title: Molecular imaging of proliferation in malignant lymphoma.
abstract: We have determined the ability of positron emission tomography (PET) with the thymidine analogue 3'-deoxy-3'-[(18)F]fluorothymidine (FLT) to detect manifestation sites of malignant lymphoma, to assess proliferative activity, and to differentiate aggressive from indolent tumors. In this prospective study, FLT-PET was done additionally to routine staging procedures in 34 patients with malignant lymphoma. Sixty minutes after i.v. injection of approximately 330 MBq FLT, emission and transmission scanning was done. Tracer uptake in lymphoma was evaluated semiquantitatively by calculation of standardized uptake values (SUV) and correlated to tumor grading and proliferation fraction as determined by Ki-67 immunohistochemistry. FLT-PET detected a total of 490 lesions compared with 420 lesions revealed by routine staging. In 11 patients with indolent lymphoma, mean FLT-SUV in biopsied lesions was 2.3 (range, 1.2-4.5). In 21 patients with aggressive lymphoma, a significantly higher FLT uptake was observed (mean FLT-SUV, 5.9; range, 3.2-9.2; P < 0.0001) and a cutoff value of SUV = 3 accurately discriminated between indolent and aggressive lymphoma. Linear regression analysis indicated significant correlation of FLT uptake in biopsied lesions and proliferation fraction (r = 0.84; P < 0.0001). In this clinical study, FLT-PET was suitable for imaging malignant lymphoma and noninvasive assessment of tumor grading. Due to specific imaging of proliferation, FLT may be a superior PET tracer for detection of malignant lymphoma in organs with high physiologic fluorodeoxyglucose uptake and early detection of progression to a more aggressive histology or potential transformation.
authors.affiliation: Department of Nuclear Medicine, Institute of Pathology, University Hospital Ulm, Ulm, Germany.
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.forename: Martin
authors.initials: M
authors.lastname: Bommer
authors.forename: Stephan
authors.initials: S
authors.lastname: Stilgenbauer
authors.forename: Malik
authors.initials: M
authors.lastname: Juweid
authors.forename: Gerhard
authors.initials: G
authors.lastname: Glatting
authors.forename: Holger
authors.initials: H
authors.lastname: Schirrmeister
authors.forename: Torsten
authors.initials: T
authors.lastname: Mattfeldt
authors.forename: Djurdja
authors.initials: D
authors.lastname: Tepsic
authors.forename: Donald
authors.initials: D
authors.lastname: Bunjes
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Bernd J
authors.initials: BJ
authors.lastname: Krause
authors.forename: Bernd
authors.initials: B
authors.lastname: Neumaier
authors.forename: Hartmut
authors.initials: H
authors.lastname: Döhner
authors.forename: Peter
authors.initials: P
authors.lastname: Möller
authors.forename: Sven N
authors.initials: SN
authors.lastname: Reske
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D048708:Cell Growth Processes / Q000502:physiology; D015224:Dideoxynucleosides / Q000493:pharmacokinetics; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000493:pharmacokinetics; D006801:Humans; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods; D011446:Prospective Studies; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics; D014018:Tissue Distribution
chemical_list: D015224:Dideoxynucleosides; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; C002854:alovudine