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Published in: Orphanet Journal of Rare Diseases 1/2021

Open Access 01-12-2021 | Research

68Ga-NOTA-Evans Blue PET/CT findings in lymphangioleiomyomatosis compared with 99mTC-ASC lymphoscintigraphy: a prospective study

Authors: Guozhu Hou, Yuanyuan Jiang, Wenshuai Xu, Zhaohui Zhu, Li Huo, Xiaoyuan Chen, Fang Li, Kai-Feng Xu, Wuying Cheng

Published in: Orphanet Journal of Rare Diseases | Issue 1/2021

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Abstract

Background

Lymphangioleiomyomatosis (LAM) is a rare multisystem disease characterized by cystic lung disease and extrapulmonary manifestations, including lymphatic system disorder. The objective of this study was to investigate the findings of 68Ga-NOTA-Evans Blue (NEB) PET/CT in LAM and compare it with that of 99mTc-ASC lymphoscintigraphy.

Methods

Ten patients diagnosed with LAM according to the American Thoracic Society/Japanese Respiratory Society guidelines for LAM were recruited in this study. PET/CT acquisition was performed at 20 to 40 min after subcutaneous injection of 68Ga-NEB into the first interdigital spaces of both feet (0.3 ml, 37 MBq/foot). All subjects also underwent 99mTc-antimony sulfide colloid (ASC) lymphoscintigraphy within a week for comparison.

Results

68Ga-NEB PET/CT displayed various lymphatic system abnormalities in 10 (100%) of 10 patients. These included pulmonary lymphatic abnormalities in 10 (100%) of 10 patients, enlarged lymph nodes in 5 (50%), lymphangioleiomyomas in 2 (20%), dilation of the lumbar trunk and/or iliac lymph vessels in 5 (50%), thoracic duct dilation in 2 (20%), chylous effusion in 1 (10%). For pulmonary lymphatic abnormalities, the positive rates of 68Ga-NEB PET/CT and 99mTc-ASC lymphoscintigraphy were 100% (10/10) and 10% (1/10), respectively (P < 0.001). As for the 7 patients with extrapulmonary lymphatic manifestations, 68Ga-NEB PET/CT also presented more information than 99mTc-ASC lymphoscintigraphy.

