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In Vitro Proton Magnetic Resonance Spectroscopic Lactate and Choline Measurements, ¹⁸F-FDG Uptake, and Prognosis in Patients with Lung Adenocarcinoma

¹ Department of Radiology, Kanazawa Medical University, Ishikawa, Japan
² Division of Advanced Medicine, Medical Research Institute, Kanazawa Medical University, Ishikawa, Japan
³ Department of Biochemistry, Kanazawa Medical University, Ishikawa, Japan
⁴ Department of Pathology, Kanazawa Medical University, Ishikawa, Japan

It has been reported that ¹⁸F-FDG uptake, lactate concentration, and choline concentration are good indicators of malignant grade in several different kinds of tumors. In this study, we investigated the correlation between ¹⁸F-FDG uptake in ¹⁸F-FDG PET imaging, lactate concentration and choline concentration measured by in vitro ¹H magnetic resonance spectroscopy (MRS), and survival probabilities in human lung adenocarcinoma. Methods: Nineteen patients with lung adenocarcinoma underwent ¹⁸F-FDG PET before surgery. The ¹H MRS spectra were obtained in vitro from methanol–chloroform–water extracts of lung adenocarcinomas and normal lungs. The ratios of the lactate (R_lac) or choline (R_cho) concentration of lung adenocarcinoma to normal lung from the same patient were correlated with the mean standardized uptake value (SUV). The Kaplan–Meier life table method was used to analyze the relationship between ¹⁸F-FDG uptake, R_lac, R_cho, and patient survival probabilities. Results: There was no significant correlation between mean SUV and R_lac or R_cho in patients with lung adenocarcinoma. An SUV > 5 means poorer survival probabilities in patients with lung adenocarcinoma (P = 0.004). A higher R_lac probably indicates a trend for patients with lung adenocarcinoma to have poorer survival probabilities; however, R_cho is not an indicator of survival probability. ¹⁸F-FDG uptake significantly correlated with cell differentiation (P = 0.007), whereas R_lac and R_cho had no correlation with it. Conclusion: No significant correlation was found between SUV and R_lac or R_cho in patients with lung adenocarcinoma. Compared with R_lac and R_cho measured by in vitro MRS, ¹⁸F-FDG uptake is a better indicator of prognosis in patients with lung adenocarcinoma.

Key Words: ¹⁸F-FDG • lung adenocarcinoma • magnetic resonance spectroscopy • lactate • choline • prognosis

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