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- •Contents
- •List of Contributors
- •Foreword
- •Preface
- •Abbreviations
- •1.1 INTRODUCTION
- •1.7 SUMMARY
- •REFERENCES
- •2.1 INTRODUCTION
- •2.2 THERANOSTICS
- •REFERENCES
- •3.1 INTRODUCTION
- •3.3 68Ge/68Ga GENERATORS
- •REFERENCES
- •4.1 INTRODUCTION
- •4.2 TECHNETIUM-99m
- •4.3 IODINE-131
- •4.4 XENON-133
- •4.5 CYCLOTRON-PRODUCED RADIONUCLIDES
- •4.6 THALLIUM-201
- •4.7 GALLIUM-67
- •4.8 INDIUM-111
- •4.9 IODINE-123
- •4.A. APPENDIX
- •REFERENCES
- •5.1 INTRODUCTION
- •5.7 SUMMARY
- •7.1 INTRODUCTION
- •REFERENCES
- •8.1 INTRODUCTION
- •9.1 INTRODUCTION
- •10.2 Cu-MEDIATED RADIOFLUORINATION
- •10.3 Cu-MEDIATED HEAVY HALIDE RADIOHALOGENATION
- •10.4 CONCLUSIONS
- •REFERENCES
- •11.1 INTRODUCTION
- •REFERENCES
- •12.1 INTRODUCTION
- •12.3 MYOCARDIAL IMAGING AGENTS
- •12.5 BRAIN IMAGING AGENTS
- •12.6 RENAL IMAGING AGENTS
- •12.7 BONE IMAGING AGENTS
- •12.9 SENTINEL LYMPH NODE IMAGING AGENTS
- •12.12 CONCLUDING REMARKS
- •13.1 INTRODUCTION
- •13.2 EARLY RADIOCHEMISTRY SYNTHESIS MODULES
- •13.3 MODERN CASSETTE-BASED MODULES
- •13.5 HYBRID MODULES
- •13.6 MICROFLUIDIC SYSTEMS
- •13.8 AUTOMATED QUALITY CONTROL TESTING
- •REFERENCES
- •14.1 OVERVIEW
- •14.4 DRIVERS OF AUTOMATED QC
- •14.5 BARRIERS TO QC AUTOMATION
- •14.6 QC INNOVATION

O
18
F
F
FN
F
F
R
H
18
O
O
N
O
O
18
F
O
O
F
F
18
O
O
N
H
N
O
8.5.2.3 Aryliodonium Salts
Extending functional group tolerance to include precursors not amenable to SNAr has
been a focus of dierent research groups[116, 117]. To this end, diaryliodonium salts have
been investigated heavily in the past 20 years, as these species can be employed for direct
aromatic radiouorination. Diaryliodonium salts are typically designed with an unreactive
aryl auxiliary, and selectivity is generally observed for the most electron-decient aryl
substituent. However, regioselectivity issues can be encountered, and the auxiliary ring
of electron-rich meta -substituted substrates can inadvertently uorinate, decreasing the
reaction eciency[116, 118]. To overcome this, a method using (2-thienyl)aryliodonium
salts has been reported (Scheme8.10)[116]. In this study, electron-rich aryl moieties were
radiouorinated selectively when the corresponding diaryliodonium precursor contained
an electron-rich 2-thienyl group, and this selectivity had previously been unattainable.
However, the true reaction selectivity can be dicult to determine accurately due to the
volatility of 2-uorothiophene. In general, o - and p- substituted substrates can display
good reactivity toward radiouorination, while the functionalization of meta-substituted
substrates is generally low yielding[119]. Electron-decient substrates can be slow to
radiouorinate, although increased yields can be observed if a microreactor is used[118].
Issues of selectivity in unsymmetrical diaryliodonium salts are inuenced by steric congestion around the iodine center, which has been termed the “ortho-eect”[119–123].
Figure 8.3 Exam-
ples of prosthetic
groups prepared
through S
Ar.
N
I
S
K[18F]F, K
2.2.2
R
18
Scheme 8.10 [18F]
F
Fluorination of
2-thienyl iodonium salts.
Recently, a CMRF method was developed to overcome the electronic bias of diaryliodonium salts to favor the less-sterically congested product[124]. Unlike the metal-free
iodonium methods, this procedure gave high conversions with electron-rich substrates.
