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Research ArticleClinical Investigations

18F-FDG Uptake in Less Affected Lung Field Provides Prognostic Stratification in Patients with Interstitial Lung Disease

Tomomi Nobashi, Takeshi Kubo, Yuji Nakamoto, Tomohiro Handa, Sho Koyasu, Takayoshi Ishimori, Michiaki Mishima and Kaori Togashi
Journal of Nuclear Medicine December 2016, 57 (12) 1899-1904; DOI: https://doi.org/10.2967/jnumed.116.174946
Tomomi Nobashi
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
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Takeshi Kubo
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
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Yuji Nakamoto
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
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Tomohiro Handa
2Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Sho Koyasu
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
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Takayoshi Ishimori
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
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Michiaki Mishima
2Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Kaori Togashi
1Department of Diagnostic Imaging and Nuclear Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan; and
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  • FIGURE 1.
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    FIGURE 1.

    Representative images of VOIs and region of interest for SUVmean and CTmean. (A) VOI of 18 cm3 was manually placed on background lung field of PET image, and SUVmean was automatically calculated as 0.82 on a workstation. (B) Corresponding region of interest was manually placed on HRCT image, and CTmean was automatically calculated as –857.

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    FIGURE 2.

    SUVmean (A), SUVTF (B), and CTmean (C) of ILD patients with UIP pattern, non-UIP pattern, and healthy controls. Horizontal bars in each rhombus represent 25th, 50th, and 75th percentiles from top. *P < 0.016 (Bonferroni adjustment).

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    FIGURE 3.

    Kaplan–Meier analysis of SUVmean (≤0.62 vs. >0.62) (A), SUVTF (≤2.57 vs. >2.57) (B), and ILD-GAP index (<3 vs. ≥3) (C) as predictors of TFS in patients with ILD. Patients with higher SUVmean (>0.62), higher SUVTF (>2.57), and higher ILD-GAP index (≥3) had significantly poorer prognosis.

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    FIGURE 4.

    Kaplan–Meier analysis of SUVmean as predictor of TFS in groups of patients with ILD-GAP index of 0–2 (A) and 3–4 (B). In patients with ILD-GAP index of 0–2, there was no difference in TFS between patients with higher (>0.45) and lower (≤0.45) SUVmean. In group with moderate mortality risk (ILD-GAP index 3–4), however, patients with higher SUVmean (>0.62) had significantly poorer TFS than those with lower SUVmean (≤0.62).

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    TABLE 1

    Patient Demographic and Clinical Characteristics

    Characteristic
    Mean age ± SD (y)55.4 ± 11.0
    Sex (male:female)51:39 (56.7%:43.3%)
    Lung transplantation (Yes:No)18:72 (20.0%:80.0%)
    Type of ILD
     IPF24 (26.7%)
     Unclassifiable ILD7 (7.8%)
     CT-ILD/idiopathic NSIP55 (61.1%)
     Chronic HP4 (4.4%)
    PFT
     Mean %FVC ± SD (n = 75; %)*58.1 ± 22.1
     Mean %DLco ± SD (n = 61; %)*29.9 ± 15.7
    ILD-GAP index (n = 75)*
     09 (12.0%)
     115 (20.0%)
     225 (33.3%)
     319 (25.3%)
     47 (9.3%)
     5–80
    Median observation period (d)395 (range, 2–2,392)
    • ↵* Because data were not acquired during designated period, numbers do not total 90.

    • NSIP = nonspecific interstitial pneumonia; HP = hypersensitivity pneumonitis.

    • View popup
    TABLE 2

    PET and CT Imaging Parameters in Included Patients

    Image parametersValues
    Mean SUVmax ± SD (n = 90)2.46 ± 0.76
    Mean SUVmean ± SD (n = 90)0.60 ± 0.24
    Mean SUVTF ± SD (n = 90)2.44 ± 0.50
    Mean CTmean ± SD (HU) (n = 83)−833 ± 68
    • TF = tissue fraction.

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    TABLE 3

    Correlations Between Imaging Parameters and Clinical Factors

    Image parameters%FVC%DLcoKL-6SP-DCRPLDH
    SUVmaxNSNS0.29 (0.014)NS0.22 (0.043)NS
    SUVmean−0.45 (<.0001)−0.46 (0.0002)0.56 (<.0001)0.36 (0.0098)NSNS
    SUVTFNS−0.29 (0.022)0.41 (0.0003)0.29 (0.040)NS0.066 (0.040)
    CTmean−0.50 (<.0001)−0.40 (0.0028)0.29 (0.019)0.40 (0.0060)NSNS
    • NS = not significant; TF = tissue fraction.

    • Rho (ρ) values are demonstrated. P values are in parentheses.

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    TABLE 4

    Univariate Analysis of Factors Associated with TFS

    VariablenHR95% CIP
    Age901.000.96–1.030.81
    Sex903.471.44–9.650.0047*
    UIP or non-UIP pattern900.700.25–1.710.45
    %FVC750.970.95–0.990.0087*
    %DLco610.930.88–0.970.0002*
    ILD-GAP index752.281.44–3.820.0003*
    KL-6731.001.00–1.000.049*
    SP-D491.001.00–1.010.050
    CRP850.810.52–1.050.13
    LDH831.001.00–1.000.87
    SUVmax900.970.58–1.620.91
    SUVmean9051.08.24–306<0.0001*
    SUVTF903.081.42–6.260.0055*
    CTmean841.001.00–1.010.059
    • ↵* P < 0.05.

    • HR = hazard ratio; CI = confidence interval; TF = tissue fraction.

    • View popup
    TABLE 5

    Multivariate Analysis of Factors Associated with TFS

    ModelnVariableP
    SUVmean and ILD-GAP index75SUVmean0.0068*
    ILD-GAP index0.0017*
    SUVTF and ILD-GAP index75SUVTF0.44
    ILD-GAP index0.0006*
    • ↵* P < 0.05.

    • TF = tissue fraction.

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Journal of Nuclear Medicine: 57 (12)
Journal of Nuclear Medicine
Vol. 57, Issue 12
December 1, 2016
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18F-FDG Uptake in Less Affected Lung Field Provides Prognostic Stratification in Patients with Interstitial Lung Disease
Tomomi Nobashi, Takeshi Kubo, Yuji Nakamoto, Tomohiro Handa, Sho Koyasu, Takayoshi Ishimori, Michiaki Mishima, Kaori Togashi
Journal of Nuclear Medicine Dec 2016, 57 (12) 1899-1904; DOI: 10.2967/jnumed.116.174946

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18F-FDG Uptake in Less Affected Lung Field Provides Prognostic Stratification in Patients with Interstitial Lung Disease
Tomomi Nobashi, Takeshi Kubo, Yuji Nakamoto, Tomohiro Handa, Sho Koyasu, Takayoshi Ishimori, Michiaki Mishima, Kaori Togashi
Journal of Nuclear Medicine Dec 2016, 57 (12) 1899-1904; DOI: 10.2967/jnumed.116.174946
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