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Vorster M. Gallium-68 Labelled Radiopharmaceuticals for Imaging Inflammatory Disorders. Semin Nucl Med 2023; 53:199-212. [PMID: 36270829 DOI: 10.1053/j.semnuclmed.2022.08.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 08/18/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022]
Abstract
Inflammation is an important component of several chronic and debilitating diseases that result in significant morbidity and mortality. This is best evidenced within the cardiovascular system where it may manifest as atherosclerosis or myocarditis, and at the extreme end of the spectrum as myocardial infarction, ventricular remodeling, or cardiac failure. Early non-invasive detection and monitoring of inflammation in these and other settings may better guide patient management with resultant improved outcomes. Key role players in inflammation pathophysiology include chemokines, macrophages, neutrophils, fibroblasts, integrins, and reactive oxygen species, amongst others. Examples of receptor expression and over-expression include somatostatin receptors, CXCR4-, folate-, mannose-, TSPO- receptors and secretion of various vascular adhesion molecules (such as VCAM and ICAM). Gallium-68-based PET offers imaging possibilities for nearly all the major pathophysiological role players in inflammation, with mounting recent interest in macrophage differentiation, various forms of receptor expression and secretion of chemokines and vascular adhesion molecules. The advantages in terms of logistics and costs of having generator-produced PET probes available is well known, and a 68Ga-based tracer provides easily translatable theranostic possibilities to especially Lu-177. Some of the more versatile and better validated Ga-68-based inflammation probes include 68Ga-DOTA-TATE/NOC/TOC, 68Ga-NOTA-RGD, 68Ga-CXCR4, 68Ga-citrate and 68Ga-FAPI.
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Affiliation(s)
- Mariza Vorster
- Nuclear Medicine, Department of Nuclear Medicine at Inkosi Albert Luthuli Hospital, University of KwaZulu-Natal, Berea, KwaZulu-Natal, South Africa.
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2
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Broens B, Duitman JW, Zwezerijnen GJC, Nossent EJ, van der Laken CJ, Voskuyl AE. Novel tracers for molecular imaging of interstitial lung disease: A state of the art review. Autoimmun Rev 2022; 21:103202. [PMID: 36150433 DOI: 10.1016/j.autrev.2022.103202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Abstract
Interstitial lung disease is an overarching term for a wide range of disorders characterized by inflammation and/or fibrosis in the lungs. Most prevalent forms, among others, include idiopathic pulmonary fibrosis (IPF) and connective tissue disease associated interstitial lung disease (CTD-ILD). Currently, only disease modifying treatment options are available for IPF and progressive fibrotic CTD-ILD, leading to reduction or stabilization in the rate of lung function decline at best. Management of these patients would greatly advance if we identify new strategies to improve (1) early detection of ILD, (2) predicting ILD progression, (3) predicting response to therapy and (4) understanding pathophysiology. Over the last years, positron emission tomography (PET) and single photon emission computed tomography (SPECT) have emerged as promising molecular imaging techniques to improve ILD management. Both are non-invasive diagnostic tools to assess molecular characteristics of an individual patient with the potential to apply personalized treatment. In this review, we encompass the currently available pre-clinical and clinical studies on molecular imaging with PET and SPECT in IPF and CTD-ILD. We provide recommendations for potential future clinical applications of these tracers and directions for future research.
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Affiliation(s)
- Bo Broens
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
| | - Jan-Willem Duitman
- Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Pulmonary Medicine, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Experimental Immunology (EXIM), Meibergdreef 9, Amsterdam, the Netherlands.
| | - Gerben J C Zwezerijnen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, De Boelelaan 1117, Amsterdam, the Netherlands.
| | - Esther J Nossent
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pulmonary Medicine, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, the Netherlands..
| | - Conny J van der Laken
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
| | - Alexandre E Voskuyl
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Rheumatology and Clinical Immunology, De Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam Infection & Immunity, Inflammatory diseases, Amsterdam, the Netherlands.
