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EJNMMI Research
Published in: EJNMMI Research 1/2017

Open Access 01-12-2017 | Original research

Comparative evaluation of 18F-FLT and 18F-FDG for detecting cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis

Authors: Takashi Norikane, Yuka Yamamoto, Yukito Maeda, Takahisa Noma, Hiroaki Dobashi, Yoshihiro Nishiyama

Published in: EJNMMI Research | Issue 1/2017

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Abstract

Background

18F-FDG PET has been used in sarcoidosis for diagnosis and determination of the extent of the disease. However, assessing inflammatory lesions in cardiac sarcoidosis using 18F-FDG can be challenging because it accumulates physiologically in normal myocardium. Another radiotracer, 3′-deoxy-3′-18F-fluorothymidine (18F-FLT), has been investigated as a promising PET tracer for evaluating tumor proliferative activity. In contrast to 18F-FDG, 18F-FLT uptake in the normal myocardium is low. The purpose of this retrospective study was to compare the uptake of 18F-FLT and 18F-FDG in the evaluation of cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis.
Data for 20 patients with newly diagnosed sarcoidosis were examined. 18F-FLT and 18F-FDG PET/CT studies had been performed at 1 h after each radiotracer injection. The patients had fasted for at least 18 h before 18F-FDG PET/CT but were given no special dietary instructions regarding the period before 18F-FLT PET/CT. Uptake of 18F-FLT and 18F-FDG was examined visually and semiquantitatively using maximal standardized uptake value (SUVmax).

Results

Two patients had cardiac sarcoidosis, 7 had extra-cardiac thoracic sarcoidosis, and 11 had both cardiac and extra-cardiac thoracic sarcoidosis. On visual analysis for diagnosis of cardiac sarcoidosis, 4/20 18F-FDG scans were rated as inconclusive because the 18F-FDG pattern was diffuse, whereas no FLT scans were rated as inconclusive. The sensitivity of 18F-FDG PET/CT for detection of cardiac sarcoidosis was 85%; specificity, 100%; and accuracy, 90%. The corresponding values for 18F-FLT PET/CT were 92, 100, and 95%, respectively. Using semiquantitative analysis of cardiac sarcoidosis, the mean 18F-FDG SUVmax was significantly higher than the mean 18F-FLT SUVmax (P < 0.005). Both 18F-FDG and 18F-FLT PET/CT studies detected all 24 extra-cardiac lesions. Using semiquantitative analysis of extra-cardiac sarcoidosis, the mean 18F-FDG SUVmax was significantly higher than the mean 18F-FLT SUVmax (P < 0.001).

