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Porter JC, Ganeshan B, Win T, Fraioli F, Khan S, Rodriguez-Justo M, Endozo R, Shortman RI, Hoy LR, Maher TM, Groves AM. [ 18F]FDG PET/CT Signal Correlates with Neoangiogenesis Markers in Patients with Fibrotic Interstitial Lung Disease Who Underwent Lung Biopsy: Implication for the Use of PET/CT in Diffuse Lung Diseases. J Nucl Med 2024; 65:617-622. [PMID: 38485275 PMCID: PMC10995524 DOI: 10.2967/jnumed.123.266445] [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: 08/23/2023] [Revised: 01/11/2024] [Indexed: 04/04/2024] Open
Abstract
The use of [18F]FDG PET/CT as a biomarker in diffuse lung diseases is increasingly recognized. We investigated the correlation between [18F]FDG uptake with histologic markers on lung biopsy of patients with fibrotic interstitial lung disease (fILD). Methods: We recruited 18 patients with fILD awaiting lung biopsy for [18F]FDG PET/CT. We derived a target-to-background ratio (TBR) of maximum pulmonary uptake of [18F]FDG (SUVmax) divided by the lung background (SUVmin). Consecutive paraffin-embedded lung biopsy sections were immunostained for alveolar and interstitial macrophages (CD68), microvessel density (MVD) (CD31 and CD105/endoglin), and glucose transporter 1. MVD was expressed as vessel area percentage per high-power field (Va%/hpf). Differences in imaging and angiogenesis markers between histologic usual interstitial pneumonia (UIP) and non-UIP were assessed using a nonparametric Mann-Whitney test. Correlation of imaging with angiogenesis markers was assessed using the nonparametric Spearman rank correlation. Univariate Kaplan-Meier survival analysis assessed the difference in the survival curves for each of the angiogenesis markers (separated by their respective optimal cutoff) using the log-rank test. Statistical analysis was performed using SPSS. Results: In total, 18 patients were followed for an average of 41.36 mo (range, 5.69-132.46 mo; median, 30.07 mo). Only CD105 MVD showed a significantly positive correlation with [18F]FDG TBR (Spearman rank correlation, 0.556; P < 0.05, n = 13). There was no correlation between [18F]FDG uptake and macrophage expression of glucose transporter 1. CD105 and CD31 were higher for UIP than for non-UIP, with CD105 reaching statistical significance (P = 0.011). In all patients, MVD assessed with either CD105 or CD31 quantification on biopsy predicted overall survival. Patients with CD105 MVD of less than 12 Va%/hpf or CD31 MVD of less than 35 Va%/hpf had a significantly better prognosis (no deaths during follow-up in the case of CD105) than did patients with higher scores of CD105 MVD (median survival, 35 mo; P = 0.041, n = 13) or CD31 MVD (median survival, 28 mo; P = 0.014, n = 13). Conclusion: Previous work has used [18F]FDG uptake in PET/CT as a biomarker in fILD. Here, we highlight a correlation between angiogenesis and [18F]FDG TBR. We show that MVD is higher for UIP than for non-UIP and is associated with mortality in patients with fILD. These data set the scene to investigate the potential role of vasculature and angiogenesis in fibrosis.
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Affiliation(s)
- Joanna C Porter
- CITR, UCL Respiratory, University College London, London, United Kingdom;
- Interstitial Lung Disease Centre, University College London Hospital, London, United Kingdom
| | - Balaji Ganeshan
- Institute of Nuclear Medicine, University College London and University College London Hospital, London, United Kingdom
| | - Thida Win
- Lister Hospital, North East Herts Trust, Stevenage, United Kingdom
| | - Francesco Fraioli
- Institute of Nuclear Medicine, University College London and University College London Hospital, London, United Kingdom
| | - Saif Khan
- Research Department of Pathology, University College London, and Department of Histopathology, University College London Hospital, London, United Kingdom; and
| | - Manuel Rodriguez-Justo
- Research Department of Pathology, University College London, and Department of Histopathology, University College London Hospital, London, United Kingdom; and
| | - Raymond Endozo
- Institute of Nuclear Medicine, University College London and University College London Hospital, London, United Kingdom
| | - Robert I Shortman
- Institute of Nuclear Medicine, University College London and University College London Hospital, London, United Kingdom
| | - Luke R Hoy
- Institute of Nuclear Medicine, University College London and University College London Hospital, London, United Kingdom
| | - Toby M Maher
- Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London and University College London Hospital, London, United Kingdom
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van Leer B, van Snick JH, Londema M, Nijsten MWN, Kasalak Ö, Slart RHJA, Glaudemans AWJM, Pillay J. [ 18F]FDG-PET/CT in mechanically ventilated critically ill patients with COVID-19 ARDS and persistent inflammation. Clin Transl Imaging 2023; 11:297-306. [PMID: 37275950 PMCID: PMC10008145 DOI: 10.1007/s40336-023-00550-y] [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: 01/10/2023] [Accepted: 02/23/2023] [Indexed: 03/14/2023]
Abstract
Purpose We report the findings of four critically ill patients who underwent an [18F]FDG-PET/CT because of persistent inflammation during the late phase of their COVID-19. Methods Four mechanically ventilated patients with COVID-19 were retrospectively discussed in a research group to evaluate the added value of [18F]FDG-PET/CT. Results Although pulmonary PET/CT findings differed, bilateral lung anomalies could explain the increased CRP and leukocytes in all patients. This underscores the limited ability of the routine laboratory to discriminate inflammation from secondary infections. Based on PET/CT findings, a secondary infection/inflammatory focus was suspected in two patients (pancreatitis and gastritis). Lymphadenopathy was present in patients with a detectable SARS-CoV-2 viral load. Muscle uptake around the hips or shoulders was observed in all patients, possibly due to the process of heterotopic ossification. Conclusion This case series illustrates the diagnostic potential of [18F]FDG-PET/CT imaging in critically ill patients with persistent COVID-19 for the identification of other causes of inflammation and demonstrates that this technique can be performed safely in mechanically ventilated critically ill patients.
