Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Journal of Nuclear Medicine and Molecular Imaging
Published in: European Journal of Nuclear Medicine and Molecular Imaging 8/2013

01-08-2013 | Original Article

Diagnostic performance of 18F-fluorothymidine PET/CT for primary colorectal cancer and its lymph node metastasis: comparison with 18F-fluorodeoxyglucose PET/CT

Authors: Masatoyo Nakajo, Masayuki Nakajo, Yoriko Kajiya, Megumi Jinguji, Nobuaki Nishimata, Shunji Shimaoka, Tohru Nihara, Kuniaki Aridome, Sadao Tanaka, Yoshihiko Fukukura, Atushi Tani, Chihaya Koriyama

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 8/2013

Login to get access

Abstract

Purpose

To examine the diagnostic performance of 18F-fluorothymidine (FLT) PET/CT in primary and metastatic lymph node colorectal cancer foci in comparison with 18F-fluorodeoxyglucose (FDG) PET/CT.

Methods

The study population comprised 28 patients with 30 newly diagnosed colorectal cancers who underwent surgical resection of the primary lesion and regional lymph nodes after both FLT and FDG PET/CT. The associations between SUVmax levels and pathological factors were evaluated using the Mann-Whitney U or Kruskal-Wallis test. Differences in diagnostic indexes for detecting nodal metastasis between the two tracers were estimated using the McNemar exact or χ 2 test.

Results

All 30 primary cancers (43.0 ± 20.0 mm, range 14 – 85 mm) were visualized by both tracers, but none of the FLT SUVmax values exceeded the FDG SUVmax values in any of the primary cancers (6.6 ± 2.4 vs. 13.6 ± 5.8, p < 0.001). The sensitivity, specificity and accuracy for detecting nodal metastasis were 41 % (15/37), 98.8 % (493/499) and 94.8 % (508/536) for FDG PET/CT, and 32 % (12/37), 98.8 % (493/499) and 94.2 % (505/536) for FLT PET/CT, respectively. The sensitivity (p = 0.45), specificity (p = 0.68) and accuracy (p = 0.58) were not different between the tracers. Nodal uptake of FLT and FDG was discordant in 7 (19 %) of 37 metastatic nodes. There were ten concordant true-positive nodes of which six showed higher FDG SUVmax and four showed higher FLT SUVmax, but the difference between FDG and FLT SUVmax was not significant (5.56 ± 3.55 and 3.62 ± 1.45, respectively; p = 0.22).

