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Research ArticlePulmonary

Glycoprotein IIb/IIIa Receptor Imaging with 18F-GP1 PET for Acute Venous Thromboembolism: An Open-Label, Nonrandomized, Phase 1 Study

Chanwoo Kim, Jae Seung Lee, Youngjin Han, Sun Young Chae, Soyoung Jin, Changhwan Sung, Hye Joo Son, Seung Jun Oh, Sang Ju Lee, Jungsu S. Oh, Yong-Pil Cho, Tae-Won Kwon, Deok Hee Lee, Seongsoo Jang, Bohyun Kim, Norman Koglin, Mathias Berndt, Andrew W. Stephens and Dae Hyuk Moon
Journal of Nuclear Medicine February 2019, 60 (2) 244-249; DOI: https://doi.org/10.2967/jnumed.118.212084
Chanwoo Kim
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Jae Seung Lee
2Department of Pulmonology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Youngjin Han
3Department of Vascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sun Young Chae
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Soyoung Jin
4Department of Nuclear Medicine, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
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Changhwan Sung
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Hye Joo Son
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Seung Jun Oh
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Sang Ju Lee
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Jungsu S. Oh
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Yong-Pil Cho
3Department of Vascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Tae-Won Kwon
3Department of Vascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Deok Hee Lee
5Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Seongsoo Jang
6Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Bohyun Kim
7Department of Laboratory Medicine, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, Chungcheongnam-do, Republic of Korea; and
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Norman Koglin
8Piramal Imaging GmbH (now Life Molecular Imaging GmbH), Berlin, Germany
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Mathias Berndt
8Piramal Imaging GmbH (now Life Molecular Imaging GmbH), Berlin, Germany
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Andrew W. Stephens
8Piramal Imaging GmbH (now Life Molecular Imaging GmbH), Berlin, Germany
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Dae Hyuk Moon
1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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  • FIGURE 1.
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    FIGURE 1.

    18F-GP1 biodistribution as function of time. Kidney, spleen, and blood-pool activities show high initial uptake followed by gradual washout, whereas DVT and PE demonstrate rapid initial accumulation followed by plateau phase, with minimal decrease of activity until 120 min after 18F-GP1 injection.

  • FIGURE 2.
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    FIGURE 2.

    18F-GP1 PET/CT and CT images of 55-y-old man with DVT and PE. (A) Anterior maximum-intensity projections of 18F-GP1 PET/CT over 120 min show positive 18F-GP1 accumulation in pulmonary arteries (arrows) and in proximal (dotted arrows) and distal (arrowheads) veins of leg, which are gradually distinct on late images as 18F-GP1 activity from other organs is excreted via both urinary and hepatobiliary tracts. (B–D) Transaxial CT images (left) clearly show pulmonary emboli in right main and left lower lobar pulmonary arteries (B, arrows) and thrombus in right popliteal vein (C, dotted arrow). Positive 18F-GP1 uptake (right) at 120 min after injection is seen at corresponding vessels (B and C, solid and dotted arrows, respectively). Additional positive 18F-GP1 uptake (right) is observed in left peroneal and gastrocnemius veins (D, arrowheads), but no corresponding filling defects are seen on CT venography (D, left).

  • FIGURE 3.
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    FIGURE 3.

    18F-GP1 PET/CT and CT images of 69-y-old woman with DVT and PE. (A) Anterior maximum-intensity projection of 18F-GP1 PET/CT at 120 min after injection shows multiple areas of increased uptake in both pulmonary arteries and veins of left lower extremity at DVT and PE sites (thick arrows), as well as foci of abnormal 18F-GP1 uptake in left common carotid artery (thin arrows); left anterior tibial, posterior tibial and peroneal veins (arrowheads); and abdominal aorta (dotted arrow). (B–D) Foci of abnormal 18F-GP1 uptake are seen in left common carotid artery (B, right, arrow); abdominal aorta (C, right, dotted arrow); and left anterior tibial, posterior tibial, and peroneal veins (D, middle and right, arrowheads). Contrast-enhanced CT images reveal low-density, noncalcified plaque in abdominal aorta (C, left, dotted arrow) but no filling defects in distal veins of left lower extremity (D, left, arrowheads). No further imaging studies were performed to characterize left carotid uptake.

