Gadoxetic acid, a common name for the Gd(III) complex of the ligand EOB-DTPA1, is a frequently used contrast agent in hepatobiliary magnetic resonance imaging (MRI).2,3 Due to its specific uptake by liver hepatocytes and high percentage of hepatobiliary excretion it enables the localization of focal lesions and hepatic tumors.2-5 However, certain limitations of the MRI technique (e.g., toxicity of the contrast agents, limited applicability in patients with claustrophobia or metal implants) call for an alternative diagnostic tool.
Positron emission tomography (PET) is a molecular imaging method, wherein a small amount of a radioactive substance (tracer) is administered, upon which its distribution in the body is recorded by a PET scanner.6 PET is a dynamic method that allows for high spatial and temporal resolution of images as well as quantification of the results, without having to deal with the side-effects of MRI contrast agents. The informative value of the obtained metabolic information can be further increased by combination with anatomical data received from additional imaging methods, as most commonly achieved by hybrid imaging with computed tomography (CT) in PET/CT scanners.
The chemical structure of a tracer suitable for PET must include a radioactive isotope serving as positron emitter. Positrons have a short life-span since they almost immediately annihilate with electrons of the atom shells of surrounding tissue. By annihilation two 511 keV gamma photons with opposite direction of movement are emitted, which are recorded by the PET scanner.7,8 To form a tracer, PET nuclides may be bound covalently to a molecule, as is the case in 2-deoxy-2-[18F]fluoroglucose (FDG), the most extensively used PET tracer.7 However, a nuclide may also form coordinative bonds to one or several ligands (e.g., [68Ga]-DOTATOC9,10) or be applied as dissolved inorganic salts (e.g., [18F] sodium fluoride11). Altogether, the structure of the tracer is crucial as it determines its biodistribution, metabolism and excretion behavior.
A suitable PET nuclide should combine favorable characteristics like convenient positron energy and availability as well as a half-life adequate for the intended investigation. The 68Ga nuclide has become an essential force in the field of PET over the last two decades.12,13 This is mainly due to its availability through a generator system, which allows on-site labeling independently from the vicinity of a cyclotron. In a generator, the mother nuclide 68Ge is absorbed on a column from which the daughter nuclide 68Ga is eluted and subsequently labeled to a suitable chelator.6,14 Since the 68Ga nuclide exists as a trivalent cation just like Gd(III)10,13, chelating EOB-DTPA with 68Ga instead would yield a complex with the same overall negative charge as gadoxetic acid. Accordingly, that 68Ga tracer might combine a similar characteristic liver specificity with the suitability for PET imaging. Although gadoxetic acid is purchased and administered as disodium salt, in the following context we will refer to it as Gd[EOB-DTPA] and to the non-radioactive Ga(III) complex as Ga[EOB-DTPA], or 68Ga[EOB-DTPA] in case of the radiolabeled component for the sake of convenience.
To evaluate their applicability as tracers for PET, radioactive metal complexes need to be examined extensively in in vitro, in vivo or ex vivo experiments first. To determine the suitability for a respective medical problem, various tracer characteristics like biodistribution behavior and clearance profile, stability, organ specificity and cell or tissue uptake need to be investigated. Due to their non-invasive character, in vitro determinations are often performed prior to in vivo experiments. It is generally acknowledged that DTPA and its derivatives are of limited suitability as chelators for 68Ga due to these complexes lacking kinetic inertness, resulting in comparably fast decomposition when administered in vivo.14-20 This is primarily caused by apo-transferrin acting as a competitor for 68Ga in plasma. Nevertheless, we investigated this new tracer concerning its possible application in hepatobiliary imaging, wherein diagnostic information may be provided within minutes post-injection3,4,21-23, thereby not necessarily requiring long-term tracer stability. For this purpose we isolated EOB-DTPA from gadoxetic acid and initially performed the complexation with natural Ga(III), which exists as mixture of two stable isotopes, 69Ga and 71Ga. The complex thus obtained served as non-radioactive standard for the following chelation of 68Ga. We used established methods and simultaneously evaluated their suitability for determining the 68Galabeling efficiency of EOB-DTPA and to investigate the lipophilicity of the new 68Ga tracer and its stability in different media.