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Abdominal Radiology

, Volume 42, Issue 4, pp 1210–1221 | Cite as

A pilot study of the diagnostic and prognostic values of FLT-PET/CT for pancreatic cancer: comparison with FDG-PET/CT

  • Masatoyo NakajoEmail author
  • Yoriko Kajiya
  • Atsushi Tani
  • Megumi Jinguji
  • Masayuki Nakajo
  • Tohru Nihara
  • Yoshihiko Fukukura
  • Takashi Yoshiura
Article

Abstract

Purpose

The purpose of the study was to examine the diagnostic and prognostic values of 18F-fluorothymidine (FLT)-PET/CT for pancreatic cancer by comparing with 18F-fluorodeoxyglucose (FDG)-PET/CT.

Methods

Fifteen patients with newly diagnosed pancreatic cancer underwent both FLT and FDG-PET/CT scans before treatment. The sensitivity, specificity, and accuracy in detecting nodal and distant metastases were compared between both scans using McNemar exact or χ 2 test. Progression-free survival (PFS) and overall survival (OS) were calculated by Kaplan–Meier method. Prognostic significance was assessed by Cox proportional hazards analysis.

Results

Both scans visualized all primary cancers. The sensitivity, specificity, and accuracy per patient basis for detecting nodal metastasis were equal and 63.6% (7/11), 100% (4/4), and 73.3% (11/15) for both scans, and for detecting distant metastasis were 100% (6/6), 88.9% (8/9), and 93.3% (14/15) for FDG-PET/CT, and 50.0% (3/6), 100% (9/9), and 80.0% (12/15) for FLT-PET/CT, respectively, without significant difference in each of them between both scans (p > 0.05). However, of 4 patients with multiple liver metastases, FDG-PET/CT was positive in all, but FLT-PET/CT was negative in three patients. At univariate analysis, only FLT-SUVmax correlated with PFS (hazard ratio, 1.306, p = 0.048), and FDG total lesion glycolysis (TLG), FLT-SUVmax, and FLT-total lesion proliferation (TLP) correlated with OS (p = 0.021, p = 0.005, and p = 0.022, respectively). At bivariate analysis, FLT-SUVmax was superior to FDG-TLG or FLT-TLP for prediction of OS [HR (adjusted for FDG-TLG), 1.491, p = 0.034, HR (adjusted for FLT-TLP), 1.542, p = 0.023].

Conclusion

FLT-PET/CT may have a potential equivalent to FDG-PET/CT for detecting primary and metastatic cancers except liver metastasis. FLT-SUVmax can provide the most significant prognostic information.

Keywords

Pancreatic cancer FDG FLT SUVmax Prognosis 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individuals participants included in the study.

