In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

Herrmann, Ken; Eckel, Florian; Schmidt, Stefan; Scheidhauer, Klemens; Krause, Bernd J.; Kleeff, Jörg; Schuster, Tibor; Wester, Hans‐Juergen; Friess, Helmut; Schmid, Roland M.; Schwaiger, Markus; Buck, Andreas K.

doi:10.2967/jnumed.108.052027

Cited by 42 publications

(23 citation statements)

References 30 publications

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“…This finding corresponds to a reduced sensitivity of 18 F-FLT PET for other solid neoplasms (lung cancer (27,28), colorectal cancer (19), and pancreatic cancer (29)). In these tumor subtypes, tracer uptake markedly lower than that of the standard radiotracer 18 F-FDG has been observed.…”

Section: Discussionmentioning

confidence: 68%

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker ¹⁸F-Fluorothymidine

Eckel

Herrmann²,

Schmidt³

et al. 2009

J Nucl Med

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We determined the ability of PET with the thymidine analog 39-deoxy-39-18 F-fluorothymidine ( 18 F-FLT) to detect hepatocellular carcinoma (HCC). Methods: In this pilot study, 18 F-FLT PET was performed in 18 untreated patients with clinically suspected HCC. Routine diagnostic procedures included ultrasound, MRI, or contrast-enhanced spiral CT of the upper gastrointestinal tract in all patients. At 45-60 min after the intravenous injection of approximately 270-340 MBq of 18 F-FLT, emission and transmission scanning was performed with a high-resolution PET scanner. Tracer uptake in the tumor and surrounding liver tissue was evaluated semiquantitatively by calculation of mean and maximum standardized uptake values (SUVs). Results were correlated with those of the conventional imaging methods. Results: A total of 13 of 18 tumors (sensitivity, 72%; 95% confidence interval [CI], 47%290%) showed focal 18 F-FLT uptake higher than surrounding liver activity and were detectable as hot lesions. Five tumors were characterized as photopenic lesions or contained a mixture of hot and cold lesions exhibiting a comparable or lower 18 F-FLT uptake than the surrounding liver tissue. When all lesions were considered, the mean 18 F-FLT SUV was 7.8 (range, 2.5-11.1), and the maximum 18 F-FLT SUV was 9.3 (range, 2.9-14.3). Histology and clinical follow-up revealed HCC in 16 patients and cholangiocarcinoma in 2 patients. In the subgroup of HCC, the sensitivity for tumor detection was 69% (11/16; 95% CI, 41%289%). Correlation analysis demonstrated a significant positive relationship between the proliferation marker MIB-1 and the mean SUV (r 5 0.66, P 5 0.02). Survival analysis (Cox proportional hazards regression) for initial 18 F-FLT uptake (mean and maximum SUVs) revealed increased hazard ratios (mean SUV, 1.20; maximum SUV, 1.12), but because of the small number of events, these results were not statistically significant. Conclusion: In this pilot study, HCC tumors showed a mixed uptake pattern for the in vivo proliferation marker 18 F-FLT. A total of 69% of the HCC lesions showed 18 F-FLT uptake higher than that of the surrounding liver tissue, whereas the remaining lesions were photopenic or contained a mixture of hot and cold lesions. High initial 18 F-FLT uptake seems to be associated with reduced overall survival and could be an important prognostic factor if this tendency can be confirmed in a larger prospective trial.

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Section: Discussionmentioning

confidence: 68%

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker ¹⁸F-Fluorothymidine

Eckel

Herrmann²,

Schmidt³

et al. 2009

J Nucl Med

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“…3′-Deoxy-3′-[ 18 F]fluorothymidine PET imaging 3′-Deoxy-3′-[ 18 F]fluorothymidine was synthesized as previously described [8]. Imaging was performed on a whole-body high-resolution PET scanner (ECAT HR+, Siemens/CTI, Knoxville, TN, USA).…”

Section: Diagnostic Workupmentioning

confidence: 99%

“…The thymidine analogue 3′-deoxy-3′-[ 18 F]fluorothymidine (FLT) [7] allows the non-invasive visualization of proliferating tissues. In a previously published pilot study, we have shown that focal FLT uptake was exclusively detected in malignant tumours of the pancreas [8]. In the present study, we aimed to assess FLT PET in a larger cohort.…”

Section: Introductionmentioning

confidence: 97%

Comparison of 3′-deoxy-3′-[18F]fluorothymidine positron emission tomography (FLT PET) and FDG PET/CT for the detection and characterization of pancreatic tumours

Herrmann

Erkan

Dobritz

et al. 2012

Eur J Nucl Med Mol Imaging

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For differentiation of pancreatic tumours, FDG PET and FDG PET/CT showed a higher sensitivity but lower specificity than FLT PET. Interestingly, visual analysis of FLT PET led to two false-positive findings by misinterpreting physiological bowel uptake as pathological FLT uptake in the pancreas. Due to the limited number of patients, the clinical value of adding FLT PET to the diagnostic workup of pancreatic tumours remains to be determined.

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“…However, these values are technique-dependent. In another study on 31 patients, all 10 benign pancreatic lesions were negative on 18 F-FLT PET (specificity, 100%; 90% confidence interval, 74%-100%) (55). On visual interpretation, 15 of 21 malignant tumors had higher uptake (sensitivity, 71.4%; 90% confidence interval, 52%-89%).…”

Section: Gastrointestinal Cancersmentioning

confidence: 99%

PET Imaging of Proliferation with Pyrimidines

Tehrani

Shields

2013

J Nucl Med

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In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

Cited by 42 publications

References 30 publications

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker ¹⁸F-Fluorothymidine

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker ¹⁸F-Fluorothymidine

Comparison of 3′-deoxy-3′-[18F]fluorothymidine positron emission tomography (FLT PET) and FDG PET/CT for the detection and characterization of pancreatic tumours

PET Imaging of Proliferation with Pyrimidines

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In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

Cited by 42 publications

References 30 publications

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker 18F-Fluorothymidine

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker 18F-Fluorothymidine

Comparison of 3′-deoxy-3′-[18F]fluorothymidine positron emission tomography (FLT PET) and FDG PET/CT for the detection and characterization of pancreatic tumours

PET Imaging of Proliferation with Pyrimidines

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Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker ¹⁸F-Fluorothymidine

Imaging of Proliferation in Hepatocellular Carcinoma with the In Vivo Marker ¹⁸F-Fluorothymidine