Diaryliodonium salts have had success in clinical applications to synthesize a number of
PET radiotracers (Figure8.4) including [
18
[
F]4F-MHPG[128, 129], [18F]UCB-H[130], [18F]FIMX[131], an aβ plaque imaging
18
F]uorodopamine[125, 126], [18F]F-DOPA[127],
probe[132], and a novel potent MMP2/MMP9 inhibitor[133]. Furthermore, the radiolabeling of various synthons from diaryliodonium salts has been explored as a way to
enhance the scope of structurally complex available PET radiotracers[134]. Despite these
advantages, synthetic limitations such as precursor and reaction sensitivity to air/moisture and functional group tolerance can limit the application of diaryliodonium salts in
Chapter 08: Fluorine-18 Radiochemistry 265

HO
HO
18
O
NHMe
[18F]MMP2/MMP9 Inhibitor
R
O
OMe
OMe
[18F]FPEB [18F]FDPA [18F]DAA1106
F
18
[F]Fluorodopamine
NH
2
HO
HO
NH
18
F
[18F]F-DOPA
OH
2
HO
18
F
[18F]4F-MHPG
H
NH
N
NH
2
18
F
N
S
Aβ Plaque Imaging Probe
O
F
N
18
F
MeHN
Me
O
N
N
S
F
F
[18F]UCB-H
N
N
N
[18F]FIMX
18
F
Figure 8.4 Radiotracers synthesized from diaryliodonium salts.
radiouorination. In particular, diaryliodonium salts are known to be photosensitive[135]
and can undergo side reactions that involve the formation of iodine radicals.
Most diaryliodonium salts are made from (diacetoxyiodo)arenes[136], and the direct
radiolabeling of these intermediates with [
precursor instability and broaden the scope of methodology available to the
chemist[137].
Alternatively, iodonium salts can be prepared in situ prior to a radiouorination to avoid
handling issues[138]. Furthermore, some limitations of diaryliodonium salts were addressed
by using iodonium salts with auxiliaries other than sacricial arenes (Scheme8.11)[81,
139]. For example, optimization studies by the Liang laboratory revealed that a ve-membered spirocyclic iodonium ylide auxiliary can aord radiouorinated arenes in excellent
yields[140]. Additives such as organocatalyts to drive the radiouorination have also been
investigated[141], and spirocyclic iodonium ylides have been used to synthesize several
PET radiotracers[139, 142] such as [
18
([
F]FPEB)[143–145], [18F]-N,N-diethyl-2-[4-(2-uoroethoxy)phenyl]-5,7-dimethylpyrazolo[1,5a]pyrimidine-3-acetamide ([
2-phenoxyphenyl)acetamide ([
18
F]-3-uoro-5-[(pyridin-3-yl)ethynyl]benzonitrile
18
F]FDPA)[146], and N-(2,5-dimethoxybenzyl)-N-(5-[18F]-uoro-
18
F]DAA1106)[147] (Scheme8.11).
18
F
18
F]uoride has been investigated to address
H
N
O
H
N
S
O
O
OH
O
18
F radio-
NH
Scheme 8.11
Radiotracers synthesized from
I
O
O
O
spirocyclic iodo-
Me
Me
N
N
N
O
NEt
nium ylides.
N
18
F
CN
266 Handbook of Radiopharmaceuticals
18
[
2
F]F
18
F
18
F
R
Me
O
18
F
N
O

For some electron-rich precursors, reaction products consistent with an aryne mecha-
Me
TsHN
]
130 °C, 20 min
nism compete with the desired product[148].
8.5.2.4 Phenols andAnilines
The radiouorination of phenols and anilines using tert-butyl as a leaving group has also
been investigated[149, 150]. This method allows for p-[
18
and p-[
F]uoroanilines (Scheme8.12b) with some structural diversity. The substrate
scope is limited to arenes bearing two mutually para-substituents, and the harshly
oxidizing conditions conferred by phenyliodonium diacetate (PIDA) limits the functional
group tolerance of this approach. While milder conditions have been developed for the
synthesis of p-[
S
Ar radiouorination[151, 152]. Furthermore, Ritter and co-workers have developed
N
18
F]uorophenol, they require two additional steps following the initial
a direct radiouorination of electron-decient phenols using PhenoFluor and related
reagents, which was proposed to proceed through a concerted nucleophilic aromatic
substitution (CS
Ar) mechanism (Scheme8.12c)[125].