References

  1. 1.
    Jemal A, Bray F, Center MM, et al. (2008) Global cancer statics. CA Cancer J Clin 61:69–90CrossRefGoogle Scholar
  2. 2.
    Wang Z, Chen JQ, Liu JL, Qin XG, Huang Y (2013) FDG-PET in diagnosis, staging and prognosis of pancreatic carcinoma: a meta-analysis. World J Gastroenterol 19:4808–4817CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Grassetto G, Rubello D (2011) Role of FDG-PET/CT in diagnosis, staging, response to treatment, and prognosis of pancreatic cancer. Am J Clin Oncol 34:111–114PubMedGoogle Scholar
  4. 4.
    De Gaetano AM, Rufini V, Castaldi P, et al. (2012) Clinical applications of 18F-FDG PET in the management of hepatobiliary and pancreatic tumors. Abdom Imaging 37:983–1003CrossRefPubMedGoogle Scholar
  5. 5.
    von Schulthess GK, Steinert HC, Hany TF (2006) Integrated PET/CT: current applications and future directions. Radiology 238:405–422CrossRefGoogle Scholar
  6. 6.
    Schellenberg D, Quon A, Minn AY, et al. (2010) 18Fluorodeoxyglucose PET is prognostic of progression-free and overall survival in locally advanced pancreas cancer treated with stereotactic radiotherapy. Int J Radiat Oncol Biol Phys 77:1420–1425CrossRefPubMedGoogle Scholar
  7. 7.
    Choi HJ, Kang CM, Lee WJ, et al. (2013) Prognostic value of 18F-fluorodeoxyglucose positron emission tomography in patients with resectable pancreatic cancer. Yonsei Med J 54:1377–1383CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Moon SY, Joo KR, So YR, et al. (2013) Predictive value of maximum standardized uptake value (SUVmax) on 18F-FDG PET/CT in patients with locally advanced or metastatic pancreatic cancer. Clin Nucl Med 38:778–783CrossRefPubMedGoogle Scholar
  9. 9.
    Chirindel A, Alluri KC, Chaudhry MA, et al. (2015) Prognostic value of FDG PET/CT-derived parameters in pancreatic adenocarcinoma at initial PET/CT staging. AJR Am J Roentgenol 204:1093–1099CrossRefPubMedGoogle Scholar
  10. 10.
    Lee JW, Kang CM, Choi HJ, et al. (2014) Prognostic value of metabolic tumor volume and total lesion glycolysis on preoperative 18F-FDG PET/CT in patients with pancreatic cancer. J Nucl Med 55:898–904CrossRefPubMedGoogle Scholar
  11. 11.
    Xu HX, Chen T, Wang WQ, et al. (2014) Metabolic tumour burden assessed by 18F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection. Eur J Nucl Med Mol Imaging 41:1093–1102CrossRefPubMedGoogle Scholar
  12. 12.
    Choi HJ, Lee JW, Kang B, et al. (2014) Prognostic significance of volume-based FDG PET/CT parameters in patients with locally advanced pancreatic cancer treated with chemoradiation therapy. Yonsei Med J 55:1498–1506CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Shields AF, Grierson JR, Dohmen BM, et al. (1998) Imaging proliferation in vivo with [F-18]FLT and positron emission tomography. Nat Med 4:1334–1336CrossRefPubMedGoogle Scholar
  14. 14.
    Rasey JS, Grierson JR, Wiens LW, Kolb PD, Schwartz JL (2002) Validation of FLT uptake as a measure of thymidine kinase-1 activity in A549 carcinoma cells. J Nucl Med 43:1210–1217PubMedGoogle Scholar
  15. 15.
    Bading JR, Shields AF (2008) Imaging of cell proliferation: status and prospects. J Nucl Med 49:64s–80sCrossRefPubMedGoogle Scholar
  16. 16.
    Herrmann K, Eckel F, Schmidt S, et al. (2008) In vivo characterization of proliferation for discriminating cancer from pancreatic pseudotumors. J Nucl Med 49:1437–1444CrossRefPubMedGoogle Scholar
  17. 17.
    Herrmann K, Erkan M, Dobritz M, et al. (2012) Comparison of 3′-deoxy-3′-[18F]fluorothymidine positron emission tomography (FLT PET) and FDG PET/CT for the detection and characterization of pancreatic tumours. Eur J Nucl Med Mol Imaging 39:846–851CrossRefPubMedGoogle Scholar
  18. 18.
    Herrmann K, Wieder HA, Buck AK, et al. (2007) Early response assessment using 3′-deoxy-3′-[18F]fluorothymidine-positron emission tomography in high-grade non-Hodgkin’s lymphoma. Clin Cancer Res 13:3552–3558CrossRefPubMedGoogle Scholar
  19. 19.
