Disease activity and 18F-FDG uptake in organising pneumonia: semi-quantitative evaluation using computed tomography and positron emission tomography

  • Ukihide Tateishi
  • Tadashi Hasegawa
  • Kunihiko Seki
  • Takashi Terauchi
  • Noriyuki Moriyama
  • Yasuaki Arai
Original article

Abstract

Purpose: The present study was conducted to evaluate whether 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in combination with computed tomography (CT) reflects disease activity in patients with organising pneumonia.Methods: Eighty-eight subjects who were normal (n=66) or who had proven organising pneumonia (n=22) underwent FDG-PET and CT imaging. The subjects included 55 men and 33 women, ranging in age from 24 to 63 years (mean 47 years). PET and CT data sets were digitally fused using a conformational PET/CT fusion algorithm. All scans were evaluated independently by two chest radiologists who were unaware of other clinical data. The visual score, maximal and mean standardised uptake value (SUV), and maximal and mean lesion-to-normal tissue ratio (LNR) were calculated. The imaging results were compared with the laboratory and pulmonary function test results. The inflammatory cells in the lesions were quantified immunohistochemically.Results: The visual score, maximal and mean SUV, and maximal and mean LNR of the patients with organising pneumonia were significantly higher than those of the normal subjects. The patients with air-space consolidation had a significantly higher SUV than those without air-space consolidation (mean±SD 3.08±0.39 vs 2.35±0.56; p<0.05). The number of CD45+ cells was positively correlated with the maximal SUV (r=0.632, p<0.01) and the maximal LNR (r=0.453, p<0.05). The number of CD8+ T lymphocytes also showed positive correlations with the maximal SUV (r=0.540, p<0.01) and the maximal LNR (r=0.547, p<0.01).Conclusion: Patients with organising pneumonia have an enhanced FDG accumulation which reflects the degree of disease activity.