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3
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Broens B, van der Laken CJ, Zwezerijnen GJ, Nossent EJ, Meijboom LJ, Spierings J, de Vries-Bouwstra JK, van Laar JM, Voskuyl AE. Positron Emission Tomography to Improve Assessment of Interstitial Lung Disease in Patients With Systemic Sclerosis Eligible for Autologous Stem Cell Transplantation. Front Immunol 2022; 13:923869. [PMID: 35865521 PMCID: PMC9294594 DOI: 10.3389/fimmu.2022.923869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Positron emission tomography (PET) is a promising technique to improve the assessment of systemic sclerosis associated interstitial lung disease (SSc-ILD). This technique could be of particular value in patients with severe diffuse cutaneous SSc (dcSSc) that are possibly eligible for autologous hematopoietic stem cell transplantation (aHSCT). aHSCT is a potentially effective therapy for patients with severe dcSSc and ILD, leading to stabilization or improvement of lung function. However, there is a high need to improve patient selection, which includes (1) the selection of patients with rapidly progressive ILD for early rather than last-resort aHSCT (2) the prediction of treatment response on ILD and (3) the understanding of the mechanism(s) of action of aHSCT in the lungs. As previous studies with 18F-FDG PET in SSc-ILD and other forms of ILD have demonstrated its potential value in predicting disease progression and reactivity to anti-inflammatory treatment, we discuss the potential benefit of using this technique in patients with early severe dcSSc and ILD in the context of aHSCT. In addition, we discuss the potential value of other PET tracers in the assessment of ILD and understanding the mechanisms of action of aHSCT in the lung. Finally, we provide several suggestions for future research.
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Affiliation(s)
- Bo Broens
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
| | - Conny J. van der Laken
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
| | | | - Esther J. Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Lilian J. Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Amsterdam, Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Julia Spierings
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | | | - Jacob M. van Laar
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Alexandre E. Voskuyl
- Department of Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, Netherlands
- *Correspondence: Alexandre E. Voskuyl,
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4
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Dhingra VK, Khan D, Kumar R, Basu S. Nonmalignant Thoracic Disorders: An Appraisal of Fluorodeoxyglucose and Non-fluorodeoxyglucose PET/Computed Tomography Applications. PET Clin 2022; 17:495-515. [PMID: 35717104 DOI: 10.1016/j.cpet.2022.03.008] [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] [Indexed: 11/20/2022]
Abstract
PET/computed tomography (CT) with fluorodeoxyglucose and nonfluorodeoxyglucose PET tracers has established itself in the management of malignant disorders. Its role in the assessment of nonmalignant conditions, such as infectious and noninfectious inflammatory diseases and other benign conditions, has emerged independently and alongside its role being evaluated in malignancy and continues to evolve. It is evident that PET/CT has the potential to play a significant role in various nonmalignant disorders of the thorax. This review highlights current developments and areas where PET/CT has a potential to impact the clinical management of nonmalignant thoracic conditions with special focus on nonfluorodeoxyglucose tracers.
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Affiliation(s)
- Vandana Kumar Dhingra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Dikhra Khan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Sandip Basu
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, 2nd floor, BARC Training School Complex, Anushaktinagar, Mumbai, Maharashtra 400094, India.
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5
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Thornton A, Fraioli F, Wan S, Garthwaite HS, Ganeshan B, Shortman RI, Endozo R, Voo S, Kayani I, Neriman D, Menezes L, Bomanji JB, Hillman T, Heightman M, Porter JC, Groves AM. Evolution of 18F-FDG-PET/CT findings in patients following COVID-19 pneumonia: An Initial Investigation. J Nucl Med 2021; 63:270-273. [PMID: 34272318 PMCID: PMC8805777 DOI: 10.2967/jnumed.121.262296] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/25/2021] [Indexed: 11/16/2022] Open
Abstract
The aim of this study was to assess the temporal evolution of pulmonary 18F-FDG uptake in patients with coronavirus disease 2019 (COVID-19) and post–COVID-19 lung disease (PCLD). Methods: Using our hospital’s clinical electronic records, we retrospectively identified 23 acute COVID-19, 18 PCLD, and 9 completely recovered 18F-FDG PET/CT patients during the 2 peaks of the U.K. pandemic. Pulmonary 18F-FDG uptake was measured as a lung target-to-background ratio (TBRlung = SUVmax/SUVmin) and compared with temporal stage. Results: In acute COVID-19, less than 3 wk after infection, TBRlung was strongly correlated with time after infection (rs = 0.81, P < 0.001) and was significantly higher in the late stage than in the early stage (P = 0.001). In PCLD, TBRlung was lower in patients treated with high-dose steroids (P = 0.003) and in asymptomatic patients (P < 0.001). Conclusion: Pulmonary 18F-FDG uptake in COVID-19 increases with time after infection. In PCLD, pulmonary 18F-FDG uptake rises despite viral clearance, suggesting ongoing inflammation. There was lower pulmonary 18F-FDG uptake in PCLD patients treated with steroids.
