Biodistribution and radiation dosimetry of a positron emission tomographic ligand, 18F-SP203, to image metabotropic glutamate subtype 5 receptors in humans

PURPOSE

A new PET ligand, 3-fluoro-5-(2-(2-(18)F-(fluoromethyl)-thiazol-4-yl)ethynyl)benzonitrile ((18)F-SP203), is a positron emission tomographic radioligand selective for metabotropic glutamate subtype 5 receptors. The purposes of this study were to estimate the radiation-absorbed doses of (18)F-SP203 in humans and to determine from the distribution of radioactivity in bone structures with various proportions of bone and red marrow whether (18)F-SP203 undergoes defluorination.

METHODS

Whole-body images were acquired for 5 h after injecting (18)F-SP203 in seven healthy humans. Urine was collected at various time points. Radiation-absorbed doses were estimated by the Medical Internal Radiation Dose scheme.

RESULTS

After injecting (18)F-SP203, the two organs with highest radiation exposure were urinary bladder wall and gallbladder wall, consistent with both urinary and fecal excretion. In the skeleton, most of the radioactivity was in bone structures that contain red marrow and not in those without red marrow. Although the dose to red marrow (30.9 microSv/MBq) was unusually high, the effective dose (17.8 microSv/MBq) of (18)F-SP203 was typical of that of other (18)F radiotracers.

CONCLUSION

(18)F-SP203 causes an effective dose in humans typical of several other (18)F radioligands and undergoes little defluorination.

(11)C-methionine uptake correlates with tumor cell density rather than with microvessel density in glioma: A stereotactic image-histology comparison

(11)C-methionine positron emission tomography ((11)C-methionine PET) provides accurate detection of brain tumors. Several reports have analyzed the correlation between uptake of (11)C-methionine and Ki-67 index or microvessel density non-stereotactically and suggested that (11)C-methionine uptake reflects both proliferation potential and angiogenic capability in gliomas. As gliomas possess heterogeneous histological architecture, non-stereotactic comparison of the histology and (11)C-methionine PET image may not be accurate. In the present study, the correlation between (11)C-methionine uptake and cell or microvessel density was analyzed using histological specimens obtained by stereotactic biopsy, and an exact local comparison of (11)C-methionine PET image and histological specimens was conducted. The tumor/normal tissue (T/N) ratio of (11)C-methionine positron emission tomography was found to correlate better with cell density (R=0.747, p=0.000042) and Ki-67 index (R=0.675, p=0.00041) than with microvessel density (R=0.467, p=0.025) in a histological comparison using a stereotactic image. Furthermore, multiple linear regression analysis revealed that cell density was the key determinant for predicting (11)C-methionine level while microvessel density was not. These results suggest that cell density contributes more to (11)C-methionine uptake than microvessel density in glioma tissues and that the previously reported correlation of (11)C-methionine uptake and microvessel density in glioma patients requires reevaluation.

Functional brain areas associated with manipulation of a prehensile tool: a PET study

Using PET, brain areas representing the use of a well-learned tool (chopsticks) were investigated in 10 normal common users. The experimental task was to hold the tool in their right hand and use it to pick up and transport a small pin from a table. Data for the same task performed using only the fingers were also obtained as a control. The results showed an extensive overlap in activated areas with and without the use of the tool. The tool-use prehension, compared to the finger prehension, was associated with higher activities in the caudal-ventral premotor, dorsal premotor, superior parietal, posterior intraparietal, middle temporal gyrus, and primary sensory, occipital cortices, and the cerebellum. These are thus considered to be the human cortical and subcortical substrates representing the use of the tool studied. The activity of the posterior intraparietal area was negatively correlated with the number of drops of the pin, whereas occipital activity was positively correlated with the same error parameter. The caudal-ventral premotor and posterior intraparietal areas are together known to be involved in tool use-related modulation in peripersonal space. The correlation results suggest that this modulation depends on the level of performance. The coactivated left middle temporal gyrus further suggests that familiarity with a tool as well as the knowledge about its usage plays a role in peripersonal space modulation. Superior parietal activation, along with occipital activation, indicates the involvement of visual-spatial attention in the tool use, possibly reflecting the effect of interaction between the prehension (task) and the tool.

