Reassessment of FDG uptake in tumor cells: high FDG uptake as a reflection of oxygen-independent glycolysis dominant energy production

Spontaneous Resolution of Idiopathic Panniculitis: Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Diagnosis and follow-up

We present the case of a-55-year-old female patient who presented with dry cough. High-resolution computed tomography chest revealed multiple nodules in both lungs. ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) was done to look for the unknown primary. It showed hypermetabolic bilateral lung nodules, subcutaneous nodules involving lower limbs, an intramuscular nodule, enlarged paratracheal, and right axillary nodes. There was no primary tumor seen. The biopsy of subcutaneous nodule revealed panniculitis with the foreign body granuloma. Follow-up scans after 6 and 9 months showed spontaneous resolution of all lesions except for few right axillary nodes. There was no active treatment given, and the patient remains asymptomatic on follow-up. Here, PET/CT played a role in excluding a primary tumor, guiding the biopsy, and follow-up.

Application of positron emission tomography-computed tomography in the diagnosis of pulmonary ground-glass nodules

The aim of the present study was to investigate the value of positron emission tomography-computed tomography (PET-CT) using ¹⁸F-fluorodeoxyglucose in the clinical diagnosis of pulmonary ground-glass nodule. In total, 54 patients with pulmonary GGN that were identified by PET-CT examination were selected and confirmed by pathology and clinical diagnosis in hospital between April 2014 and April 2015. The association between PET-CT findings and pathology, and the value of PET-CT were then evaluated. In the 54 patients, solitary pulmonary GGN with a nodule diameter of between 0.6 and 2.0 cm were detected. Amongst them, the PET-CT examination of 42 patients revealed hyper metabolic nodules, and were all mixed GGN type nodules with a diameter >1 cm. The PET-CT examination of the remaining 12 patients demonstrated no evidence of metabolic abnormalities and the nodules in these patients were pure or mixed GGN with a diameter <1 cm (except 2 cases with a diameter ≥1 cm). Furthermore, the diagnoses for all patients were pathologically confirmed by CT-guided needle biopsy or thoracoscopic surgical resection. Amongst them, there were 41 cases of lung adenocarcinoma, 4 cases of fungal infection, 7 cases of inflammation and 2 cases of adenomatoid hyperplasia. Additionally, PET-CT has a lower detection rate for smaller GGN exhibits no clear advantage for pure GGN, but has a higher detection rate for larger GGN. In conclusion, to a certain extent, PET-CT makes up for the shortcomings of traditional imaging and has some clinical value for the diagnosis of GGN.

Impact of Oxygenation Status on 18F-FDG Uptake in Solid Tumors

The influence of changes in tumor oxygenation (monitored by EPR oximetry) on the uptake of 18F-FDG tracer was evaluated using micro-PET in two different human tumor models. The 18F-FDG uptake was higher in hypoxic tumors compared to tumors that present a pO2 value larger than 10 mmHg.

The increase in tumor oxygenation under carbogen breathing induces a decrease in the uptake of [(18)F]-fluoro-deoxy-glucose

We investigated the impact of oxygenation status (measured by EPR oximetry) on the uptake of (18)F-FDG (measured by PET) in two different tumor models during a carbogen breathing challenge. We observed a significant drop in (18)F-FDG uptake under carbogen breathing that suggests a rapid metabolic adaptation to the oxygen environment.

Mass effect of injected dose in small rodent imaging by SPECT and PET

This paper discusses the effect of mass (chemical quantity) of injected dose on positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Commonly, PET or SPECT imaging study uses a "no-carrier added" dose, which contains a small amount of radioactive imaging agent (in picogram to microgram). For small animal (rodent) imaging studies, specifically targeting binding sites or biological processes, the mass (chemical quantity) in the dose may significantly modify the binding, pharmacokinetics and, ultimately, the imaging outcome. Due to differences in size and other physiological factors between humans and rodents, there is a dramatic divergence of mass effect between small animal and human imaging study. In small animal imaging studies, the mass, or effective dose (ED(50)), a dose required for 50% of receptor or binding site occupancy, is usually not directly related to binding potential (B(max)/K(d)) (measured by in vitro binding assay). It is likely that dynamic interplays between specific and nonspecific binding in blood circulation, transient lung retention, kidney excretion, liver-gallbladder flow, soft tissue retention as well as metabolism could each play a significant role in determining the concentration of the tracer in the target regions. When using small animal imaging for studying drug occupancy (either by a pretreatment, coinjection or chasing dose), the mass effects on imaging outcome are important factors for consideration.

