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Moon JW, Song YH, Kim YN, Woo JY, Son HJ, Hwang HS, Lee SH. [ 18F]FDG PET/CT is useful in discriminating invasive adenocarcinomas among pure ground-glass nodules: comparison with CT findings-a bicenter retrospective study. Ann Nucl Med 2024; 38:754-762. [PMID: 38795306 DOI: 10.1007/s12149-024-01944-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/15/2024] [Indexed: 05/27/2024]
Abstract
PURPOSE Predicting the malignancy of pure ground-glass nodules (GGNs) using CT is challenging. The optimal role of [18F]FDG PET/CT in this context has not been clarified. We compared the performance of [18F]FDG PET/CT in evaluating GGNs for predicting invasive adenocarcinomas (IACs) with CT. METHODS From June 2012 to December 2020, we retrospectively enrolled patients with pure GGNs on CT who underwent [18F]FDG PET/CT within 90 days. Overall, 38 patients with 40 ≥ 1-cm GGNs were pathologically confirmed. CT images were analyzed for size, attenuation, uniformity, shape, margin, tumor-lung interface, and internal/surrounding characteristics. Visual [18F]FDG positivity, maximum standardized uptake value (SUVmax), and tissue fraction-corrected SUVmax (SUVmaxTF) were evaluated on PET/CT. RESULTS The histopathology of the 40 GGNs were: 25 IACs (62.5%), 9 minimally invasive adenocarcinomas (MIA, 22.5%), and 6 adenocarcinomas in situ (AIS, 15.0%). No significant differences were found in CT findings according to histopathology, whereas visual [18F]FDG positivity, SUVmax, and SUVmaxTF were significantly different (P=0.001, 0.033, and 0.018, respectively). The size, visual [18F]FDG positivity, SUVmax, and SUVmaxTF showed significant diagnostic performance to predict IACs (area under the curve=0.693, 0.773, 0.717, and 0.723, respectively; P=0.029, 0.001, 0.018, and 0.013, respectively). In the multivariate logistic regression analysis, visual [18F]FDG positivity discriminated IACs among GGNs among various CT and PET findings (P=0.008). CONCLUSIONS [18F]FDG PET/CT demonstrated superior diagnostic performance compared to CT in differentiating IAC from AIS/MIA among pure GGNs, thus it has the potential to guide the proper management of patients with pure GGNs.
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Affiliation(s)
- Jung Won Moon
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea
| | - Yun Hye Song
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea
| | - Yoo Na Kim
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea
| | - Ji Young Woo
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea
| | - Hye Joo Son
- Department of Nuclear Medicine, Dankook University Medical Center, Cheonan, Chungnam, Republic of Korea
| | - Hee Sung Hwang
- Department of Nuclear Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 22 Gwanpyeong-ro 170 beon-gil, Dongan-gu,Anyang-si, Gyeonggi-do, 14068, Republic of Korea.
| | - Suk Hyun Lee
- Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-Ro, Yeongdeungpo-Gu, Seoul, 07441, Republic of Korea.
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Deniel G, Dhelft F, Lancelot S, Orkisz M, Roux E, Mouton W, Benzerdjeb N, Richard JC, Bitker L. Pulmonary inflammation decreases with ultra-protective ventilation in experimental ARDS under VV-ECMO: a positron emission tomography study. Front Med (Lausanne) 2024; 11:1338602. [PMID: 38444415 PMCID: PMC10912585 DOI: 10.3389/fmed.2024.1338602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/24/2024] [Indexed: 03/07/2024] Open
Abstract
Background Experimentally, ultra-protective ventilation (UPV, tidal volumes [VT] < 4 mL.kg-1) strategies in conjunction with veno-venous extracorporeal membrane oxygenation (VV-ECMO) are associated with lesser ventilator-induced lung injuries (VILI) during acute respiratory distress syndrome (ARDS). However, whether these strategies reduce lung inflammation more effectively than protective ventilation (PV) remains unclear. We aimed to demonstrate that a UPV strategy decreases acute lung inflammation in comparison with PV in an experimental swine model of ARDS. Methods ARDS was induced by tracheal instillation of chlorhydric acid in sedated and paralyzed animals under mechanical ventilation. Animals were randomized to receive either UPV (VT 1 mL.kg-1, positive end-expiration pressure [PEEP] set to obtain plateau pressure between 20 and 25 cmH2O and respiratory rate [RR] at 5 min-1 under VV-ECMO) or PV (VT 6 mL.kg-1, PEEP set to obtain plateau pressure between 28 and 30 cmH2O and RR at 25 min-1) during 4 h. After 4 h, a positron emission tomography with [11C](R)-PK11195 (ligand to TSPO-bearing macrophages) injection was realized, coupled with quantitative computerized tomography (CT). Pharmacokinetic multicompartment models were used to quantify regional [11C](R)-PK11195 lung uptake. [11C](R)-PK11195 lung uptake and CT-derived respiratory variables were studied regionally across eight lung regions distributed along the antero-posterior axis. Results Five pigs were randomized to each study group. Arterial O2 partial pressure to inspired O2 fraction were not significantly different between study groups after experimental ARDS induction (75 [68-80] mmHg in a PV group vs. 87 [69-133] mmHg in a UPV group, p = 0.20). Compared to PV animals, UPV animals exhibited a significant decrease in the regional non-aerated compartment in the posterior lung levels, in mechanical power, and in regional dynamic strain and no statistical difference in tidal hyperinflation after 4 h. UPV animals had a significantly lower [11C](R)-PK11195 uptake, compared to PV animals (non-displaceable binding potential 0.35 [IQR, 0.20-0.59] in UPV animals and 1.01 [IQR, 0.75-1.59] in PV animals, p = 0.01). Regional [11C](R)-PK11195 uptake was independently associated with the interaction of regional tidal hyperinflation and regional lung compliance. Conclusion In an experimental model of ARDS, 4 h of UPV strategy significantly decreased lung inflammation, in relation to the control of VT-derived determinants of VILI.
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Affiliation(s)
- Guillaume Deniel
- Service de Médecine Intensive-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, Inserm, CREATIS UMR, Villeurbanne, France
| | - François Dhelft
- Service de Médecine Intensive-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Université de Lyon, Université LYON 1, Lyon, France
| | - Sophie Lancelot
- Université de Lyon, Université LYON 1, Lyon, France
- CERMEP – Imagerie du Vivant, Lyon, France
- Hospices Civils de Lyon, Lyon, France
| | - Maciej Orkisz
- Univ Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, Inserm, CREATIS UMR, Villeurbanne, France
| | - Emmanuel Roux
- Univ Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, Inserm, CREATIS UMR, Villeurbanne, France
| | - William Mouton
- Laboratoire Commun de Recherche Hospices Civils de Lyon/bioMérieux, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Nazim Benzerdjeb
- Université de Lyon, Université LYON 1, Lyon, France
- Centre d’Anatomie et Cytologie Pathologique, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jean-Christophe Richard
- Service de Médecine Intensive-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, Inserm, CREATIS UMR, Villeurbanne, France
- Université de Lyon, Université LYON 1, Lyon, France
| | - Laurent Bitker
- Service de Médecine Intensive-Réanimation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France
- Univ Lyon, Université Claude Bernard Lyon 1, INSA-Lyon, CNRS, Inserm, CREATIS UMR, Villeurbanne, France
- Université de Lyon, Université LYON 1, Lyon, France
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Leek F, Anderson C, Robinson AP, Moss RM, Porter JC, Garthwaite HS, Groves AM, Hutton BF, Thielemans K. Optimisation of the air fraction correction for lung PET/CT: addressing resolution mismatch. EJNMMI Phys 2023; 10:77. [PMID: 38049611 PMCID: PMC10695904 DOI: 10.1186/s40658-023-00595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/20/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Increased pulmonary [Formula: see text]F-FDG metabolism in patients with idiopathic pulmonary fibrosis, and other forms of diffuse parenchymal lung disease, can predict measurements of health and lung physiology. To improve PET quantification, voxel-wise air fractions (AF) determined from CT can be used to correct for variable air content in lung PET/CT. However, resolution mismatches between PET and CT can cause artefacts in the AF-corrected image. METHODS Three methodologies for determining the optimal kernel to smooth the CT are compared with noiseless simulations and non-TOF MLEM reconstructions of a patient-realistic digital phantom: (i) the point source insertion-and-subtraction method, [Formula: see text]; (ii) AF-correcting with varyingly smoothed CT to achieve the lowest RMSE with respect to the ground truth (GT) AF-corrected volume of interest (VOI), [Formula: see text]; iii) smoothing the GT image to match the reconstruction within the VOI, [Formula: see text]. The methods were evaluated both using VOI-specific kernels, and a single global kernel optimised for the six VOIs combined. Furthermore, [Formula: see text] was implemented on thorax phantom data measured on two clinical PET/CT scanners with various reconstruction protocols. RESULTS The simulations demonstrated that at [Formula: see text] iterations (200 i), the kernel width was dependent on iteration number and VOI position in the lung. The [Formula: see text] method estimated a lower, more uniform, kernel width in all parts of the lung investigated. However, all three methods resulted in approximately equivalent AF-corrected VOI RMSEs (<10%) at [Formula: see text]200i. The insensitivity of AF-corrected quantification to kernel width suggests that a single global kernel could be used. For all three methodologies, the computed global kernel resulted in an AF-corrected lung RMSE <10% at [Formula: see text]200i, while larger lung RMSEs were observed for the VOI-specific kernels. The global kernel approach was then employed with the [Formula: see text] method on measured data. The optimally smoothed GT emission matched the reconstructed image well, both within the VOI and the lung background. VOI RMSE was <10%, pre-AFC, for all reconstructions investigated. CONCLUSIONS Simulations for non-TOF PET indicated that around 200i were needed to approach image resolution stability in the lung. In addition, at this iteration number, a single global kernel, determined from several VOIs, for AFC, performed well over the whole lung. The [Formula: see text] method has the potential to be used to determine the kernel for AFC from scans of phantoms on clinical scanners.
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Affiliation(s)
- Francesca Leek
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK.
- Nuclear Medicine Metrology, National Physical Laboratory, Teddington, UK.
| | - Cameron Anderson
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Andrew P Robinson
- Nuclear Medicine Metrology, National Physical Laboratory, Teddington, UK
- Christie Medical Physics and Engineering, The Christie NHS Foundation Trust, Manchester, UK
- Schuster Laboratory, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Robert M Moss
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - Joanna C Porter
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London Hospitals NHS Trust, London, UK
| | - Helen S Garthwaite
- UCL Respiratory, University College London and Interstitial Lung Disease Service, University College London Hospitals NHS Trust, London, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
- Centre for Medical Image Computing, University College London, London, UK
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Song YH, Moon JW, Kim YN, Woo JY, Son HJ, Lee SH. Prone position PET/CT is useful in reducing gravity-dependent opacity-related [ 18F]fluorodeoxyglucose uptake. Eur Radiol 2023; 33:8270-8278. [PMID: 37322163 DOI: 10.1007/s00330-023-09831-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES This study aimed to investigate whether performing [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in the prone position could reduce [18F]FDG uptake in dependent lungs. METHODS Patients who underwent [18F]FDG PET/CT in both supine and prone positions from October 2018 to September 2021 were reviewed retrospectively. [18F]FDG uptake of dependent and nondependent lungs was analysed visually and semi-quantitatively. A linear regression analysis was performed to examine the association between the mean standardised uptake value (SUVmean) and the Hounsfield unit (HU). RESULTS A total of 135 patients (median age, 66 years [interquartile range: 58-75 years]; 80 men) were included. Dependent lungs showed significantly higher SUVmean and HU than nondependent lungs on supine position PET/CT (sPET/CT, 0.59 ± 0.14 vs. 0.36 ± 0.09, p < 0.001; - 671 ± 66 vs. - 802 ± 43, p < 0.001, respectively) and prone position PET/CT (pPET/CT, 0.45 ± 0.12 vs. 0.42 ± 0.08, p < 0.001; - 731 ± 67 vs. - 790 ± 40, p < 0.001, respectively). Linear regression analysis revealed a strong association between the SUVmean and HU in sPET/CT (R = 0.86, p < 0.001) and moderate association in pPET/CT (R = 0.65, p < 0.001). One hundred and fifteen patients (85.2%) had visually discernible [18F]FDG uptake in the posterior lung on sPET/CT, which disappeared on pPET/CT in all but one patient (0.7%, p < 0.001). CONCLUSIONS [18F]FDG uptake of the lung had moderate-to-strong associations with HU. Gravity-dependent opacity-related [18F]FDG uptake can be effectively reduced on prone position PET/CT. CLINICAL RELEVANCE STATEMENT Prone position PET/CT effectively reduces gravity-dependent opacity-related [18F]fluorodeoxyglucose uptake in the lung, potentially improving diagnostic accuracy in evaluating nodules in dependent lungs and offering a more accurate assessment of lung inflammation parameters in interstitial lung disease evaluations. KEY POINTS • The study evaluated whether performing [18F]fluorodeoxyglucose ([18F]FDG) PET/CT could reduce [18F]FDG uptake in lungs. • In prone and supine position PET/CT, the [18F]FDG uptake and Hounsfield unit were moderately to strongly associated. • Prone position PET/CT can reduce gravity-dependent opacity-related [18F]FDG uptake by the posterior lung.
