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PET with O-(2-¹⁸F-Fluoroethyl)-L-Tyrosine in Peripheral Tumors: First Clinical Results

¹ Clinic of Nuclear Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
² Brain Imaging Center West, Institute of Medicine, Research Center Jülich, Jülich, Germany
³ Institute of Nuclear Chemistry, Research Center Jülich, Jülich, Germany
⁴ School of Biochemistry and Molecular Biology, Faculty of Science, Australian National University, Canberra, Australia

O-(2-¹⁸F-Fluoroethyl)-L-Tyrosine (¹⁸F-FET) PET has shown promising results in brain tumor diagnosis. The aim of this prospective study was to evaluate ¹⁸F-FET PET in comparison with ¹⁸F-FDG PET in patients with peripheral tumors. Methods: Forty-four consecutive patients with suspected malignant tumors underwent ¹⁸F-FET PET and ¹⁸F-FDG PET within 7 d. Whole-body PET studies were performed 1 h after intravenous injection of 370 MBq of ¹⁸F-FET or ¹⁸F-FDG. Six patients were excluded from the analysis because a malignant tumor could not be verified. In 38 patients (7 with colorectal cancer, 6 with pancreatic cancer, 9 with head-neck cancer, 4 with lymphomas, 3 with lung cancer, 3 with ovarian cancer, 4 with breast cancer, and 2 with prostatic cancer), ¹⁸F-FET PET and ¹⁸F-FDG PET were compared. Results: ¹⁸F-FET was positive in only 13 of 38 patients (8 with head-neck cancer, 3 with breast cancer, and 2 with lung cancer), whereas ¹⁸F-FDG exhibited increased uptake in 37 of 38 patients. All squamous cell carcinomas were found to be ¹⁸F-FET-positive tumors (8 head-neck cancer and 2 lung cancer), whereas most adenocarcinomas were found to be ¹⁸F-FET-negative tumors. In patients with colorectal cancer, pancreatic cancer, ovarian cancer, prostatic cancer, and lymphomas, no increased ¹⁸F-FET uptake could be identified. All lesions that exhibited increased ¹⁸F-FET uptake also showed increased ¹⁸F-FDG uptake. No additional lesion was identified by ¹⁸F-FET PET but not by ¹⁸F-FDG PET. A subgroup analysis of patients with head-neck carcinomas allowed a better distinction between malignant and inflammatory tissues with ¹⁸F-FET than with ¹⁸F-FDG. Conclusion: ¹⁸F-FET is inferior to ¹⁸F-FDG as a PET tracer for general tumor diagnosis. Our preliminary results suggest rather selective uptake of ¹⁸F-FET in squamous cell carcinomas. Compared with ¹⁸F-FDG PET, ¹⁸F-FET PET may allow a better distinction between tumors and inflammatory tissues in patients with squamous cell carcinomas.

Key Words: O-(2-¹⁸F-fluoroethyl)-L-tyrosine • ¹⁸F-FDG • peripheral tumors • squamous cell carcinomas • amino acids • PET

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