  • FIGURE 4.
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    FIGURE 4.

    Relationship between P-selectin expression on circulating platelets and 18F-GP1 uptake. Scattergram shows positive correlation between highest SUVmax of 18F-GP1 among all reference lesions at 120 min after injection and percentage of P-selectin–positive platelets measured by flow cytometry using CD62P monoclonal antibody.

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    TABLE 1

    Baseline Characteristics of Patients with Acute DVT or PE

    CharacteristicDVT (n = 10)PE (n = 10)Total
    Demographic
     Age (y)59.9 ± 13.858.4 ± 18.159.2 ± 15.7
     Male sex5 (50%)4 (40%)9 (45%)
     Non-Hispanic/Latino and Asian (Korean)10 (100%)10 (100%)20 (100%)
    Clinical feature
     Duration of signs and symptoms (d)*18.8 ± 11.49.5 ± 8.714.2 ± 11.0
     Active cancer1 (10%)1 (10%)2 (10%)
     Paralysis, paresis, or recent immobilization1 (10%)None1 (5%)
     Recently bedridden > 3 d or major surgery3 (30%)1 (10%)4 (20%)
     Estrogen use by womenNone1 (10%)1 (5%)
     Body mass index ≥ 30 kg/m21 (10%)2 (20%)3 (15%)
    Laboratory test (d-dimer [μg/mL FEU])9.7 ± 5.47.0 ± 4.78.4 ± 5.1
    Treatment before 18F-GP1 PET/CT
     Duration of anticoagulant therapy (d)†2.8 ± 1.13.2 ± 1.13.0 ± 1.1
     Prior antiplatelet therapy4 (40%)1 (10%)5 (25%)
    • ↵* Duration before 18F-GP1 PET/CT.

    • ↵† Duration of anticoagulation therapy before 18F-GP1 PET/CT or interval between standard imaging studies and 18F-GP1 PET/CT.

    • FEU = fibrinogen-equivalent units.

    • Qualitative data are expressed as numbers, followed by percentages in parentheses; continuous data are expressed as mean ± SD.

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Journal of Nuclear Medicine: 60 (2)
Journal of Nuclear Medicine
Vol. 60, Issue 2
February 1, 2019
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Glycoprotein IIb/IIIa Receptor Imaging with 18F-GP1 PET for Acute Venous Thromboembolism: An Open-Label, Nonrandomized, Phase 1 Study
Chanwoo Kim, Jae Seung Lee, Youngjin Han, Sun Young Chae, Soyoung Jin, Changhwan Sung, Hye Joo Son, Seung Jun Oh, Sang Ju Lee, Jungsu S. Oh, Yong-Pil Cho, Tae-Won Kwon, Deok Hee Lee, Seongsoo Jang, Bohyun Kim, Norman Koglin, Mathias Berndt, Andrew W. Stephens, Dae Hyuk Moon
Journal of Nuclear Medicine Feb 2019, 60 (2) 244-249; DOI: 10.2967/jnumed.118.212084

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Glycoprotein IIb/IIIa Receptor Imaging with 18F-GP1 PET for Acute Venous Thromboembolism: An Open-Label, Nonrandomized, Phase 1 Study
Chanwoo Kim, Jae Seung Lee, Youngjin Han, Sun Young Chae, Soyoung Jin, Changhwan Sung, Hye Joo Son, Seung Jun Oh, Sang Ju Lee, Jungsu S. Oh, Yong-Pil Cho, Tae-Won Kwon, Deok Hee Lee, Seongsoo Jang, Bohyun Kim, Norman Koglin, Mathias Berndt, Andrew W. Stephens, Dae Hyuk Moon
Journal of Nuclear Medicine Feb 2019, 60 (2) 244-249; DOI: 10.2967/jnumed.118.212084
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Keywords

  • deep vein thrombosis
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  • positron emission tomography
  • 18F-GP1
  • platelet activation
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