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Affiliation(s)
- Yun Hye Song
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Jung Won Moon
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Yoo Na Kim
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Ji Young Woo
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea
| | - Hye Joo Son
- Department of Nuclear Medicine, Dankook University Medical Center, Cheonan, Chungnam, Republic of Korea
| | - Suk Hyun Lee
- Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea.
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Imaging the acute respiratory distress syndrome: past, present and future. Intensive Care Med 2022; 48:995-1008. [PMID: 35833958 PMCID: PMC9281340 DOI: 10.1007/s00134-022-06809-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/27/2022] [Indexed: 12/13/2022]
Abstract
In patients with the acute respiratory distress syndrome (ARDS), lung imaging is a fundamental tool in the study of the morphological and mechanistic features of the lungs. Chest computed tomography studies led to major advances in the understanding of ARDS physiology. They allowed the in vivo study of the syndrome's lung features in relation with its impact on respiratory physiology and physiology, but also explored the lungs' response to mechanical ventilation, be it alveolar recruitment or ventilator-induced lung injuries. Coupled with positron emission tomography, morphological findings were put in relation with ventilation, perfusion or acute lung inflammation. Lung imaging has always been central in the care of patients with ARDS, with modern point-of-care tools such as electrical impedance tomography or lung ultrasounds guiding clinical reasoning beyond macro-respiratory mechanics. Finally, artificial intelligence and machine learning now assist imaging post-processing software, which allows real-time analysis of quantitative parameters that describe the syndrome's complexity. This narrative review aims to draw a didactic and comprehensive picture of how modern imaging techniques improved our understanding of the syndrome, and have the potential to help the clinician guide ventilatory treatment and refine patient prognostication.
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Hiroyama S, Matsunaga K, Ito M, Iimori H, Tajiri M, Nakano Y, Shimosegawa E, Abe K. Usefulness of 18F-FPP-RGD2 PET in pathophysiological evaluation of lung fibrosis using a bleomycin-induced rat model. Eur J Nucl Med Mol Imaging 2022; 49:4358-4368. [DOI: 10.1007/s00259-022-05908-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/07/2022] [Indexed: 11/04/2022]
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Bastos AL, Ferreira GA, Mamede M, Mancuzo EV, Teixeira MM, Santos FPST, Ferreira CS, Correa RA. PET/CT and inflammatory mediators in systemic sclerosis-associated interstitial lung disease. JORNAL BRASILEIRO DE PNEUMOLOGIA : PUBLICACAO OFICIAL DA SOCIEDADE BRASILEIRA DE PNEUMOLOGIA E TISILOGIA 2022; 48:e20210329. [PMID: 35674522 PMCID: PMC9262436 DOI: 10.36416/1806-3756/e20210329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/03/2022] [Indexed: 11/25/2022]
Abstract
Objective: To investigate the correlation of HRCT findings with pulmonary metabolic activity in the corresponding regions using 18F-FDG PET/CT and inflammatory markers in patients with systemic sclerosis (SSc)-associated interstitial lung disease (ILD). Methods: This was a cross-sectional study involving 23 adult patients with SSc-associated ILD without other connective tissue diseases. The study also involved 18F-FDG PET/CT, HRCT, determination of serum chemokine levels, clinical data, and pulmonary function testing. Results: In this cohort of patients with long-term disease (disease duration, 11.8 ± 8.7 years), a nonspecific interstitial pneumonia pattern was found in 19 (82.6%). Honeycombing areas had higher median standardized uptake values (1.95; p = 0.85). Serum levels of soluble tumor necrosis factor receptor 1, soluble tumor necrosis factor receptor 2, C-C motif chemokine ligand 2 (CCL2), and C-X-C motif chemokine ligand 10 were higher in SSc patients than in controls. Serum levels of CCL2-a marker of fibroblast activity-were correlated with pure ground-glass opacity (GGO) areas on HRCT scans (p = 0.007). 18F-FDG PET/CT showed significant metabolic activity for all HRCT patterns. The correlation between serum CCL2 levels and GGO on HRCT scans suggests a central role of fibroblasts in these areas, adding new information towards the understanding of the mechanisms surrounding cellular and molecular elements and their expression on HRCT scans in patients with SSc-associated ILD. Conclusions: 18F-FDG PET/CT appears to be unable to differentiate the intensity of metabolic activity across HRCT patterns in chronic SSc patients. The association between CCL2 and GGO might be related to fibroblast activity in these areas; however, upregulated CCL2 expression in the lung tissue of SSc patients should be investigated in order to gain a better understanding of this association.
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Affiliation(s)
- Andréa L Bastos
- . Departamento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Gilda A Ferreira
- . Departamento do Aparelho Locomotor, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Marcelo Mamede
- . Departamento de Anatomia e Imagem, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Eliane V Mancuzo
- . Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Mauro M Teixeira
- . Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Flávia P S T Santos
- . Serviço de Reumatologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Cid S Ferreira
- . Departamento de Radiologia, Hospital das Clínicas, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
| | - Ricardo A Correa
- . Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais - UFMG - Belo Horizonte (MG) Brasil
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Tissue Fraction Correction and Visual Analysis Increase Diagnostic Sensitivity in Predicting Malignancy of Ground-Glass Nodules on [ 18F]FDG PET/CT: A Bicenter Retrospective Study. Diagnostics (Basel) 2022; 12:diagnostics12051292. [PMID: 35626447 PMCID: PMC9140844 DOI: 10.3390/diagnostics12051292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 05/16/2022] [Accepted: 05/21/2022] [Indexed: 01/15/2023] Open
Abstract
We investigated the role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in evaluating ground-glass nodules (GGNs) by visual analysis and tissue fraction correction. A total of 40 pathologically confirmed ≥1 cm GGNs were evaluated visually and semiquantitatively. [18F]FDG uptake of GGN distinct from background lung activity was considered positive in visual analysis. In semiquantitative analysis, we performed tissue fraction correction for the maximum standardized uptake value (SUVmax) of GGN. Of the 40 GGNs, 25 (63%) were adenocarcinomas, 9 (23%) were minimally invasive adenocarcinomas (MIAs), and 6 (15%) were adenocarcinomas in situ (AIS). On visual analysis, adenocarcinoma showed the highest positivity rate among the three pathological groups (88%, 44%, and 17%, respectively). Both SUVmax and tissue-fraction−corrected SUVmax (SUVmaxTF) were in the order of adenocarcinoma > MIA > AIS (p = 0.033 and 0.018, respectively). SUVmaxTF was significantly higher than SUVmax before correction (2.4 [1.9−3.0] vs. 1.3 [0.8−1.8], p < 0.001). When using a cutoff value of 2.5, the positivity rate of GGNs was significantly higher in SUVmaxTF than in SUVmax (50% vs. 5%, p < 0.001). The diagnostic sensitivity of [18F]FDG PET/CT in predicting the malignancy of lung GGN was improved by tissue fraction correction and visual analysis.
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Gulhane AV, Chen DL. Overview of positron emission tomography in functional imaging of the lungs for diffuse lung diseases. Br J Radiol 2022; 95:20210824. [PMID: 34752146 PMCID: PMC9153708 DOI: 10.1259/bjr.20210824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Positron emission tomography (PET) is a quantitative molecular imaging modality increasingly used to study pulmonary disease processes and drug effects on those processes. The wide range of drugs and other entities that can be radiolabeled to study molecularly targeted processes is a major strength of PET, thus providing a noninvasive approach for obtaining molecular phenotyping information. The use of PET to monitor disease progression and treatment outcomes in DLD has been limited in clinical practice, with most of such applications occurring in the context of research investigations under clinical trials. Given the high costs and failure rates for lung drug development efforts, molecular imaging lung biomarkers are needed not only to aid these efforts but also to improve clinical characterization of these diseases beyond canonical anatomic classifications based on computed tomography. The purpose of this review article is to provide an overview of PET applications in characterizing lung disease, focusing on novel tracers that are in clinical development for DLD molecular phenotyping, and briefly address considerations for accurately quantifying lung PET signals.
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Affiliation(s)
- Avanti V Gulhane
- Department of Radiology, University of Washington School of Medicine, Seattle, United States
| | - Delphine L Chen
- Department of Radiology, University of Washington School of Medicine, Seattle, United States
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Non-invasive quantification of acute macrophagic lung inflammation with [ 11C](R)-PK11195 using a three-tissue compartment kinetic model in experimental acute respiratory distress syndrome. Eur J Nucl Med Mol Imaging 2022; 49:2122-2136. [PMID: 35129652 DOI: 10.1007/s00259-022-05713-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/30/2022] [Indexed: 12/18/2022]
Abstract
PURPOSE Imaging of acute lung inflammation is pivotal to evaluate innovative ventilation strategies. We aimed to develop and validate a three-tissue compartment kinetic model (3TCM) of [11C](R)-PK11195 lung uptake in experimental acute respiratory distress syndrome (ARDS) to help quantify macrophagic inflammation, while accounting for the impact of its non-specific and irreversible uptake in lung tissues. MATERIAL AND METHODS We analyzed the data of 38 positron emission tomography (PET) studies performed in 21 swine with or without experimental ARDS, receiving general anesthesia and mechanical ventilation. Model input function was a plasma, metabolite-corrected, image-derived input function measured in the main pulmonary artery. Regional lung analysis consisted in applying both the 3TCM and the two-tissue compartment model (2TCM); in each region, the best model was selected using a selection algorithm with a goodness-of-fit criterion. Regional best model binding potentials (BPND) were compared to lung macrophage presence, semi-quantified in pathology. RESULTS The 3TCM was preferred in 142 lung regions (62%, 95% confidence interval: 56 to 69%). BPND determined by the 2TCM was significantly higher than the value computed with the 3TCM (overall median with interquartile range: 0.81 [0.44-1.33] vs. 0.60 [0.34-0.94], p < 0.02). Regional macrophage score was significantly associated with the best model BPND (p = 0.03). Regional BPND was significantly increased in the hyperinflated lung compartment, compared to the normally aerated one (median with interquartile range: 0.8 [0.6-1.7] vs. 0.6 [0.3-0.8], p = 0.03). CONCLUSION To assess the intensity and spatial distribution of acute macrophagic lung inflammation in the context of experimental ARDS with mechanical ventilation, PET quantification of [11C](R)-PK11195 lung uptake was significantly improved in most lung regions using the 3TCM. This new methodology offers the opportunity to non-invasively evaluate innovative ventilatory strategies aiming at controlling acute lung inflammation.
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Sari H, Mingels C, Alberts I, Hu J, Buesser D, Shah V, Schepers R, Caluori P, Panin V, Conti M, Afshar-Oromieh A, Shi K, Eriksson L, Rominger A, Cumming P. First results on kinetic modelling and parametric imaging of dynamic 18F-FDG datasets from a long axial FOV PET scanner in oncological patients. Eur J Nucl Med Mol Imaging 2022; 49:1997-2009. [PMID: 34981164 DOI: 10.1007/s00259-021-05623-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the kinetics of 18F-fluorodeoxyglucose (18F-FDG) by positron emission tomography (PET) in multiple organs and test the feasibility of total-body parametric imaging using an image-derived input function (IDIF). METHODS Twenty-four oncological patients underwent dynamic 18F-FDG scans lasting 65 min using a long axial FOV (LAFOV) PET/CT system. Time activity curves (TAC) were extracted from semi-automated segmentations of multiple organs, cerebral grey and white matter, and from vascular structures. The tissue and tumor lesion TACs were fitted using an irreversible two-tissue compartment (2TC) and a Patlak model. Parametric images were also generated using direct and indirect Patlak methods and their performances were evaluated. RESULTS We report estimates of kinetic parameters and metabolic rate of glucose consumption (MRFDG) for different organs and tumor lesions. In some organs, there were significant differences between MRFDG values estimated using 2TC and Patlak models. No statistically significant difference was seen between MRFDG values estimated using 2TC and Patlak methods in tumor lesions (paired t-test, P = 0.65). Parametric imaging showed that net influx (Ki) images generated using direct and indirect Patlak methods had superior tumor-to-background ratio (TBR) to standard uptake value (SUV) images (3.1- and 3.0-fold mean increases in TBRmean, respectively). Influx images generated using the direct Patlak method had twofold higher contrast-to-noise ratio in tumor lesions compared to images generated using the indirect Patlak method. CONCLUSION We performed pharmacokinetic modelling of multiple organs using linear and non-linear models using dynamic total-body 18F-FDG images. Although parametric images did not reveal more tumors than SUV images, the results confirmed that parametric imaging furnishes improved tumor contrast. We thus demonstrate the feasibility of total-body kinetic modelling and parametric imaging in basic research and oncological studies. LAFOV PET can enhance dynamic imaging capabilities by providing high sensitivity parametric images and allowing total-body pharmacokinetic analysis.