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Affiliation(s)
- Andrew Thornton
- Institute of Nuclear Medicine, University College London, United Kingdom
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London, United Kingdom
| | - Simon Wan
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | - Helen S Garthwaite
- Interstitial Lung Disease Service, University College London Hospital, United Kingdom
| | | | - Robert Ian Shortman
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | - Raymond Endozo
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | - Stefan Voo
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | - Irfan Kayani
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | - Deena Neriman
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | - Leon Menezes
- Institute of Nuclear Medicine, University College London Hospital, United Kingdom
| | | | - Toby Hillman
- Post-COVID Disease Service, University College London Hospital, United Kingdom
| | - Melissa Heightman
- Post-COVID Disease Service, University College London Hospital, United Kingdom
| | - Joanna C Porter
- Interstitial Lung Disease Service, University College London Hospital, United Kingdom
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, United Kingdom
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6
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Giraudo C, Evangelista L, Fraia AS, Lupi A, Quaia E, Cecchin D, Casali M. Molecular Imaging of Pulmonary Inflammation and Infection. Int J Mol Sci 2020; 21:ijms21030894. [PMID: 32019142 PMCID: PMC7037834 DOI: 10.3390/ijms21030894] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/27/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
Infectious and inflammatory pulmonary diseases are a leading cause of morbidity and mortality worldwide. Although infrequently used in this setting, molecular imaging may significantly contribute to their diagnosis using techniques like single photon emission tomography (SPET), positron emission tomography (PET) with computed tomography (CT) or magnetic resonance imaging (MRI) with the support of specific or unspecific radiopharmaceutical agents. 18F-Fluorodeoxyglucose (18F-FDG), mostly applied in oncological imaging, can also detect cells actively involved in infectious and inflammatory conditions, even if with a low specificity. SPET with nonspecific (e.g., 67Gallium-citrate (67Ga citrate)) and specific tracers (e.g., white blood cells radiolabeled with 111Indium-oxine (111In) or 99mTechnetium (99mTc)) showed interesting results for many inflammatory lung diseases. However, 67Ga citrate is unfavorable by a radioprotection point of view while radiolabeled white blood cells scan implies complex laboratory settings and labeling procedures. Radiolabeled antibiotics (e.g., ciprofloxacin) have been recently tested, although they seem to be quite unspecific and cause antibiotic resistance. New radiolabeled agents like antimicrobic peptides, binding to bacterial cell membranes, seem very promising. Thus, the aim of this narrative review is to provide a comprehensive overview about techniques, including PET/MRI, and tracers that can guide the clinicians in the appropriate diagnostic pathway of infectious and inflammatory pulmonary diseases.
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Affiliation(s)
- Chiara Giraudo
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
- Correspondence: ; Tel.: +39-049-821-2357; Fax: +39-049-821-1878
| | - Laura Evangelista
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
| | - Anna Sara Fraia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Amalia Lupi
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Emilio Quaia
- Department of Medicine-DIMED,Institute of Radiology, University of Padova, 35100 Padova, Italy; (A.S.F.); (A.L.); (E.Q.)
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine-DIMED, University of Padova, 35128 Padova, Italy; (L.E.); (D.C.)
