Cerenkov Luminescence Imaging in Prostate Cancer: Not the Only Light That Shines

Abstract

Introduction. Cerenkov luminescence imaging (CLI) is a novel imaging technology that might have the ability to assess surgical margins intra-operatively during prostatectomy using Gallium-68 prostate-specific membrane antigen ([ 68 Ga]Ga-PSMA-11). This study evaluates the accuracy of CLI compared to histopathology and as exploratory objective investigates the characteristics of the identified chemiluminescence signal.Materials and Methods. After intravenous injection of a mean 68 Ga-PSMA-11 activity of 69MBq intraoperatively, all excised specimens were imaged with CLI. Areas of increased signal were marked for histopathological comparison and scored for likelihood of being a positive surgical margin (PSM) using a 5-point Likert scale. In addition, the chemiluminescence signal was investigated in three radioactive and three non-radioactive specimens using CLI.Results. In 15 patients, the agreement between CLI and histopathology was 60%; this improved to 83% when including close surgical margins (≤1mm). In six hotspots, CLI correctly identified PSMs on histopathology, located at the apex and mid-prostate. In all 15 patients an increased signal at the prostate base was observed, without the presence of the primary tumor in this area in eight patients. This chemiluminescence signal was also observed in non-radioactive prostate specimens, with a half-life of 48±11min. The chemiluminescence hampered the visual interpretation of four PSMs at the base. Conclusion.CLI is able to correctly identify margin status, including close margins, in 83% of the cases. The presence of a diathermy-induced chemiluminescent signal hampered image interpretation, especially at the base of the prostate. In the current form, CLI is most applicable to detect PSMs and close margins in the apex and midprostate.

Imaging of bacterial infection: Harnessing positron emission tomography and Cherenkov luminescence imaging with UBI‐derived octapeptide

“…Moreover, CLI holds the potential for managing infections as well. Previous studies have examined the use of fluorine‐18 ( 18 F) in the form of [ 18 F]FDG for CLI (Olde Heuvel et al, 2019, 2022). Based on our observations, CLI in animal models provided clear visualization of infection foci in the dorsal images at the site of infection.…”

Molecularly generated light and its biomedical applications

“…Heuvel reported that, with 68 Ga-prostate-specific membrane antigen ( 68 Ga-PSMA-11), CeLI could be used to assess surgical margins intraoperatively during prostatectomy. [73] In addition, beyond radioactive isotopes, therapeutic electron beams also produce Cerenkov luminescence and can be used for in vivo CeLI imaging. [74] Recently, Jia et al demonstrated that high-resolution optical luminescence sensing could be achieved during a standard dynamic treatment plan for a whole breast radiotherapy geometry.…”

“…Moreover, studies indicated that CeLI could be used to guide surgeries. Heuvel reported that, with 68 Ga‐prostate‐specific membrane antigen ( 68 Ga‐PSMA‐11), CeLI could be used to assess surgical margins intraoperatively during prostatectomy [73] . In addition, beyond radioactive isotopes, therapeutic electron beams also produce Cerenkov luminescence and can be used for in vivo CeLI imaging [74] .…”

PET/Fluorescence Imaging: An Overview of the Chemical Strategies to Build Dual Imaging Tools

“…On the other hand, CLI is made possible by the fact that a significant fraction of the β + particles emitted by positron emitters have an energy (Table ) above the Cerenkov threshold in tissue (219 keV) and therefore are able to produce a detectable amount of Cerenkov radiation. This is why radiotracers labeled with fluorine-18 or carbon-11 like [ 18 F]­FDG, − [ 18 F]­FET, [ 18 F]­FLT, [ 11 C]­choline, or peptides, proteins, antibodies, and nanovectors labeled with iodine-124 − or radiometals (copper-64, , gallium-68, − zirconium-89 − ) have been used for bimodal PET/FLI. Even if several preclinical proofs of concept have been established today, CLI suffers of several weaknesses.…”