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Affiliation(s)
- Hasan Sari
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland.
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Clemens Mingels
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Ian Alberts
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Jicun Hu
- Siemens Medical Solutions, USA Inc., Knoxville, TN, USA
| | - Dorothee Buesser
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Vijay Shah
- Siemens Medical Solutions, USA Inc., Knoxville, TN, USA
| | - Robin Schepers
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Patrik Caluori
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | | | | | - Ali Afshar-Oromieh
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Kuangyu Shi
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Lars Eriksson
- Siemens Medical Solutions, USA Inc., Knoxville, TN, USA
- Department of Oncology and Pathology, Medical Radiation Physics, Karolinska Institutet, Stockholm, Sweden
| | - Axel Rominger
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Paul Cumming
- Department of Nuclear Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010, Bern, Switzerland
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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12
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Lukey PT, Wilson FJ. Quantification of the α v β 6 Integrin by PET/CT Imaging in the Lungs of Patients After SARS-CoV2 Infection and Comparison to Fibrotic Lungs. J Nucl Med 2022; 63:166. [PMID: 33837070 PMCID: PMC8717206 DOI: 10.2967/jnumed.121.262342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pauline T. Lukey
- Target to Treatment Consulting Ltd., Stevenage, United Kingdom E-mail:
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13
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Yoon HY, Lee SH, Ha S, Ryu JS, Song JW. The Value of 18F-FDG PET/CT in Evaluating Disease Severity and Prognosis in Idiopathic Pulmonary Fibrosis Patients. J Korean Med Sci 2021; 36:e257. [PMID: 34697928 PMCID: PMC8546311 DOI: 10.3346/jkms.2021.36.e257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 08/30/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Several parameters are useful for assessing disease severity in idiopathic pulmonary fibrosis (IPF); however, the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is not well-defined. We aimed to evaluate the value of 18F-FDG PET/CT for assessing disease severity and prognosis in IPF patients. METHODS Clinical data of 89 IPF patients (mean age: 68.1 years, male: 94%) who underwent 18F-FDG PET/CT for evaluation of lung nodules or cancer staging were retrospectively reviewed. Mean and maximal standardized uptake values (SUVmean, SUVmax, respectively) were measured in the fibrotic area. Adjusted SUV, including SUV ratio (SUVR, defined as SUVmax-to-liver SUVmean ratio), tissue fraction-corrected SUVmean (SUVmeanTF), and SUVR (SUVRTF), and tissue-to-blood ratio (SUVmax/SUVmean venous; TBRblood) were obtained. Death was defined as the primary outcome, and associations between other clinical parameters (lung function, exercise capacity, C-reactive protein [CRP] level) were also investigated. RESULTS All SUV parameters were inversely correlated with the forced vital capacity, diffusing capacity for carbon monoxide, and positively correlated with CRP level and the gender-age-physiology index. The SUVmean, SUVmax, and SUVmeanTF were associated with changes in lung function at six months. The SUVR (hazard ratio [HR], 1.738; 95% confidence interval [CI], 1.011-2.991), SUVRTF (HR, 1.441; 95% CI, 1.000-2.098), and TBRblood (HR, 1.377; 95% CI, 1.038-1.827) were significant predictors for mortality in patients with IPF in the univariate analysis, but not in the multivariate analysis. CONCLUSION 18F-FDG PET/CT may provide additional information on the disease severity and prognosis in IPF patients, and the SUVR may be superior to other SUV parameters.
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Affiliation(s)
- Hee-Young Yoon
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk Hyun Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Division of Nuclear Medicine, Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Sejin Ha
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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14
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18F-FDG PET/CT predicts acute exacerbation in idiopathic pulmonary fibrosis after thoracic surgery. BMC Pulm Med 2021; 21:294. [PMID: 34530787 PMCID: PMC8447514 DOI: 10.1186/s12890-021-01659-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 09/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Acute exacerbation (AE) is the most lethal postoperative complication in idiopathic pulmonary fibrosis (IPF); however, prediction before surgery is difficult. We investigated the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in predicting postoperative AE in IPF. Method Clinical data of 48 IPF patients who underwent 18F-FDG PET/CT before thoracic surgery were retrospectively analyzed. Mean and maximal standardized uptake values (SUVmean and SUVmax, respectively) were measured in the fibrotic area. Additionally, adjusted values-SUV ratio (SUVR, defined as SUVmax-to-liver SUVmean ratio), tissue fraction-corrected SUVmean (SUVmeanTF), and SUVR (SUVRTF)-were calculated. Results The mean age of the subjects was 67.8 years and 91.7% were male. After thoracic surgery, 21 (43.8%) patients experienced postoperative complications including prolonged air leakage (29.2%), death (14.6%), and AE (12.5%) within 30 days. Patients who experienced AE showed higher SUVmax, SUVR, SUVmeanTF, and SUVRTF than those who did not, but other clinical parameters were not different between patients with and without AE. The SUV parameters did not differ for other complications. The SUVR (odds ratio [OR] 29.262; P = 0.030), SUVmeanTF (OR 3.709; P = 0.041) and SUVRTF (OR 20.592; P = 0.017) were significant predicting factors for postoperative AE following a multivariate logistic regression analysis. On receiver operating characteristics curve analysis, SUVRTF had the largest area under the curve (0.806, P = 0.007) for predicting postoperative AE among SUV parameters. Conclusions Our findings suggest that 18F-FDG PET/CT may be useful in predicting postoperative AE in IPF patients and among SUVs, SUVRTF is the best parameter for predicting postoperative AE in IPF patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01659-4.
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15
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Porter JC, Win T, Erlandsson K, Fraioli F, Rashidnasab A, Holman B, Ganeshan B, Screaton NJ, Maher TM, Endozo R, Hoath J, Shortman RI, Emond E, Thielemans K, Hutton BF, Lukey PT, Aigbirhio F, Khan S, Rodriguez-Justo M, Groves AM. Measurement of hypoxia in the lung in IPF: an F-MISO PET CT study. Eur Respir J 2021; 58:13993003.04584-2020. [PMID: 34244317 DOI: 10.1183/13993003.04584-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/04/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Joanna C Porter
- CITR, UCL and Interstitial Lung Disease Centre, UCLH, London, UK.,Joint First Authors
| | - Thida Win
- Respiratory Medicine, Lister Hospital, Stevenage, UK.,Joint First Authors
| | | | | | | | | | | | | | - Toby M Maher
- Hastings Centre for Pulmonary Research and Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, USA.,Inflammation, Repair and Development Section, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton Hospital, London, UK
| | | | - John Hoath
- Institute of Nuclear Medicine, UCL/H, London, UK
| | | | - Elise Emond
- Institute of Nuclear Medicine, UCL/H, London, UK
| | | | | | - Pauline T Lukey
- Target to Treatment Consulting Ltd, Stevenage Bioscience Catalyst, Stevenage, UK
| | | | - Saif Khan
- Department of Histopathology, UCLH, London, UK
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16
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Botros L, Jansen SM, Ashek A, Spruijt OA, Tramper J, Noordegraaf AV, Aman J, Harms H, de Man FS, Huisman MC, Zhao L, Bogaard HJ. Application of [18F]FLT-PET in pulmonary arterial hypertension: a clinical study in pulmonary arterial hypertension patients and unaffected bone morphogenetic protein receptor type 2 mutation carriers. Pulm Circ 2021; 11:20458940211028017. [PMID: 34276963 PMCID: PMC8256252 DOI: 10.1177/20458940211028017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/05/2021] [Indexed: 11/17/2022] Open
Abstract
Pulmonary arterial hypertension is a heterogeneous group of diseases characterized by vascular cell proliferation leading to pulmonary vascular remodelling and ultimately right heart failure. Previous data indicated that 3'-deoxy-3'-[18F]-fluorothymidine (18FLT) positron emission tomography (PET) scanning was increased in pulmonary arterial hypertension patients, hence providing a possible biomarker for pulmonary arterial hypertension as it reflects vascular cell hyperproliferation in the lung. This study sought to validate 18FLT-PET in an expanded cohort of pulmonary arterial hypertension patients in comparison to matched healthy controls and unaffected bone morphogenetic protein receptor type 2 mutation carriers. 18FLT-PET scanning was performed in 21 pulmonary arterial hypertension patients (15 hereditary pulmonary arterial hypertension and 6 idiopathic pulmonary arterial hypertension), 11 unaffected mutation carriers and 9 healthy control subjects. In-depth kinetic analysis indicated that there were no differences in lung 18FLT k3 phosphorylation among pulmonary arterial hypertension patients, unaffected bone morphogenetic protein receptor type 2 mutation carriers and healthy controls. Lung 18FLT uptake did not correlate with haemodynamic or clinical parameters in pulmonary arterial hypertension patients. Sequential 18FLT-PET scanning in three patients demonstrated uneven regional distribution in 18FLT uptake by 3D parametric mapping of the lung, although this did not follow the clinical course of the patient. We did not detect significantly increased lung 18FLT uptake in pulmonary arterial hypertension patients, nor in the unaffected bone morphogenetic protein receptor type 2 mutation carriers, as compared to healthy subjects. The conflicting results with our preliminary human 18FLT report may be explained by a small sample size previously and we observed large variation of lung 18FLT signals between patients, challenging the application of 18FLT-PET as a biomarker in the pulmonary arterial hypertension clinic.
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Affiliation(s)
- Liza Botros
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Samara M.A. Jansen
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ali Ashek
- Faculty of MedicineNational Heart and Lung InstituteImperial College LondonHammersmith HospitalLondonUK
| | - Onno A. Spruijt
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jelco Tramper
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Anton V. Noordegraaf
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Jurjan Aman
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Hans Harms
- Cardiovascular Imaging ProgramDepartments of Radiology and Medicine; Division of Nuclear Medicine and Molecular ImagingBrigham and Women’s Hospitaland Harvard Medical SchoolBostonMAUSA
- Institute of Clinical MedicineAarhus University HospitalAarhusDenmark
| | - Frances S. de Man
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Marc C. Huisman
- Department of Radiology and Nuclear MedicineAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Lan Zhao
- Faculty of MedicineNational Heart and Lung InstituteImperial College LondonHammersmith HospitalLondonUK
| | - Harm J. Bogaard
- Department of PulmonologyAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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17
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Increased 18F-FDG accumulation in less-affected lung area in patients with non-small cell lung cancer and postoperative acute exacerbation of interstitial lung disease. Eur J Radiol 2020; 135:109477. [PMID: 33401111 DOI: 10.1016/j.ejrad.2020.109477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/25/2020] [Accepted: 12/09/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To investigate whether or not 18F-FDG accumulation in normal or less-affected lung fields increased in non-small cell lung cancer (NSCLC) patients with postoperative acute exacerbation (PAE) of interstitial lung disease (ILD) MATERIAL AND METHODS: Thirty-six NSCLC patients with ILD and 50 patients without ILD (non-ILD patients) underwent pre-operative 18F-FDG-PET/CT at 2 institutions. Volume-of-interest (VOI) was placed to measure the mean standardized uptake value (SUVmean) in normal or less-affected lung fields at pre-defined 12 areas on ventral and dorsal locations of both lungs. SUVtissue fraction (TF) was defined as corrected SUVmean by using TF and mean computed tomography density on PET/CT. Harmonized SUVmean (hSUVmean) and SUVTF (hSUVTF) were calculated based on results of phantom study, which was performed to optimize the measured SUV difference among 2 institutions. Both the h-SUVmean and the h-SUVTF were compared between 8 patients with PAE of ILD (PAE group) or remaining 28 patients without PAE of ILD (non-PAE group) and non-ILD patients in each of the 12 areas. RESULTS The hSUVmean in PAE group was higher in 9 out of 12 locations as compared with non-ILD patients, whereas the hSUVmean was mostly similar between non-PAE group and non-ILD patients. In contrast, the hSUVTF in non-PAE group was similar to that in PAE group, and higher than in non-ILD patients in most locations. CONCLUSION 18F-FDG-PET/CT demonstrated increased SUVmean along with elevated SUVTF in normal or less-affected lung fields for NSCLC patients with PAE of ILD, which may reflect regional invisible fibrosis and inflammatory change.
