Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF)

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Title: Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF)
Authors: Win, T
Screaton, NJ
Porter, JC
Ganeshan, B
Maher, TM
Fraioli, F
Endozo, R
Shortman, RI
Hurrell, L
Holman, BF
Thielemans, K
Rashidnasab, A
Hutton, BF
Lukey, PT
Flynn, A
Ell, PJ
Groves, AM
Item Type: Journal Article
Abstract: PURPOSE: There is a lack of prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) patients. The objective of this study is to investigate the potential of 18F-FDG-PET/ CT to predict mortality in IPF. METHODS: A total of 113 IPF patients (93 males, 20 females, mean age ± SD: 70 ± 9 years) were prospectively recruited for 18F-FDG-PET/CT. The overall maximum pulmonary uptake of 18F-FDG (SUVmax), the minimum pulmonary uptake or background lung activity (SUVmin), and target-to-background (SUVmax/ SUVmin) ratio (TBR) were quantified using routine region-of-interest analysis. Kaplan-Meier analysis was used to identify associations of PET measurements with mortality. We also compared PET associations with IPF mortality with the established GAP (gender age and physiology) scoring system. Cox analysis assessed the independence of the significant PET measurement(s) from GAP score. We investigated synergisms between pulmonary 18F-FDG-PET measurements and GAP score for risk stratification in IPF patients. RESULTS: During a mean follow-up of 29 months, there were 54 deaths. The mean TBR ± SD was 5.6 ± 2.7. Mortality was associated with high pulmonary TBR (p = 0.009), low forced vital capacity (FVC; p = 0.001), low transfer factor (TLCO; p < 0.001), high GAP index (p = 0.003), and high GAP stage (p = 0.003). Stepwise forward-Wald-Cox analysis revealed that the pulmonary TBR was independent of GAP classification (p = 0.010). The median survival in IPF patients with a TBR < 4.9 was 71 months, whilst in those with TBR > 4.9 was 24 months. Combining PET data with GAP data ("PET modified GAP score") refined the ability to predict mortality. CONCLUSIONS: A high pulmonary TBR is independently associated with increased risk of mortality in IPF patients.
Issue Date: 1-May-2018
Date of Acceptance: 14-Dec-2017
ISSN: 1619-7070
Publisher: Springer Verlag
Start Page: 806
End Page: 815
Journal / Book Title: European Journal of Nuclear Medicine and Molecular Imaging
Volume: 45
Issue: 5
Copyright Statement: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: National Institute for Health Research
Funder's Grant Number: BRU 6279
Keywords: Fluorine-18 FDG
Interstitial lung disease
Positron-emission tomography and computed tomography
1103 Clinical Sciences
0299 Other Physical Sciences
Nuclear Medicine & Medical Imaging
Publication Status: Published
Conference Place: Germany
Online Publication Date: 2018-01-16
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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