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Affiliation(s)
- Bram van Leer
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
| | - Johannes H. van Snick
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mark Londema
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
| | - Maarten W. N. Nijsten
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
| | - Ömer Kasalak
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Riemer H. J. A. Slart
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Biomedical Photonic Imaging Group, Faculty of Science and Technology, University of Twente, Enschede, The Netherlands
| | - Andor W. J. M. Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Janesh Pillay
- Department of Critical Care, University Medical Center Groningen, University of Groningen, TA29, PO box: 30 001, 9700 RB Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Elsakka A, Yeh R, Das J. The Clinical Utility of Molecular Imaging in COVID-19: An Update. Semin Nucl Med 2023; 53:98-106. [PMID: 36243572 PMCID: PMC9492514 DOI: 10.1053/j.semnuclmed.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 01/28/2023]
Abstract
The novel pathogen severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first discovered in Wuhan, China in late 2019 with Coronavirus disease 2019 (COVID-19) declared a global pandemic in March 2020. Primarily involving the lungs, conventional imaging with chest radiography and CT can play a complementary role to RT-PCR in the initial diagnosis, and also in follow up of select patients. As a broader understanding of the multi-systemic nature of COVID-19 has evolved, a potential role for molecular imaging has developed, that may detect functional changes in advance of standard cross-sectional imaging. In this review, we highlight the evolving role of molecular imaging such as fluorine-18 (18F) fluorodeoxyglucose (FDG) with PET/CT and PET/MRI in the evaluation of both pulmonary and extra-pulmonary COVID-19, ventilation and perfusion scan with SPECT/CT for thromboembolic disease, long term follow-up of COVID-19 infection, and COVID-19 vaccine-related complications.
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Affiliation(s)
- Ahmed Elsakka
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY,Body Imaging Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY
| | - Randy Yeh
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Jeeban Das
- Molecular Imaging and Therapy Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY,Body Imaging Service, Department of Radiology Memorial Sloan Kettering Cancer Center, New York, NY
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Increased Lung Immune Metabolic Activity in COVID-19 Survivors. Clin Nucl Med 2022; 47:1019-1025. [PMID: 36026599 PMCID: PMC9653065 DOI: 10.1097/rlu.0000000000004376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE We quantified lung glycolytic metabolic activity, clinical symptoms and inflammation, coagulation, and endothelial activation biomarkers in 2019 coronavirus disease (COVID-19) pneumonia survivors. METHODS Adults previously hospitalized with moderate to severe COVID-19 pneumonia were prospectively included. Subjects filled out a questionnaire on clinical consequences, underwent chest CT and 18 F-FDG PET/CT, and provided blood samples on the same day. Forty-five volunteers served as control subjects. Analysis of CT images and quantitative voxel-based analysis of PET/CT images were performed for both groups. 18 F-FDG uptake in the whole-lung volume and in high- and low-attenuation areas was calculated and normalized to liver values. Quantification of plasma markers of inflammation (interleukin 6), d -dimer, and endothelial cell activation (angiopoietins 1 and 2, vascular cell adhesion molecule 1, and intercellular adhesion molecule 1) was also performed. RESULTS We enrolled 53 COVID-19 survivors (62.3% were male; median age, 50 years). All survivors reported at least 1 persistent symptom, and 41.5% reported more than 6 symptoms. The mean lung density was greater in survivors than in control subjects, and more metabolic activity was observed in normal and dense lung areas, even months after symptom onset. Plasma proinflammatory, coagulation, and endothelial activation biomarker concentrations were also significantly higher in survivors. CONCLUSION We observed more metabolic activity in areas of high and normal lung attenuation several months after moderate to severe COVID-19 pneumonia. In addition, plasma markers of thromboinflammation and endothelial activation persisted. These findings may have implications for our understanding of the in vivo pathogenesis and long-lasting effects of COVID-19 pneumonia.