Modulation of neuronal activity after spinal cord stimulation for neuropathic pain; H(2)15O PET study

Spinal cord stimulation (SCS) is an effective therapy for chronic neuropathic pain. However, the detailed mechanisms underlying its effects are not well understood. Positron emission tomography (PET) with H(2)(15)O was applied to clarify these mechanisms. Nine patients with intractable neuropathic pain in the lower limbs were included in the study. All patients underwent SCS therapy for intractable pain, which was due to failed back surgery syndrome in three patients, complex regional pain syndrome in two, cerebral hemorrhage in two, spinal infarction in one, and spinal cord injury in one. Regional cerebral blood flow (rCBF) was measured by H(2)(15)O PET before and after SCS. The images were analyzed with statistical parametric mapping software (SPM2). SCS reduced pain; visual analog scale values for pain decreased from 76.1+/-25.2 before SCS to 40.6+/-4.5 after SCS (mean+/-SE). Significant rCBF increases were identified after SCS in the thalamus contralateral to the painful limb and in the bilateral parietal association area. The anterior cingulate cortex (ACC) and prefrontal areas were also activated after SCS. These results suggest that SCS modulates supraspinal neuronal activities. The contralateral thalamus and parietal association area would regulate the pain threshold. The ACC and prefrontal areas would control the emotional aspects of intractable pain, resulting in the reduction of neuropathic pain after SCS.

The role of CT and ¹⁸F-FDG PET in managing the neck in node-positive head and neck cancer after chemoradiotherapy

CONCLUSION

Patients showing a complete response on computed tomography (CT) can be spared from neck dissection.

OBJECTIVE

To determine whether CT or fluorine-18-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) is superior in the evaluation of persistent nodal disease after chemoradiotherapy in patients with node-positive head and neck squamous cell carcinoma (HNSCC).

PATIENTS AND METHODS

Study entry criteria included node-positive HNSCC treated with definitive chemoradiotherapy, a local complete response, and post-treatment CT and (18)F-FDG PET studies 7 weeks after chemoradiotherapy. Forty-eight patients with 60 node-positive necks were eligible. Nodes larger than 1 cm, or with central necrosis on CT, or any visually hypermetabolic nodes on (18)F-FDG PET were considered positive. Regardless of PET findings, necks with positive CT were subjected to neck dissection, whereas those with negative CT were observed without neck dissection.

RESULTS

Twenty-two necks showed positive CT, 20 and 2 of which underwent neck dissection and fine needle aspiration cytology, respectively, resulting in pathologic evidence of persistent nodal disease in 13 necks. Five of 38 necks with negative CT developed regional recurrence. Diagnostic accuracy was equivalent between CT and (18)F-FDG PET. There was no difference in 3-year cause-specific survival between patients with positive and negative CT (79% and 81%, respectively).

Metallic artifacts caused by dental metal prostheses on PET images: a PET/CT phantom study using different PET/CT scanners

OBJECTIVE

The objective of this study was to investigate the effects of computed tomography (CT) artifacts caused by dental metal prostheses on positron emission tomography (PET) images.

METHODS

A dental arch cast was fixed in a cylindrical water-bath phantom. A spherical phantom positioned in the vicinity of the dental arch cast was used to simulate a tumor. To simulate the tumor imaging, the ratio of the (18)F-fluoro-deoxy-glucose radioactivity concentration of the spherical phantom to that of the water-bath phantom was set at 2.5. A dental bridge composed of a gold-silver-palladium alloy on the right mandibular side was prepared. A spherical phantom was set in the white artifact area on the CT images (site A), in a slightly remote area from the white artifact (site B), and in a black artifact area (site C). A PET/CT scan was performed with and without the metal bridge at each simulated tumor site, and the artifactual influence was evaluated on the axial attenuation-corrected (AC) PET images, in which the simulated tumor produced the strongest accumulation. Measurements were performed using three types of PET/CT scanners (scanners 1 and 2 with CT-based attenuation correction, and 3 with Cesium-137 ((137)Cs)-based attenuation correction). The influence of the metal bridge was evaluated using the change rate of the SUVmean with and without the metal bridge.