- Padova Neuroscience Center (PNC), University of Padova, 35131 Padova, Italy
| | - Massimiliano Casali
- Azienda Unità Sanitaria Locale–IRCCS di Reggio Emilia, 42121 Reggio Emilia, Italy;
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7
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Anzola LK, Glaudemans AWJM, Dierckx RAJO, Martinez FA, Moreno S, Signore A. Somatostatin receptor imaging by SPECT and PET in patients with chronic inflammatory disorders: a systematic review. Eur J Nucl Med Mol Imaging 2019; 46:2496-2513. [PMID: 31463594 PMCID: PMC6813755 DOI: 10.1007/s00259-019-04489-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/15/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To review the literature on the clinical application of radiolabeled somatostatin receptor scintigraphy (SRS) by SPECT and PET in adults with chronic inflammatory diseases. RESEARCH DESIGN Systematic review of published observational studies between 1993 and 2017. DATA COLLECTION AND ANALYSIS The Cochrane Central Register of Controlled Trials, MedLine, EMBASE, PubMed, Google Scholar, OVID, EBSCO, Scopus, and Web of Science were used to search for studies on the use of SRS in adults with chronic inflammatory diseases. A team of reviewers independently screened for eligible studies. Quality of evidence was assessed by QUADAS approach. RESULTS Eligible papers included 38 studies. Studied populations were heterogeneous, and patients were classified according to the diagnosed disease: endothelial inflammation, rheumatoid arthritis, cardiac allograft rejection, granulomatous diseases, small vessel vasculitis, idiopathic pulmonary fibrosis, sarcoidosis, and thyroid exophthalmopathy. Because of many quality differences between studies, it was not possible to pool data, and a narrative synthesis is reported. CONCLUSION Results highlight the value of SRS to detect active inflammation in several chronic inflammatory conditions, despite the bias related to the index test, showing lack of standardization of the scintigraphic technique and high variability of methods used to clinically evaluate inflammatory condition.
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Affiliation(s)
- Luz Kelly Anzola
- Nuclear Medicine Unit, Clinica Reina Sofia, Bogotà, Colombia.
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudi A J O Dierckx
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sergio Moreno
- Clinical Epidemiologist Universidad Nacional de Colombia, Bogota, Colombia
| | - Alberto Signore
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University, Rome, Italy
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8
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Weatherley ND, Eaden JA, Stewart NJ, Bartholmai BJ, Swift AJ, Bianchi SM, Wild JM. Experimental and quantitative imaging techniques in interstitial lung disease. Thorax 2019; 74:611-619. [PMID: 30886067 PMCID: PMC6585263 DOI: 10.1136/thoraxjnl-2018-211779] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 01/05/2019] [Accepted: 01/14/2019] [Indexed: 01/19/2023]
Abstract
Interstitial lung diseases (ILDs) are a heterogeneous group of conditions, with a wide and complex variety of imaging features. Difficulty in monitoring, treating and exploring novel therapies for these conditions is in part due to the lack of robust, readily available biomarkers. Radiological studies are vital in the assessment and follow-up of ILD, but currently CT analysis in clinical practice is qualitative and therefore somewhat subjective. In this article, we report on the role of novel and quantitative imaging techniques across a range of imaging modalities in ILD and consider how they may be applied in the assessment and understanding of ILD. We critically appraised evidence found from searches of Ovid online, PubMed and the TRIP database for novel and quantitative imaging studies in ILD. Recent studies have explored the capability of texture-based lung parenchymal analysis in accurately quantifying several ILD features. Newer techniques are helping to overcome the challenges inherent to such approaches, in particular distinguishing peripheral reticulation of lung parenchyma from pleura and accurately identifying the complex density patterns that accompany honeycombing. Robust and validated texture-based analysis may remove the subjectivity that is inherent to qualitative reporting and allow greater objective measurements of change over time. In addition to lung parenchymal feature quantification, pulmonary vessel volume analysis on CT has demonstrated prognostic value in two retrospective analyses and may be a sign of vascular changes in ILD which, to date, have been difficult to quantify in the absence of overt pulmonary hypertension. Novel applications of existing imaging techniques, such as hyperpolarised gas MRI and positron emission tomography (PET), show promise in combining structural and functional information. Although structural imaging of lung tissue is inherently challenging in terms of conventional proton MRI techniques, inroads are being made with ultrashort echo time, and dynamic contrast-enhanced MRI may be used for lung perfusion assessment. In addition, inhaled hyperpolarised 129Xenon gas MRI may provide multifunctional imaging metrics, including assessment of ventilation, intra-acinar gas diffusion and alveolar-capillary diffusion. PET has demonstrated high standard uptake values (SUVs) of 18F-fluorodeoxyglucose in fibrosed lung tissue, challenging the assumption that these are ‘burned out’ and metabolically inactive regions. Regions that appear structurally normal also appear to have higher SUV, warranting further exploration with future longitudinal studies to assess if this precedes future regions of macroscopic structural change. Given the subtleties involved in diagnosing, assessing and predicting future deterioration in many forms of ILD, multimodal quantitative lung structure-function imaging may provide the means of identifying novel, sensitive and clinically applicable imaging markers of disease. Such imaging metrics may provide mechanistic and phenotypic information that can help direct appropriate personalised therapy, can be used to predict outcomes and could potentially be more sensitive and specific than global pulmonary function testing. Quantitative assessment may objectively assess subtle change in character or extent of disease that can assist in efficacy of antifibrotic therapy or detecting early changes of potentially pneumotoxic drugs involved in early intervention studies.
