Baseline and longitudinal variability of normal tissue uptake values of [F-18]-fluorothymidine-PET images

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Title: Baseline and longitudinal variability of normal tissue uptake values of [F-18]-fluorothymidine-PET images
Authors: Cysouw, MCF
Kramer, GM
Frings, V
De Langen, AJ
Wondergem, MJ
Kenny, LM
Aboagye, EO
Kobe, C
Wolff, J
Hoekstra, OS
Boellaard, R
Item Type: Journal Article
Abstract: Purpose [18F]-fluorothymidine ([18F]-FLT) is a PET-tracer enabling in-vivo visualization and quantification of tumor cell proliferation. For qualitative and quantitative analysis, adequate knowledge of normal tissue uptake is indispensable. This study aimed to quantitatively investigate baseline tracer uptake of blood pool, lung, liver and bone marrow and their precision, and to assess the longitudinal effect of systemic treatment on biodistribution. Methods 18F–FLT-PET(/CT) scans (dynamic or static) of 90 treatment-naïve oncological patients were retrospectively evaluated. Twenty-three patients received double baseline scans, and another 39 patients were also scanned early and late during systemic treatment with a tyrosine kinase inhibitor. Reproducible volume of interest were placed in blood pool, lung, liver, and bone marrow. For semi-quantitative analysis, SUVmean, SUVmax, and SUVpeak with several normalizations were derived. Results SUVs of basal lung, liver, and bone marrow were not significantly different between averaged dynamic and static images, in contrast with blood pool and apical lung. Highest repeatability was seen for liver and bone marrow, with repeatability coefficients of 18.6% and 20.4% when using SUVpeak. Systemic treatment with TKIs both increased and decreased normal tissue tracer uptake at early and late time points during treatment. Conclusion Simultaneous evaluation of liver and bone marrow uptake in longitudinal response studies may be used to assess image quality, where changes in uptake outside repeatability limits should trigger investigators to perform additional quality control on individual PET images. Advances in knowledge For [18F]-FLT PET images, liver and bone marrow have low intra-patient variability when quantified with SUVpeak, but may be affected by systemic treatment. Implications for patient care In [18F]-FLT-PET response monitoring trials, liver and bone marrow uptake may be used for quality control of [18F]-FLT PET images.
Issue Date: 10-May-2017
Date of Acceptance: 4-May-2017
URI: http://hdl.handle.net/10044/1/51306
DOI: https://dx.doi.org/10.1016/j.nucmedbio.2017.05.002
ISSN: 0969-8051
Publisher: Elsevier
Start Page: 18
End Page: 24
Journal / Book Title: Nuclear Medicine and Biology
Volume: 51
Copyright Statement: © 2017 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Sponsor/Funder: Cancer Research UK
Funder's Grant Number: C2536/A16584
Keywords: Science & Technology
Life Sciences & Biomedicine
Radiology, Nuclear Medicine & Medical Imaging
F-18-FLT
PET
Normal tissue uptake values
Quality control
POSITRON-EMISSION-TOMOGRAPHY
CANCER-PATIENTS
LUNG-CANCER
ROI DEFINITION
F-18-FDG PET
REPRODUCIBILITY
PROLIFERATION
(18)F–FLT
1103 Clinical Sciences
Nuclear Medicine & Medical Imaging
Publication Status: Published
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine



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