Skip to main content

Advertisement

Log in

18F-Fluorodeoxyglucose positron emission tomography pulmonary imaging in idiopathic pulmonary fibrosis is reproducible: implications for future clinical trials

  • Original Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Noninvasive markers of disease activity in patients with idiopathic pulmonary fibrosis (IPF) are lacking. We performed this study to investigate the reproducibility of pulmonary 18F-FDG PET/CT in patients with IPF.

Methods

The study group comprised 13 patients (11 men, 2 women; mean age 71.1 ± 9.9 years) with IPF recruited for two thoracic 18F-FDG PET/CT studies performed within 2 weeks of each other. All patients were diagnosed with IPF in consensus at multidisciplinary meetings as a result of typical clinical, high-resolution CT and pulmonary function test features. Three methods for evaluating pulmonary 18F-FDG uptake were used. The maximal 18F-FDG pulmonary uptake (SUVmax) in the lungs was determined using manual region-of-interest placement. An 18F-FDG uptake intensity histogram was automatically constructed from segmented lungs to evaluate the distribution of SUVs. Finally, mean SUV was determined for volumes-of-interest in pulmonary regions with interstitial lung changes identified on CT scans. Processing included correction for tissue fraction effects. Bland-Altman analysis was performed and interclass correlation coefficients (ICC) were determined to assess the reproducibility between the first and second PET scans, as well as the level of intraobserver and interobserver agreement.

Results

The mean time between the two scans was 6.3 ± 4.3 days. The interscan ICCs for pulmonary SUVmax analysis and mean SUV corrected for tissue fraction effects were 0.90 and 0.91, respectively. Intensity histograms were different in only 1 of the 13 paired studies. Intraobserver agreement was also excellent (0.80 and 0.85, respectively). Some bias was observed between observers, suggesting that serial studies would benefit from analysis by the same observer.

Conclusion

This study demonstrated that there is excellent short-term reproducibility in pulmonary 18F-FDG uptake in patients with IPF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Raghu G, Weycker D, Edelsberg J, Bradford WZ, Oster G. Incidence and prevalence of idiopathic pulmonary fibrosis. Am J Respir Crit Care Med. 2006;174:810–6.

    Article  PubMed  Google Scholar 

  2. Gross TJ, Hunninghake GW. Idiopathic pulmonary fibrosis. N Engl J Med. 2001;345:517–25.

    Article  PubMed  CAS  Google Scholar 

  3. Noth I, Martinez FJ. Recent advances in idiopathic pulmonary fibrosis. Chest. 2007;132:637–50.

    Article  PubMed  Google Scholar 

  4. American Thoracic Society, European Respiratory Society. American Thoracic Society/European Respiratory Society International Multidisciplinary Consensus Classification of the Idiopathic Interstitial Pneumonias. Am J Respir Crit Care Med. 2002;165:277–304.

    Google Scholar 

  5. Groves AM, Win T, Haim SB, Ell PJ. Non-[18F]FDG PET in clinical oncology. Lancet Oncol. 2007;8:822–30.

    Article  PubMed  Google Scholar 

  6. Jeon TY, Lee KS, Yi CA, Chung MP, Kwon OJ, Kim BT, et al. Incremental value of PET/CT Over CT for mediastinal nodal staging of non-small cell lung cancer: comparison between patients with and without idiopathic pulmonary fibrosis. AJR Am J Roentgenol. 2010;195:370–6.

    Article  PubMed  Google Scholar 

  7. Groves AM, Win T, Screaton NJ, Berovic M, Endozo R, Booth H, et al. Idiopathic pulmonary fibrosis and diffuse parenchymal lung disease: implications from initial experience with 18F-FDG-PET/CT. J Nucl Med. 2009;50:538–45.

    Article  PubMed  Google Scholar 

  8. Umeda Y, Demura Y, Ishizaki T, Ameshima S, Miyamori I, Saito Y, et al. Dual-time-point (18)F-FDG PET imaging for diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia. Eur J Nucl Med Mol Imaging. 2009;36:1121–30.