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Affiliation(s)
| | - James A Eaden
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Neil J Stewart
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Brian J Bartholmai
- Department of Radiology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Andrew J Swift
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
| | - Stephen Mark Bianchi
- Department of Respiratory Medicine, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - Jim M Wild
- Academic Unit of Academic Radiology, University of Sheffield, Sheffield, UK
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Xiong Y, Nie D, Liu S, Ma H, Su S, Sun A, Zhao J, Zhang Z, Xiang X, Tang G. Apoptotic PET Imaging of Rat Pulmonary Fibrosis With [ 18F]ML-8. Mol Imaging 2019; 17:1536012118795728. [PMID: 30348035 PMCID: PMC6201178 DOI: 10.1177/1536012118795728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective: To investigate the value of 2-(3-[18F]fluoropropyl)-2-methyl-malonic acid
([18F]ML-8) positron emission tomography (PET) imaging of rat pulmonary
fibrosis. Methods: Male Sprague-Dawley rats were divided into 2 groups, including pulmonary fibrosis model
group and control group. The rat model was established by an intratracheal instillation
of bleomycin (BLM). Control rats were treated with saline. Positron emission
tomography/computed tomography (CT) with [18F]ML-8 or
18F-fluorodeoxyglucose ([18F]FDG) was performed on 2 groups. After
PET/CT imaging, lung tissues were collected for histologic examination. Data were
analyzed and comparisons between 2 groups were performed using Student
t test. Results: Bleomycin-treated rats showed a higher lung uptake of [18F]ML-8 than control
rats (P < .05). In BLM-treated rats, the lung to muscle relative
uptake ratio of [18F]ML-8 was also higher than that of [18F]FDG
(P < .05). Pathological examination showed overproliferation of
fibroblasts and deposition of collagen in lungs from BLM-treated rats. Compared to
control rats, BLM-treated rats had higher lung hydroxyproline content
(P < .05). Immunofluorescence staining indicated more apoptotic
cells in BLM-treated rats than those in control rats. Moreover, the apoptosis rate of
lung tissues obtained from BLM-treated rats was higher than that from control rats
(P < .05). Conclusions: 2-(3-[18F]fluoropropyl)-2-methyl-malonic acid PET/CT could be used for
noninvasive diagnosis of pulmonary fibrosis in a rat model.