Conclusion

FLT has the same potential as FDG in PET/CT for the diagnosis of primary and nodal foci of colorectal cancer despite significantly lower FLT uptake in primary foci.
Literature
1.
Haggar FA, Boushey RP. Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009;22:191–7.PubMedCrossRef
2.
Iyer RB, Silverman PM, Dubrow RA, Charnsangavej C. Imaging in the diagnosis, staging, and follow-up of colorectal cancer. AJR Am J Roentgenol. 2002;179:3–13.PubMedCrossRef
3.
Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49:480–508.PubMedCrossRef
4.
von Schulthess GK, Steinert HC, Hany TF. Integrated PET/CT: current applications and future directions. Radiology. 2006;238:405–22.CrossRef
5.
Cohade C, Osman M, Leal J, Whal RL. Direct comparison of 18F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med. 2003;44:1797–803.PubMed
6.
Delbeke D, Martin W. PET and PET-CT for evaluation of colorectal carcinoma. Semin Nucl Med. 2004;34:209–23.PubMedCrossRef
7.
Park IJ, Kim HC, Yu CS, Ryu MH, Chang HM, Kim JH, et al. Efficacy of PET/CT in the accurate evaluation of primary colorectal carcinoma. Eur J Surg Oncol. 2006;32:941–7.PubMedCrossRef
8.
Shields AF, Grierson JR, Dohmen BM, Machulla HJ, Stayanoff JC, Lawhorn-Crews JM, et al. Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med. 1998;4:1334–6.PubMedCrossRef
9.
Rasey JS, Grierson JR, Wiens LW, Kolb PD, Schwartz JL. Validation of FLT uptake as a measure of thymidine kinase-1 activity in A549 carcinoma cells. J Nucl Med. 2002;43:1210–7.PubMed
10.
Bading JR, Shields AF. Imaging of cell proliferation: status and prospects. J Nucl Med. 2008;49:64s–80.PubMedCrossRef
11.
Francis DL, Visvikis D, Costa DC, Arulampalam TH, Townsend C, Luthra SK, et al. Potential impact of [18F]3′-deoxy-3′-fluorothymidine versus [18F]fluror-2-deoxy-D-glucose in positron emission tomography for colorectal cancer. Eur J Nucl Med Mol Imaging. 2003;30:988–94.PubMedCrossRef
12.
Francis DL, Freeman A, Visvikis D, Costa DC, Luthra SK, Novelli M, et al. In vivo imaging of cellular proliferation in colorectal cancer using positron emission tomography. Gut. 2003;52:1602–6.PubMedCrossRef
13.
Wieder HA, Geinitz H, Rosenberg R, Lordick F, Becker K, Stahl A, et al. PET imaging with [18F]3′-deoxy-3′-fluorothymidine for prediction of response to neoadjuvant treatment in patients with rectal cancer. Eur J Nucl Med Mol Imaging. 2007;34:878–83.PubMedCrossRef
14.
Yamamoto Y, Kameyama R, Izuishi K, Takebayashi R, Hagiike M, Asakura M, et al. Detection of colorectal cancer using 18F-FLT PET: comparison with 18F-FDG PET. Nucl Med Commun. 2009;30:841–5.PubMedCrossRef
15.
Muijs CT, Beukema JC, Widder J, van den Bergh AC, Havenga K, Pruim J, et al. 18F-FLT-PET for detection of rectal cancer. Radiother Oncol. 2011;98:357–9.PubMedCrossRef
16.
Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Radiology. 2003;226:24–8.PubMedCrossRef
17.
Yamamoto Y, Nishiyama Y, Ishikawa S, Nakano J, Chang SS, Bandoh S, et al. Correlation of 18F-FLT and 18F-FDG uptake on PET with Ki-67 immunohistochemistry in non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2007;34:1610–6.PubMedCrossRef
18.
Menda Y, Boles Ponto LL, Dornfeld KJ, Tewson TJ, Watkins GL, Schultz MK, et al. Kinetic analysis of 3′-deox-3′-18F-fluoro-thymidine (18F-FLT) in head and neck cancer patients before and early after initiation of chemoradiation therapy. J Nucl Med. 2009;50:1028–35.PubMedCrossRef
19.