RESULTS

At site A, an overestimation was shown (scanner 1: +5.0% and scanner 2: +2.5%), while scanner 3 showed an underestimation of -31.8%. At site B, an overestimation was shown (scanner 1: +2.1% and scanner 2: +2.0%), while scanner 3 showed an underestimation of -2.6%. However, at site C, an underestimation was shown (scanner 1: -25.0%, scanner 2: -32.4%, and scanner 3: -8.4%).

CONCLUSIONS

When CT is used for attenuation correction in patients with dental metal prostheses, an underestimation of radioactivity of accumulated tracer is anticipated in the dark streak artifact area on the CT images. In this study, the dark streak artifacts of the CT caused by metallic dental prostheses may cause false negative finding of PET/CT in detecting small and/or low uptake tumor in the oral cavity.

Use of fractional anisotropy for determination of the cut-off value in 11C-methionine positron emission tomography for glioma

Multimodal imaging is one of the necessary steps in the treatment of malignant brain tumors, and use of magnetic resonance imaging (MRI) and positron emission tomography (PET) are the current gold standard technique for the morphological and biological assessment of malignant brain tumors. In addition, fractional anisotropy (FA) obtained from diffusion tensor imaging (DTI) and 11C-methionine PET are useful to determine the tumor border at the tumor and white matter interface. Although there is no question of their value, a universally accepted cut-off value to discriminate normal and abnormal tissue has not been established. In this study we attempted to calculate and determine the cut-off values in FA and 11C-methionine PET that will allow delineation of the tumor border at the tumor and white matter interface by combining these two modalities. We were able to determine individual cut-off values for 11 patients, and then found an average cut-off value in the T/N ratio of 11C-methionine PET of 1.27 and in FA of 0.26, values similar to those previously confirmed by histological study. Moreover, reconstructing images delineating the tumor border was possible combining these two imaging modalities. We propose that the combined analysis of DTI and 11C-methionine PET has the potential to improve tumor border imaging in glioma patients, providing important information for establishing neurosurgical strategies.

18F-FDG-PET in patients with malignant lymphoma having long-term follow-up: staging and restaging, and evaluation of treatment response and recurrence

OBJECTIVE

The aim of this study was to evaluate the diagnostic accuracy of positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) for staging/restaging, evaluating the treatment response, and screening of recurrence in patients with malignant lymphoma (ML) during long-term follow-up, and to compare that with computer tomography (CT)/magnetic resonance imaging (MRI).

METHODS

The study was conducted in 59 ML patients who underwent whole-body 18F-FDG-PET examinations three times or more from October 1998 to August 2006. The location of the lesions in the patients with positive findings on 18F-FDG-PET and/or the corresponding CT/MRI was classified into supradiaphragmatic (n = 10), infradiaphragmatic (n = 7), and extranodal sites (n = 20), and the findings were compared on a site basis according to the gold standard, which consisted of all clinical information available, including follow-up results.

RESULTS

A total of 156 18F-FDG-PET examinations for which the corresponding CT/MRI images were also available were evaluated, and a total of 305 sites showed positive findings on 18F-FDG-PET and/or CT/MRI. Concordant positive findings were obtained in 76% for staging/restaging, 34% for evaluation of the treatment response, and 50% for screening of recurrence. The accuracy of 18F-FDG-PET versus CT/MRI was 92% versus 84% (P = 0.06) for staging/restaging, 84% versus 50% (P < 0.05) for the evaluation of the treatment response, and 83% versus 72% (P = 0.21) for the screening of recurrence. At pathologic sites with discrepant findings between 18F-FDG-PET and CT/MRI (n = 122), the frequency of accurate diagnosis by 18F-FDG-PET (76%) was higher than that by CT/MRI (24%), especially for the evaluation of the treatment response.

CONCLUSIONS

18F-FDG-PET is expected to play a significant role in the management of ML patients even after effective treatment is initiated.