N
18
F]uorophenols (Scheme8.12a)
Me
OH
Me
Me
Me
Me
(i) PIDA, TFA,[18F]TBAF, rt, 10 min
(ii) TFA, rt, 10 mi
(i) PIDA, TFA or HF-pyridine, [18F]TEAF
Ar
(i)
DCM, rt, 15 min
(ii) TFA, 10 min
N
Cl
Ar
N
Ag2CO3, CHCl3, 60 °C
Cl
(ii) 18F , butanone:EtOH
R
HO
TsHN
18
R
R
HO
R
18
Since 2000, several new methodologies have been developed to install C(sp2)–18F bonds.
A common class of methodology development includes the use of a transition-metal.
Initially, attempts were made to adapt the Pd-mediated uorination of aryl triates
reported by Buchwald[153, 154]. [
required carrier-added uoride to obtain meaningful RCYs (Scheme8.13a)[155]. A study
by Ritter in 2011 described a Pd
metal-mediated radiouorination reaction[132]. In this report, a Pd complex was treated
18
with [
F]uoride to generate a Pd-18F complex, which could in turn react with another Pd
complex to give the desired labeled product.
18
F]Radiouorination of aryl triates was realized but
II
/PdIV catalytic cycle (Scheme8.13b) that could promote a
18
F
Scheme 8.12
[a]
Radiouorination of phenols
and anilines.
18
F
[b
F
[c]
Chapter 08: Fluorine-18 Radiochemistry 267

[a]
[b]
[c]
[d]
Ad
[18F]-Bavarostat
Scheme 8.13
Transition metal-
mediated radiouorination of arenes.
N
Me
OTf
R
carrier added [18F]CsF
[Pd], phosphine ligand
18
F
N
N
Pd
N
N
N
N
B
N
N
R
N
[Pd]
R
Acetone, 85 °C, 10 min
R
18
F
18
F
MeO OMe
NN
I
[Ni]
R
OH
OMe
Aqueous[18F]F , 18-crown-6
MeCN, 23 °C, <1 min
(i) [Ru], EtOH, 85 °C, 30 min
(ii) CIIM, MeCN/DMSO, [18F]F
(iii) NH2OH, NaOH, THF/MeOH
O
2OTf
R
Ad N
Me
18
F
18
F
OMe
O
The active Pd-18F complex was generated from nucleophilic [18F]uoride but conferred
umpolung reactivity since it behaved as an electrophilic source of uorine[156]. Later,
18
the Pd-
F uorination methodology was applied to synthesize known PET radiotracers on
a clinical scale[157]. Further improvements were subsequently implemented, including
the use of an aryl-Ni complex with aqueous [
need to synthesize a M-
18
reaction, simplifying the overall procedure (Scheme8.13c)[159, 160]. Building on this
work, the Ritter laboratory has also reported a Ru-mediated deoxyuorination, which
was later used to synthesize [
(Scheme8.13d)[161, 162]. Owing to their specialized nature, the adoption of these
methods for the clinical production of PET radiotracers has been somewhat slow to date.
Of the new transition-metal-promoted uorination methods, CMRF has emerged as
an operationally simple and powerful labeling technique that has been widely used by the
PET radiochemistry community. Originally introduced by Sanford in 2013 for uorination
268 Handbook of Radiopharmaceuticals
18
F]uoride[158]. This update avoided the
F complex alongside a M-aryl complex during the course of the
18
F]bavarostat for non-human primate animal studies

of aryl iodonium salts, stannanes, and organoborons[163, 164], Sanford and Scott soon
[a]
[b]
R
18
[c]
R
R
[18F]Cabozantinib [18F]Track
[18F]FBnTP
O
thereafter described an adapted CMRF of (mesityl)(aryl)iodonium salts (vide supra)[124].
Concurrently, a method for the CMRF of pinacol boronates (Bpin) was reported by Gouverneur (Scheme8.14a)[165, 166], while Sanford and Scott have also disclosed the
18
F-uorination of arylboronic acids (Scheme8.14b)[167] and stannanes (Scheme8.14c)[168].