Conclusion

68Ga-NEB PET/CT visualized pulmonary lymphatic abnormality and displayed extrapulmonary lymphatic system disorders of LAM, and might play a role in the diagnosis and evaluation of the disease. 68Ga-NEB PET/CT is advantageous over conventional 99mTc-ASC lymphoscintigraphy in LAM by providing more detailed information of lymphatic dysfunction.
Literature
1.
go back to reference Taylor JR, Ryu J, Colby TV, Raffin TA. Lymphangioleiomyomatosis. Clinical course in 32 patients. New Engl J Med. 1990;323(18):1254–60.CrossRef Taylor JR, Ryu J, Colby TV, Raffin TA. Lymphangioleiomyomatosis. Clinical course in 32 patients. New Engl J Med. 1990;323(18):1254–60.CrossRef
2.
go back to reference Kitaichi M, Nishimura K, Itoh H, Izumi T. Pulmonary lymphangioleiomyomatosis: a report of 46 patients including a clinicopathologic study of prognostic factors. Am J Respir Crit Care Med. 1995;151(2 Pt 1):527–33.CrossRef Kitaichi M, Nishimura K, Itoh H, Izumi T. Pulmonary lymphangioleiomyomatosis: a report of 46 patients including a clinicopathologic study of prognostic factors. Am J Respir Crit Care Med. 1995;151(2 Pt 1):527–33.CrossRef
3.
go back to reference Chu SC, Horiba K, Usuki J, Avila NA, Chen CC, Travis WD, et al. Comprehensive evaluation of 35 patients with lymphangioleiomyomatosis. Chest. 1999;115(4):1041–52.CrossRef Chu SC, Horiba K, Usuki J, Avila NA, Chen CC, Travis WD, et al. Comprehensive evaluation of 35 patients with lymphangioleiomyomatosis. Chest. 1999;115(4):1041–52.CrossRef
4.
go back to reference Matsui K, Beasley MB, Nelson WK, Barnes PM, Bechtle J, Falk R, et al. Prognostic significance of pulmonary lymphangioleiomyomatosis histologic score. Am J Surg Pathol. 2001;25(4):479–84.CrossRef Matsui K, Beasley MB, Nelson WK, Barnes PM, Bechtle J, Falk R, et al. Prognostic significance of pulmonary lymphangioleiomyomatosis histologic score. Am J Surg Pathol. 2001;25(4):479–84.CrossRef
5.
go back to reference Hayashida M, Seyama K, Inoue Y, Fujimoto K, Kubo K. The epidemiology of lymphangioleiomyomatosis in Japan: a nationwide cross-sectional study of presenting features and prognostic factors. Respirology. 2007;12(4):523–30.CrossRef Hayashida M, Seyama K, Inoue Y, Fujimoto K, Kubo K. The epidemiology of lymphangioleiomyomatosis in Japan: a nationwide cross-sectional study of presenting features and prognostic factors. Respirology. 2007;12(4):523–30.CrossRef
6.
go back to reference Aberle DR, Hansell DM, Brown K, Tashkin DP. Lymphangiomyomatosis: CT, chest radiographic, and functional correlations. Radiology. 1990;176(2):381–7.CrossRef Aberle DR, Hansell DM, Brown K, Tashkin DP. Lymphangiomyomatosis: CT, chest radiographic, and functional correlations. Radiology. 1990;176(2):381–7.CrossRef
7.
go back to reference Zhang C, Chen X, Wen T, Zhang Q, Huo M, Dong J, et al. Computed tomography lymphangiography findings in 27 cases of lymphangioleiomyomatosis. Acta Radiol (Stockholm, Sweden: 1987). 2017;58(11):1342–8. Zhang C, Chen X, Wen T, Zhang Q, Huo M, Dong J, et al. Computed tomography lymphangiography findings in 27 cases of lymphangioleiomyomatosis. Acta Radiol (Stockholm, Sweden: 1987). 2017;58(11):1342–8.
8.
go back to reference Hou G, Hou B, Jiang Y, Zhu Z, Long X, Chen X, et al. 68Ga-NOTA-Evans Blue TOF PET/MR Lymphoscintigraphy Evaluation of the Severity of Lower Limb Lymphedema. Clin Nucl Med. 2019;44(6):439–45.CrossRef Hou G, Hou B, Jiang Y, Zhu Z, Long X, Chen X, et al. 68Ga-NOTA-Evans Blue TOF PET/MR Lymphoscintigraphy Evaluation of the Severity of Lower Limb Lymphedema. Clin Nucl Med. 2019;44(6):439–45.CrossRef
9.
go back to reference Zhang J, Lang L, Zhu Z, Li F, Niu G, Chen X. Clinical translation of an albumin-binding PET radiotracer 68Ga-NEB. J Nucl Med: Off Publ Soc Nucl Med. 2015;56(10):1609–14.CrossRef Zhang J, Lang L, Zhu Z, Li F, Niu G, Chen X. Clinical translation of an albumin-binding PET radiotracer 68Ga-NEB. J Nucl Med: Off Publ Soc Nucl Med. 2015;56(10):1609–14.CrossRef