Statistical parametric analysis of cerebral blood flow in vascular dementia with small-vessel disease using Tc-HMPAO SPECT

BACKGROUND

Subcortical ischemic vascular dementia (SVD) caused by small-artery disease is a major cause of dementia. It still remains unclear, however, whether SVD may present with localized regional cerebral blood flow (rCBF) changes. We aimed to clarify the local rCBF changes associated with dementia in patients with early-stage SVD.

METHODS

The subjects consisted of 15 patients with early-stage SVD [Mini Mental State Examination (MMSE) score: 20 +/- 3.5] without apparent brain atrophy (SVD group), 11 patients without dementia with white matter lesions (non-dementia-WML group) and 16 age-matched controls. All the subjects were right-handed and underwent brain perfusion single photon emission computed tomography (SPECT), magnetic resonance imaging and cognitive function testing. Statistical analysis of the differences in the SPECT rCBF was performed by SPM2. The degree of severity of the WMLs was evaluated based on the Scheltens rating scale.

RESULTS

The results of SPM analysis revealed that the rCBF in the SVD group was significantly decreased in the pulvinar nuclei of the thalamus of both sides as compared with that in the controls, and in the left pulvinar nucleus as compared with that in the non-dementia-WML group. On the other hand, SPM analysis revealed no significant reduction in rCBF in the non-dementia-WML group as compared with that in the controls. The WMLs in the left parietal region were severer in the SVD group than in the non-dementia-WML group.

CONCLUSIONS

In patients with early-stage SVD without apparent brain atrophy, significant rCBF reduction in the bilateral pulvinar nuclei as compared with that in normal controls, and in the left pulvinar nucleus as compared with that in patients without dementia with WMLs was found.

Effects of cardiac energy efficiency in diastolic heart failure: assessment with positron emission tomography with 11C-acetate

Diastolic heart failure (DHF) has become a high social burden, and its major underlying cardiovascular disease is hypertensive heart disease. However, the pathogenesis of DHF remains to be clarified. This study aimed to assess the effects of cardiac energy efficiency in DHF patients. (11)C-Acetate positron emission tomography and echocardiography were conducted in 11 DHF Japanese patients and 10 normal volunteers. The myocardial clearance rate of radiolabeled (11)C-acetate was measured to calculate the work metabolic index (WMI), an index of cardiac efficiency. The ratio of peak mitral E wave velocity to peak early diastolic septal myocardial velocity (E/e') was calculated to assess left ventricular (LV) filling pressure. The LV mass index was greater and the mean age was higher in the DHF patients than in the normal volunteers. There was no difference in WMI between the two groups. However, WMI varied widely among the DHF patients and was inversely correlated with E/e' (r=-0.699, p=0.017). In contrast, there was no correlation in the normal volunteers. In conclusion, the inefficiency of energy utilization is not a primary cause of diastolic dysfunction or DHF, and cardiac efficiency may not affect diastolic function in normal hearts. However, the energy-wasting state may induce the elevation of LV filling pressure in DHF patients, which was considered to principally result from the progressive diastolic dysfunction.

Chronic middle cerebral artery occlusion: a hemodynamic and metabolic study with positron-emission tomography

BACKGROUND AND PURPOSE

Chronic middle cerebral artery (MCA) occlusion is more common than generally thought. It is important to assess the cerebral hemodynamic status in patients with this chronic condition. We investigated the cerebral hemodynamic and metabolic disturbances in these patients in relation to the development of the collateral vasculature.

MATERIALS AND METHODS

We studied 13 patients with chronic unilateral MCA occlusion who had a minor or no stroke by using positron-emission tomography (PET). PET was performed by the oxygen 15 ((15)O) gas steady-state inhalation method. The intracranial arteries were evaluated by digital subtraction angiography. We divided the patients into 2 subgroups according to whether they had a normal or increased oxygen extraction fraction (OEF) in the occluded MCA territory and compared the 2 groups.