Investigation of the interaction of pig muscle lactate dehydrogenase with acidic phospholipids at low pH

Interaction of pig muscle lactate dehydrogenase (LDH) with acidic phospholipids is strongly dependent on pH and is most efficient at pH values<6.5. The interaction is ionic strength sensitive and is not observed when bilayer structures are disrupted by detergents. Bilayers made of phosphatidylcholine (PC) do not bind the enzyme. The LDH interaction with mixed composition bilayers phosphatidylserine/phosphatidylcholine (PS/PC) and cardiolipin/phosphatidylcholine (CL/PC) leads to dramatic changes in the specific activity of the enzyme above a threshold of acidic phospholipid concentration likely when a necessary surface charge density is achieved. The threshold is dependent on the kind of phospholipid. Cardiolipin (CL) is much more effective compared to phosphatidylserine, which is explained as an effect of availability of both phosphate groups in a CL molecule for interaction with the enzyme. A requirement of more than one binding point on the enzyme molecule for the modification of the specific activity is postulated and discussed. Changes in CD spectra induced by the presence of CL and PS vesicles evidence modification of the conformational state of the protein molecules. In vivo qualitative as well as quantitative phospholipid composition of membrane binding sites for LDH molecules would be crucial for the yield of the binding and its consequences for the enzyme activity in the conditions of lowered pH.

Metabolic significance of the pattern, intensity and kinetics of 18F-FDG uptake in malignant pleural mesothelioma

BACKGROUND

Malignant pleural mesothelioma is an aggressive neoplasm with a highly variable course. This pilot study evaluated the significance of the pattern, intensity and kinetics of 18F-FDG uptake in mesothelioma in the context of histopathology and surgical staging.

METHODS

Sixteen consecutive patients with pleural disease on CT scan underwent 18F-FDG imaging. Imaging was performed with a dual detector gamma camera operating in coincidence mode. Semiquantitative image analysis was performed by obtaining lesion-to-background ratios (18F-FDG uptake index) and calculating the increment of 18F-FDG lesion uptake over time (malignant metabolic potential index (MMPi)).

RESULTS

Twelve patients had histologically proven malignant mesotheliomas (10 epithelial, two sarcomatoid). Thirty two lesions were positive for tumour. Patterns of uptake matched the extent of pleural and parenchymal involvement observed on CT scanning and surgery. Mean (SD) 18F-FDG uptake index for malignant lesions was 3.99 (1.92), range 1.5-9.46. Extrathoracic spread and metastases had higher 18F-FDG uptake indices (5.17 (2)) than primary (3.42 (1.52)) or nodal lesions (2.99 (1)). No correlation was found between histological grade and stage. The intensity of lesion uptake had poor correlation with histological grade but good correlation with surgical stage. 18F-FDG lesion uptake increased over time at a higher rate in patients with more advanced disease. The MMPi was a better predictor of disease aggressiveness than the histological grade.

CONCLUSIONS

This pilot study suggests that the pattern, intensity, and kinetics of 18F-FDG uptake in mesothelioma are good indicators of tumour aggressiveness and are superior to the histological grade in this regard.

Evaluation of 2-deoxy-D-glucose as a chemotherapeutic agent: mechanism of cell death

Nutrient deprivation has been shown to cause cancer cell death. To exploit nutrient deprivation as anti-cancer therapy, we investigated the effects of the anti-metabolite 2-deoxy-D-glucose on breast cancer cells in vitro. This compound has been shown to inhibit glucose metabolism. Treatment of human breast cancer cell lines with 2-deoxy-D-glucose results in cessation of cell growth in a dose dependent manner. Cell viability as measured by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide conversion assay and clonogenic survival are decreased with 2-deoxy-D-glucose treatment indicating that 2-deoxy-D-glucose causes breast cancer cell death. The cell death induced by 2-deoxy-D-glucose was found to be due to apoptosis as demonstrated by induction of caspase 3 activity and cleavage of poly (ADP-ribose) polymerase. Breast cancer cells treated with 2-deoxy-D-glucose express higher levels of Glut1 transporter protein as measured by Western blot analysis and have increased glucose uptake compared to non-treated breast cancer cells. From these results we conclude that 2-deoxy-D-glucose treatment causes death in human breast cancer cell lines by the activation of the apoptotic pathway. Our data suggest that breast cancer cells treated with 2-deoxy-D-glucose accelerate their own demise by initially expressing high levels of glucose transporter protein, which allows increased uptake of 2-deoxy-D-glucose, and subsequent induction of cell death. These data support the targeting of glucose metabolism as a site for chemotherapeutic intervention by agents such as 2-deoxy-D-glucose.