Since these reports, there have been several updates, including a robustness screen to
determine functional group tolerance[169], investigation into pyridine eects[170],
order of addition studies, the use of pyridinium sulfates[171], the use of promoter
alcohols[172], improved drying methods[173], and a comparison of CMRF with the spirocyclic iodonium ylide method (vide supra)[174, 175]. CMRF has proven to be a versatile
approach for the late-stage uorination of bioactive molecules to date, and the original
reports have inspired the synthesis of numerous PET radiotracers (Figure8.5)[115], such
18
as 6-[
F]Fluorodihydroxyphenylalanine ([18F]FDOPA)[176], [18F]DAA1106, (vide supra),
amino acids[177, 178], 4-[
18
[
F]cabozantinib[180], and [18F]TRACK[181].
18
F]uorobenzyltriphenylphosphonium cation ([18F]FBnTP)[179],
Bpin
[Cu(OTf)2(py)4]
[18F]KF/K
DMF, 110 °C, 20 min
2.2.2
R
F
Scheme 8.14 Cop-
per-mediated
radiouorination
of arenes.
18
B(OH)
SnR
2
3
Cu(OTf)2, pyridine, [18F]KF
110 °C, 20 min
[Cu],[18F]KF
R
R
F
18
F
Other radiouorination methodologies have been developed, but not widely implemented for various reasons. Of these, radiouorination of C(sp
explored area with few methodologies available. In 2002, a C(sp
2
)–H bonds is an under-
2
)–H radiouorination
using an electrochemical method was achieved using benzene as the model substrate
18
F
F
H
N
P
O
18
N
F
OMe
OMe
H
N
O
O
18
F
HN
N
N
N
N
Figure 8.5 Select
radiotracers synthesized with
Cu-mediated radio-
uorination.
Chapter 08: Fluorine-18 Radiochemistry 269

(Scheme8.15a)[182]. Limitations of this and subsequent electrochemical methods are
[b]
18
that substituted precursors require carrier-added [
18
F]uoride and aord low yields,
and possess selectivity issues[183, 184]. Furthermore, a recent radiouorination using a
cleavable 8-aminoquinoline directing group has been developed by employing a copper
catalyst in conjunction with 1,8-Diazabicyclo[5.4.0]undec-7-ene (DBU)[25]. Carboxylic
acid products can be obtained by simply cleaving the directing group (Scheme8.15b).
Notably, [
18
F]KF outperformed [18F]AgF, which was shown to be the optimal uorine-19
source in the original report from Dauglulis[185].
Scheme 8.15
Radiouorination of
aryl C–H bonds.
H
N
HN
O
R
2 e , 18F
(MeCN)4CuOTf, K[18F], K
DBU
DMF, 100 °C, 30 min
2.2.2
F
N
HN
R
[a]
O
18
F
A challenge that PET radiochemists face is functional group compatibility with
18
[
F]uoride. Overcoming this challenge to synthesize radiopharmaceuticals usually
entails a two-step procedure consisting of initial radiouorination and subsequent
removal of protecting groups. However, given the growing popularity of technologies like
immuno-PET[186], there are situations where this approach is infeasible. For example,
scenarios requiring labeling of complicated molecules that are not compatible with uorination/deprotection conditions, or sensitive biologics/macromolecules, require dierent
labeling strategies. In such cases, it is often preferred to directly label a prosthetic group
that can then be added to the molecule/macromolecule/biologic that is ill-suited for
direct uorination. To this end, a number of strategies have been developed, which are
highlighted in this section.
There is utility in the use of prosthetic groups, as they allow molecules to be investigated by PET imaging that would otherwise be dicult to radiolabel directly. This provides the potential to rapidly screen a number of peptides or small molecules of interest.
Since the last edition of the Handbook, the use of classical prosthetic groups such as
270 Handbook of Radiopharmaceuticals

[18F]uoroethyltosylate and N-succinimidyl 4-[18F]uorobenzoate ([18F]SFB) has continued.