RESULTS

Of the 13 patients, 9 were classified into the normal OEF and 4 were classified into the increased OEF group. In the increased OEF group, the mean OEF values were also increased in the territories of the ipsilateral anterior cerebral artery, ipsilateral posterior cerebral artery, and contralateral MCA. The patients in the increased OEF group had more than 1 steno-occlusive lesion in the major intracranial arteries (P = .008). Three of the 4 patients in the increased OEF group also had vascular lesions in the collateral pathways to the MCA territory.

CONCLUSION

Most patients with chronic MCA occlusion did not show severe hemodynamic impairment. Those with increased OEF tended to have other areas of severe hemodynamic impairment and other vascular lesions, especially in the collateral pathways.

Phase II clinical trial of Wilms tumor 1 peptide vaccination for patients with recurrent glioblastoma multiforme

OBJECT

The object of this study was to investigate the safety and clinical responses of immunotherapy targeting the WT1 (Wilms tumor 1) gene product in patients with recurrent glioblastoma multiforme (GBM).

METHODS

Twenty-one patients with WT1/HLA-A*2402-positive recurrent GBM were included in a Phase II clinical study of WT1 vaccine therapy. In all patients, the tumors were resistant to standard therapy. Patients received intra-dermal injections of an HLA-A*2402-restricted, modified 9-mer WT1 peptide every week for 12 weeks. Tumor size, which was obtained by measuring the contrast-enhanced area on magnetic resonance images, was determined every 4 weeks. The responses were analyzed according to Response Evaluation Criteria in Solid Tumors (RECIST) 12 weeks after the initial vaccination. Patients who achieved an effective response continued to be vaccinated until tumor progression occurred. Progression-free survival and overall survival after initial WT1 treatment were estimated.

RESULTS

The protocol was well tolerated; only local erythema occurred at the WT1 vaccine injection site. The clinical responses were as follows: partial response in 2 patients, stable disease in 10 patients, and progressive disease in 9 patients. No patient had a complete response. The overall response rate (cases with complete or partial response) was 9.5%, and the disease control rate (cases with complete or partial response as well as those in which disease was stable) was 57.1%. The median progression-free survival (PFS) period was 20.0 weeks, and the 6-month (26-week) PFS rate was 33.3%.

CONCLUSIONS

Although a small uncontrolled nonrandomized trial, this study showed that WT1 vaccine therapy for patients with WT1/HLA-A*2402-positive recurrent GBM was safe and produced a clinical response. Based on these results, further clinical studies of WT1 vaccine therapy in patients with malignant glioma are warranted.

Mucosa-associated lymphoid tissue lymphoma studied with FDG-PET: a comparison with CT and endoscopic findings

OBJECTIVE

We investigated the accumulation of 2-deoxy-2-[(18)F] fluoro-D: -glucose positron emission tomography (FDG-PET) in patients with mucosa-associated lymphoid tissue (MALT) lymphoma patients as compared with computerized tomography (CT) and endoscopic imaging.

METHODS

FDG-PET was performed on 13 untreated patients with MALT lymphoma. CT scanning of the affected areas was performed in all the patients to compare with the FDG-PET images. In five patients with gastric MALT lymphoma, comparison was also made with the endoscopic findings.

RESULTS

Of the 13 untreated MALT lymphoma patients, all 8 non-gastric MALT lymphoma patients exhibited abnormal accumulation of FDG. However, in the five gastric MALT lymphoma patients, no abnormal FDG accumulation was observed. Although lesions could be confirmed on CT images from the patients other than those with gastric MALT lymphoma, the mucosal lesions of gastric MALT lymphoma could be observed only by endoscopy.

CONCLUSIONS

FDG-PET can be used to detect MALT lymphoma when it forms mass lesions, whereas it is difficult to detect non-massive MALT lymphoma of gastrointestinal origin.

Prognostic Value of FDG-PET in patients with oropharyngeal carcinoma treated with concurrent chemoradiotherapy

Purpose

The purpose of this study was to evaluate the predictive value of 2-deoxy-2-[F-18]fluoro-d-glucose-positron emission tomography (FDG-PET) following concurrent chemoradiotherapy (CRT) on survival in patients with carcinoma of the oropharynx (OPC).