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18
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Chen DL, Ballout S, Chen L, Cheriyan J, Choudhury G, Denis-Bacelar AM, Emond E, Erlandsson K, Fisk M, Fraioli F, Groves AM, Gunn RN, Hatazawa J, Holman BF, Hutton BF, Iida H, Lee S, MacNee W, Matsunaga K, Mohan D, Parr D, Rashidnasab A, Rizzo G, Subramanian D, Tal-Singer R, Thielemans K, Tregay N, van Beek EJR, Vass L, Vidal Melo MF, Wellen JW, Wilkinson I, Wilson FJ, Winkler T. Consensus Recommendations on the Use of 18F-FDG PET/CT in Lung Disease. J Nucl Med 2020; 61:1701-1707. [PMID: 32948678 PMCID: PMC9364897 DOI: 10.2967/jnumed.120.244780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/09/2020] [Indexed: 01/04/2023] Open
Abstract
PET with 18F-FDG has been increasingly applied, predominantly in the research setting, to study drug effects and pulmonary biology and to monitor disease progression and treatment outcomes in lung diseases that interfere with gas exchange through alterations of the pulmonary parenchyma, airways, or vasculature. To date, however, there are no widely accepted standard acquisition protocols or imaging data analysis methods for pulmonary 18F-FDG PET/CT in these diseases, resulting in disparate approaches. Hence, comparison of data across the literature is challenging. To help harmonize the acquisition and analysis and promote reproducibility, we collated details of acquisition protocols and analysis methods from 7 PET centers. From this information and our discussions, we reached the consensus recommendations given here on patient preparation, choice of dynamic versus static imaging, image reconstruction, and image analysis reporting.
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Affiliation(s)
- Delphine L Chen
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
| | - Safia Ballout
- School of Physics and Astronomy, University of Leeds, Leeds, United Kingdom
| | - Laigao Chen
- Worldwide Research, Development, and Medical, Pfizer Inc., Cambridge, Massachusetts
| | - Joseph Cheriyan
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gourab Choudhury
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Elise Emond
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Kjell Erlandsson
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Marie Fisk
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Roger N Gunn
- inviCRO, London, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University, Osaka, Japan
| | - Beverley F Holman
- Nuclear Medicine Department, Royal Free Hospital, London, United Kingdom
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Hidehiro Iida
- Faculty of Biomedicine and Turku PET Center, University of Turku, Turku, Finland
| | - Sarah Lee
- Amallis Consulting Ltd., London, United Kingdom
| | - William MacNee
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Keiko Matsunaga
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University, Osaka, Japan
| | - Divya Mohan
- Medical Innovation, Value Evidence, and Outcomes, GlaxoSmithKline R&D, Collegeville, Pennsylvania
| | - David Parr
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Alaleh Rashidnasab
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Gaia Rizzo
- inviCRO, London, United Kingdom
- Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Ruth Tal-Singer
- Medical Innovation, Value Evidence, and Outcomes, GlaxoSmithKline R&D, Collegeville, Pennsylvania
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Nicola Tregay
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Edwin J R van Beek
- Edinburgh Imaging, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laurence Vass
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Marcos F Vidal Melo
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jeremy W Wellen
- Research and Early Development, Celgene, Cambridge, Massachusetts; and
| | - Ian Wilkinson
- Cambridge University Hospitals, NHS Foundation Trust, Cambridge, United Kingdom
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Frederick J Wilson
- Clinical Imaging, Clinical Pharmacology, and Experimental Medicine, GlaxoSmithKline, Stevenage, United Kingdom
| | - Tilo Winkler
- Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
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19
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Dos Santos Rocha A, Fodor GH, Kassai M, Degrugilliers L, Bayat S, Petak F, Habre W. Physiologically variable ventilation reduces regional lung inflammation in a pediatric model of acute respiratory distress syndrome. Respir Res 2020; 21:288. [PMID: 33129315 PMCID: PMC7602830 DOI: 10.1186/s12931-020-01559-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Benefits of variable mechanical ventilation based on the physiological breathing pattern have been observed both in healthy and injured lungs. These benefits have not been characterized in pediatric models and the effect of this ventilation mode on regional distribution of lung inflammation also remains controversial. Here, we compare structural, molecular and functional outcomes reflecting regional inflammation between PVV and conventional pressure-controlled ventilation (PCV) in a pediatric model of healthy lungs and acute respiratory distress syndrome (ARDS). METHODS New-Zealand White rabbit pups (n = 36, 670 ± 20 g [half-width 95% confidence interval]), with healthy lungs or after induction of ARDS, were randomized to five hours of mechanical ventilation with PCV or PVV. Regional lung aeration, inflammation and perfusion were assessed using x-ray computed tomography, positron-emission tomography and single-photon emission computed tomography, respectively. Ventilation parameters, blood gases and respiratory tissue elastance were recorded hourly. RESULTS Mechanical ventilation worsened respiratory elastance in healthy and ARDS animals ventilated with PCV (11 ± 8%, 6 ± 3%, p < 0.04), however, this trend was improved by PVV (1 ± 4%, - 6 ± 2%). Animals receiving PVV presented reduced inflammation as assessed by lung normalized [18F]fluorodeoxyglucose uptake in healthy (1.49 ± 0.62 standardized uptake value, SUV) and ARDS animals (1.86 ± 0.47 SUV) compared to PCV (2.33 ± 0.775 and 2.28 ± 0.3 SUV, respectively, p < 0.05), particularly in the well and poorly aerated lung zones. No benefit of PVV could be detected on regional blood perfusion or blood gas parameters. CONCLUSIONS Variable ventilation based on a physiological respiratory pattern, compared to conventional pressure-controlled ventilation, reduced global and regional inflammation in both healthy and injured lungs of juvenile rabbits.
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Affiliation(s)
- Andre Dos Santos Rocha
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva and University of Geneva, rue Willy Donzé 6, 1205, Geneva, Switzerland.
| | - Gergely H Fodor
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva and University of Geneva, rue Willy Donzé 6, 1205, Geneva, Switzerland.,Department of Medical Physics and Informatics, University of Szeged, 9 Korányi fasor, Szeged, 6720, Hungary
| | - Miklos Kassai
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva and University of Geneva, rue Willy Donzé 6, 1205, Geneva, Switzerland
| | - Loic Degrugilliers
- Department of Pediatric Intensive Care, Amiens University Hospital, Amiens, France
| | - Sam Bayat
- Inserm UA7 STROBE Laboratory &, Department of Clinical Physiology, Sleep and Exercise, Grenoble University Hospital, Boulevard de La Chantourne, 38700, Grenoble, La Tronche, France
| | - Ferenc Petak
- Department of Medical Physics and Informatics, University of Szeged, 9 Korányi fasor, Szeged, 6720, Hungary
| | - Walid Habre
- Unit for Anaesthesiological Investigations, Department of Acute Medicine, University Hospitals of Geneva and University of Geneva, rue Willy Donzé 6, 1205, Geneva, Switzerland
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20
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Vass L, Fisk M, Lee S, Wilson FJ, Cheriyan J, Wilkinson I. Advances in PET to assess pulmonary inflammation: A systematic review. Eur J Radiol 2020; 130:109182. [DOI: 10.1016/j.ejrad.2020.109182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/27/2020] [Accepted: 07/07/2020] [Indexed: 12/12/2022]
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21
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Nikpanah M, Katal S, Christensen TQ, Werner TJ, Hess S, Malayeri AA, Gholamrezanezhad A, Alavi A, Saboury B. Potential Applications of PET Scans, CT Scans, and MR Imaging in Inflammatory Diseases: Part II: Cardiopulmonary and Vascular Inflammation. PET Clin 2020; 15:559-576. [PMID: 32792228 DOI: 10.1016/j.cpet.2020.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Detecting inflammation is among the most important aims of medical imaging. Inflammatory process involves immune system activity and local tissue response. The role of PET with fludeoxyglucose F 18 has been expanded. Systemic vasculitides and cardiopulmonary inflammatory disorders constitute a wide range of diseases with multisystemic manifestations. PET with fludeoxyglucose F 18 is useful in their diagnosis, assessment, and follow-up. This article provides an overview of the current status and potentials of hybrid molecular imaging in evaluating cardiopulmonary and vascular inflammatory diseases focusing on the potential for PET with fludeoxyglucose F 18/MR imaging and PET/CT scans.
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Affiliation(s)
- Moozhan Nikpanah
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Sanaz Katal
- Department of Nuclear Medicine/PET-CT, Kowsar Hospital, Shiraz, Iran
| | - Thomas Q Christensen
- Department of Clinical Engineering, Region of Southern Denmark, Esbjerg, Denmark 5000
| | - Thomas J Werner
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Søren Hess
- Department of Radiology and Nuclear Medicine, Hospital of South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark 6700; Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Ashkan A Malayeri
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Health Sciences Campus, 1500 San Pablo Street, Los Angeles, California 90033, USA
| | - Abass Alavi
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
| | - Babak Saboury
- Department of Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20892, USA; Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA.
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Lukey PT, Coello C, Gunn R, Parker C, Wilson FJ, Saleem A, Garman N, Costa M, Kendrick S, Onega M, Kang'ombe AR, Listanco A, Davies J, Ramada-Magalhaes J, Moz S, Fahy WA, Maher TM, Jenkins G, Passchier J, Marshall RP. Clinical quantification of the integrin αvβ6 by [ 18F]FB-A20FMDV2 positron emission tomography in healthy and fibrotic human lung (PETAL Study). Eur J Nucl Med Mol Imaging 2020; 47:967-979. [PMID: 31814068 PMCID: PMC7075837 DOI: 10.1007/s00259-019-04586-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/16/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE The RGD-integrin, αvβ6, plays a role in the pathogenesis of pulmonary fibrosis through activation of transforming growth factor beta (TGFβ). This study sought to quantify expression of αvβ6 in the lungs of healthy humans and subjects with pulmonary fibrosis using the αvβ6-selective [18F]FB-A20FMDV2 PET ligand. METHODS [18F]FB-A20FMDV2 PET/CT scans were performed in healthy subjects and those with fibrotic lung disease. Standard uptake values (SUV) and volume of distribution (VT) were used to quantify αvβ6 expression. In subjects with fibrotic lung disease, qualitative assessment of the relationship between αvβ6 expression and the distribution of fibrosis on high resolution computed tomography was conducted. RESULTS A total of 15 participants (6 healthy, 7 with idiopathic pulmonary fibrosis (IPF) and 2 with connective tissue disease (CTD) associated PF) were enrolled. VT and SUV of [18F]FB-A20FMDV2 were increased in the lungs of subjects with pulmonary fibrosis (PF) compared with healthy subjects. Geometric mean VT (95% CI) was 0.88 (0.60, 1.29) mL/cm3 for healthy subjects, and 1.40 (1.22, 1.61) mL/cm3 for subjects with IPF; and SUV was 0.54 (0.36, 0.81) g/mL for healthy subjects and 1.03 (0.86, 1.22) g/mL for subjects with IPF. The IPF/healthy VT ratio (geometric mean, (95% CI of ratio)) was 1.59 (1.09, 2.32) (probability ratio > 1 = 0.988)) and the SUV ratio was 1.91 (1.27, 2.87) (probability ratio > 1 = 0.996). Increased uptake of [18F]FB-A20FMDV2 in PF was predominantly confined to fibrotic areas. [18F]FB-A20FMDV2 measurements were reproducible at an interval of 2 weeks. [18F]FB-A20FMDV2 was safe and well tolerated. CONCLUSIONS Lung uptake of [18F]FB-A20FMDV2, a measure of expression of the integrin αvβ6, was markedly increased in subjects with PF compared with healthy subjects.
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Affiliation(s)
- Pauline T Lukey
- GlaxoSmithKline Research and Development, Brentford, UK.