For example, a study design and workow for screening radiotracers using [
18
F]SFB was
described by the Sutclie lab[187]. In addition, new prosthetic groups continue to be
developed, such as [
18
F]uoroalkynes, which can be synthesized and used in a Cu(I)-catalyzed 1,3-dipolar cycloaddition (a class of click reaction) with molecules of interest containing a terminal azide (Scheme8.16a)[188]. This concept of using click chemistry has been
widely adopted by the radiochemistry community[189–192]. For example, clinical studies
supporting drug development was fully realized in work from Donnelly and co-workers,
where a 2-nitropyridine with an ether linkage to a polyethylene glycol chain that terminates with an azide is rst radiolabeled by reaction with [
18
F]uoride (Scheme8.16b)[193].
This moiety was then combined with an anti–PD-L1 adnectin (a therapeutic protein) containing a strained alkyne to promote a cycloaddition for the attachment of the radiolabeled prosthetic group. The group at Bristol-Meyers Squibb took this through preclinical
development and translated the use of this imaging agent and method to clinical trials,
demonstrating the utility of this approach for the radiolabeling of biomolecules.
Click reactions are not limited to the 1,3-dipolar cycloadditions of azides and alkynes
but can be any reaction that can occur in an orthogonal manner to “click” two molecules of
interest together. Several other click methods have been developed, including the formation
of oximes, hydrazones, thiol-Michael additions, and inverse-electron demand Diels-Alder
reactions[194, 195]. In the oxime methods [
18
F]uorobenzaldehyde is treated with a molecule
of interest containing a hydroxylamine with an aniline catalyst (Scheme8.16c)[196]. Glaser
and co-workers found the oxime bond formation superior to both Si–F bond formation and
Al-F- 1,4,7-triazacyclononane-1,4,7-triacetic acid (NOTA) methods (vide infra)[197]. In analogy,
Dirksen has utilized hydrazone-based prosthetic group strategies. In this study, both oxime
and a hydrazone conjugates were investigated, and the use of aniline as a catalyst was critical
for the appreciable radiolabeling of peptides and proteins (Scheme8.16d)[198]. In the thiolMichael approach, a maleimide bound to a labile moiety can be radiolabeled in the presence
of tris(2-carboxyethyl)phosphine (TCEP) and subsequently attached to a biomolecule of
interest that contains a thiol (such as a cysteine) to form a bond rapidly and orthogonally to
other functional groups present (Scheme8.16e)[199].
Finally, the inverse-electron demand Diels-Alder reaction provides another version
of a click reaction recently developed for use with PET labeled prosthetic groups. The
Conti lab demonstrated that tetrazine-trans-cyclooctenes may be synthesized from a
18
[
F]cyclooctene derived prosthetic group and tetrazines via Diels-Alder cycloaddition.
This approach is rapid and can be conducted at low concentrations, which is an important attribute given that high molar activity demands the use of small amounts of radiolabeled material for the prosthetic group (Scheme8.16f)[195, 200]. This ability of this
process to occur at low concentration was further explored and exploited by the Lewis
lab to develop a method for pretargeting a protein of interest with an antibody that contains a cyclooctene. Once the antibody had been given sucient time to bind its target,
the tetrazine connected to a uorine-18 containing moiety was injected[201]. In vivo
experiments indicated targeted uptake of the tetrazine-labeled moiety, demonstrating
that the Diels-Alder reaction could even occur at physiological dilution. This is an interesting development as it allows large biomolecules like antibodies that have biological
Chapter 08: Fluorine-18 Radiochemistry 271

[b]
[d]
O
18
18
18
F
n
N
CuI, DIEA, Sodium Ascorbate
Peptide
3
F
N
n
N
N
O
[a]
Peptide
adnectin
O
O
18
N
F
O
N
3
Phosphate-Buffered Saline
O
adnectin
N
18
F
NNN
O
O
O
O
F
F
NH
O
N
H
O
[c]
18
F
H
N
NH
N
O
N
H
N
O O
[e]
O
H
18
F
O
H
18
F
O
N
H
N
F
O O
Anti-HER2-ONH
MeOH, NH4OAc, 15 min, 70 °C
O
NH
HSA
HYNIC, Sodium Phosphate
aniline, rt
peptide
Phosphate-Buffered Saline
DMSO, TCEP HCl
N
SH
NH
2
NH
2
Anti-HER2
18
HSA
18
S
18
F
H
O
H
NNNN
NN
N
NN
N
peptide
O
18
[f]
F
N
Scheme 8.16 Use of click reactions for prosthetic group radiolabeling.
half-lives (days) incompatible with the physical half-life of uorine-18 to be imaged with
uorine-18 through pretargeting. Further investigations have been reported, although
the method has not been advanced to clinical use, suggesting that further developments
are required.