Methods

Eighteen patients with primary OPC who underwent PET pre- and post-CRT were evaluated prospectively for survival. The prognostic performance of post-CRT PET and CT for recurrence was compared.

Results

Patients with positive post-CRT PET exhibited significantly lower 2-year cause-specific survival and disease-free survival (50% vs. 91%, P < 0.05 and 0% vs. 83%, P < 0.0001); however, patients with positive post-CRT CT did not exhibit any significant difference (67% vs. 83%, P = 0.416 and 50% vs. 75%, P = 0.070). Other factors, such as clinical and pre-CRT PET variables, also did not indicate any significant difference. The accuracy of prediction of residual and local recurrence for post-CRT PET and CT (local%/regional%) was 83%/94% and 83%/78%, respectively.

Conclusion

OPC patients with positive post-CRT PET exhibit poor survival. The prognostic accuracy of post-CRT PET is superior to that of CT. The results of post-CRT FDG-PET should be included in the management of the OPC patients.

Effect of PK11195 on attenuating the enhancement of glucose utilization induced by quinolinic acid infusion in the rat brain

PK11195, a selective PBR ligand, has been reported to exert a protective effect against the neuronal damage induced by the intrastriatal infusion of quinolinic acid, an excitatory amino acid. The neuroprotective effect of PK11195 observed at 48 h after the infusion was mediated by the inhibition of microglial activation. The aim of this study is to search the mechanism for the effect of PK11195 other than the inhibition of activation of microglia. In this study, the effect of PK11195 on glucose metabolism as well as neuroprotection in the early phase (2 h) after the injection of quinolinic acid was examined. Intrastriatal injection of quinolinic acid (60 nmol/microL) alone caused a significant enhancement of [(14)C]DG utilization in the infused striatum (about 160% vs. the contralateral side). This enhancement of glucose utilization might be due to an increase in phosphorylation rate of [(14)C]DG rather than delivery process from the plasma into the brain, since the initial uptake of [(14)C]DG (1 min) was not changed by quinolinic acid. Coinjection of PK11195 (10 nmol/microL) completely blocked the enhancement of [(14)C]DG uptake induced by quinolinic acid. The attenuating effect of PK11195 on glucose metabolic disturbance induced by quinolinic acid seemed to be related to voltage-dependent anion channels (VDAC), which are component of the PBR complex and associated with the regulation of hexokinase activity. PK11195 also showed neuroprotective effect at 2 h after the infusion of quinolinic acid, despite no significant activation of microglia was observed at this time-point. Thus, the neuroprotection of PK11195 might be related to normalization of the metabolic disturbance by the excitatory amino acid.

Brain responses during the first desire to void: a positron emission tomography study

OBJECTIVES

First desire to void (FDV) is defined as the first feeling that would lead the patient to pass urine. The aim of the present study is to identify the brain regions activated during FDV.

METHODS

Six healthy right-handed male volunteers, aged 31-40 years, agreed to participate in this study. Rather than inserting a urethral catheter, we used a urinary volume monitoring unit and a self-adhesive external condom catheter for this study. Positron emission tomography (PET) scans obtained in the FDV and post-voiding (absence of urge to void) (REST) states were analyzed and compared.

RESULTS

First desire to void state was associated with increased blood flow in the right and left cerebellum, right parahippocampal gyrus (Brodmann area [BA] 30), left superior frontal gyrus (BA9), and left cingulate gyrus (BA32). Rest state was associated with decreased blood flow in the right superior temporal gyrus (BA22), right uncus (BA28), right cingulate gyrus (BA32), left middle temporal gyrus (BA21), and left medial frontal gyrus (BA25). According to region of interest analysis, regional cerebral blood flow of the periaqueductal grey and pons was significantly increased at FDV as opposed to REST.

CONCLUSIONS

We located possible brain activity associated with the FDV sensation. Combined activation of the right and left cerebellum, parahippocampal gyrus, superior frontal gyrus, and left cingulate gyrus could be associated with FDV.