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Affiliation(s)
- Ying Xiong
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dahong Nie
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoyu Liu
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hui Ma
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shu Su
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Aixia Sun
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jing Zhao
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhanwen Zhang
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xianhong Xiang
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ganghua Tang
- 1 Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals and Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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10
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Schniering J, Benešová M, Brunner M, Haller S, Cohrs S, Frauenfelder T, Vrugt B, Feghali-Bostwick CA, Schibli R, Distler O, Mueller C, Maurer B. Visualisation of interstitial lung disease by molecular imaging of integrin αvβ3 and somatostatin receptor 2. Ann Rheum Dis 2018; 78:218-227. [PMID: 30448769 DOI: 10.1136/annrheumdis-2018-214322] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/26/2018] [Accepted: 11/02/2018] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate integrin αvβ3 (alpha-v-beta-3)-targeted and somatostatin receptor 2 (SSTR2)-targeted nuclear imaging for the visualisation of interstitial lung disease (ILD). METHODS The pulmonary expression of integrin αvβ3 and SSTR2 was analysed in patients with different forms of ILD as well as in bleomycin (BLM)-treated mice and respective controls using immunohistochemistry. Single photon emission CT/CT (SPECT/CT) was performed on days 3, 7 and 14 after BLM instillation using the integrin αvβ3-targeting 177Lu-DOTA-RGD and the SSTR2-targeting 177Lu-DOTA-NOC radiotracer. The specific pulmonary accumulation of the radiotracers over time was assessed by in vivo and ex vivo SPECT/CT scans and by biodistribution studies. RESULTS Expression of integrin αvβ3 and SSTR2 was substantially increased in human ILD regardless of the subtype. Similarly, in lungs of BLM-challenged mice, but not of controls, both imaging targets were stage-specifically overexpressed. While integrin αvβ3 was most abundantly upregulated on day 7, the inflammatory stage of BLM-induced lung fibrosis, SSTR2 expression peaked on day 14, the established fibrotic stage. In agreement with the findings on tissue level, targeted nuclear imaging using SPECT/CT specifically detected both imaging targets ex vivo and in vivo, and thus visualised different stages of experimental ILD. CONCLUSION Our preclinical proof-of-concept study suggests that specific visualisation of molecular processes in ILD by targeted nuclear imaging is feasible. If transferred into clinics, where imaging is considered an integral part of patients' management, the additional information derived from specific imaging tools could represent a first step towards precision medicine in ILD.
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Affiliation(s)
- Janine Schniering
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Martina Benešová
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland.,Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Matthias Brunner
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Stephanie Haller
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
| | - Susan Cohrs
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland
| | - Thomas Frauenfelder
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Bart Vrugt
- Institute of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Carol A Feghali-Bostwick
- Division of Rheumatology & Immunology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Roger Schibli
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland.,Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Oliver Distler
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - Cristina Mueller
- Center for Radiopharmaceutical Sciences, Paul Scherrer Institute, Villigen, Switzerland.,Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Britta Maurer
- Center of Experimental Rheumatology, Department of Rheumatology, University Hospital Zurich, Zurich, Switzerland
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11
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Xiong Y, Nie D, Liu S, Ma H, Su S, Sun A, Zhao J, Zhang Z, Xiang X, Tang G. Apoptotic PET Imaging of Rat Pulmonary Fibrosis with Small-Molecule Radiotracer. Mol Imaging Biol 2018; 21:491-499. [PMID: 30167994 DOI: 10.1007/s11307-018-1242-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to assess the potential utility of small-molecule apoptotic radiotracer, 2-(5-[18F]fluoropentyl)-2-methyl malonic acid ([18F]ML-10), for positron emission tomography (PET)/computed tomography (CT) monitoring the progression of pulmonary fibrosis in a rat model. PROCEDURES Male Sprague-Dawley rats were used to establish a rat model of pulmonary fibrosis by means of bleomycin (BLM) administration; control rats received saline (n = 12 per group). PET/CT with [18F]ML-10 and 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) was performed in two groups at different stages of pulmonary fibrosis. The fibrotic response and the cell apoptosis were assessed with histologic examination. Differences in the apoptosis rate, fibrotic activity, and the lung uptake of [18F]ML-10 and [18F]FDG between two groups were determined with Student t test. RESULTS Compared with control group, BLM group showed a higher lung uptake of [18F]ML-10 at all imaging time points (all P < 0.001). During the fibrotic phase of this disease model (days 21 and 28), the lung uptake of [18F]ML-10 was higher than that of [18F]FDG in the BLM group (all P < 0.001). Moreover, accumulation of [18F]ML-10 in the lung tissues increased in proportion to the apoptosis rate (R2 = 0.9863, P < 0.0001) and fibrotic activity (R2 = 0.9631, P < 0.0001) of rat pulmonary fibrosis. Conversely, no correlation between [18F]FDG uptake and fibrotic activity was found. CONCLUSIONS [18F]ML-10 PET/CT enabled monitoring the progression of rat pulmonary fibrosis, whereas [18F]FDG PET/CT could not. Implications for noninvasive diagnosis of pulmonary fibrosis, assessment of fibrotic activity, and evaluation of antifibrotic therapy are expected.
