用于评估包括心脏和中枢神经系统受累在内的系统性结节病的FLT-PET：一项与FDG-PET对比的前瞻性研究

FLT-PET for the assessment of systemic sarcoidosis including cardiac and CNS involvement: a prospective study with comparison to FDG-PET.

作者信息

Martineau Patrick, Pelletier-Galarneau Matthieu, Juneau Daniel, Leung Eugene, Nery Pablo, deKemp Rob, Beanlands Rob, Birnie David

机构信息

Functional Imaging Department, BC Cancer Agency, 600 W 10th Ave, Vancouver, BC, V5Z 4E6, Canada.

Gordon Center for Medical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

EJNMMI Res. 2020 Dec 10;10(1):154. doi: 10.1186/s13550-020-00742-x.

DOI:10.1186/s13550-020-00742-x

PMID:33301054

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7728930/

Abstract

BACKGROUND

2-deoxy-2-[18F]fluoro-D-glucose's (FDG) biodistribution limits the evaluation of cardiac sarcoidosis (CS) and neurosarcoidosis (NS). While protocols for cardiac suppression exist, they can be inconvenient for patients and lead to incomplete cardiac suppression in many cases. Furthermore, FDG PET is limited in the detection of neurosarcoidosis due to an inability to suppress high level of physiological uptake within the brain. 3'-deoxy-3'-[F]fluorothymidine (FLT) has been shown to accumulate in sarcoidosis lesions and this tracer lacks significant physiological myocardial and brain uptake, suggesting that this tracer may be useful for the assessment of sarcoidosis, including CS and NS, without the need for patient preparation. This prospective pilot study examined the performance of FLT vs FDG PET for systemic sarcoidosis, including cardiac and neural involvement.

MATERIALS AND METHODS

Fourteen subjects with sarcoidosis were prospectively recruited and imaged with FDG- and FLT-PET. Two blinded, experienced readers independently reviewed the FLT-PET and FDG-PET images. Lesion distribution was compared between FLT and FDG. Agreement between FLT- and FDG-PET was determined using Cohen's kappa and the intra-class correlation coefficient. Inter-observer variability of FLT and FDG-PET was assessed.

RESULTS

Twelve subjects had CS as per Heart Rhythm Society criteria and 1 had NS. FLT-PET was positive in 12 (86%), and FDG-PET in 11 (79%), with cardiac uptake present in 6 (50%) and 7 (58%) of subjects with CS, respectively. The subject with NS demonstrated uptake on both FLT and FDG-PET, with more lesions on FLT. There were no significant differences in the anatomical distribution of lesions between FLT and FDG. SUVs were significantly (p < 0.001) higher for FDG than FLT (5.8 ± 3.0 vs 2.3 ± 1.1, respectively), but not (p = 0.90) after adjusting for blood pool activity (2.8 ± 1.4 vs 2.8 ± 1.1, respectively). Agreement between FLT- and FDG-PET was good to excellent for the diagnosis of sarcoidosis, lung involvement, CS, and NS (κ = 0.76, 0.69, 0.86, and 1.0, respectively). Inter-observer agreement for FLT was excellent for diagnosing sarcoidosis, CS and NS (κ = 0.81, 0.85, and 1.0, respectively) and comparable to that of FDG.

CONCLUSIONS

FLT-PET may be useful for the assessment of systemic sarcoidosis, as well as cardiac and neural involvement.

摘要

背景

2-脱氧-2-[¹⁸F]氟-D-葡萄糖（FDG）的生物分布限制了心脏结节病（CS）和神经结节病（NS）的评估。虽然存在心脏抑制方案，但这些方案对患者来说可能不方便，并且在许多情况下会导致心脏抑制不完全。此外，由于无法抑制大脑内高水平的生理性摄取，FDG PET在神经结节病的检测方面存在局限性。3'-脱氧-3'-[¹⁸F]氟胸苷（FLT）已被证明在结节病病变中蓄积，并且这种示踪剂在心肌和大脑中没有明显的生理性摄取，这表明这种示踪剂可能有助于评估结节病，包括CS和NS，而无需患者准备。这项前瞻性试点研究考察了FLT与FDG PET在系统性结节病（包括心脏和神经受累）方面的表现。

材料与方法

前瞻性招募了14名结节病患者，并用FDG和FLT PET进行成像。两名经验丰富的盲法阅片者独立审查FLT PET和FDG PET图像。比较了FLT和FDG之间的病变分布。使用Cohen's kappa和组内相关系数确定FLT和FDG PET之间的一致性。评估了FLT和FDG PET的观察者间变异性。

结果

根据心律协会标准，12名受试者患有CS，1名患有NS。FLT PET在12名（86%）受试者中呈阳性，FDG PET在11名（79%）受试者中呈阳性，CS患者中分别有6名（50%）和7名（58%）出现心脏摄取。患有NS的受试者在FLT和FDG PET上均显示摄取，FLT上的病变更多。FLT和FDG之间病变的解剖分布没有显著差异。FDG的SUV显著高于FLT（分别为5.8±3.0和2.3±1.1，p<0.001），但在调整血池活性后无显著差异（分别为2.8±1.4和2.8±1.1，p=0.90）。FLT和FDG PET在结节病、肺部受累、CS和NS的诊断方面一致性良好至优秀（κ分别为0.76、0.69、0.86和1.0）。FLT在结节病、CS和NS诊断方面的观察者间一致性优秀（κ分别为0.81、0.85和1.0），与FDG相当。