10.
go back to reference Hou G, Jiang Y, Jian S, Niu Y, Cheng W. Hemolymphangioma involving bones and bladder detected on 68Ga-NEB PET/CT: a rare case report. Medicine. 2019;98(15):e15213.CrossRef Hou G, Jiang Y, Jian S, Niu Y, Cheng W. Hemolymphangioma involving bones and bladder detected on 68Ga-NEB PET/CT: a rare case report. Medicine. 2019;98(15):e15213.CrossRef
11.
go back to reference Hou G, Li X, Hou B, Zhou W, Cheng W. Lymphangioma on 68Ga-NOTA-Evans Blue PET/MRI. Clin Nucl Med. 2018;43(7):553–5.CrossRef Hou G, Li X, Hou B, Zhou W, Cheng W. Lymphangioma on 68Ga-NOTA-Evans Blue PET/MRI. Clin Nucl Med. 2018;43(7):553–5.CrossRef
12.
go back to reference Niu G, Chen X. Lymphatic imaging: focus on imaging probes. Theranostics. 2015;5(7):686–97.CrossRef Niu G, Chen X. Lymphatic imaging: focus on imaging probes. Theranostics. 2015;5(7):686–97.CrossRef
13.
go back to reference Long X, Zhang J, Zhang D, o C, Chi C, Yang E, et al. Microsurgery guided by sequential preoperative lymphography using (68)Ga-NEB PET and MRI in patients with lower-limb lymphedema. Eur J Nucl Med Mol Imaging. 2017;44(9):1501–10.CrossRef Long X, Zhang J, Zhang D, o C, Chi C, Yang E, et al. Microsurgery guided by sequential preoperative lymphography using (68)Ga-NEB PET and MRI in patients with lower-limb lymphedema. Eur J Nucl Med Mol Imaging. 2017;44(9):1501–10.CrossRef
14.
go back to reference Zhang W, Wu P, Li F, Tong G, Chen X, Zhu Z. Potential applications of using 68Ga-Evans Blue PET/CT in the evaluation of lymphatic disorder: preliminary observations. Clin Nucl Med. 2016;41(4):302–8.CrossRef Zhang W, Wu P, Li F, Tong G, Chen X, Zhu Z. Potential applications of using 68Ga-Evans Blue PET/CT in the evaluation of lymphatic disorder: preliminary observations. Clin Nucl Med. 2016;41(4):302–8.CrossRef
15.
go back to reference Hou G, Xu W, Jiang Y, Xu KF, Chen X, Li F, et al. Lymphangioleiomyomatosis revealed by (68)Ga-NOTA-Evans Blue PET/CT. Eur J Nucl Med Mol Imaging. 2020;47(10):2469–70.CrossRef Hou G, Xu W, Jiang Y, Xu KF, Chen X, Li F, et al. Lymphangioleiomyomatosis revealed by (68)Ga-NOTA-Evans Blue PET/CT. Eur J Nucl Med Mol Imaging. 2020;47(10):2469–70.CrossRef
16.
go back to reference Gupta N. Lymphangioleiomyomatosis diagnosis and management: high-resolution chest computed tomography, transbronchial lung biopsy, and pleural disease management. Off Am Thoracic Soc/Jpn Respir Soc Clin Pract Guidel. 2017;196(10):1337–48. Gupta N. Lymphangioleiomyomatosis diagnosis and management: high-resolution chest computed tomography, transbronchial lung biopsy, and pleural disease management. Off Am Thoracic Soc/Jpn Respir Soc Clin Pract Guidel. 2017;196(10):1337–48.
17.
go back to reference Seyama K, Kumasaka T, Souma S, Sato T, Kurihara M, Mitani K, et al. Vascular endothelial growth factor-D is increased in serum of patients with lymphangioleiomyomatosis. Lymphat Res Biol. 2006;4(3):143–52.CrossRef Seyama K, Kumasaka T, Souma S, Sato T, Kurihara M, Mitani K, et al. Vascular endothelial growth factor-D is increased in serum of patients with lymphangioleiomyomatosis. Lymphat Res Biol. 2006;4(3):143–52.CrossRef
18.
go back to reference Henske EP, McCormack FX. Lymphangioleiomyomatosis - a wolf in sheep’s clothing. J Clin Investig. 2012;122(11):3807–16.CrossRef Henske EP, McCormack FX. Lymphangioleiomyomatosis - a wolf in sheep’s clothing. J Clin Investig. 2012;122(11):3807–16.CrossRef
19.
go back to reference Kumasaka T, Seyama K, Mitani K, Sato T, Souma S, Kondo T, et al. Lymphangiogenesis in lymphangioleiomyomatosis: its implication in the progression of lymphangioleiomyomatosis. Am J Surg Pathol. 2004;28(8):1007–16.CrossRef Kumasaka T, Seyama K, Mitani K, Sato T, Souma S, Kondo T, et al. Lymphangiogenesis in lymphangioleiomyomatosis: its implication in the progression of lymphangioleiomyomatosis. Am J Surg Pathol. 2004;28(8):1007–16.CrossRef