- Target to Treatment Consulting Ltd, Stevenage BioScience Catalyst, Stevenage, SG1 2FX, UK.
| | | | | | | | | | | | - Nadia Garman
- GlaxoSmithKline Research and Development, Brentford, UK
| | - Maria Costa
- GlaxoSmithKline Research and Development, Brentford, UK
| | | | | | | | | | | | | | | | | | - Toby M Maher
- NIHR Respiratory Clinical Research Facility, Royal Brompton Hospital, London, UK
- Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Gisli Jenkins
- National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham University Hospitals, Nottingham, UK
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Saleem A, Helo Y, Win Z, Dale R, Cook J, Searle GE, Wells P. Integrin αvβ6 Positron Emission Tomography Imaging in Lung Cancer Patients Treated With Pulmonary Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 107:370-376. [PMID: 32060008 DOI: 10.1016/j.ijrobp.2020.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/28/2020] [Accepted: 02/02/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Post radiation therapy (RT) lung fibrosis is a major barrier to improved cure rate in lung cancer. Integrin αvβ6 plays a key role in fibrogenesis by activating transforming growth factor-β. Positron emission tomography (PET) studies with a fluorine-18 radiolabelled αvβ6 radioligand, [18F]-FBA-A20FMDV2, were performed to assess uptake, and the relationship to RT dose parameters was explored. METHODS AND MATERIALS Recently treated non-small cell lung cancer patients (<6 months after RT) had [18F]-FBA-A20FMDV2-PET scans, coregistered with the RT planning computed tomography and segmented to RT doses of >40 Gy (excluding tumor), 25 to 40 Gy, 15 to 25 Gy, 8 to 15 Gy, and <8 Gy. PET uptake (standardized uptake value; SUV) corrected for tissue density between 10 and 60 minutes (SUV10-60) was calculated and compared with RT dose, dose per fraction, and biological effective dose (BED). PET uptake was also evaluated in healthy volunteers. RESULTS Six non-small cell lung cancer (3 male; 3 female) subjects scanned between 6 and 22 weeks after RT and 6 healthy volunteers (3 males; 3 females) were evaluated. Higher mean PET uptake (SUV10-60) was observed in the irradiated lung compared with the healthy lung (2.97 vs 1.99; P < .05). A significant and positive pharmacodynamic relationship was observed between radioligand uptake (SUV10-60) and dose per RT fraction (r2 = 0.63; P < .001) and with BED for fibrosis (r2 = 0.38; P < .001 for α/β 3 Gy and r2 = 0.33; P < 0.001 for α/β 5 Gy). CONCLUSIONS Higher uptake in the irradiated lung and a pharmacodynamic relationship between αvβ6 radioligand uptake versus RT dose per fraction and BED for lung fibrosis is consistent with RT induced activation of αvβ6 integrin and supports a role for αvβ6 in the induction of lung fibrosis after pulmonary RT. αvβ6-PET imaging may potentially aid in the assessment and management of radiation-induced pulmonary fibrosis.
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Affiliation(s)
- Azeem Saleem
- University of Hull, Cottingam Road, Hull, England; Invicro, A Konica Minolta Company, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, England.
| | - Yusuf Helo
- Invicro, A Konica Minolta Company, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, England
| | - Zarni Win
- Department of Radiology, Imperial College Health Care NHS Trust, Hammersmith Hospital, Du Cane Road, London, England
| | - Roger Dale
- Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Du Cane Road, London, England
| | - Jo Cook
- Department of Radiotherapy, King George V Building, St Bartholomew's Hospital, London, England
| | - Graham E Searle
- Invicro, A Konica Minolta Company, Burlington Danes Building, Hammersmith Hospital, Du Cane Road, London, England
| | - Paula Wells
- Department of Radiotherapy, King George V Building, St Bartholomew's Hospital, London, England
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24
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Vass LD, Lee S, Wilson FJ, Fisk M, Cheriyan J, Wilkinson I. Reproducibility of compartmental modelling of 18F-FDG PET/CT to evaluate lung inflammation. EJNMMI Phys 2019; 6:26. [PMID: 31844995 PMCID: PMC6915187 DOI: 10.1186/s40658-019-0265-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/25/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction Compartmental modelling is an established method of quantifying 18F-FDG uptake; however, only recently has it been applied to evaluate pulmonary inflammation. Implementation of compartmental models remains challenging in the lung, partly due to the low signal-to-noise ratio compared to other organs and the lack of standardisation. Good reproducibility is a key requirement of an imaging biomarker which has yet to be demonstrated in pulmonary compartmental models of 18F-FDG; in this paper, we address this unmet need. Methods Retrospective subject data were obtained from the EVOLVE observational study: Ten COPD patients (age =66±9; 8M/2F), 10 α1ATD patients (age =63±8; 7M/3F) and 10 healthy volunteers (age =68±8; 9M/1F) never smokers. PET and CT images were co-registered, and whole lung regions were extracted from CT using an automated algorithm; the descending aorta was defined using a manually drawn region. Subsequent stages of the compartmental analysis were performed by two independent operators using (i) a MIAKATTM based pipeline and (ii) an in-house developed pipeline. We evaluated the metabolic rate constant of 18F-FDG (Kim) and the fractional blood volume (Vb); Bland-Altman plots were used to compare the results. Further, we adjusted the in-house pipeline to identify the salient features in the analysis which may help improve the standardisation of this technique in the lung. Results The initial agreement on a subject level was poor: Bland-Altman coefficients of reproducibility for Kim and Vb were 0.0031 and 0.047 respectively. However, the effect size between the groups (i.e. COPD, α1ATD and healthy subjects) was similar using either pipeline. We identified the key drivers of this difference using an incremental approach: ROI methodology, modelling of the IDIF and time delay estimation. Adjustment of these factors led to improved Bland-Altman coefficients of reproducibility of 0.0015 and 0.027 for Kim and Vb respectively. Conclusions Despite similar methodology, differences in implementation can lead to disparate results in the outcome parameters. When reporting the outcomes of lung compartmental modelling, we recommend the inclusion of the details of ROI methodology, input function fitting and time delay estimation to improve reproducibility.
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Affiliation(s)
- Laurence D Vass
- Experimental Medicine and Immunotherapeutics, Department of Medicine, Addenbrookes Hospital, Cambridge, UK.
| | | | | | - Marie Fisk
- Experimental Medicine and Immunotherapeutics, Department of Medicine, Addenbrookes Hospital, Cambridge, UK.,Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Joseph Cheriyan
- Experimental Medicine and Immunotherapeutics, Department of Medicine, Addenbrookes Hospital, Cambridge, UK.,GSK R &D, Brentford, UK.,Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Ian Wilkinson
- Experimental Medicine and Immunotherapeutics, Department of Medicine, Addenbrookes Hospital, Cambridge, UK.,Cambridge University Hospitals NHS Trust, Cambridge, UK
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Emond EC, Groves AM, Hutton BF, Thielemans K. Effect of positron range on PET quantification in diseased and normal lungs. Phys Med Biol 2019; 64:205010. [PMID: 31539891 DOI: 10.1088/1361-6560/ab469d] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The impact of positron range on PET image reconstruction has often been investigated as a blurring effect that can be partly corrected by adding an element to the PET system matrix in the reconstruction, usually based on a Gaussian kernel constructed from the attenuation values. However, the physics involved in PET is more complex. In regions where density does not vary, positron range indeed involves mainly blurring. However, in more heterogeneous media it can cause other effects. This work focuses on positron range in the lungs and its impact on quantification, especially in the case of pathologies such as cancer or pulmonary fibrosis, for which the lungs have localised varying density. Using Monte Carlo simulations, we evaluate the effects of positron range for multiple radionuclides (18F, 15O, 68Ga, 89Zr, 82Rb, 64Cu and 124I) as, for novel radiotracers, the choice of the labelling radionuclide is important. The results demonstrate quantification biases in highly heterogeneous media, where the measured uptake of high-density regions can be increased by the neighbouring radioactivity from regions of lower density, with the effect more noticeable for radionuclides with high-energy positron emission. When the low-density regions are considered to have less radioactive uptake (e.g. due to the presence of air), the effect is less severe.
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Affiliation(s)
- Elise C Emond
- Institute of Nuclear Medicine, University College London, London NW1 2BU, United Kingdom. Author to whom correspondence should be addressed
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26
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Garpered S, Minarik D, Diaz S, Valind S, Edenbrandt L, Wollmer P. Measurement of airway inflammation in current smokers by positron emission tomography. Clin Physiol Funct Imaging 2019; 39:393-398. [PMID: 31278814 DOI: 10.1111/cpf.12590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Accepted: 06/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Accumulation of activated neutrophilic leucocytes is known to increase uptake of 18 F-fluorodeoxyglucose (18 F-FDG) into lung tissue. Available evidence suggests that smokers and subjects with chronic obstructive pulmonary disease (COPD) have neutrophilic inflammation in peripheral airways. The aim of this study was to examine whether current smokers have higher lung tissue uptake of 18 F-FDG than never-smokers when correcting for air fraction of the lungs. METHODS We prospectively recruited 33 current smokers and 33 never-smokers among subjects referred for diagnosis or staging of cancer, other than lung cancer, with combined positron emission tomography/computed tomography (PET/CT) with 18 F-FDG. Subjects with focal 18 F-FDG uptake or focal CT abnormalities in the lungs were excluded. The lungs were segmented in the CT image, and lung density measured. 18 F-FDG uptake was measured in the corresponding volume and corrected for air fraction. RESULTS Lung uptake of 18 F-FDG, corrected for air fraction, was 12·5 and 8 per cent higher in the right and left lungs, respectively, in current smokers than in never-smokers (P<0·05). Conclusion Abnormal lung tissue uptake of 18 F-FDG may be masked by reduced lung density if the uptake is not related to air fraction. Increased uptake of 18 F-FDG in lung tissue in current smokers relative to never-smokers may reflect inflammation in peripheral airways. Measurements of 18 F-FDG uptake in the lung tissue may be useful for animal and human studies of airways disease in COPD and the relation between airway and systemic inflammation.
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Affiliation(s)
- Sabine Garpered
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Lund, Sweden
| | - David Minarik
- Department of Radiation Physics, Skane University Hospital Malmö, Malmö, Sweden
| | - Sandra Diaz
- Department of Radiology, Skane University Hospital Malmö, Malmö, Sweden
| | - Sven Valind
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Lund, Sweden
| | - Lars Edenbrandt
- Sahlgrenska Hospital Nuclear Medicine Unit, University Gothenburg, Gothenburg, Sweden
| | - Per Wollmer
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Lund, Sweden
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Interlesional Heterogeneity of Metastatic Neuroendocrine Tumors Based on 18F-DOPA PET/CT. Clin Nucl Med 2019; 44:612-619. [DOI: 10.1097/rlu.0000000000002640] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Lukey PT, Harrison SA, Yang S, Man Y, Holman BF, Rashidnasab A, Azzopardi G, Grayer M, Simpson J, Bareille P, Paul L, Woodcock HV, Toshner R, Saunders P, Molyneaux PL, Thielemans K, Wilson FJ, Mercer PF, Chambers RC, Groves AM, Fahy WA, Marshall RP, Maher TM. A randomised, placebo-controlled study of omipalisib (PI3K/mTOR) in idiopathic pulmonary fibrosis. Eur Respir J 2019; 53:13993003.01992-2018. [DOI: 10.1183/13993003.01992-2018] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/11/2018] [Indexed: 11/05/2022]
Abstract
Phosphatidylinositol 3-kinases (PI3Ks) and mammalian target of rapamycin (mTOR) play a role in the pathogenesis of idiopathic pulmonary fibrosis (IPF). Omipalisib (GSK2126458) is a potent inhibitor of PI3K/mTOR.A randomised, placebo-controlled, double-blind, repeat dose escalation, experimental medicine study of omipalisib in subjects with IPF was conducted (NCT01725139) to test safety, tolerability, pharmacokinetics and pharmacodynamics. Omipalisib was dosed at 0.25 mg, 1 mg and 2 mg twice daily for 8 days in four cohorts of four subjects randomised 3:1 to receive omipalisib or placebo (two cohorts received 2 mg twice daily).17 subjects with IPF were enrolled. The most common adverse event was diarrhoea, which was reported by four participants. Dose-related increases in insulin and glucose were observed. Pharmacokinetic analysis demonstrated that exposure in the blood predicts lung exposure. Exposure-dependent inhibition of phosphatidylinositol 3,4,5 trisphosphate and pAKT confirmed target engagement in blood and lungs. 18F-2-fluoro-2-deoxy-d-glucose(FDG)-positron emission tomography/computed tomography scans revealed an exposure-dependent reduction in 18F-FDG uptake in fibrotic areas of the lung, as measured by target-to-background, ratio thus confirming pharmacodynamic activity.This experimental medicine study demonstrates acceptable tolerability of omipalisib in subjects with IPF at exposures for which target engagement was confirmed both systemically and in the lungs.