Hoshikawa H, Nishiyama Y, Kishino T, Yamamoto Y, Haba R, Mori N. Comparison of FLT-PET and FDG-PET for visualization of head and neck squamous cell cancers. Mol Imaging Biol. 2011;13:172–7.PubMedCrossRef
20.
Oh SJ, Mosdzianowski C, Chi DY, Kim JY, Kang SH, Ryu JS, et al. Fully automated synthesis system of 3′-deoxy-3′-[18F]fluorothymidine. Nucl Med Biol. 2004;31:803–9.PubMedCrossRef
21.
American Joint Committee on Cancer. AJCC cancer staging manual. 6th ed. Berlin: Springer; 2002. p. 113–23.
22.
Tian J, Yang X, Yu L, Chen P, Xin J, Ma L, et al. A multicenter clinical trial on the diagnostic value of dual-tracer PET/CT in pulmonary lesions using 3′-deoxy-3′-18F-fluorothymidine and 18F-FDG. J Nucl Med. 2008;49:186–94.PubMedCrossRef
23.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.PubMedCrossRef
24.
Been LB, Suurmeijer AJ, Cobben DC, Jager PL, Hoekstra HJ, Elsinga PH. [18F]FLT-PET in oncology: current status and opportunities. Eur J Nucl Med Mol Imaging. 2004;31:1659–72.PubMedCrossRef
25.
Romero-Garcia S, Lopez-Gonzalez JS, Baez-Viveros JL, Aguilar-Cazares D, Prado-Garcia H. Tumor cell metabolism: an integral view. Cancer Biol Ther. 2011;12:939–48.PubMed
26.
Kubota K, Kubota R, Yamada S. FDG accumulation in tumor tissue. J Nucl Med. 1993;34:419–21.PubMed
27.
Higashi K, Clavo AC, Wahl RL. Does FDG uptake measure proliferative activity of human cancer cells? In vitro comparison with DNA flow cytometry and tritiated thymidine uptake. J Nucl Med. 1993;34:414–9.PubMed
28.
van Westreenen HL, Cobben DC, Jager PL, van Dullemen HM, Wesseling J, Elsinga PH, et al. Comparison of 18F-FLT PET and 18F-FDG PET in esophageal cancer. J Nucl Med. 2005;46:400–4.PubMed
29.
Huang T, Civelek AC, Li J, Jiang H, Ng CK, Postel GC, et al. Tumor microenvironment-dependent 18F-FDG, 18F-fluorothymidine, and 18F-misonidazole uptake: a pilot study in mouse models of human non-small cell lung cancer. J Nucl Med. 2012;53:1262–8.PubMedCrossRef
30.
Izuishi K, Yamamoto Y, Sano T, Takebayashi R, Nishiyama Y, Mori H, et al. Molecular mechanism underlying the detection of colorectal cancer by 18F-2-fluoro2-deoxy-d-glucose positron emission tomography. J Gastrointest Surg. 2012;16:394–400.PubMedCrossRef
31.
Hong R, Lim SC. 18F-fluoro-2-deoxyglucose uptake on PET CT and glucose transporter 1 expression in colorectal adenocarcinoma. World J Gastroenterol. 2012;18:168–74.PubMedCrossRef
32.
Gu J, Yamamoto H, Fukunaga H, Danno K, Takemasa I, Ikeda M, et al. Correlation of GLUT-1 overexpression, tumor size, and depth of invasion with 18F-2-fluoro2-deoxy-D-glucose uptake by positron emission tomography in colorectal cancer. Dig Dis Sci. 2006;51:2198–205.PubMedCrossRef
33.
Mainenti PP, Iodice D, Segreto S, Storto G, Magliulo M, De Palma GD, et al. Colorectal cancer and 18FDG-PET/CT: what about adding the T to the N parameter in loco-regional staging? World J Gastroenterol. 2011;17:1427–33.PubMedCrossRef
34.
Tsujikawa T, Otsuka H, Morita N, Saegusa H, Kobayashi M, Okazawa H, et al. Does partial volume corrected maximum SUV based on count recovery coefficient in 3D-PET/CT correlate with clinical aggressiveness of non-Hodgkin’s lymphoma? Ann Nucl Med. 2008;22:23–30.PubMedCrossRef
35.
Kubota K. From tumor biology to clinical PET: a review of positron emission tomography (PET) in oncology. Ann Nucl Med. 2001;15:471–86.PubMedCrossRef
36.
Van Waarde A, Cobben DC, Suurmeijer AJ, Maas B, Vaalburg W, de Vries EF, et al. Selectivity of 18F-FLT and 18F-FDG for differentiating tumor from inflammation in a rodent model. J Nucl Med. 2004;45:695–700.PubMed
37.
