers, the median cycle 1 renal absorbed dose was 0.56 Gy/GBq (range, 0.14–1.27 Gy/GBq), whereas the median pretherapy SSTR PET renal uptake was 110.7 Bq/mL/MBq (range, 28.6–287.7 Bq/mL/MBq). The differences among center means were statistically significant for both absorbed dose and PET uptake (P < 0.0001 from 1-way ANOVA). A significant (P < 0.05) correlation was observed between kidney SSTR PET uptake and 177Lu-DOTATATE absorbed dose for each center (center-specific coefficient of determination ranged from 0.14 to 0.53). When data across all centers were aggregated, the mixed-effects model achieved a coefficient of determination of 0.25 (P < 0.01), resulting in an mean absolute error of 0.15 Gy/GBq (SD, 0.11 Gy/GBq) and an mean relative absolute error of 28% (SD, 24%) for external validation and 0.12 Gy/GBq (SD, 0.10 Gy/GBq) and 22% (SD, 20%) for internal validation. Conclusion: The correlations observed between SSTR PET renal uptake and 177Lu-DOTATATE absorbed dose to kidneys across a multicenter population are statistically significant yet modest. The prediction model achieved a mean relative absolute error 28% or less for both external and internal validation of PET-predicted absorbed doses. The intercenter differences suggest the need for standardized imaging protocols and dosimetry workflows.

  • SSTR PET/CT
  • 177Lu-DOTATATE PRRT
  • dosimetry
  • absorbed dose prediction

Footnotes

  • ↵* Contributed equally to this work.

  • Published online May 22, 2025.

  • © 2025 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 66 (5)
Journal of Nuclear Medicine
Vol. 66, Issue 5
May 1, 2025
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Can 177Lu-DOTATATE Kidney Absorbed Doses be Predicted from Pretherapy SSTR PET? Findings from Multicenter Data
Azadeh Akhavanallaf, Zhonglin Lu, Avery B. Peterson, Johan Blakkisrud, Sara Kurkowska, Surekha Yadav, Chang Wang, Carlos Uribe, Caroline Stokke, Arman Rahmim, Ka Kit Wong, Jean-Mathieu Beauregard, Thomas A. Hope, Katarina Sjögreen Gleisner, Yuni K. Dewaraja
Journal of Nuclear Medicine May 2025, jnumed.124.269098; DOI: 10.2967/jnumed.124.269098

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Can 177Lu-DOTATATE Kidney Absorbed Doses be Predicted from Pretherapy SSTR PET? Findings from Multicenter Data
Azadeh Akhavanallaf, Zhonglin Lu, Avery B. Peterson, Johan Blakkisrud, Sara Kurkowska, Surekha Yadav, Chang Wang, Carlos Uribe, Caroline Stokke, Arman Rahmim, Ka Kit Wong, Jean-Mathieu Beauregard, Thomas A. Hope, Katarina Sjögreen Gleisner, Yuni K. Dewaraja
Journal of Nuclear Medicine May 2025, jnumed.124.269098; DOI: 10.2967/jnumed.124.269098
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Keywords

  • SSTR PET/CT
  • 177Lu-DOTATATE PRRT
  • dosimetry
  • absorbed dose prediction
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