FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET
Abstract Background 2-deoxy-2-[18F]fluoro-d-glucose’s (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furt...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
SpringerOpen
2020-12-01
|
| Series: | EJNMMI Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13550-020-00742-x |
| _version_ | 1819122110039064576 |
|---|---|
| author | Patrick Martineau Matthieu Pelletier-Galarneau Daniel Juneau Eugene Leung Pablo Nery Rob deKemp Rob Beanlands David Birnie |
| author_facet | Patrick Martineau Matthieu Pelletier-Galarneau Daniel Juneau Eugene Leung Pablo Nery Rob deKemp Rob Beanlands David Birnie |
| author_sort | Patrick Martineau |
| collection | DOAJ |
| description | Abstract Background 2-deoxy-2-[18F]fluoro-d-glucose’s (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. 3′-deoxy-3′-[18F]fluorothymidine (FLT) has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement. Materials and methods Fourteen subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen’s kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed. Results Twelve subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p < 0.001) higher for FDG than FLT (5.8 ± 3.0 vs 2.3 ± 1.1, respectively), but not (p = 0.90) after adjusting for blood pool activity (2.8 ± 1.4 vs 2.8 ± 1.1, respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG. Conclusions FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement. |
| first_indexed | 2024-12-22T06:47:14Z |
| format | Article |
| id | doaj.art-7f08db4dc1c2401499c9b30b6c543df5 |
| institution | Directory Open Access Journal |
| issn | 2191-219X |
| language | English |
| last_indexed | 2024-12-22T06:47:14Z |
| publishDate | 2020-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | EJNMMI Research |
| spelling | doaj.art-7f08db4dc1c2401499c9b30b6c543df52022-12-21T18:35:15ZengSpringerOpenEJNMMI Research2191-219X2020-12-0110111110.1186/s13550-020-00742-xFLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PETPatrick Martineau0Matthieu Pelletier-Galarneau1Daniel Juneau2Eugene Leung3Pablo Nery4Rob deKemp5Rob Beanlands6David Birnie7Functional Imaging Department, BC Cancer AgencyGordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical SchoolCentre Hospitalier de L’Université de Montréal (CHUM), Université de MontréalDivision of Nuclear Medicine, Department of Medicine, The Ottawa HospitalArrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart InstituteMolecular Function and Imaging Program, The National Cardiac PET Centre and the Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart InstituteMolecular Function and Imaging Program, The National Cardiac PET Centre and the Arrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart InstituteArrhythmia Service, Division of Cardiology, Department of Medicine, University of Ottawa Heart InstituteAbstract Background 2-deoxy-2-[18F]fluoro-d-glucose’s (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. 3′-deoxy-3′-[18F]fluorothymidine (FLT) has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement. Materials and methods Fourteen subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen’s kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed. Results Twelve subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p < 0.001) higher for FDG than FLT (5.8 ± 3.0 vs 2.3 ± 1.1, respectively), but not (p = 0.90) after adjusting for blood pool activity (2.8 ± 1.4 vs 2.8 ± 1.1, respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG. Conclusions FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.https://doi.org/10.1186/s13550-020-00742-xSarcoidosisNeurosarcoidosisCardiac sarcoidosisFluorothymidineFLT-PETFDG-PET |
| spellingShingle | Patrick Martineau Matthieu Pelletier-Galarneau Daniel Juneau Eugene Leung Pablo Nery Rob deKemp Rob Beanlands David Birnie FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET EJNMMI Research Sarcoidosis Neurosarcoidosis Cardiac sarcoidosis Fluorothymidine FLT-PET FDG-PET |
| title | FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET |
| title_full | FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET |
| title_fullStr | FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET |
| title_full_unstemmed | FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET |
| title_short | FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET |
| title_sort | flt pet for the assessment of systemic sarcoidosis including cardiac and cns involvement a prospective study with comparison to fdg pet |
| topic | Sarcoidosis Neurosarcoidosis Cardiac sarcoidosis Fluorothymidine FLT-PET FDG-PET |
| url | https://doi.org/10.1186/s13550-020-00742-x |
| work_keys_str_mv | AT patrickmartineau fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT matthieupelletiergalarneau fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT danieljuneau fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT eugeneleung fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT pablonery fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT robdekemp fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT robbeanlands fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet AT davidbirnie fltpetfortheassessmentofsystemicsarcoidosisincludingcardiacandcnsinvolvementaprospectivestudywithcomparisontofdgpet |