Keywords

18F-FDG PET CT Chest medicine Organising pneumonia Disease activity 

References

  1. 1.
    Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler EA. Bronchiolitis obliterans organizing pneumonia. N Engl J Med 1985;312:152–158PubMedCrossRefGoogle Scholar
  2. 2.
    Yousem SA, Lohr RH, Colby TV. Idiopathic bronchiolitis obliterans organizing pneumonia/cryptogenic organizing pneumonia with unfavorable outcome: pathologic predictors. Mod Pathol 1997;10:864–871PubMedGoogle Scholar
  3. 3.
    Cordier JF, Loire R, Brune J. Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients. Chest 1989;96:999–1004PubMedCrossRefGoogle Scholar
  4. 4.
    Cordier JF. Organizing pneumonia. Thorax 2000;55:318–328CrossRefPubMedGoogle Scholar
  5. 5.
    Siddiqui MT, Garrity ER, Husain AN. Bronchiolitis obliterans organizing pneumonia-like reactions: a nonspecific response or an atypical form of rejection or infection in lung allograft recipients? Hum Pathol 1996;27:714–719CrossRefPubMedGoogle Scholar
  6. 6.
    Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin JC, Cordier JF. Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d’Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM“O”P). Am J Respir Crit Care Med 1998;158:1929–1935PubMedGoogle Scholar
  7. 7.
    Douglas WW, Tazelaar HD, Hartman TE, Hartman RP, Decker PA, Schroeder DR, et al. Polymyositis-dermatomyositis-associated interstitial lung disease. Am J Respir Crit Care Med 2001;164:1182–1185PubMedGoogle Scholar
  8. 8.
    Ohnishi H, Yokoyama A, Yasuhara Y, Watanabe A, Naka T, Hamada H, et al. Circulating KL-6 levels in patients with drug induced pneumonitis. Thorax 2003;58:872–875CrossRefPubMedGoogle Scholar
  9. 9.
    Müller NL, Staples CA, Miller RR. Cryptogenic organizing pneumonia: CT findings in 14 patients. Am J Roentogenol 1990;154:983–987Google Scholar
  10. 10.
    Nishimura K, Itoh H. High-resolution computed tomographic features of bronchiolitis obliterans organizing pneumonia. Chest 1992;102:26–31CrossRefGoogle Scholar
  11. 11.
    Oikonomou A, Hansell DM. Organizing pneumonia: the many morphological faces. Eur Radiol 2002;12:1486–1496CrossRefPubMedGoogle Scholar
  12. 12.
    Murphy JM, Schnyder P, Verschakelen J, Leuenberger P, Flower CD. Linear opacities on HRCT in bronchiolitis obliterans organising pneumonia. Eur Radiol 1999;9:1813–1817CrossRefPubMedGoogle Scholar
  13. 13.
    Ujita M, Renzoni EA, Veeraraghavan S, Well AU, Hansell DM. Organizing pneumonia: perilobular pattern at thin-section CT. Radiology 2004;232:757–761PubMedCrossRefGoogle Scholar
  14. 14.
    Akira M, Sakatani M, Hara H. Thin-section CT findings in rheumatoid arthritis-associated lung disease: CT patterns and their courses. J Comput Assist Tomogr 1999;23:941–948CrossRefPubMedGoogle Scholar
  15. 15.
    Kim SJ, Lee KS, Ryu YH, Yoon YC, Choe KO, Kim TS, et al. Reversed halo sign on high-resolution CT of cryptogenic organizing pneumonia: diagnostic implications. Am J Roentgenol 2003;180:1251–1254Google Scholar
  16. 16.
    Kapucu LO, Meltzer CC, Townsend DW. Fluorine-8-fluorodeoxyglucose uptake in pneumonia. J Nucl Med 1998;39:1267–1269PubMedGoogle Scholar
  17. 17.
    Lowe VJ, Hoffman JM, DeLong DM, Patz EF, Coleman RE. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med 1994;35:1771–1776PubMedGoogle Scholar
  18. 18.
    Alavi A, Gupta N, Alberini JL, Hickeson M, Adam LE, Bhargava P, et al. Positro emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med 2002;32:293–321CrossRefPubMedGoogle Scholar
  19. 19.
    Bakheet SM, Saleem M, Powe J, Amro AA, Larsson SG, Mahassin Z. F-18 fluorodeoxyglucose chest uptake in lung inflammation and infection. Clin Nucl Med 2000;25:273–278CrossRefPubMedGoogle Scholar
  20. 20.
    Ichiya Y, Kuwabara Y, Sasaki M, Yoshida T, Akashi Y, Murayama S, et al. FDG-PET in infectious lesions: the detection and assessment of lesion activity. Ann Nucl Med 1996;10:185–191PubMedCrossRefGoogle Scholar
  21. 21.
    Shin L, Katz DS, Yung E. Hypermetabolism on F-18 FDG PET of multiple pulmonary nodules resulting from bronchiolitis obliterans organizing pneumonia. Clin Nucl Med 2004;29:654–656CrossRefPubMedGoogle Scholar
  22. 22.
    Majeski EI, Harley RA, Bellum SC, London SD, London L. Differential role for T cells in the development of fibrotic lesions associated with reovirus 1/L-induced bronchiolitis obliterans organizing pneumonia versus acute respiratory distress syndrome. Am J Respir Cell Mol Biol 2003;28:208–217CrossRefPubMedGoogle Scholar
  23. 23.
    Kubota R, Yamada S, Kubota K, Ishiwata K, Tamahashi N, Ido T. Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. J Nucl Med 1992;33:1972–1980PubMedGoogle Scholar
  24. 24.
    Mukae H, Kadota J, Kohno S, Matsukura S, Hara K. Increase of activated T-cells in BAL fluid of Japanese patients with bronchiolitis obliterans organizing pneumonia and chronic eosinophilic pneumonia. Chest 1995;108:123–128PubMedCrossRefGoogle Scholar
  25. 25.
    Oymak FS, Demirbas HM, Mavili E, Akgun H, Gulmez I, Demir R, et al. Bronchiolitis obliterans organizing pneumonia. Clinical and roentgenological features in 26 cases. Respiration 2005;72:254–262CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Ukihide Tateishi
    • 1
  • Tadashi Hasegawa
    • 2
  • Kunihiko Seki
    • 3
  • Takashi Terauchi
    • 4
  • Noriyuki Moriyama
    • 4
  • Yasuaki Arai
    • 1
  1. 1.Division of Diagnostic RadiologyNational Cancer Center HospitalTokyoJapan
  2. 2.Department of Clinical PathologySapporo Medical University School of MedicineSapporoJapan
  3. 3.Pathology DivisionNational Cancer Center HospitalTokyoJapan
  4. 4.Division of RadiologyResearch Center for Cancer Prevention and Screening, National Cancer CenterTokyoJapan

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