Conclusions

The results of this preliminary study suggest that 18F-FLT PET/CT can detect cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis as well as 18F-FDG PET/CT, although uptake of 18F-FLT in lesions was significantly lower than that of 18F-FDG. However, 18F-FLT PET/CT may be easier to perform since it requires neither prolonged fasting nor a special diet prior to imaging.
Literature
1.
2.
Youssef G, Beanlands RS, Birnie DH, Nery PB. Cardiac sarcoidosis: applications of imaging in diagnosis and directing treatment. Heart. 2011;97:2078–87.CrossRefPubMed
3.
4.
Kubota R, Yamada S, Kubota K, Ishikawa K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med. 1992;33:1972–80.PubMed
5.
Alavi A, Gupta N, Alberini JL, et al. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med. 2002;32:293–321.CrossRefPubMed
6.
Nishiyama Y, Yamamoto Y, Fukunaga K, et al. Comparative evaluation of 18F-FDG PET and 67Ga scintigraphy in patients with sarcoidosis. J Nucl Med. 2006;47:1571–6.PubMed
7.
Braun JJ, Kessler R, Constantinesco A, Imperiale A. 18F-FDG PET/CT in sarcoidosis management: review and report of 20 cases. Eur J Nucl Med Mol Imaging. 2008;35:1537–43.CrossRefPubMed
8.
Yamada Y, Uchida Y, Tatsumi K, et al. Fluorine-18-fluorodeoxyglucose and carbon-11-methionine evaluation of lymphadenopathy in sarcoidosis. J Nucl Med. 1998;39:1160–6.PubMed
9.
Youssef G, Leung E, Mylonas I, et al. The use of 18F-FDG PET in the diagnosis of cardiac sarcoidosis: a systematic review and meta analysis including the Ontario experience. J Nucl Med. 2012;53:241–8.CrossRefPubMed
10.
Langah R, Spicer K, Gebregziabher M, Gordon L. Effectiveness of prolonged fasting 18f-FDG PET-CT in the detection of cardiac sarcoidosis. J Nucl Cardiol. 2009;16:801–10.CrossRefPubMed
11.
Morooka M, Moroi M, Uno K, et al. Long fasting is effective in inhibiting physiological myocardial 18F-FDG uptake and for evaluating active lesions of cardiac sarcoidosis. EJNMMI Res. 2014;4:1–11.CrossRefPubMedPubMedCentral
12.
13.
Ishimaru S, Tsujino I, Takei T, et al. Focal uptake on 18F-fluoro-2-deoxyglucose positron emission tomography images indicates cardiac involvement of sarcoidosis. Eur Heart J. 2005;26:1538–43.CrossRefPubMed
14.
Ohira H, Tsujino I, Ishimaru S, et al. Myocardial imaging with 18F-fluoro-2-deoxyglucose positron emission tomography and magnetic resonance imaging in sarcoidosis. Eur J Nucl Med Mol Imaging. 2008;35:933–41.CrossRefPubMed
15.
Soussan M, Brillet PY, Nunes H, et al. Clinical value of a high-fat and low-carbohydrate diet before FDG-PET/CT for evaluation of patients with suspected cardiac sarcoidosis. J Nucl Cardiol. 2013;20:120–7.CrossRefPubMed
16.
Ambrosini V, Zompatori M, Fasano L, et al. 18F-FDG PET/CT for the assessment of disease extension and activity in patients with sarcoidosis. Results of preliminary prospective study. Clin Nucl Med. 2013;38:e171–7.CrossRefPubMed
17.
Tadamura E, Yamamuro M, Kubo S, et al. Images in cardiovascular medicine. Multimodality imaging of cardiac sarcoidosis before and after steroid therapy. Circulation. 2006;113:e771–3.CrossRefPubMed
18.
Pandya C, Brunken RC, Tchou P, Schoenhagen P, Culver DA. Detecting cardiac involvement in sarcoidosis: a call for prospective studies of newer imaging techniques. Eur Respir J. 2007;29:418–22.CrossRefPubMed
19.
Tahara N, Tahara A, Nitta Y, et al. Heterogeneous myocardial FDG uptake and the disease activity in cardiac sarcoidosis. JACC Cardiovasc Imaging. 2010;3:1219–28.CrossRefPubMed
20.
Yokoyama R, Miyagawa M, Okayama H, et al. Quantitative analysis of myocardial 18 F-fluorodeoxyglucose uptake by PET/CT for detection of cardiac sarcoidosis. Int J Cardiol. 2015;195:180–7.CrossRefPubMed
21.
Sobic-Saranovic D, Artiko V, Obradovic V. FDG PET imaging in sarcoidosis. Semin Nucl Med. 2013;43:404–11.CrossRefPubMed
22.
Yamagishi H, Shirai N, Takagi M, et al. Identification of cardiac sarcoidosis with 13N-NH3/18F-FDG PET. J Nucl Med. 2003;44:1030–6.PubMed
23.
Okumura W, Iwasaki T, Toyama T, et al. Usefulness of fasting 18F-FDG PET in identification of cardiac sarcoidosis. J Nucl Med. 2004;45:1989–98.PubMed