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Bondue B, Castiaux A, Van Simaeys G, Mathey C, Sherer F, Egrise D, Lacroix S, Huaux F, Doumont G, Goldman S. Absence of early metabolic response assessed by 18F-FDG PET/CT after initiation of antifibrotic drugs in IPF patients. Respir Res 2019; 20:10. [PMID: 30646908 PMCID: PMC6334423 DOI: 10.1186/s12931-019-0974-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/02/2019] [Indexed: 02/08/2023] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) is characterized by a progressive and irreversible respiratory failure. Non-invasive markers of disease activity are essential for prognosis and evaluation of early response to anti-fibrotic treatments. Objectives The aims of this study were to determine whether fluorodeoxyglucose ([18F]-FDG) lung uptake is reduced after initiation of pirfenidone or nintedanib and to assess its possible use as a prognostic factor. Methods [18F]-FDG PET/CT was performed in IPF patients and in a murine model of pulmonary fibrosis. PET/CTs were performed at day 8 and day 15 post-instillation of bleomycin in pirfenidone- or vehicule-treated mice. In IPF patients, PET-CT was performed before and 3 months after the initiation of pirfenidone or nintedanib. Results In bleomycin-treated mice, pirfenidone significantly reduced the [18F]-FDG uptake compared to vehicule-treated mice at day 15 (p < 0.001), whereas no difference was observed at day 8 after bleomycin administration. In IPF patients, [18F]-FDG lung uptake before and after 3 months of treatment by nintedanib (n = 11) or pirfenidone (n = 14) showed no significant difference regardless the antifibrotic treatment. Moreover, no difference was noticed between patients with progressive or non-progressive disease at one year of follow up. Conclusions Pirfenidone significantly reduces the lung [18F]-FDG uptake during the fibrotic phase in a mouse model of IPF. However, these preclinical data were not confirmed in IPF patients 3 months after the initiation of antifibrotic therapy. [18F]-FDG seems therefore not useful in clinical practice to assess the early response of IPF patients to nintedanib or pirfenidone. Electronic supplementary material The online version of this article (10.1186/s12931-019-0974-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Benjamin Bondue
- Department of Respiratory Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.
| | - Amélie Castiaux
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium
| | - Gaetan Van Simaeys
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Céline Mathey
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium
| | - Félicie Sherer
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Dominique Egrise
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Simon Lacroix
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - François Huaux
- Louvain Centre for Toxicology and Applied Pharmacology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Avenue Hippocrate, 57 bte B1.57.06, 1200, Woluwe-Saint-Lambert, Belgium
| | - Gilles Doumont
- Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
| | - Serge Goldman
- Department of Nuclear Medicine, Erasme University Hospital, Université libre de Bruxelles (ULB), route de Lennik 808, 1070, Brussels, Belgium.,Center for Microscopy and Molecular Imaging, Université libre de Bruxelles (ULB), rue Adrienne Bolland 8, 6041, Charleroi, Belgium
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30
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Castiaux A, Van Simaeys G, Goldman S, Bondue B. Assessment of 18F-FDG uptake in idiopathic pulmonary fibrosis: influence of lung density changes. Eur J Hybrid Imaging 2018. [DOI: 10.1186/s41824-018-0045-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Verwer EE, Kavanagh TR, Mischler WJ, Feng Y, Takahashi K, Wang S, Shoup TM, Neelamegam R, Yang J, Guehl NJ, Ran C, Massefski W, Cui Y, El-Chemaly S, Sadow PM, Oldham WM, Kijewski MF, El Fakhri G, Normandin MD, Priolo C. [ 18F]Fluorocholine and [ 18F]Fluoroacetate PET as Imaging Biomarkers to Assess Phosphatidylcholine and Mitochondrial Metabolism in Preclinical Models of TSC and LAM. Clin Cancer Res 2018; 24:5925-5938. [PMID: 30054282 DOI: 10.1158/1078-0432.ccr-17-3693] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 06/01/2018] [Accepted: 07/23/2018] [Indexed: 01/30/2023]
Abstract
PURPOSE Tuberous sclerosis complex (TSC) is an autosomal dominant disorder caused by inactivating mutations of the TSC1 or TSC2 gene, characterized by neurocognitive impairment and benign tumors of the brain, skin, heart, and kidneys. Lymphangioleiomyomatosis (LAM) is a diffuse proliferation of α-smooth muscle actin-positive cells associated with cystic destruction of the lung. LAM occurs almost exclusively in women, as a TSC manifestation or a sporadic disorder (TSC1/TSC2 somatic mutations). Biomarkers of whole-body tumor burden/activity and response to rapalogs or other therapies remain needed in TSC/LAM. EXPERIMENTAL DESIGN These preclinical studies aimed to assess feasibility of [18F]fluorocholine (FCH) and [18F]fluoroacetate (FACE) as TSC/LAM metabolic imaging biomarkers. RESULTS We previously reported that TSC2-deficient cells enhance phosphatidylcholine synthesis via the Kennedy pathway. Here, we show that TSC2-deficient cells exhibit rapid uptake of [18F]FCH in vivo and can be visualized by PET imaging in preclinical models of TSC/LAM, including subcutaneous tumors and pulmonary nodules. Treatment with rapamycin (72 hours) suppressed [18F]FCH standardized uptake value (SUV) by >50% in tumors. Interestingly, [18F]FCH-PET imaging of TSC2-deficient xenografts in ovariectomized mice also showed a significant decrease in tumor SUV. Finally, we found rapamycin-insensitive uptake of FACE by TSC2-deficient cells in vitro and in vivo, reflecting its mitochondrial accumulation via inhibition of aconitase, a TCA cycle enzyme. CONCLUSIONS Preclinical models of TSC2 deficiency represent informative platforms to identify tracers of potential clinical interest. Our findings provide mechanistic evidence for testing the potential of [18F]FCH and [18F]FACE as metabolic imaging biomarkers for TSC and LAM proliferative lesions, and novel insights into the metabolic reprogramming of TSC tumors.
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Affiliation(s)
- Eline E Verwer
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Taylor R Kavanagh
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - William J Mischler
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - You Feng
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kazue Takahashi
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Shuyan Wang
- Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Timothy M Shoup
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ramesh Neelamegam
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jing Yang
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Nicolas J Guehl
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chongzhao Ran
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Walter Massefski
- Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ye Cui
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Souheil El-Chemaly
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - William M Oldham
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marie F Kijewski
- Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Georges El Fakhri
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Marc D Normandin
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carmen Priolo
- Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
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Grootjans W, de Geus-Oei LF, Bussink J. Image-guided adaptive radiotherapy in patients with locally advanced non-small cell lung cancer: the art of PET. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2018; 62:369-384. [PMID: 29869486 DOI: 10.23736/s1824-4785.18.03084-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
With a worldwide annual incidence of 1.8 million cases, lung cancer is the most diagnosed form of cancer in men and the third most diagnosed form of cancer in women. Histologically, 80-85% of all lung cancers can be categorized as non-small cell lung cancer (NSCLC). For patients with locally advanced NSCLC, standard of care is fractionated radiotherapy combined with chemotherapy. With the aim of improving clinical outcome of patients with locally advanced NSCLC, combined and intensified treatment approaches are increasingly being used. However, given the heterogeneity of this patient group with respect to tumor biology and subsequent treatment response, a personalized treatment approach is required to optimize therapeutic effect and minimize treatment induced toxicity. Medical imaging, in particular positron emission tomography (PET), before and during the course radiotherapy is increasingly being used to personalize radiotherapy. In this setting, PET imaging can be used to improve delineation of target volumes, employ molecularly-guided dose painting strategies, early response monitoring, prediction and monitoring of treatment-related toxicity. The concept of PET image-guided adaptive radiotherapy (IGART) is an interesting approach to personalize radiotherapy for patients with locally advanced NSCLC, which might ultimately contribute to improved clinical outcomes and reductions in frequency of treatment-related adverse events in this patient group. In this review, we provide a comprehensive overview of available clinical data supporting the use of PET imaging for IGART in patients with locally advanced NSCLC.
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Affiliation(s)
- Willem Grootjans
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands -
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan Bussink
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF). Eur J Nucl Med Mol Imaging 2018; 45:806-815. [PMID: 29335764 PMCID: PMC5978900 DOI: 10.1007/s00259-017-3917-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Purpose There is a lack of prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) patients. The objective of this study is to investigate the potential of 18F-FDG-PET/ CT to predict mortality in IPF. Methods A total of 113 IPF patients (93 males, 20 females, mean age ± SD: 70 ± 9 years) were prospectively recruited for 18F-FDG-PET/CT. The overall maximum pulmonary uptake of 18F-FDG (SUVmax), the minimum pulmonary uptake or background lung activity (SUVmin), and target-to-background (SUVmax/ SUVmin) ratio (TBR) were quantified using routine region-of-interest analysis. Kaplan–Meier analysis was used to identify associations of PET measurements with mortality. We also compared PET associations with IPF mortality with the established GAP (gender age and physiology) scoring system. Cox analysis assessed the independence of the significant PET measurement(s) from GAP score. We investigated synergisms between pulmonary 18F-FDG-PET measurements and GAP score for risk stratification in IPF patients. Results During a mean follow-up of 29 months, there were 54 deaths. The mean TBR ± SD was 5.6 ± 2.7. Mortality was associated with high pulmonary TBR (p = 0.009), low forced vital capacity (FVC; p = 0.001), low transfer factor (TLCO; p < 0.001), high GAP index (p = 0.003), and high GAP stage (p = 0.003). Stepwise forward-Wald–Cox analysis revealed that the pulmonary TBR was independent of GAP classification (p = 0.010). The median survival in IPF patients with a TBR < 4.9 was 71 months, whilst in those with TBR > 4.9 was 24 months. Combining PET data with GAP data (“PET modified GAP score”) refined the ability to predict mortality. Conclusions A high pulmonary TBR is independently associated with increased risk of mortality in IPF patients. Electronic supplementary material The online version of this article (10.1007/s00259-017-3917-8) contains supplementary material, which is available to authorized users.
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Satoh Y, Motosugi U, Saito A, Omiya Y, Onishi H. Pretreatment 18F-fluorodeoxyglucose Uptake in the Lung Parenchyma Predicts Poor Survival After Stereotactic Body Radiation Therapy in Patients With Stage I Non-Small Cell Lung Cancer. Technol Cancer Res Treat 2018; 17:1533033818794934. [PMID: 30222060 PMCID: PMC6141922 DOI: 10.1177/1533033818794934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE In this study, we aimed to evaluate the prognostic value of fluorodeoxyglucose uptake in the lung parenchyma and the presence of subclinical interstitial lung disease on computed tomography as predictive factors for survival following stereotactic body radiation therapy in patients with stage I non-small cell lung cancer. METHODS We retrospectively evaluated 125 patients with stage I non-small cell lung cancer who underwent stereotactic body radiation therapy at our institute between December 2005 and March 2013 for various demographic and clinical parameters. The fluorodeoxyglucose uptake in the lung parenchyma corrected with computed tomography value (tissue fraction-corrected standardized uptake value) was quantified using fluorodeoxyglucose-positron emission tomography/computed tomography before the therapy. Additionally, the radiological findings of interstitial lung disease on computed tomography were evaluated. The prognostic analyses were performed using the Kaplan-Meier analysis and Cox proportional hazards regression model for univariate and multivariate analyses. RESULTS The median follow-up period was 39 months. The 3-year overall survival rate was 67.9%, and the 3-year progression-free survival rate was 52.0%. The multivariate analysis indicated that the tissue fraction-corrected standardized uptake value was correlated with the patients' overall survival ( P = .027, hazard ratio: 2.694, 95% confidence interval: 1.109-8.057). The presence of subclinical interstitial lung disease showed no correlation with the overall survival ( P = .535, hazard ratio: 1.256, 95% confidence interval: 0.592-2.473). CONCLUSION The results indicated that fluorodeoxyglucose uptake in the lung parenchyma, expressed as the tissue fraction-corrected standardized uptake value, was an independent prognostic factor in patients with stage I non-small cell lung cancer who have received stereotactic body radiation therapy.
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Affiliation(s)
- Yoko Satoh
- 1 Yamanashi PET Imaging Clinic, Kofu Neurosurgical Hospital, Chuo City, Yamanashi Prefecture, Japan.,2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Utaroh Motosugi
- 2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Akitoshi Saito
- 3 Department of Radiology, Yamanashi Prefectural Hospital, Kofu City, Yamanashi Prefecture, Japan
| | - Yoshie Omiya
- 2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
| | - Hiroshi Onishi
- 2 Department of Radiology, University of Yamanashi, Chuo City, Yamanashi Prefecture, Japan
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35
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Matsunaga K, Yanagawa M, Otsuka T, Hirata H, Kijima T, Kumanogoh A, Tomiyama N, Shimosegawa E, Hatazawa J. Quantitative pulmonary blood flow measurement using 15O-H 2O PET with and without tissue fraction correction: a comparison study. EJNMMI Res 2017; 7:102. [PMID: 29274016 PMCID: PMC5741573 DOI: 10.1186/s13550-017-0350-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 12/04/2017] [Indexed: 11/23/2022] Open
Abstract
Background Physiological measures per lung parenchyma, rather than per lung volume, sometimes reflect the disease status. PET images of the lung, which are usually expressed per lung volume, could confound the interpretation of the disease status, especially in cases with a prominent heterogeneity in aeration. The aim of the present study was to develop a method for measuring pulmonary blood flow (PBF) with aeration correction using 15O-H2O PET and to compare the results with those obtained using a conventional method. We obtained the voxel-based tissue fraction (TF) derived from density images converted from transmission images obtained using an external 137Cs point source. Quantitative PBF values with and without the TF were calculated using 15O-H2O PET to examine contralateral lung tissue in 9 patients with unilateral lung cancer. The heterogeneity in PBF before and after TF correction was then evaluated and compared. As a measure of PBF heterogeneity, we used the skewness and kurtosis of the PBF distribution. Results The mean PBF of contralateral lung was 1.4 ± 0.3 mL/min per mL of lung. The TF-corrected PBF was 5.0 ± 0.6 mL/min per mL of lung parenchyma. After TF correction, the skewness and kurtosis of the PBF decreased significantly. Conclusions The present PBF calculation method using TF correction demonstrated that the normal PBF increased significantly and the PBF distribution became uniform. The proposed TF correction method is a promising technique to account for variations in density when interpreting PBF in PET studies.