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Minamimoto R. Oncology and cardiology positron emission tomography/computed tomography faced with COVID-19: A review of available literature data. Front Med (Lausanne) 2022; 9:1052921. [DOI: 10.3389/fmed.2022.1052921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/07/2022] [Indexed: 01/18/2023] Open
Abstract
The COVID-19 pandemic has forced people to significantly change their lifestyles and attitudes, and has greatly burdened healthcare delivery systems worldwide. The redistribution of the medical delivery system to maintain normal medical care while responding generously to COVID-19 is a continuing challenge that weighs heavily on medical institutions. Among imaging modalities, chest X-rays and computed tomography (CT) examinations have clearly made a large contribution to treatment of COVID-19. In contrast, it is difficult to express the standpoint of nuclear medicine examinations in a straightforward manner, as the greatest emphasis in this modality has been on how necessary medical care can continue to be provided. Many clinical reports of nuclear medicine examinations related to COVID-19 have been published, and knowledge continues to accumulate. This review provides a summary of the current state of oncology and cardiology positron emission tomography (PET) examinations related to COVID-19, and includes preparation of the nuclear medicine department, trends in PET examinations, specific imaging findings on 18F-fluorodeoxyglucose (FDG) PET/CT, imaging of complications of COVID-19, PET tracers other than FDG, and the effects of vaccines on PET imaging findings.
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Alice B, Andrea BP, Marianna S, Ludovico D, Niccolò FP, Clarissa V, Paolo M, Andrea B, Sandro S. 18F-FDG PET-CT incidental lung findings in asymptomatic COVID-19 patients: evidences from the Italian core of the first pandemic peak. ASIA OCEANIA JOURNAL OF NUCLEAR MEDICINE & BIOLOGY 2022; 10:57-63. [PMID: 35083352 PMCID: PMC8742859 DOI: 10.22038/aojnmb.2021.58035.1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/01/2021] [Accepted: 08/04/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To illustrate incidental 18F-FDG PET-CT findings and related CT alterations of suspicious pulmonary interstitial involvement in asymptomatic oncologic patients during the first COVID-19 outbreak in the core of Italian peak. METHODS We retrospectively evaluated the 18F-FDG PET-CT follow-up examinations performed during the first Italian COVID-19 outbreak (March 3rd-April 15th, 2020) in 10 asymptomatic oncologic patients with a highly suspicious interstitial pulmonary involvement on CT. Six cases were confirmed SARS-CoV-2 by molecular tests. The following parameters were assessed: 1) lung involvement on co-registration CT as extension (laterality, number of lobes), pattern (ground-glass opacities/GGO, consolidations, mixed) and stage (early, progressive, peak, and absorption); 2) the maximum standardized uptake value (SUVmax) of lung lesions on 18F-FDG PET. RESULTS The involved lobes were 5 in 5 cases (3 confirmed SARS-CoV-2), 2-4 in 4 cases and 1 in 1 case. GGO were found in all patients; 3 cases also showed a combination of GGO and peripheral consolidations (mixed). Five cases were suggestive for an early stage of interstitial pneumonia, 4 for progressive and 1 for peak. All the lung lesions showed increased FDG uptake. In early stages SUVmax ranged from 1.5 to 11, in progressive from 3.3 to 6.8, in peak from 2.4 to 7.7. SUVmax ranged 1.5-11 in patients with only GGO and 2.8-7.7 in those with mixed pattern. CONCLUSIONS 18F-FDG PET-CT findings in suspected COVID-19 pulmonary involvement of asymptomatic oncologic patients showed an increase in FDG uptake of GGO and consolidations, but with a wide and apparently nonspecific range of SUVmax values.
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Affiliation(s)
- Bonanomi Alice
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy,Corresponding author: Alice Bonanomi. Department of Radiology, ASST Papa Giovanni XXIII, Piazza OMS 1, 24127 Bergamo (BG), Italy. Tel: 0352675030; E-mail address:
| | - Bonaffini Pietro Andrea
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy
| | - Spallino Marianna
- Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Dulcetta Ludovico
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy
| | - Franco Paolo Niccolò
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy
| | - Valle Clarissa
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy
| | - Marra Paolo
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy
| | - Bruno Andrea
- Department of Nuclear Medicine, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sironi Sandro
- Department of Radiology, Papa Giovanni XXIII Hospital, Bergamo, Italy,School of Medicine, University of Milano Bicocca, Milano, Italy
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Gheysens O, Belkhir L, Jamar F. Imaging in Post-COVID Lung Disease (PCLD): does [ 18F]-FDG-PET/CT have the Key? J Nucl Med 2021; 63:268-269. [PMID: 34675111 PMCID: PMC8805787 DOI: 10.2967/jnumed.121.263166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/12/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Olivier Gheysens
- Cliniques universitaires Saint-Luc and Institute for Clinical and Experimental Reasearch, Belgium
| | - Leïla Belkhir
- Cliniques universitaires Saint-Luc and Institute for Clinical and Experimental Reasearch, Belgium
| | - François Jamar
- Cliniques universitaires Saint-Luc and Institute for Clinical and Experimental Reasearch, Belgium
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