Hypoxic tolerance induction in rat brain slices following hypoxic preconditioning due to expression of neuroprotective proteins as revealed by dynamic changes in glucose metabolism

We prepared rat brain slices following sublethal hypoxic pretreatment (preconditioning) and untreated (control) rats, and measured the cerebral glucose metabolic rate (CMRglc) by dynamic positron autoradiography with [18F]2-fluoro-2-deoxy-D-glucose before and after originally lethal 20-min hypoxic loading. In the regions of interest such as the frontal cortex, the CMRglc before hypoxic loading did not differ between the preconditioning and control groups. The CMRglc after reoxygenation was markedly lower than that before hypoxic loading in the control group but did not significantly differ from the preloading value in the preconditioning group. Thus, hypoxic tolerance induction by preconditioning was demonstrated using the maintenance of CMRglc as a neuronal viability index. In addition, profiling of gene expression using an Atlas Rat Stress Array suggested the involvement of the expression of genes such as stress protein in hypoxic tolerance induction.

Posthypoxic reoxygenation-induced neurotoxicity prevented by free radical scavenger and NMDA/non-NMDA antagonist in tandem as revealed by dynamic changes in glucose metabolism with positron autoradiography

Using a positron autoradiography technique, dynamic changes in the cerebral glucose metabolic rate (CMRglc) induced by hypoxia/reoxygenation were investigated in living brain slices. After incubating fresh rat brain slices (300 microm thick) with [(18)F]2-fluoro-2-deoxy-D-glucose ([(18)F]FDG) in oxygenated Krebs-Ringer solution at 36 degrees C, serial two-dimensional time-resolved images of [(18)F]FDG uptake in the slices were obtained on imaging plates. As compared to the unloaded control values, with hypoxia-loading [(18)F]FDG uptake increased markedly, suggesting enhanced glycolysis. The net influx constant (K) of [(18)F]FDG at pre-hypoxia-loading and after reoxygenation with loading hypoxia for various periods of time was quantitatively evaluated by applying the Patlak graphical method to the image data. Regardless of the brain region, with hypoxia of </=10-min duration, the K value returned to the preloading level, whereas with hypoxia of >/=20 min duration only partial or no recovery was seen, indicating irreversible neuronal damage. The 30-min administration of either N-methyl-D-aspartate (NMDA)/non-NMDA antagonist or a free radical scavenger at the same time as reoxygenation after 20 min hypoxia showed a neuroprotective effect inhibiting the decrease in the post-hypoxia-loading K value. In contrast, no such neuroprotective effect was evident with administration of either of these agents only during hypoxia loading, possibly indicating that immediately after reoxygenation neuronal damage was induced mediated by excitatory amino acids and free radicals in tandem. These results demonstrate that serial quantitative evaluation of CMRglc using this technique may be of use in investigating the brain tissue injury associated with hypoxia/reoxygenation as well as clarifying the underlying mechanisms and protective effect of various drugs against such injury.

Deoxyglucose uptake by a head and neck squamous carcinoma: influence of changes in proliferative fraction

PURPOSE

Positron emission tomography, using the glucose analogue fluorodeoxy-D-glucose (FDG), is proving to be useful in the early response detection of head and neck tumors. Presently mechanisms underlying changes in FDG uptake after therapy are poorly understood. Response of tumors to therapy is often accompanied by a decrease in tumor cell proliferation. The purpose of this study was to assess whether or not changes in the uptake of deoxyglucose (DG) may reflect differences in proliferative fraction independent of other metabolic changes induced by using therapeutic agents.

METHODS AND MATERIALS

HN5 head and neck tumor cells were grown to different cell densities producing populations of cells with different proliferative indices without the need for exogenous agents to manipulate cell-cycle kinetics. (3)H-DG uptake, S-phase fraction (Spf), and lactate production were determined in each population of cells.

RESULTS

Large differences in Spf between populations of cells were associated with differences in DG incorporation. Lactate production was also found to correlate strongly with DG uptake.

CONCLUSION

Therapy-induced changes in FDG uptake by tumors may be partly due to changes in proliferation.