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Affiliation(s)
- Ying Xiong
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Dahong Nie
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Shaoyu Liu
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Hui Ma
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Shu Su
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Aixia Sun
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Jing Zhao
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Zhanwen Zhang
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China
| | - Xianhong Xiang
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
| | - Ganghua Tang
- Department of Medical Imaging and Guangdong Engineering Research Center for Translational Application of Medical Radiopharmaceuticals, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, 510080, China.
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12
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Holman BF, Cuplov V, Millner L, Endozo R, Maher TM, Groves AM, Hutton BF, Thielemans K. Improved quantitation and reproducibility in multi-PET/CT lung studies by combining CT information. EJNMMI Phys 2018; 5:14. [PMID: 29869186 PMCID: PMC5986691 DOI: 10.1186/s40658-018-0212-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 04/09/2018] [Indexed: 02/06/2023] Open
Abstract
Background Matched attenuation maps are vital for obtaining accurate and reproducible kinetic and static parameter estimates from PET data. With increased interest in PET/CT imaging of diffuse lung diseases for assessing disease progression and treatment effectiveness, understanding the extent of the effect of respiratory motion and establishing methods for correction are becoming more important. In a previous study, we have shown that using the wrong attenuation map leads to large errors due to density mismatches in the lung, especially in dynamic PET scans. Here, we extend this work to the case where the study is sub-divided into several scans, e.g. for patient comfort, each with its own CT (cine-CT and ‘snap shot’ CT). A method to combine multi-CT information into a combined-CT has then been developed, which averages the CT information from each study section to produce composite CT images with the lung density more representative of that in the PET data. This combined-CT was applied to nine patients with idiopathic pulmonary fibrosis, imaged with dynamic 18F-FDG PET/CT to determine the improvement in the precision of the parameter estimates. Results Using XCAT simulations, errors in the influx rate constant were found to be as high as 60% in multi-PET/CT studies. Analysis of patient data identified displacements between study sections in the time activity curves, which led to an average standard error in the estimates of the influx rate constant of 53% with conventional methods. This reduced to within 5% after use of combined-CTs for attenuation correction of the study sections. Conclusions Use of combined-CTs to reconstruct the sections of a multi-PET/CT study, as opposed to using the individually acquired CTs at each study stage, produces more precise parameter estimates and may improve discrimination between diseased and normal lung.
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Affiliation(s)
- Beverley F Holman
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK.
| | - Vesna Cuplov
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK
| | - Lynn Millner
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK
| | - Raymond Endozo
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK
| | - Toby M Maher
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton Hospital, Sydney St, London, SW3 6NP, UK.,Fibrosis Research Group, Inflammation, Repair and Development Section, NHLI, Sir Alexander Flemming Building, Imperial College London, London, SW7 2AZ, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK
| | - Brian F Hutton
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK.,Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
| | - Kris Thielemans
- Institute of Nuclear Medicine, University College London, UCLH (T-5), Euston Road, London, NW1 2BU, UK
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13
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Pomper MG, Lee S. Molecularly Targeted MR Imaging Agent in Liver Fibrosis: High Sensitivity and Low Gadolinium Mean High Translational Potential. Radiology 2018; 287:590-591. [DOI: 10.1148/radiol.2018180084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martin G. Pomper
- From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287
| | - Seulki Lee
- From the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St, Baltimore, MD 21287
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14
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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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15
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FDG-PET/CT in the prediction of pulmonary function improvement in nonspecific interstitial pneumonia. A Pilot Study. Eur J Radiol 2016; 85:2200-2205. [DOI: 10.1016/j.ejrad.2016.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 08/30/2016] [Accepted: 10/02/2016] [Indexed: 11/20/2022]
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16
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Abstract
Lung inflammatory diseases contribute significantly to the socioeconomic burden of disease. Yet very few new, effective therapies for respiratory disease have been approved for use. A major contributing factor is the lack of biomarkers that can accurately quantify the lung inflammatory burden and can be used to understand the contribution of lung inflammation to loss in lung function. Molecular imaging approaches can detect and quantify the recruitment and activation of specific immune cells in lung inflammation. We review the clinical techniques used to image lung inflammation, provide an overview of clinical and emerging PET techniques for quantifying lung inflammation, and discuss potential clinical applications.
