This report describes a multimodal whole-body 3'-deoxy-3'[(18)F]-fluorothymidine positron emission tomography (FLT-PET) and dual-energy computed tomography (DECT) method to identify leukemia distribution within the bone marrow environment (BME) and to develop disease- and/or BME-specific radiation strategies. A control participant and a newly diagnosed patient with acute myeloid leukemia prior to induction chemotherapy were scanned with FLT-PET and DECT. The red marrow (RM) and yellow marrow (YM) of the BME were segmented from DECT using a basis material decomposition method. Functional total marrow irradiation (fTMI) treatment planning simulations were performed combining FLT-PET and DECT imaging to differentially target irradiation to the leukemia niche and the rest of the skeleton. Leukemia colonized both RM and YM regions, adheres to the cortical bone in the spine, and has enhanced activity in the proximal/distal femur, suggesting a potential association of leukemia with the BME. The planning target volume was reduced significantly in fTMI compared with conventional TMI. The dose to active disease (standardized uptake value >4) was increased by 2-fold, while maintaining doses to critical organs similar to those in conventional TMI. In conclusion, a hybrid system of functional-anatomical-physiological imaging can identify the spatial distribution of leukemia and will be useful to both help understand the leukemia niche and develop targeted radiation strategies.

中文翻译：

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基于FLT-PET和双能CT的白血病全身分布和功能性全辐射。

本报告介绍了一种多峰全身3'-脱氧-3'[（18）F]-氟胸苷正电子发射断层显像（FLT-PET）和双能计算机断层显像（DECT）方法，以鉴定白血病在骨髓环境中的分布（BME），并制定针对疾病和/或BME的放射策略。用FLT-PET和DECT对对照组和一名新诊断的急性髓性白血病患者进行诱导化疗。使用基础材料分解方法从DECT中分离出BME的红色骨髓（RM）和黄色骨髓（YM）。功能性全骨髓照射（fTMI）治疗计划模拟是结合FLT-PET和DECT成像进行的，以差异化地针对白血病小生境和骨骼的其余部位进行照射。白血病在RM和YM地区都定居，黏附在脊柱的皮质骨上，并在股骨近端/远端具有增强的活性，表明白血病与BME可能存在关联。与传统的TMI相比，fTMI中的计划目标量显着减少。活动性疾病的剂量（标准摄取值> 4）增加了2倍，同时维持了对关键器官的剂量，与传统TMI相似。总之，功能-解剖-生理成像的混合系统可以识别白血病的空间分布，对于帮助了解白血病的利基和制定靶向的放射策略将非常有用。与传统的TMI相比，fTMI中的计划目标量显着减少。活动性疾病的剂量（标准摄取值> 4）增加了2倍，同时维持了对关键器官的剂量，与传统TMI相似。总之，功能-解剖-生理成像的混合系统可以识别白血病的空间分布，对于帮助了解白血病的利基和制定靶向的放射策略将非常有用。与传统的TMI相比，fTMI中的计划目标量显着减少。活动性疾病的剂量（标准摄取值> 4）增加了2倍，同时维持了对关键器官的剂量，与传统TMI相似。总之，功能-解剖-生理成像的混合系统可以识别白血病的空间分布，对于帮助了解白血病的利基和制定靶向的放射策略将非常有用。