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Affiliation(s)
- Keiko Matsunaga
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita city, Osaka, Japan
| | - Masahiro Yanagawa
- Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tomoyuki Otsuka
- Department of Respiratory Medicine, Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Haruhiko Hirata
- Department of Respiratory Medicine, Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kijima
- Department of Respiratory Medicine, Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine, Allergy and Rheumatic Disease, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noriyuki Tomiyama
- Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Eku Shimosegawa
- Department of Molecular Imaging in Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.,Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita city, Osaka, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita city, Osaka, Japan.
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Cuplov V, Holman BF, McClelland J, Modat M, Hutton BF, Thielemans K. Issues in quantification of registered respiratory gated PET/CT in the lung. ACTA ACUST UNITED AC 2017; 63:015007. [DOI: 10.1088/1361-6560/aa950b] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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37
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Gallezot JD, Nabulsi NB, Holden D, Lin SF, Labaree D, Ropchan J, Najafzadeh S, Donnelly DJ, Cao K, Bonacorsi S, Seiders J, Roppe J, Hayes W, Huang Y, Du S, Carson RE. Evaluation of the Lysophosphatidic Acid Receptor Type 1 Radioligand 11C-BMT-136088 for Lung Imaging in Rhesus Monkeys. J Nucl Med 2017; 59:327-333. [PMID: 28864634 DOI: 10.2967/jnumed.117.195073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 08/22/2017] [Indexed: 01/01/2023] Open
Abstract
The lysophosphatidic acid receptor type 1 (LPA1) is 1 of 6 known receptors of the extracellular signaling molecule lysophosphatidic acid. It mediates effects such as cell proliferation, migration, and differentiation. In the lung, LPA1 is involved in pathways leading, after lung tissue injury, to pulmonary fibrosis instead of normal healing, by mediating fibroblast recruitment and vascular leakage. Thus, a LPA1 PET radiotracer may be useful for studying lung fibrosis or for developing LPA1-targeting drugs. We developed and evaluated the radiotracer 11C-BMT-136088 (1-(4'-(3-methyl-4-(((1(R)-(3-11C-methylphenyl)ethoxy)carbonyl)amino)isoxazol-5-yl)-[1,1'-biphenyl]-4-yl)cyclopropane-1-carboxylic acid) in rhesus monkeys to image LPA1 in the lung in vivo with PET. Methods: The study consisted of 3 parts: test-retest scans; self-saturation to estimate the tracer's in vivo dissociation constant, nondisplaceable volume of distribution (VND), and nondisplaceable binding potential (BPND); and dosimetry. In the first 2 parts, the radiotracer was administered using a bolus-plus-infusion protocol, the arterial input function was measured, and the animals underwent 2 scans per day separated by about 4 h. Lung regions of interest were segmented, and the tissue density estimated, from CT images. A fixed blood volume correction was applied. The tracer volume of distribution (VT) was estimated using multilinear analysis 1 (MA1) or equilibrium analysis (EA). Results:11C-BMT-136088 baseline VT was 1.83 ± 0.16 (MA1, n = 5) or 2.1 ± 0.55 (EA, n = 7) mL of plasma per gram of tissue in the left and right lung regions of interest, with a test-retest variability of -6% (MA1, n = 1) or -1% ± 14% (EA, n = 2). For the self-saturation study, 11C-BMT-136088 VND and BPND were estimated to be 0.9 ± 0.08 mL of plasma per gram of tissue and 1.1 ± 0.14, respectively. The unlabeled drug dose and plasma concentration leading to a 50% reduction of 11C-BMT-136088 specific binding were 73 ± 30 nmol/kg and 28 ± 12 nM, respectively. The average plasma free fraction was 0.2%; thus, the tracer's in vivo dissociation constant was estimated to be 55 pM. For the dosimetry study, the highest organ dose was in the liver (43.1 ± 4.9 and 68.9 ± 9.4 μSv/MBq in reference human male and female phantoms, respectively), and the effective dose equivalent was 6.9 ± 0.6 and 8.7 ± 0.6 μSv/MBq, respectively. Conclusion: Specific binding of 11C-BMT-136088 can be reliably measured to quantify LPA1 in the lungs of rhesus monkeys in vivo.
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Affiliation(s)
| | - Nabeel B Nabulsi
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Daniel Holden
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Shu-Fei Lin
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - David Labaree
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Jim Ropchan
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Soheila Najafzadeh
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - David J Donnelly
- Discovery Chemistry Platforms, Bristol-Myers Squibb, Princeton, New Jersey
| | - Kai Cao
- Discovery Chemistry Platforms, Bristol-Myers Squibb, Princeton, New Jersey
| | - Samuel Bonacorsi
- Discovery Chemistry Platforms, Bristol-Myers Squibb, Princeton, New Jersey
| | - Jon Seiders
- Amira Pharmaceuticals, San Diego, California; and
| | | | - Wendy Hayes
- Imaging, Bristol-Myers Squibb, Princeton, New Jersey
| | - Yiyun Huang
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
| | - Shuyan Du
- Imaging, Bristol-Myers Squibb, Princeton, New Jersey
| | - Richard E Carson
- Radiology and Biomedical Imaging, Yale University, New Haven, Connecticut
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38
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Coello C, Fisk M, Mohan D, Wilson FJ, Brown AP, Polkey MI, Wilkinson I, Tal-Singer R, Murphy PS, Cheriyan J, Gunn RN. Quantitative analysis of dynamic 18F-FDG PET/CT for measurement of lung inflammation. EJNMMI Res 2017; 7:47. [PMID: 28547129 PMCID: PMC5445063 DOI: 10.1186/s13550-017-0291-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 05/09/2017] [Indexed: 11/23/2022] Open
Abstract
Background An inflammatory reaction in the airways and lung parenchyma, comprised mainly of neutrophils and alveolar macrophages, is present in some patients with chronic obstructive pulmonary disease (COPD). Thoracic fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) has been proposed as a promising imaging biomarker to assess this inflammation. We sought to introduce a fully quantitative analysis method and compare this with previously published studies based on the Patlak approach using a dataset comprising 18F-FDG PET scans from COPD subjects with elevated circulating inflammatory markers (fibrinogen) and matched healthy volunteers (HV). Dynamic 18F-FDG PET scans were obtained for high-fibrinogen (>2.8 g/l) COPD subjects (N = 10) and never smoking HV (N = 10). Lungs were segmented using co-registered computed tomography images and subregions (upper, middle and lower) were semi-automatically defined. A quantitative analysis approach was developed, which corrects for the presence of air and blood in the lung (qABL method), enabling direct estimation of the metabolic rate of FDG in lung tissue. A normalised Patlak analysis approach was also performed to enable comparison with previously published results. Effect sizes (Hedge’s g) were used to compare HV and COPD groups. Results The qABL method detected no difference (Hedge’s g = 0.15 [−0.76 1.04]) in the tissue metabolic rate of FDG in the whole lung between HV (μ = 6.0 ± 1.9 × 10−3 ml cm−3 min−1) and COPD (μ = 5.7 ± 1.7 × 10−3 ml cm−3 min−1). However, analysis with the normalised Patlak approach detected a significant difference (Hedge’s g = −1.59 [−2.57 −0.48]) in whole lung between HV (μ = 2.9 ± 0.5 × 10−3 ml cm−3 min−1) and COPD (μ = 3.9 ± 0.7 × 10−3 ml cm−3 min−1). The normalised Patlak endpoint was shown to be a composite measure influenced by air volume, blood volume and actual uptake of 18F-FDG in lung tissue. Conclusions We have introduced a quantitative analysis method that provides a direct estimate of the metabolic rate of FDG in lung tissue. This work provides further understanding of the underlying origin of the 18F-FDG signal in the lung in disease groups and helps interpreting changes following standard or novel therapies. Electronic supplementary material The online version of this article (doi:10.1186/s13550-017-0291-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christopher Coello
- Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK. .,Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.
| | - Marie Fisk
- Experimental Medicine and Immunotherapeutics (EMIT) Division, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Divya Mohan
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK.,GSK R&D, King of Prussia, PA, USA
| | | | - Andrew P Brown
- Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK
| | - Michael I Polkey
- NIHR Respiratory Biomedical Research Unit at the Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Ian Wilkinson
- Experimental Medicine and Immunotherapeutics (EMIT) Division, Department of Medicine, University of Cambridge, Cambridge, UK.,Cambridge Clinical Trials Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | | | - Joseph Cheriyan
- Experimental Medicine and Immunotherapeutics (EMIT) Division, Department of Medicine, University of Cambridge, Cambridge, UK.,GSK R&D, Cambridge, UK.,Cambridge Clinical Trials Unit, Addenbrooke's Hospital, Cambridge, UK.,Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK
| | - Roger N Gunn
- Imanova Ltd., Centre for Imaging Sciences, Hammersmith Hospital, London, UK.,Division of Brain Sciences, Department of Medicine, Imperial College London, London, UK.,Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
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39
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Désogère P, Tapias LF, Hariri LP, Rotile NJ, Rietz TA, Probst CK, Blasi F, Day H, Mino-Kenudson M, Weinreb P, Violette SM, Fuchs BC, Tager AM, Lanuti M, Caravan P. Type I collagen-targeted PET probe for pulmonary fibrosis detection and staging in preclinical models. Sci Transl Med 2017; 9:eaaf4696. [PMID: 28381537 PMCID: PMC5568793 DOI: 10.1126/scitranslmed.aaf4696] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 10/20/2016] [Accepted: 03/16/2017] [Indexed: 12/26/2022]
Abstract
Pulmonary fibrosis is scarring of the lungs that can arise from radiation injury, drug toxicity, environmental or genetic causes, and for unknown reasons [idiopathic pulmonary fibrosis (IPF)]. Overexpression of collagen is a hallmark of organ fibrosis. We describe a peptide-based positron emission tomography (PET) probe (68Ga-CBP8) that targets collagen type I. We evaluated 68Ga-CBP8 in vivo in the bleomycin-induced mouse model of pulmonary fibrosis. 68Ga-CBP8 showed high specificity for pulmonary fibrosis and high target/background ratios in diseased animals. The lung PET signal and lung 68Ga-CBP8 uptake (quantified ex vivo) correlated linearly (r2 = 0.80) with the amount of lung collagen in mice with fibrosis. We further demonstrated that the 68Ga-CBP8 probe could be used to monitor response to treatment in a second mouse model of pulmonary fibrosis associated with vascular leak. Ex vivo analysis of lung tissue from patients with IPF supported the animal findings. These studies indicate that 68Ga-CBP8 is a promising candidate for noninvasive imaging of human pulmonary fibrosis.
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Affiliation(s)
- Pauline Désogère
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Luis F Tapias
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Lida P Hariri
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Nicholas J Rotile
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Tyson A Rietz
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Clemens K Probst
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Francesco Blasi
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Helen Day
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Mari Mino-Kenudson
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | | | | | - Bryan C Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Andrew M Tager
- Division of Pulmonary and Critical Care Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Michael Lanuti
- Division of Thoracic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA.
