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First Demonstration of Leukemia Imaging with the Proliferation Marker ¹⁸F-Fluorodeoxythymidine

¹ Department of Nuclear Medicine, University of Ulm, Ulm, Germany; ² Department of Hematology/Oncology, University of Ulm, Ulm, Germany; ³ Department of Radiology, University of Iowa, Iowa City, Iowa; ⁴ Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa; and ⁵ Institute of Pathology, University of Ulm, Ulm, Germany

Correspondence: For correspondence or reprints contact: Andreas Buck, Department of Nuclear Medicine, Technische Universität München, Ismaninger Strasse 22, D-81675 Munich, Germany. E-mail: andreas.buck{at}tum.de

Acute myeloid leukemia (AML) is a neoplasm of hematopoietic stem cells with partial or complete loss of the ability to differentiate but with preserved proliferation capacity. The aim of our study was to evaluate if the in vivo proliferation marker 3'-deoxy-3'-¹⁸F-fluorothymidine (FLT) is suitable for visualizing leukemia manifestation sites and if ¹⁸F-FLT is a surrogate marker for disease activity. Methods: In this pilot study, 10 patients with AML underwent pretherapeutic imaging with ¹⁸F-FLT PET or ¹⁸F-FLT PET/CT. The biodistribution of ¹⁸F-FLT was assessed 60 min after intravenous injection of the radiotracer. Standardized uptake values were calculated for reference segments of bone marrow, spleen, and normal organs. ¹⁸F-FLT PET in 10 patients with benign pulmonary nodules and the absence of malignant or inflammatory disease served as controls. Results: Retention of ¹⁸F-FLT was observed predominantly in bone marrow and spleen and was significantly higher in AML patients than in controls (mean ¹⁸F-FLT SUV in bone marrow, 11.5 and 6.6, P < 0.05; mean ¹⁸F-FLT SUV in spleen, 6.1 and 1.8, P < 0.05). Outside bone marrow, focal ¹⁸F-FLT uptake showed extramedullary manifestation sites of leukemia in 4 patients (meningeal disease, pericardial, abdominal, testicular, and lymph node), proven by other diagnostic procedures. Conclusion: This pilot study indicated that PET using ¹⁸F-FLT is able to visualize extramedullary manifestation sites of AML and reflects disease activity. Because ¹⁸F-FLT uptake in bone marrow is caused by a combination of both neoplastic and normal hematopoietic cells, the correlation of ¹⁸F-FLT uptake in bone marrow and leukemic blast infiltration did not reach statistical significance.

Key Words: acute myeloid leukemia • nucleoside analogs • proliferation • positron emission tomography

^* Contributed equally to this work.

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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