Positron emission tomography of esophageal carcinoma using (11)C-choline and (18)F-fluorodeoxyglucose: a novel method of preoperative lymph node staging

BACKGROUND

Accurate preoperative staging is an important but difficult problem in determining therapy for patients with esophageal carcinoma. Positron emission tomography (PET) is used with [methyl-(11)C]choline ((11)C-choline) and 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) to detect a variety of malignancies. The authors used PET with both of these agents to detect lymph node metastases in patients with esophageal carcinoma.

METHODS

Lymph node metastases in 33 patients with biopsy-proven esophageal carcinoma (16 patients with tumors classified as T1 and 17 patients with tumors classified as T2-4) was examined by PET using (11)C-choline and (18)F-FDG, and the accuracy of the results was correlated with pathology findings after surgery.

RESULTS

(11)C-choline PET was more effective than (18)F-FDG PET and computed tomography (CT) in detecting very small metastases localized in the mediastinum. It was ineffective, however, in detecting metastases localized in the upper abdomen, because of the normal uptake of (11)C-choline in the liver. (18)F-FDG PET was superior to CT in detecting metastases in the mediastinum and the upper abdomen, whereas (11)C-choline PET was superior to (18)F-FDG PET in detecting metastases in the mediastinum. When (11)C-choline PET and (18)F-FDG PET were used in combination, they were very effective in evaluating the lymph node status in both the mediastinum and the upper abdomen, and detected 85% of the metastatic lymph nodes (n = 46).

CONCLUSIONS

In this study, the combination of (11)C-choline PET and (18)F-FDG PET was very effective in evaluating the lymph node status of patients with esophageal carcinoma preoperatively.

Cytosolic/microsomal redox pathway: a reductive retention mechanism of a PET-oncology tracer, cu-pyruvaldehyde-bis(N4-methylthiosemicarbazone) (cu-PTSM)

OBJECTIVE

To clarify the retention mechanism of a PET imaging agent Cu-pyruvaldehyde-bis(N4-methylthiosemicarbazone) (Cu-62-PTSM) in tumor cells, reductive metabolism of non-radioactive Cu-PTSM in five cultured tumor cell lines, a tumor specimen and non-tumor tissues in vitro was evaluated by electron spin resonance spectrometry (ESR).

RESULTS

In the brain, mitochondrial electron transport enzyme reduced Cu-PTSM specifically. On the other hand, Cu-PTSM was not reduced in tumor mitochondria. The mitochondrial electron transport enzyme in tumor cells was not damaged, but NADH was considered to be depleted. In compensation for that, the tumor cells acquired complementary reduction activity in the microsome/cytosol. The reduction was enzymatic and NADH-dependent, possibly similar to the activation mechanism of bioreductive anticancer drugs.

CONCLUSION

Cu-PTSM and its derivatives are considered to be used as a marker for microsome/cytosol redox ability in PET oncology, although the physiological role of the redox enzyme system in tumor cells has not been clarified. The change in electron (NADH) flow in tumor cells might be a mechanism supporting aerobic glycolysis in tumor cells.

The importance of glucose transport activity as the rate-limiting step of 2-deoxyglucose uptake in tumor cells in vitro

Glucose transporter (GLUT) expression and hexokinase activity are thought to be related to high [18F]-fluorodeoxyglucose (FDG) uptake in tumor cells, but their relative importance is still unknown. To determine which is the predominant factor in FDG uptake in tumor cells, cultured tumor cell lines and a normal cell line were studied in vitro with respect to 2-deoxyglucose (DG) uptake, hexokinase activity, and the initial uptake rate of 3-O-methylglucose (3-O-MG) transport, which is generally accepted as indicating the amount of GLUT expressed on the plasma membrane. In 16 types of tumor cells and one fibroblast cell line, DG uptake was assessed for 60 min, the initial uptake rate of 3-O-MG transport was measured for 1 min, and total hexokinase activity, including that in the mitochondrial fraction, was determined. Across all 16 tumor cell lines, there was a significant correlation between DG uptake and 3-O-MG transport (p = 0.0012, F test), but not between DG uptake and hexokinase activity. Hexokinase activity of the tumor cells was comparable to that of the human fibroblast cells in the exponential growth phase. Most tumor cells showed higher DG uptake and 3-O-MG transport than the human fibroblast cells. The results suggest that DG uptake of cultured tumor cells is governed by GLUT expression, which may be a distinct characteristic of the neoplastic process.