Kinetic Analysis of 3′-Deoxy-3′-18F-Fluorothymidine (18F-FLT) in Head and Neck Cancer Patients Before and Early After Initiation of Chemoradiation Therapy

Yusuf Menda; Laura L. Boles Ponto; Kenneth J. Dornfeld; Timothy J. Tewson; G. Leonard Watkins; Michael K. Schultz; John J. Sunderland; Michael M. Graham; John M. Buatti

doi:10.2967/jnumed.108.058495

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FIGURE 1.
Standard ¹⁸F-FLT plasma curves presented as value normalized by administered dose (Bq/mL/MBq). Solid line represents measured curve, and dashed line is metabolite-corrected curve. Individual patient data and table of plotted values are available in supplemental material.
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FIGURE 2.
Pretherapy (left) and midtherapy (right) ¹⁸F-FLT PET images of patient with right tonsillar neoplasm (arrowhead), with bilateral cervical nodal metastases (solid arrows). Note interval decrease in ¹⁸F-FLT uptake in tumor and marked reduction in cervical bone marrow activity (dashed arrow).
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FIGURE 3.
Comparison of SUV₆₀ with K-FLT derived from 4-parameter fits in 4 patients with arterial blood sampling (A) and with K-Patlak in all patients (B), including pretherapy and midtherapy scans. B includes values determined in patients without arterial sampling through use of scaled standard input function.
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FIGURE 4.
Comparison of change in SUV₆₀ between pretherapy and midtherapy scans with change in K-FLT in patients with arterial blood sampling (A) and comparison of SUV and K-Patlak in all patients (B). B includes values determined in patients without arterial sampling through use of scaled standard input function.
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FIGURE 5.
¹⁸F-FLT uptake in primary tumor at different time points expressed as percentage of the concentration at 60 min after administration at pretherapy (A) and midtherapy (B) scans. Heavy solid line represents mean value at each time point. At 45 min, uptake is within ±10% of 60-min concentration in all patients for both pretherapy and midtherapy scans.
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FIGURE 6.
Correlation between K-Patlak and SUV at particular time point vs. midpoint time (min) of imaging interval for pretherapy (solid curve) and midtherapy (dashed curve) scans.

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TABLE 1

Comparison of Kinetic Parameters and SUV by Tissue and Treatment Status

	Parameter
Tissue	K-FLT-4p (1/min)	K-FLT-3p (1/min)	K-Patlak (1/min)	SUV-60	SUV-60 max
Primary tumor
Before therapy	0.075 ± 0.006	0.054 ± 0.006	0.042 ± 0.004	3.4 ± 0.5	4.8 ± 0.8
Midtherapy	0.040 ± 0.010	0.029 ± 0.015	0.018 ± 0.016	1.8 ± 1.1	2.6 ± 1.6
¹⁸F-FLT–avid neck nodes
Before therapy	0.047 ± 0.015	0.031 ± 0.008	0.026 ± 0.008	2.3 ± 0.7	3.2 ± 1.2
Midtherapy	0.024 ± 0.007	0.017 ± 0.011	0.010 ± 0.007	1.2 ± 0.5	1.7 ± 0.8

K-FLT-4p = influx parameter as defined in text derived from 4-parameter model fit; K-FLT-3p = influx parameter derived from fit holding k₄ = 0; SUV-60 = mean SUV from 55 to 60 min after initiation of ¹⁸F-FLT infusion; max = maximum value for same region of interest.
Data are mean ± SD for patients with full arterial and venous sampling (n = 4 on 2 occasions).

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TABLE 2

Correlations Between Kinetic Parameters and SUVs

Parameter	Primary tumor and neck node	Primary tumor only	Neck node only
K-Patlak vs. K-FLT-4p	0.896	0.931	0.862
K-Patlak vs. K-FLT-3p	0.987	0.983	0.987
K-Patlak vs. SUV-60	0.987	0.980	0.988
K-Patlak vs. SUV-60 max	0.966	0.972	0.958
K-FLT-4p vs. K-FLT-3p	0.916	0.953	0.873
K-FLT-4p vs. SUV-60	0.910	0.904	0.895
K-FLT-4p vs. SUV-60 max	0.889	0.875	0.873
K-FLT-3p vs. SUV-60	0.969	0.961	0.975
K-FLT-3p vs. SUV-60 max	0.944	0.951	0.939
SUV-60 vs. SUV-60 max	0.987	0.990	0.983

K-FLT-4p = influx parameter as defined in text derived from 4-parameter model fit; K-FLT-3p = influx parameter derived from fit holding k₄ = 0; SUV-60 = mean SUV from 55 to 60 min after initiation of ¹⁸F-FLT infusion; max = maximum value for same region of interest.