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40
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Schwartz J, Grkovski M, Rimner A, Schöder H, Zanzonico PB, Carlin SD, Staton KD, Humm JL, Nehmeh SA. Pharmacokinetic Analysis of Dynamic 18F-Fluoromisonidazole PET Data in Non-Small Cell Lung Cancer. J Nucl Med 2017; 58:911-919. [PMID: 28232611 DOI: 10.2967/jnumed.116.180422] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/19/2016] [Indexed: 01/08/2023] Open
Abstract
Hypoxic tumors exhibit increased resistance to radiation, chemical, and immune therapies. 18F-fluoromisonidazole (18F-FMISO) PET is a noninvasive, quantitative imaging technique used to evaluate the magnitude and spatial distribution of tumor hypoxia. In this study, pharmacokinetic analysis (PKA) of 18F-FMISO dynamic PET extended to 3 h after injection is reported for the first time, to our knowledge, in stage III-IV non-small cell lung cancer (NSCLC) patients. Methods: Sixteen patients diagnosed with NSCLC underwent 2 PET/CT scans (1-3 d apart) before radiation therapy: a 3-min static 18 F-FDG and a dynamic 18F-FMISO scan lasting 168 ± 15 min. The latter data were acquired in 3 serial PET/CT dynamic imaging sessions, registered with each other and analyzed using pharmacokinetic modeling software. PKA was performed using a 2-tissue, 3-compartment irreversible model, and kinetic parameters were estimated for the volumes of interest determined using coregistered 18F-FDG images for both the volume of interest-averaged and the voxelwise time-activity curves for each patient's lesions, normal lung, and muscle. Results: We derived average values of 18F-FMISO kinetic parameters for NSCLC lesions as well as for normal lung and muscle. We also investigated the correlation between the trapping rate (k3) and delivery rate (K1), influx rate (Ki ) constants, and tissue-to-blood activity concentration ratios (TBRs) for all tissues. Lesions had trapping rates 1.6 times larger, on average, than those of normal lung and 4.4 times larger than those in muscle. Additionally, for almost all cases, k3 and Ki had a significant strong correlation for all tissue types. The TBR-k3 correlation was less straightforward, showing a moderate to strong correlation for only 41% of lesions. Finally, K1-k3 voxelwise correlations for tumors were varied, but negative for 76% of lesions, globally exhibiting a weak inverse relationship (average R = -0.23 ± 0.39). However, both normal tissue types exhibited significant positive correlations for more than 60% of patients, with 41% having moderate to strong correlations (R > 0.5). Conclusion: All lesions showed distinct 18F-FMISO uptake. Variable 18F-FMISO delivery was observed across lesions, as indicated by the variable values of the kinetic rate constant K1 Except for 3 cases, some degree of hypoxia was apparent in all lesions based on their nonzero k3 values.
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Affiliation(s)
- Jazmin Schwartz
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Milan Grkovski
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Andreas Rimner
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Pat B Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean D Carlin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - Kevin D Staton
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York; and
| | - John L Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sadek A Nehmeh
- National Center for Cancer Care and Research, Doha, Qatar
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Chen DL, Cheriyan J, Chilvers ER, Choudhury G, Coello C, Connell M, Fisk M, Groves AM, Gunn RN, Holman BF, Hutton BF, Lee S, MacNee W, Mohan D, Parr D, Subramanian D, Tal-Singer R, Thielemans K, van Beek EJR, Vass L, Wellen JW, Wilkinson I, Wilson FJ. Quantification of Lung PET Images: Challenges and Opportunities. J Nucl Med 2017; 58:201-207. [PMID: 28082432 DOI: 10.2967/jnumed.116.184796] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 01/10/2017] [Indexed: 01/03/2023] Open
Abstract
Millions of people are affected by respiratory diseases, leading to a significant health burden globally. Because of the current insufficient knowledge of the underlying mechanisms that lead to the development and progression of respiratory diseases, treatment options remain limited. To overcome this limitation and understand the associated molecular changes, noninvasive imaging techniques such as PET and SPECT have been explored for biomarker development, with 18F-FDG PET imaging being the most studied. The quantification of pulmonary molecular imaging data remains challenging because of variations in tissue, air, blood, and water fractions within the lungs. The proportions of these components further differ depending on the lung disease. Therefore, different quantification approaches have been proposed to address these variabilities. However, no standardized approach has been developed to date. This article reviews the data evaluating 18F-FDG PET quantification approaches in lung diseases, focusing on methods to account for variations in lung components and the interpretation of the derived parameters. The diseases reviewed include acute respiratory distress syndrome, chronic obstructive pulmonary disease, and interstitial lung diseases such as idiopathic pulmonary fibrosis. Based on review of prior literature, ongoing research, and discussions among the authors, suggested considerations are presented to assist with the interpretation of the derived parameters from these approaches and the design of future studies.
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Affiliation(s)
- Delphine L Chen
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Joseph Cheriyan
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Edwin R Chilvers
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Gourab Choudhury
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Martin Connell
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marie Fisk
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Roger N Gunn
- Imanova Ltd., London, United Kingdom.,Department of Medicine, Imperial College London, London, United Kingdom
| | - Beverley F Holman
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Sarah Lee
- Medical Image Analysis Consultant, London, United Kingdom
| | - William MacNee
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Divya Mohan
- Clinical Discovery, Respiratory Therapy Area Unit, GlaxoSmithKline R&D, King of Prussia, Pennsylvania
| | - David Parr
- University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | | | - Ruth Tal-Singer
- Clinical Discovery, Respiratory Therapy Area Unit, GlaxoSmithKline R&D, King of Prussia, Pennsylvania
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, London, United Kingdom
| | - Edwin J R van Beek
- Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Laurence Vass
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Jeremy W Wellen
- Worldwide Research and Development, Pfizer, Inc., Cambridge, Massachusetts; and
| | - Ian Wilkinson
- Department of Medicine, University of Cambridge, Cambridge, United Kingdom.,Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Frederick J Wilson
- Experimental Medicine Imaging, GlaxoSmithKline, Stevenage, United Kingdom
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Nobashi T, Kubo T, Nakamoto Y, Handa T, Koyasu S, Ishimori T, Mishima M, Togashi K. 18F-FDG Uptake in Less Affected Lung Field Provides Prognostic Stratification in Patients with Interstitial Lung Disease. J Nucl Med 2016; 57:1899-1904. [DOI: 10.2967/jnumed.116.174946] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/23/2016] [Indexed: 12/11/2022] Open
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Holman BF, Cuplov V, Hutton BF, Groves AM, Thielemans K. The effect of respiratory induced density variations on non-TOF PET quantitation in the lung. Phys Med Biol 2016; 61:3148-63. [PMID: 27007013 DOI: 10.1088/0031-9155/61/8/3148] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Accurate PET quantitation requires a matched attenuation map. Obtaining matched CT attenuation maps in the thorax is difficult due to the respiratory cycle which causes both motion and density changes. Unlike with motion, little attention has been given to the effects of density changes in the lung on PET quantitation. This work aims to explore the extent of the errors caused by pulmonary density attenuation map mismatch on dynamic and static parameter estimates. Dynamic XCAT phantoms were utilised using clinically relevant (18)F-FDG and (18)F-FMISO time activity curves for all organs within the thorax to estimate the expected parameter errors. The simulations were then validated with PET data from 5 patients suffering from idiopathic pulmonary fibrosis who underwent PET/Cine-CT. The PET data were reconstructed with three gates obtained from the Cine-CT and the average Cine-CT. The lung TACs clearly displayed differences between true and measured curves with error depending on global activity distribution at the time of measurement. The density errors from using a mismatched attenuation map were found to have a considerable impact on PET quantitative accuracy. Maximum errors due to density mismatch were found to be as high as 25% in the XCAT simulation. Differences in patient derived kinetic parameter estimates and static concentration between the extreme gates were found to be as high as 31% and 14%, respectively. Overall our results show that respiratory associated density errors in the attenuation map affect quantitation throughout the lung, not just regions near boundaries. The extent of this error is dependent on the activity distribution in the thorax and hence on the tracer and time of acquisition. Consequently there may be a significant impact on estimated kinetic parameters throughout the lung.
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Affiliation(s)
- Beverley F Holman
- Institute of Nuclear Medicine, UCLH, 235 Euston Road (T-5), London, NW1 2BU, UK
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Holman BF, Cuplov V, Millner L, Hutton BF, Maher TM, Groves AM, Thielemans K. Improved correction for the tissue fraction effect in lung PET/CT imaging. Phys Med Biol 2015; 60:7387-402. [DOI: 10.1088/0031-9155/60/18/7387] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Win T, Thomas BA, Lambrou T, Hutton BF, Screaton NJ, Porter JC, Maher TM, Endozo R, Shortman RI, Afaq A, Lukey P, Ell PJ, Groves AM. Areas of normal pulmonary parenchyma on HRCT exhibit increased FDG PET signal in IPF patients. Eur J Nucl Med Mol Imaging 2014; 41:337-42. [PMID: 23942907 PMCID: PMC3890564 DOI: 10.1007/s00259-013-2514-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/07/2013] [Indexed: 11/07/2022]
Abstract
PURPOSE Patients with idiopathic pulmonary fibrosis (IPF) show increased PET signal at sites of morphological abnormality on high-resolution computed tomography (HRCT). The purpose of this investigation was to investigate the PET signal at sites of normal-appearing lung on HRCT in IPF. METHODS Consecutive IPF patients (22 men, 3 women) were prospectively recruited. The patients underwent (18)F-FDG PET/HRCT. The pulmonary imaging findings in the IPF patients were compared to the findings in a control population. Pulmonary uptake of (18)F-FDG (mean SUV) was quantified at sites of morphologically normal parenchyma on HRCT. SUVs were also corrected for tissue fraction (TF). The mean SUV in IPF patients was compared with that in 25 controls (patients with lymphoma in remission or suspected paraneoplastic syndrome with normal PET/CT appearances). RESULTS The pulmonary SUV (mean ± SD) uncorrected for TF in the controls was 0.48 ± 0.14 and 0.78 ± 0.24 taken from normal lung regions in IPF patients (p < 0.001). The TF-corrected mean SUV in the controls was 2.24 ± 0.29 and 3.24 ± 0.84 in IPF patients (p < 0.001). CONCLUSION IPF patients have increased pulmonary uptake of (18)F-FDG on PET in areas of lung with a normal morphological appearance on HRCT. This may have implications for determining disease mechanisms and treatment monitoring.
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Affiliation(s)
- Thida Win
- Respiratory Medicine, Lister Hospital, Stevenage, UK
| | - Benjamin A. Thomas
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Tryphon Lambrou
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Brian F. Hutton
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | | | - Joanna C. Porter
- Centre for Respiratory Diseases, University College Hospital, University College London, Euston Rd, London, UK
| | - Toby M. Maher
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Raymondo Endozo
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Robert I. Shortman
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Asim Afaq
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Pauline Lukey
- Fibrosis DPU, Research and Development, GSK, Stevenage, UK
| | - Peter J. Ell
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
| | - Ashley M. Groves
- Institute of Nuclear Medicine, University College Hospital, University College London, 5th Floor, 235 Euston Road, London, NW1 2BU UK
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Dolovich MB, Bailey DL. Positron emission tomography (PET) for assessing aerosol deposition of orally inhaled drug products. J Aerosol Med Pulm Drug Deliv 2013; 25 Suppl 1:S52-71. [PMID: 23215847 DOI: 10.1089/jamp.2012.1su6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The topical distribution of inhaled therapies in the lung can be viewed using radionuclides and imaging. Positron emission tomography (PET) is a three-dimensional functional imaging technique providing quantitatively accurate localization of the quantity and distribution of an inhaled or injected PET radiotracer in the lung. A series of transaxial slices through the lungs are obtained, comparable to an X-ray computed tomography (CT) scan. Subsequent reformatting allows coronal and sagittal images of the distribution of radioactivity to be viewed. This article describes procedures for administering [(18)F]-fluorodeoxyglucose aerosol to human subjects for the purpose of determining dose and distribution following inhalation from an aerosol drug delivery device (ADDD). The advantages of using direct-labeled PET drugs in the ADDD are discussed with reference to the literature. The methods for designing the inhalation system, determining proper radiation shielding, calibration, and validation of administered radioactivity, scanner setup, and data handling procedures are described. Obtaining an X-ray CT or radionuclide transmission scan to provide accurate geometry of the lung and also correct for tissue attenuation of the PET radiotracer is discussed. Protocols for producing accurate images, including factors that need to be incorporated into the data calibration, are described, as well as a proposed standard method for partitioning the lung into regions of interest. Alternate methods are described for more detailed assessments. Radiation dosimetry/risk calculations for the procedures are appended, as well as a sample data collection form and spreadsheet for calculations. This article should provide guidance for those interested in using PET to determine quantity and distribution of inhaled therapeutics.
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Affiliation(s)
- Myrna B Dolovich
- Faculty of Health Sciences, Michael de Groote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
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Erlandsson K, Buvat I, Pretorius PH, Thomas BA, Hutton BF. A review of partial volume correction techniques for emission tomography and their applications in neurology, cardiology and oncology. Phys Med Biol 2012; 57:R119-59. [DOI: 10.1088/0031-9155/57/21/r119] [Citation(s) in RCA: 320] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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49
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18F-Fluorodeoxyglucose positron emission tomography pulmonary imaging in idiopathic pulmonary fibrosis is reproducible: implications for future clinical trials. Eur J Nucl Med Mol Imaging 2011; 39:521-8. [DOI: 10.1007/s00259-011-1986-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Accepted: 10/21/2011] [Indexed: 10/15/2022]
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