Michaud Laure, Beattie B J, Akhurst T, Dunphy M, Zanzonico P, Finn R, Mauguen A, Schöder H, Weber W A, Lassman A B, Blasberg R
Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, Box 77, New York, NY, 10065, USA.
Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Eur J Nucl Med Mol Imaging. 2020 Jun;47(6):1353-1367. doi: 10.1007/s00259-019-04433-1. Epub 2019 Aug 15.
The aim of our study was to investigate the efficacy of F-Fluciclovine brain PET imaging in recurrent gliomas, and to compare the utility of these images to that of contrast enhanced magnetic resonance imaging (MRI) and to [C-methyl]-L-methionine (C-Methionine) PET imaging. We also sought to gain insight into the factors affecting the uptake of F-FACBC in both tumors and normal brain, and specifically to evaluate how the uptake in these tissues varied over an extended period of time post injection.
Twenty-seven patients with recurrent or progressive primary brain tumor (based on clinical and MRI/CT data) were studied using dynamic F-Fluciclovine brain imaging for up to 4 h. Of these, 16 patients also had C-Methionine brain scans. Visual findings, semi-quantitative analyses and pharmacokinetic modeling of a subset of the F-Fluciclovine images was conducted. The information derived from these analyses were compared to data from C-Methionine and to contrast-enhanced MRI.
F-Fluciclovine was positive for all 27 patients, whereas contrast MRI was indeterminate for three patients. Tumor F-Fluciclovine SUVmax ranged from 1.5 to 10.5 (average: 4.5 ± 2.3), while C-Methionine's tumor SUVmax ranged from 2.2 to 10.2 (average: 5.0 ± 2.2). Image contrast was higher with F-Fluciclovine compared to C-Methionine (p < 0.0001). This was due to F-Fluciclovine's lower background in normal brain tissue (0.5 ± 0.2 compared to 1.3 ± 0.4 for C-Methionine). F-Fluciclovine uptake in both normal brain and tumors was well described by a simple one-compartment (three-parameter: V,k,k) model. Normal brain was found to approach transient equilibrium with a half-time that varied greatly, ranging from 1.5 to 8.3 h (mean 2.7 ± 2.3 h), and achieving a consistent final distribution volume averaging 1.4 ± 0.2 ml/cc. Tumors equilibrated more rapidly (tranging from 4 to 148 min, average 57 ± 51 min), with an average distribution volume of 3.2 ± 1.1 ml/cc. A qualitative comparison showed that the rate of normal brain uptake of C-Methionine was much faster than that of F-Fluciclovine.
Tumor uptake of F-Fluciclovine correlated well with the established brain tumor imaging agent C-Methionine but provided significantly higher image contrast. F-Fluciclovine may be particularly useful when the contrast MRI is non-diagnostic. Based on the data gathered, we were unable to determine whether Fluciclovine uptake was due solely to recurrent tumor or if inflammation or other processes also contributed.
本研究旨在探讨F-氟代脱氧胸苷脑PET成像在复发性胶质瘤中的疗效，并将这些图像的效用与对比增强磁共振成像（MRI）和[C-甲基]-L-蛋氨酸（C-蛋氨酸）PET成像的效用进行比较。我们还试图深入了解影响肿瘤和正常脑组织中F-FACBC摄取的因素，特别是评估这些组织中的摄取在注射后较长时间内如何变化。
对27例复发或进展性原发性脑肿瘤患者（基于临床和MRI/CT数据）进行了长达4小时的动态F-氟代脱氧胸苷脑成像研究。其中，16例患者还进行了C-蛋氨酸脑扫描。对一部分F-氟代脱氧胸苷图像进行了视觉观察、半定量分析和药代动力学建模。将这些分析得出的信息与C-蛋氨酸的数据以及对比增强MRI的数据进行了比较。
27例患者的F-氟代脱氧胸苷均为阳性，而3例患者的对比MRI结果不确定。肿瘤F-氟代脱氧胸苷的SUVmax范围为1.5至10.5（平均：4.5±2.3），而C-蛋氨酸的肿瘤SUVmax范围为2.2至10.2（平均：5.0±2.2）。与C-蛋氨酸相比，F-氟代脱氧胸苷的图像对比度更高（p<0.0001）。这是由于F-氟代脱氧胸苷在正常脑组织中的本底较低（0.5±0.2，而C-蛋氨酸为1.3±0.4）。正常脑和肿瘤中F-氟代脱氧胸苷的摄取可用简单的单室（三参数：V、k、k）模型很好地描述。发现正常脑接近瞬时平衡，半衰期变化很大，范围为1.5至8.3小时（平均2.7±2.3小时），最终分布容积一致，平均为1.4±0.2ml/cc。肿瘤平衡更快（t范围为4至148分钟，平均57±51分钟），平均分布容积为3.2±1.1ml/cc。定性比较表明，C-蛋氨酸在正常脑中的摄取速率比F-氟代脱氧胸苷快得多。
肿瘤对F-氟代脱氧胸苷的摄取与已确立的脑肿瘤成像剂C-蛋氨酸密切相关，但提供了显著更高的图像对比度。当对比MRI无法诊断时，F-氟代脱氧胸苷可能特别有用。根据收集到的数据，我们无法确定氟代脱氧胸苷的摄取是否仅归因于复发性肿瘤，或者炎症或其他过程是否也有贡献。
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