    Kenny L, Coombes RC, Vigushin DM, et al. (2007) Imaging early changes in proliferation at 1 week post chemotherapy: a pilot study in breast cancer patients with 3′-deoxy-3′-[18F]fluorothymidine positron emission tomography. Eur J Nucl Med Mol Imaging 34:1339–1347CrossRefPubMedGoogle Scholar
  20. 20.
    Pio BS, Park CK, Pietras R, et al. (2006) Usefulness of 3′-[F-18]fluoro-3′-deoxythymidine with positron emission tomography in predicting breast cancer response to therapy. Mol Imaging Biol 8:36–42CrossRefPubMedGoogle Scholar
  21. 21.
    Herrmann K, Buck AK, Schuster T, et al. (2011) Predictive value of initial 18F-FLT uptake in patients with aggressive non-Hodgkin lymphoma receiving R-CHOP treatment. J Nucl Med 52:690–696CrossRefPubMedGoogle Scholar
  22. 22.
    Hoshikawa H, Mori T, Yamamoto Y, et al. (2015) Prognostic value comparison between 18F-FLT PET/CT and 18F-FDG PET/CT volume-based metabolic parameters in patients with head and neck cancer. Clin Nucl Med 40:464–468CrossRefPubMedGoogle Scholar
  23. 23.
    Oh SJ, Mosdzianowski C, Chi DY, et al. (2004) Fully automated synthesis system of 3′-deoxy-3′-[18F]fluorothymidine. Nucl Med Biol 31:803–809CrossRefPubMedGoogle Scholar
  24. 24.
    Tian J, Yang X, Yu L, et al. (2008) A multicenter clinical trial on the diagnostic value of dual-tracer PET/CT in pulmonary lesions using 3′-deoxy-3′-18F-fluorothymidine and 18F-FDG. J Nucl Med 49:186–194CrossRefPubMedGoogle Scholar
  25. 25.
    Li D, Xie K, Wolff R, Abbruzzese JL (2004) Pancreatic cancer. Lancet 363:1049–1057CrossRefPubMedGoogle Scholar
  26. 26.
    International Union Against Cancer (2009) Pancreas. In: Sobin LH (ed) TNM classification of malignant tumours, 7th edn. Chichester: Wiley, pp 132–135Google Scholar
  27. 27.
    Tang S, Huang G, Liu J, et al. (2011) Usefulness of 18F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: a meta-analysis. Eur J Radiol 78:142–150CrossRefPubMedGoogle Scholar
  28. 28.
    Nakajo M, Nakajo M, Kajiya Y, et al. (2013) Diagnostic performance of 18F-fluorothymidine PET/CT for primary colorectal cancer and its lymph node metastasis: comparison with 18F-fluorodeoxyglucose PET/CT. Eur J Nucl Med Mol Imaging 40:1223–1232CrossRefPubMedGoogle Scholar
  29. 29.
    Been LB, Suurmeijer AJ, Cobben DC, et al. (2004) [18F]FLT-PET in oncology: current status and opportunities. Eur J Nucl Med Mol Imaging 31:1659–1672CrossRefPubMedGoogle Scholar
  30. 30.
    Francis DL, Visvikis D, Costa DC, et al. (2003) Potential impact of [18F]3′-deoxy-3′-fluorothymidine versus [18F]fluror-2-deoxy-d-glucose in positron emission tomography for colorectal cancer. Eur J Nucl Med Mol Imaging 30:988–994CrossRefPubMedGoogle Scholar
  31. 31.
    Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A (2013) Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging 40:290–301CrossRefPubMedGoogle Scholar
  32. 32.
    Wahl RL, Jacene H, Kasamon Y, Lodge MA (2009) From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med 50(Suppl 1):122S–150SCrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Uto F, Shiba E, Onoue S, et al. (2010) Phantom study on radiotherapy planning using PET/CT-delineation of GTV by evaluating SUV. J Radiat Res 51:157–164CrossRefPubMedGoogle Scholar
  34. 34.
    Challapalli A, Barwick T, Pearson RA, et al. (2015) 3′-Deoxy-3′-18F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer. Eur J Nucl Med Mol Imaging 42:831–840CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Masatoyo Nakajo
    • 1
    • 2
    Email author
  • Yoriko Kajiya
    • 2
  • Atsushi Tani
    • 1
  • Megumi Jinguji
    • 1
  • Masayuki Nakajo
    • 2
  • Tohru Nihara
    • 3
  • Yoshihiko Fukukura
    • 1
  • Takashi Yoshiura
    • 1
  1. 1.Department of Radiology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan
  2. 2.Department of RadiologyNanpuh HospitalKagoshimaJapan
  3. 3.Department of GastroenterologyNanpuh HospitalKagoshimaJapan

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