20.
go back to reference Carrington CB, Cugell DW, Gaensler EA, Marks A, Redding RA, Schaaf JT, et al. Lymphangioleiomyomatosis. Physiologic-pathologic-radiologic correlations. Am Rev Respir Dis. 1977;116(6):977–95.PubMed Carrington CB, Cugell DW, Gaensler EA, Marks A, Redding RA, Schaaf JT, et al. Lymphangioleiomyomatosis. Physiologic-pathologic-radiologic correlations. Am Rev Respir Dis. 1977;116(6):977–95.PubMed
21.
go back to reference Vázquez JJ, Fernández-Cuervo L, Fidalgo B. Lymphangiomyomatosis: morphogenetic study and ultrastructural confirmation of the histogenesis of the lung lesion. Cancer. 1976;37(5):2321–8.CrossRef Vázquez JJ, Fernández-Cuervo L, Fidalgo B. Lymphangiomyomatosis: morphogenetic study and ultrastructural confirmation of the histogenesis of the lung lesion. Cancer. 1976;37(5):2321–8.CrossRef
22.
go back to reference Basset F, Soler P, Marsac J, Corrin B. Pulmonary lymphangiomyomatosis: three new cases studied with electron microscopy. Cancer. 1976;38(6):2357–66.CrossRef Basset F, Soler P, Marsac J, Corrin B. Pulmonary lymphangiomyomatosis: three new cases studied with electron microscopy. Cancer. 1976;38(6):2357–66.CrossRef
23.
go back to reference Johnson SR, Cordier JF, Lazor R, Cottin V, Costabel U, Harari S, et al. European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis. Eur Respir J. 2010;35(1):14–26.CrossRef Johnson SR, Cordier JF, Lazor R, Cottin V, Costabel U, Harari S, et al. European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis. Eur Respir J. 2010;35(1):14–26.CrossRef
24.
go back to reference Avila NA, Kelly JA, Chu SC, Dwyer AJ, Moss J. Lymphangioleiomyomatosis: abdominopelvic CT and US findings. Radiology. 2000;216(1):147–53.CrossRef Avila NA, Kelly JA, Chu SC, Dwyer AJ, Moss J. Lymphangioleiomyomatosis: abdominopelvic CT and US findings. Radiology. 2000;216(1):147–53.CrossRef
25.
go back to reference Cornog JL Jr, Enterline HT. Lymphangiomyoma, a benign lesion of chyliferous lymphatics synonymous with lymphangiopericytoma. Cancer. 1966;19(12):1909–30.CrossRef Cornog JL Jr, Enterline HT. Lymphangiomyoma, a benign lesion of chyliferous lymphatics synonymous with lymphangiopericytoma. Cancer. 1966;19(12):1909–30.CrossRef
26.
go back to reference Joliat G, Stalder H, Kapanci Y. Lymphangiomyomatosis: a clinico-anatomical entity. Cancer. 1973;31(2):455–61.CrossRef Joliat G, Stalder H, Kapanci Y. Lymphangiomyomatosis: a clinico-anatomical entity. Cancer. 1973;31(2):455–61.CrossRef
27.
go back to reference Ryu JH, Moss J, Beck GJ, Lee JC, Brown KK, Chapman JT, et al. The NHLBI lymphangioleiomyomatosis registry: characteristics of 230 patients at enrollment. Am J Respir Crit Care Med. 2006;173(1):105–11.CrossRef Ryu JH, Moss J, Beck GJ, Lee JC, Brown KK, Chapman JT, et al. The NHLBI lymphangioleiomyomatosis registry: characteristics of 230 patients at enrollment. Am J Respir Crit Care Med. 2006;173(1):105–11.CrossRef
28.
go back to reference Zhan Y, Shen L, Xu W, Wu X, Zhang W, Wang J, et al. Functional improvements in patients with lymphangioleiomyomatosis after sirolimus: an observational study. Orphanet J Rare Dis. 2018;13(1):34.CrossRef Zhan Y, Shen L, Xu W, Wu X, Zhang W, Wang J, et al. Functional improvements in patients with lymphangioleiomyomatosis after sirolimus: an observational study. Orphanet J Rare Dis. 2018;13(1):34.CrossRef
Metadata
Title
68Ga-NOTA-Evans Blue PET/CT findings in lymphangioleiomyomatosis compared with 99mTC-ASC lymphoscintigraphy: a prospective study
Authors
Guozhu Hou
Yuanyuan Jiang
Wenshuai Xu
Zhaohui Zhu
Li Huo
Xiaoyuan Chen
Fang Li
Kai-Feng Xu
Wuying Cheng
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Orphanet Journal of Rare Diseases / Issue 1/2021
Electronic ISSN: 1750-1172
DOI
https://doi.org/10.1186/s13023-021-01895-1

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