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18F-FPRGD2 PET/CT imaging of musculoskeletal disorders

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Abstract

Objective

This work reports on musculoskeletal uptake of 18F-FPRGD2, targeting the integrin αvβ3, in patients who had undergone 18F-FPRGD2 positron emission tomography combined with computed tomography (PET/CT) for oncologic purposes.

Methods

Whole-body 18F-FPRGD2 PET/CT images of 62 cancer patients were retrospectively reviewed to detect foci of musculoskeletal 18F-FPRGD2 uptake. For 37 patients, a FDG PET/CT performed in clinical settings was available. In each joint with an abnormal uptake, the maximum standardized uptake value (SUVmax) was estimated.

Results

A total of 260 musculoskeletal foci of 18F-FPRGD2 uptake were detected. Most common sites of uptake were joints and discs (n = 160; 61.5 %), entheses (osteotendinous and osteoligamentous junctions; n = 55; 21.2 %) and recent fractures (n = 18; 6.9 %). In addition, 27 (10.4 %) miscellaneous foci were detected. Out of the 146 lesions for which a FDG PET was available, 63 % showed both 18F-FPRGD2 and FDG uptake, 33.6 % did not show FDG avidity and 3.4 % showed only FDG uptake. The uptake intensity of the 92 lesions positive with 18F-FPRGD2 and FDG was similar with both radiopharmaceuticals, but the target-to-background (blood pool or muscle) ratios were significantly higher with 18F-FPRGD2 than with FDG (p < 0.0001).

Conclusion

The 18F-FPRGD2 uptake in joints, spine degenerative diseases and tendons was highly prevalent in our population. Up to one-third of 18F-FPRGD2 foci showed no FDG uptake suggesting that 18F-FPRGD2 signal may not be related to inflammatory angiogenesis only.

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Acknowledgments

The prospective study was financially supported by the belgian “Fondation contre le Cancer” and by the «Plan Cancer» of the federal Ministry of Health. Part of this work was presented at the 2013 Annual Meeting of the Society of Nuclear Medicine and Molecular imaging, Vancouver, Canada. A poster was presented at the 17th Belnuc Maastricht Symposium, May 2015, Netherland. The authors thank Laurence Seidel for providing statistical data, Sandra Ormenese and the GIGA “Cell Imaging and Flow Cytometry” facility for their help in FACS analysis, and the GIGA-Immunohistology platform for technical support.

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    Authors and Affiliations

    1. Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU Liege, Liege, Belgium

      Nadia Withofs & Roland Hustinx

    2. Department and Laboratory of Rheumatology CHU Liege and GIGA-Research, University of Liege, Liege, Belgium

      Edith Charlier, Olivier Malaise, Dominique de Seny & Michel Malaise

    3. Division of Diagnostic Imaging, Department of Medical Physics, CHU Liege, Liege, Belgium

      Paolo Simoni & Victoria Alvarez-Miezentseva

    4. Cyclotron Research Centre, University of Liege, Liege, Belgium

      Frédéric Mievis, Fabrice Giacomelli & Christine Mella

    5. Department of Radiology, Molecular Imaging Program at Stanford (MIPS), Stanford University, Stanford, CA, USA

      Sanjiv S. Gambhir

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    1. Nadia Withofs
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    Correspondence to Nadia Withofs.

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    N. Withofs, E. Charlier, M. Malaise and R. Hustinx equally contributed to the work.

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    Withofs, N., Charlier, E., Simoni, P. et al. 18F-FPRGD2 PET/CT imaging of musculoskeletal disorders. Ann Nucl Med 29, 839–847 (2015). https://doi.org/10.1007/s12149-015-1011-5

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