272 Handbook of Radiopharmaceuticals

]
]
]
tBu
tBu
18
peptide
peptide
–F BOND
In recent years, radiochemists have begun to look beyond the C–18F bond in favor of
other heteroatomic bonds to uorine-18, and a number of attractive examples that
exploit the mild conditions associated with uorine-acceptor chemistry have been
reported. Fluorine-acceptor chemistry takes advantage of stable uorine bonds to
aluminum, boron, and silicon. These atoms have strong Lewis acid character, and uorine
can be introduced under mild ion-exchange or chelation conditions. For example, the
18
[
F]uoroorganosilanes–[18F]uorotriphenylsilane, [18F]uoro-tbutyldiphenylsilane, and
18
[
F]uorodi-tbutylphenylsilane–were evaluated by Schirmmacher and co-workers[202].
They determined that di-tert-butyl substituted peptides gave the greatest in vivo stability
in addition to ease of labeling with uorine-18 to yield [
Development of one-step kit-like labeling of boronic acid ester peptides with uorine-18
to give [
18
F]tetrauoroborates has been reported by Perrin and co-workers. Unlike most
methods, this chemistry does not require drying of uoride and can be carried out under
aqueous conditions (Scheme8.17b)[203].
18
F]silyl uorides (Scheme8.17a).
F
R
Me
O
N
H
Me Me
O
O
N N
O
OH
N
Al
O
O
HN
Si
tBu
Bpin
peptide
[18F]KF/K
2.2.2
MeCN, 15 min
18
F]KHF
[
2
MeCN, 45 min, rt
[18F]KF
Saline, EtOH
15 min, 90–100 °C
R
peptide
O
O
Si
tBu
O
N
H
Me Me
O
N
Al
N N
O
Scheme 8.17 Alternative approaches for 18F-labeling with silicon, boron,
and aluminum.
F
[a
Me
18
F
O
HN
K
F
18
F
B
F
[b
[c
Chapter 08: Fluorine-18 Radiochemistry 273

Another kit-like preparation for radiolabeling involves the use of NOTA peptides with
H
Me
O
Me
2
3+
Al
hydroxide complexes[204]. In this example, uorine-18 can displace hydroxide and
form a strong Al–F bond (Scheme8.17c). Finally, Inkster and colleagues disclosed syntheses of sulfonyl uoride-based prosthetic groups such as [
18
F]3-formyl-2,4,6-trimethylbenzenesulfonyl uoride, which can be prepared from the corresponding sulfonyl
chloride[205]. The prosthetic group was used for radiolabeling bombesin analogs (BBNONH
) through imine formation (Scheme8.18).
2
Scheme 8.18 [18F]
Sulfonyl uoride-
based pros-
thetic group.
BBN
O
Me
N
H
Me
SO
18
F
2
NO
BBN
H
SO
Me
18
F
2
Me
DMSO, Co-Solvent
To answer the increasing demand for novel radiopharmaceuticals labeled with uorine-18, a number of research groups have initiated method-development programs for
late-stage radiouorination. Consequently, an impressive battery of novel methods for
direct aliphatic and aromatic radiouorination have been described in recent years, and
continue to be reported [206]. Concurrently, the introduction of new prosthetic groups
and strategies for generating
thesis of established radiotracers, while also enabling
18
FB, 18FSi, 18FS, and 18FAl bonds have improved the syn-
18
F-labeling of bioactive molecules in an increasingly complex chemical space that has been previously inaccessible to
imaging scientists.
1. Ametamey, S.M., Honer, M., and Schubiger, P.A. (2008). Molecular imaging with PET.
Chem. Rev. 108 (5): 1501–1516. https://doi.org/10.1021/cr0782426.
2. Cai, L., Lu, S., and Pike, V.W. (2008). Chemistry with [
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