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Imaging Proliferation in Lung Tumors with PET: ¹⁸F-FLT Versus ¹⁸F-FDG

¹ Department of Nuclear Medicine, University of Ulm, Ulm, Germany
² Department of Thoracic Surgery, University of Ulm, Ulm, Germany
³ Department of Pathology, University of Ulm, Ulm, Germany
⁴ Department of Internal Medicine II, University of Ulm, Ulm, Germany

View larger version (79K): [in a new window]   FIGURE 1. Patient 5, with NSCLC in left upper lobe. (A) Transaxial 18F-FLT PET scan demonstrates high 18F-FLT uptake (arrow) in tumor margin. 18F-FLT uptake in vertebral column, scapula, and ribs represents proliferating bone marrow. (B and C) Corresponding 18F-FDG PET and CT scans show high 18F-FDG uptake in tumor margin and primary lung tumor. (D) On Ki-67 immunohistochemistry, Ki-67–positive nuclei (brown) demonstrate high proliferation rate of 54%, and hematoxylin background staining reveals Ki-67–negative nuclei (blue).

View larger version (65K): [in a new window]   FIGURE 2. Patient 21, with history of colorectal cancer and suggestive nodule in right middle lobe, for which histopathology revealed solitary tuberculoma. (A) Transaxial 18F-FDG PET scan demonstrates moderate 18F-FDG uptake (arrow) in tumor. (B) No focal tracer accumulation is seen in corresponding 18F-FLT PET scan. (C) Corresponding CT scan shows pulmonary nodule in right middle lobe. (D) On Ki-67 immunohistochemistry, 5% of nuclei show immunoreactivity to Ki-67 antigen.

View larger version (64K): [in a new window]   FIGURE 3. Patient 15, with pulmonary metastases from colorectal cancer. (A) Transaxial 18F-FDG PET scan demonstrates high 18F-FDG uptake (B) in metastatic nodule in right middle lobe. (B) 18F-FLT PET scan shows no tumoral 18F-FLT accumulation. (C) Corresponding CT scan shows pulmonary nodule in right middle lobe. (D) On Ki-67 immunohistochemistry, 12% of nuclei exhibit immunoreactivity to Ki-67–specific antibody MIB-1, indicating low proliferative activity.

View larger version (10K): [in a new window]   FIGURE 4. Linear regression analysis of mean tumoral SUVs of 18F-FLT and 18F-FDG and proliferation fraction (percentage of Ki-67–positive tumor cells). Mean 18F-FLT SUV: significant correlation for P < 0.0001, r = 0.92. Mean 18F-FDG SUV: significant correlation for P < 0.001, r = 0.59.