Römer W, Hanauske A R, Ziegler S, Thödtmann R, Weber W, Fuchs C, Enne W, Herz M, Nerl C, Garbrecht M, Schwaiger M
Nuklearmedizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munchen, Germany.
Blood. 1998 Jun 15;91(12):4464-71.
Positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG) was performed in non-Hodgkin's lymphoma (NHL), which is known to be highly responsive to chemotherapy, but also yields variable treatment results to answer the following questions: (1) What is the extent and time course of changes in FDG utilization in response to chemotherapy? (2) Are the changes of FDG uptake at early time points of chemotherapy predictive for therapy outcome? (3) Which quantitative FDG parameter provides the most sensitive measures of initial tumor response? Dynamic PET scans were performed in 11 patients at baseline and 1 and 6 weeks after initiation of chemotherapy. Based on attenuation corrected images acquired 30 to 60 minutes postinjection, standardized uptake values (SUV) were determined. Arterial input functions were estimated from vascular F-18 activity and the metabolic rates for FDG (MRFDG) were calculated using Patlak analysis. Before chemotherapy, high FDG uptake was found in all lesions (SUV[max] 13.3 +/- 4.2). Seven days after initiation of chemotherapy, tumor FDG uptake decreased 60% (SUV[max]). A further decrease of 42% was seen at day 42 resulting in a total decrease of 79% from baseline to day 42. During a follow-up of 16.0 +/- 4.2 months, six of the 11 patients continued to show complete remission. Seven days after initiation of chemotherapy, this group of patients displayed significantly lower mean MRFDG than the group of patients with relapse. At day 42, all parameters of FDG uptake showed a significant difference for both patient groups. The relative change of MRFDG from baseline to day 42, as well as from day 7 to day 42, was significantly larger as compared with SUV parameters. Standard chemotherapy of patients with NHL causes rapid decrease of tumor FDG uptake as early as 7 days after treatment, which continues to decline during therapy, indicating the sensitivity of metabolic signals to chemotherapeutic interventions. FDG uptake at 42 days after therapy was superior in prediction of long-term outcome over day 7 parameters. Dynamic data acquisition combined with Patlak analysis of FDG kinetics may provide superior information in therapy monitoring.
使用F-18氟脱氧葡萄糖（FDG）的正电子发射断层扫描（PET）应用于非霍奇金淋巴瘤（NHL），已知其对化疗高度敏感，但治疗结果也存在差异，以回答以下问题：（1）化疗后FDG摄取变化的范围和时间进程是怎样的？（2）化疗早期FDG摄取的变化能否预测治疗结果？（3）哪个定量FDG参数能最敏感地衡量初始肿瘤反应？对11例患者在基线、化疗开始后1周和6周进行了动态PET扫描。基于注射后30至60分钟采集的衰减校正图像，确定标准化摄取值（SUV）。从血管F-18活性估计动脉输入函数，并使用Patlak分析计算FDG的代谢率（MRFDG）。化疗前，所有病变均显示高FDG摄取（SUV[max] 13.3±4.2）。化疗开始7天后，肿瘤FDG摄取降低60%（SUV[max]）。在第42天观察到进一步降低42%，导致从基线到第42天总共降低79%。在16.0±4.2个月的随访期间，11例患者中有6例持续完全缓解。化疗开始7天后，这组患者的平均MRFDG显著低于复发组患者。在第42天，两组患者的所有FDG摄取参数均显示出显著差异。与SUV参数相比，从基线到第42天以及从第7天到第42天MRFDG的相对变化显著更大。NHL患者的标准化化疗在治疗后7天即导致肿瘤FDG摄取迅速降低，在治疗期间持续下降，表明代谢信号对化疗干预的敏感性。治疗后42天的FDG摄取在预测长期结果方面优于第7天的参数。动态数据采集结合FDG动力学的Patlak分析可能在治疗监测中提供更优信息。
