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Imaging Gastric Cancer with PET and the Radiotracers ¹⁸F-FLT and ¹⁸F-FDG: A Comparative Analysis

¹ Department of Nuclear Medicine, Technische Universität München, Munich, Germany; ² Department of Surgery, Technische Universität München, Munich, Germany; ³ Department of Internal Medicine III, Technische Universität München, Munich, Germany; ⁴ Department of Pathology, Technische Universität München, Munich, Germany; and ⁵ Department of Medical Statistics, Technische Universität München, Munich, Germany

Correspondence: For correspondence or reprints contact: Ken Herrmann, MD, Department of Nuclear Medicine, Technische Universität München, Ismaninger Str. 22, D-81675 Munich, Germany. E-mail: ken.herrmann{at}web.de

In this pilot study, we evaluated 3'-deoxy-3'-¹⁸F-fluorothymidine (FLT) PET for the detection of gastric cancer and compared the diagnostic accuracy with that of ¹⁸F-FDG PET. Methods: Forty-five patients (31 male and 14 female) with histologically proven locally advanced gastric cancer underwent attenuation-corrected whole-body ¹⁸F-FLT PET and ¹⁸F-FDG PET/CT (low-dose CT). ¹⁸F-FLT emission images were acquired on a full-ring PET scanner 45 min after the injection of 270–340 MBq of ¹⁸F-FLT. ¹⁸F-FDG PET/CT was performed 60 min after the injection of 300–370 MBq of ¹⁸F-FDG. Mean standardized uptake values for ¹⁸F-FLT and ¹⁸F-FDG were calculated using circular ROIs (diameter, 1.5 cm) in the primary tumor manifestation site, in a reference segment of the liver, and in the bone marrow and were compared on a lesion-by-lesion basis. Results: According to the Lauren classification, 15 tumors (33%) were of the intestinal subtype and 30 (67%) of the nonintestinal subtype. ¹⁸F-FLT PET images showed high contrast for the primary tumor and proliferating bone marrow. In all patients (45/45), focal ¹⁸F-FLT uptake could be detected in the primary tumor. In contrast, 14 primary tumors were negative for ¹⁸F-FDG uptake, with lesional ¹⁸F-FDG uptake lower than or similar to background activity. The mean standardized uptake value for ¹⁸F-FLT in malignant primaries was 6.0 ± 2.5 (range, 2.4–12.7). In the subgroup of ¹⁸F-FDG–positive patients, the mean value for ¹⁸F-FDG was 8.4 ± 4.1 (range, 3.8/19.0), versus 6.8 ± 2.6 for ¹⁸F-FLT (Wilcoxon test: P = 0.03). Comparison of mean ¹⁸F-FLT and ¹⁸F-FDG uptake in tumors with signet ring cells revealed no statistically significant difference between the tracers (6.2 ± 2.1 for ¹⁸F-FLT vs. 6.4 ± 2.8 for ¹⁸F-FDG; Wilcoxon test: P = 0.94). Conclusion: The results of this study indicate that imaging gastric cancer with the proliferation marker ¹⁸F-FLT is feasible. ¹⁸F-FLT PET was more sensitive than ¹⁸F-FDG PET, especially in tumors frequently presenting without or with low ¹⁸F-FDG uptake, and may improve early evaluation of response to neoadjuvant treatment.

Key Words: FLT • gastric cancer • proliferation • PET

^* Contributed equally to this work.

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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