Konishi T, Miyama T, Sakamoto S, Hirata T, Mafune K, Hiraishi M, et al. Activities of thymidylate synthetase and thymidine kinase in gastric cancer. Surg Oncol. 1992;1:215–21.PubMedCrossRef
38.
Tsunoda Y, Ito M, Fujii H, Kuwano H, Saito N. Preoperative diagnosis of lymph node metastases of colorectal cancer by FDG-PET/CT. Jpn J Clin Oncol. 2008;38:347–53.PubMedCrossRef
39.
Troost EG, Vogel WV, Merkx MA, Slootweg PJ, Marres HA, Peeters WJ, et al. 18F-FLT PET does not discriminate between reactive and metastatic lymph nodes in primary head and neck cancer patients. J Nucl Med. 2007;48:726–35.PubMedCrossRef
40.
Hui W, Jinming Z, Jiahe T, Baolin Q, Tianran L, Yingmao C, et al. Using dual-tracer PET to predict the biologic behavior of human colorectal cancer. J Nucl Med. 2009;50:1857–64.CrossRef
41.
Dittmann H, Dohmen BM, Kehlbach R, Bartusek G, Pritzkow M, Sarbia M, et al. Early change in [18F]FLT uptake after chemotherapy: an experimental study. Eur J Nucl Med. 2002;29:1462–9.CrossRef
42.
Mudd SR, Holich KD, Voorbach MJ, Cole TB, Reuter DR, Tapang P, et al. Pharmacodynamic evaluation of irinotecan therapy by FDG and FLT PET/CT imaging in a colorectal cancer xenograft model. Mol Imaging Biol. 2012;14:617–24.PubMedCrossRef
43.
Pio BS, Park CK, Pietras R, Hsueh WA, Satyamurthy N, Pegram MD, et al. Usefulness of 3′-[F-18]fluoro-3′-deoxythymidine with positron emission tomography in predicting breast cancer response to therapy. Mol Imaging Biol. 2006;8:36–42.PubMedCrossRef
44.
Kishino T, Hoshikawa H, Nishiyama Y, Yamamoto Y, Mori N. Usefulness of 3′-deoxy-3′-18F-fluorothymidine PET for predicting early response to chemoradiotherapy in head and neck cancer. J Nucl Med. 2012;53:1521–7.PubMedCrossRef
45.
Graf N, Herrmann K, Numberger B, Zwisler D, Aichler M, Feuchtinger A, et al. [18F]FLT is superior to [18F]FDG for predicting early response to antiproliferative treatment in high-grade lymphoma in a dose-dependent manner. Eur J Nucl Med Mol Imaging. 2013;40:34–43.PubMedCrossRef
Metadata
Title
Diagnostic performance of 18F-fluorothymidine PET/CT for primary colorectal cancer and its lymph node metastasis: comparison with 18F-fluorodeoxyglucose PET/CT
Authors
Masatoyo Nakajo
Masayuki Nakajo
Yoriko Kajiya
Megumi Jinguji
Nobuaki Nishimata
Shunji Shimaoka
Tohru Nihara
Kuniaki Aridome
Sadao Tanaka
Yoshihiko Fukukura
Atushi Tani
Chihaya Koriyama
Publication date
01-08-2013
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 8/2013
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-013-2424-9

Other articles of this Issue 8/2013

European Journal of Nuclear Medicine and Molecular Imaging 8/2013 Go to the issue

Original Article

Improved quantification of small hearts for gated myocardial perfusion imaging

Original Article

Radiolabelled somatostatin analogue treatment in gastroenteropancreatic neuroendocrine tumours: factors associated with response and suggestions for therapeutic sequence

Editorial

Critical considerations on the combined use of 18F-FDG and 18F-fluoride for PET assessment of metastatic bone disease

Original Article

Standardized added metabolic activity (SAM) IN 18F-FDG PET assessment of treatment response in colorectal liver metastases

Original Article

Automated quantitative coronary computed tomography correlates of myocardial ischaemia on gated myocardial perfusion SPECT

Original Article

Predictive variables for hard cardiac events and coronary revascularization in patients with normal left ventricular myocardial perfusion and systolic function