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Affiliation(s)
| | - Delphine L Chen
- Washington University School of Medicine, St. Louis, Missouri
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17
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Bondue B, Sherer F, Van Simaeys G, Doumont G, Egrise D, Yakoub Y, Huaux F, Parmentier M, Rorive S, Sauvage S, Lacroix S, Vosters O, De Vuyst P, Goldman S. PET/CT with 18F-FDG- and 18F-FBEM-labeled leukocytes for metabolic activity and leukocyte recruitment monitoring in a mouse model of pulmonary fibrosis. J Nucl Med 2015; 56:127-32. [PMID: 25537989 DOI: 10.2967/jnumed.114.147421] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
UNLABELLED Idiopathic pulmonary fibrosis is characterized by a progressive and irreversible respiratory failure. Validated noninvasive methods able to assess disease activity are essential for prognostic purposes as well as for the evaluation of emerging antifibrotic treatments. METHODS C57BL/6 mice were used in a murine model of pulmonary fibrosis induced by an intratracheal instillation of bleomycin (control mice were instilled with a saline solution). At different times after instillation, PET/CT with (18)F-FDG- or (18)F-4-fluorobenzamido-N-ethylamino-maleimide ((18)F-FBEM)-labeled leukocytes was performed to assess metabolic activity and leukocyte recruitment, respectively. RESULTS In bleomycin-treated mice, a higher metabolic activity was measured on (18)F-FDG PET/CT scans from day 7 to day 24 after instillation, with a peak of activity measured at day 14. Of note, lung mean standardized uptake values correlated with bleomycin doses, histologic score of fibrosis, lung hydroxyproline content, and weight loss. Moreover, during the inflammatory phase of the model (day 7), but not the fibrotic phase (day 23), bleomycin-treated mice presented with an enhanced leukocyte recruitment as assessed by (18)F-FBEM-labeled leukocyte PET/CT. Autoradiographic analysis of lung sections and CD45 immunostaining confirm the higher and early recruitment of leukocytes in bleomycin-treated mice, compared with control mice. CONCLUSION (18)F-FDG- and (18)F-FBEM-labeled leukocyte PET/CT enable monitoring of metabolic activity and leukocyte recruitment in a mouse model of pulmonary fibrosis. Implications for preclinical evaluation of antifibrotic therapy are expected.
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Affiliation(s)
- Benjamin Bondue
- Service de Pneumologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (I.R.I.B.H.M.), Université Libre de Bruxelles, Brussels, Belgium
| | - Félicie Sherer
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium Service de Médecine Nucléaire, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Gaetan Van Simaeys
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium Service de Médecine Nucléaire, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Gilles Doumont
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium Service de Médecine Nucléaire, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Dominique Egrise
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium Service de Médecine Nucléaire, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Yousof Yakoub
- Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - François Huaux
- Centre for Toxicology and Applied Pharmacology, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marc Parmentier
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (I.R.I.B.H.M.), Université Libre de Bruxelles, Brussels, Belgium
| | - Sandrine Rorive
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium
| | - Sébastien Sauvage
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium
| | - Simon Lacroix
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium Service de Médecine Nucléaire, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
| | - Olivier Vosters
- Institut de Recherche Interdisciplinaire en Biologie Humaine et Moléculaire (I.R.I.B.H.M.), Université Libre de Bruxelles, Brussels, Belgium
| | - Paul De Vuyst
- Service de Pneumologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Serge Goldman
- Center for Microscopy and Molecular Imaging, Université Libre de Bruxelles, Gosselies, Belgium Service de Médecine Nucléaire, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium; and
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