Original Article

Annals of Nuclear Medicine

, Volume 22, Issue 10, pp 833-839

First online:

Usefulness of triple-phase thallium-201 SPECT in non-small-cell lung cancer (NSCLC): association with proliferative activity

  • Seigo FujitaAffiliated withDepartment of Radiology, Miyazaki Medical College Email author 
  • , Shigeki NagamachiAffiliated withDepartment of Radiology, Miyazaki Medical College
  • , Hideyuki WakamatsuAffiliated withDepartment of Radiology, Miyazaki Medical College
  • , Ryuichi NishiiAffiliated withDepartment of Radiology, Miyazaki Medical College
  • , Shigemi FutamiAffiliated withDepartment of Radiology, Miyazaki Medical College
  • , Shozo TamuraAffiliated withDepartment of Radiology, Miyazaki Medical College
  • , Yasunori MatsuzakiAffiliated withDepartment of the Second Surgery, Miyazaki Medical College
  • , Toshio OnizukaAffiliated withDepartment of the Second Surgery, Miyazaki Medical College
  • , Kinta HatakeyamaAffiliated withDepartment of the First Pathology, Miyazaki Medical College
    • , Yujiro AsadaAffiliated withDepartment of the First Pathology, Miyazaki Medical College

Rent the article at a discount

Rent now

* Final gross prices may vary according to local VAT.

Get Access

Abstract

Objective

The conventional delayed scan in dual phase of thallium-201 (201Tl) single-photon emission computed tomography (SPECT) is useful for estimating the viability of non-small-cell lung cancer (NSCLC). However, the influence of tumor blood flow cannot be ignored by the scan at 4 h after the tracer injection. For the purpose of improving the diagnostic capability and for clarifying the association between 201Tl uptake and proliferative activity, we investigated the usefulness of super-delayed scan obtained at 24 h in triple-phase 201Tl SPECT.

Methods

A total of 122 patients with lung nodule, 106 of NSCLC and 16 of benign nodule, were given 201Tl SPECT before the tumor resection. Early image (15 min), delayed image (4 h), and super-delayed image (24 h) were obtained after intravenous injection of 201Tl chloride (111 MBq). On the each SPECT image, regions of interest (ROIs) were placed over the tumor contour (T) and contra-lateral normal lung tissue (N) area on one transverse view clearly defined lesions, and T/N ratio on the early image (ER), the delayed image (DR), and the super-delayed image (sDR), and retention indexes (RI and sRI) were calculated. All patients underwent subsequent surgical excision, and the specimens were immunostained for Ki-67 and CD34. The proliferative capability was measured as a percentage of positive nuclear area for Ki-67 (MIB-1 index). The angiogenesis was measured density of positive micro-vessels for CD34 (micro-vessel density, MVD). Correlation analysis was performed to evaluate the relationship between the MIB-1 index, MVD, and SPECT parameters.

Results

The diagnostic accuracy of sDR in the differential of NSCLC was higher than that of DR (83.6% vs. 91.8%). Both DR and sDR were positively correlated with MIB-1 index. The correlation coefficient was higher in sDR (0.53 vs. 0.69). The MIB-1 index of the increasing pattern (RI < sRI) group was significantly higher (P < 0.001) than that of the decreasing pattern (RI > sRI) group.

Conclusions

The super-delayed scan in the triple-phase 201Tl SPECT is more useful than conventional delayed scan for both the diagnostic capability and assessing proliferation of NSCLC.

Keywords

Triple-phase 201Tl SPECT Super-delayed image Proliferation NSCLC