24.
Ohira H, Tsujino I, Yoshinaga K. 18F-fluoro-2-deoxyglucose positron emission tomography in cardiac sarcoidosis. Eur J Nucl Med Mol Imaging. 2011;38:1773–83.CrossRefPubMed
25.
Manabe O, Ohira H, Yoshinaga K, et al. Elevated 18F-fluorodeoxyglucose uptake in the interventricular septum is associated with atrioventricular block in patients with suspected cardiac involvement sarcoidosis. Eur J Nucl Med Mol Imaging. 2013;40:1558–66.CrossRefPubMed
26.
Birnie DH, Sauer WH, Bogun F, et al. HRS expert consensus statement on the diagnosis and management of arrhythmias associated with cardiac sarcoidosis. Heart Rhythm. 2014;11:1305–23.CrossRefPubMed
27.
Ishida Y, Yoshinaga K, Miyagawa M, et al. Recommendations for 18F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology recommendations. Ann Nucl Med. 2014;28:393–403.CrossRefPubMed
28.
Shields AF, Grierson JR, Dohmen BM, et al. Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med. 1998;4:1334–6.CrossRefPubMed
29.
Zhao S, Kuge Y, Kohanawa M, et al. Usefulness of 11C-methionine for differentiating tumors from granulomas in experimental rat models: a comparison with 18F-FDG and 18F-FLT. J Nucl Med. 2008;49:135–41.CrossRefPubMed
30.
Kim SK, Im HJ, Kim W, Kim TS, Hwangbo B, Kim HJ. F-18 fluorodeoxyglucose and F-18 fluorothymidine positron emission tomography/computed tomography imaging in a case of neurosarcoidosis. Clin Nucl Med. 2010;35:67–70.CrossRefPubMed
31.
Norikane T, Yamamoto Y, Maeda Y, Noma T, Nishiyama Y. 18F-FLT PET imaging in a patient with sarcoidosis with cardiac involvement. Clin Nucl Med. 2015;40:433–4.CrossRefPubMed
32.
33.
34.
Machulla HJ, Blocher A, Kuntzsch M, Piert M, Wei R, Grierson JR. Simplified labeling approach for synthesizing 3′-deoxy-3′-[18F]fluorothymidine ([18F]FLT). J Radioanal Nucl Chem. 2000;24:843–6.CrossRef
35.
Toorongian SA, Mulholland GK, Jewett DM, Bachelor MA, Kilbourn MR. Routine production of 2-deoxy-2-[18F]fluoro-D-glucose by direct nucleophilic exchange on a quaternary 4-aminopyridinium resin. Int J Rad Appl Instrum B. 1990;17:273–9.CrossRefPubMed
36.
Gormsen LC, Haraldsen A, Kramer S, Dias AH, Kim WY, Borghammer P. A dual tracer 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT pilot study for detection of cardiac sarcoidosis. EJNMMI Res. 2016;6:52.CrossRefPubMedPubMedCentral
37.
Osborne MT, Hulten EA, Murthy VL, et al. Patient preparation for cardiac fluorine-18 fluorodeoxyglucose positron emission tomography imaging of inflammation. J Nucl Cardiol. 2017;24:86–99.CrossRefPubMed
38.
39.
Wang Z, Wang Y, Sui X, et al. Performance of FLT-PET for pulmonary lesion diagnosis compared with traditional FDG-PET: a meta-analysis. Eur J Radiol. 2015;84:1371–7.CrossRefPubMed
40.
van der Gaag RD, van Maarsseveen AC, Broekhuizen-Davies JM, Stam J. Application of in-vitro techniques to determine proliferation in human sarcoid lymph nodes. J Pathol. 1983;139:239–45.CrossRefPubMed
41.
Weinberg RL, Morgenstern R, DeLuca A, Chen J, Bokhari S. F-18 sodium fluoride PET/CT does not effectively image myocardial inflammation due to suspected cardiac sarcoidosis. J Nucl Cardiol. 2016 May 19; [Epub ahead of print].
42.
Teirstein AS, Machac J, Almeida O, et al. Results of 188 whole-body fluorodeoxyglucose positron emission tomography scans in 137 patients with sarcoidosis. Chest. 2007;132:1949–53.CrossRefPubMed
43.
Ohira H, Tsujino I, Sato T, et al. Early detection of cardiac sarcoid lesions with 18F-fluoro-2-deoxyglucose positron emission tomography. Intern Med. 2011;50:1207–9.CrossRefPubMed
Metadata
Title
Comparative evaluation of 18F-FLT and 18F-FDG for detecting cardiac and extra-cardiac thoracic involvement in patients with newly diagnosed sarcoidosis
Authors
Takashi Norikane
Yuka Yamamoto
Yukito Maeda
Takahisa Noma
Hiroaki Dobashi
Yoshihiro Nishiyama
Publication date
01-12-2017
Publisher
Springer Berlin Heidelberg
Published in
EJNMMI Research / Issue 1/2017
Electronic ISSN: 2191-219X
DOI
https://doi.org/10.1186/s13550-017-0321-0

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