    Article  PubMed  Google Scholar 

  9. Nusair S, Rubinstein R, Freedman NM, Amir G, Bogot NR, Izhar U, et al. Positron emission tomography in interstitial lung disease. Respirology. 2007;12:843–7.

    Article  PubMed  Google Scholar 

  10. Meissner H, Soo-Hoo GW, Khonsary SA, Mandelkern M, Brown CV, Santiago SM. Idiopathic pulmonary fibrosis: evaluation with positron emission tomography. Respiration. 2006;73:197–202.

    PubMed  Google Scholar 

  11. Ambrosini V, Zompatori M, De Luca F, Antonia D, Allegri V, Nanni C, et al. 68Ga-DOTANOC PET/CT allows somatostatin receptor imaging in idiopathic pulmonary fibrosis: preliminary results. J Nucl Med. 2010;51:1950–5.

    Article  PubMed  Google Scholar 

  12. Win T, Screaton NJ, Porter J, Endozo R, Wild D, Kayani I, et al. Novel positron emission tomography/computed tomography of diffuse parenchymal lung disease combining a labeled somatostatin receptor analogue and 2-deoxy-2[(18)F]fluoro-d-glucose. Mol Imaging. 2011;Sep 28. Epub ahead of print.

  13. Rudd JH, Myers KS, Bansilal S, Machac J, Rafique A, Farkouh M, et al. (18)Fluorodeoxyglucose positron emission tomography imaging of atherosclerotic plaque inflammation is highly reproducible: implications for atherosclerosis therapy trials. J Am Coll Cardiol. 2007;50:892–6.

    Article  PubMed  Google Scholar 

  14. Lambrou T, Groves AM, Erlandsson K, Screaton N, Endozo R, Win T, et al. The importance of correction for tissue fraction effects in lung PET: preliminary investigation. Eur J Nucl Med Mol Imaging. 2011;38:2238–2246. doi:10.1007/s00259-011-1906-x.

    Google Scholar 

  15. Studholme C, Hill DLG, Hawkes DJ. An overlap invariant entropy measure of 2D medical image alignment. Pattern Recogn. 1999;32:71–86.

    Article  Google Scholar 

  16. Coultas DB, Zumwalt RE, Black WC, Sobonya RE. The epidemiology of interstitial lung diseases. Am J Resp Crit Care Med. 1994;150:967–72.

    PubMed  CAS  Google Scholar 

  17. Cheson BD. Role of functional imaging in the management of lymphoma. J Clin Oncol. 2011;29:1844–54.

    Article  PubMed  Google Scholar 

  18. Herrmann K, Buck AK, Schuster T, Junger A, Wieder HA, Graf N, et al. Predictive value of initial 18F-FLT uptake in patients with aggressive non-Hodgkin lymphoma receiving R-CHOP treatment. J Nucl Med. 2011;52:690–6.

    Article  PubMed  Google Scholar 

  19. Chaudhari AJ, Bowen SL, Burkett GW, Packard NJ, Godinez F, Joshi AA, et al. High-resolution (18)F-FDG PET with MRI for monitoring response to treatment in rheumatoid arthritis. Eur J Nucl Med Mol Imaging. 2010;37:1047.

    Article  PubMed  Google Scholar 

  20. Rinne JO, Brooks DJ, Rossor MN, Fox NC, Bullock R, Klunk WE, et al. 11C-PiB PET assessment of change in fibrillar amyloid-beta load in patients with Alzheimer's disease treated with bapineuzumab: a phase 2, double-blind, placebo-controlled, ascending-dose study. Lancet Neurol. 2010;9:363–72.

    Article  PubMed  CAS  Google Scholar 

  21. Ishii H, Nishio M, Takahashi H, Aoyama T, Tanaka M, Toriyama T, et al. Comparison of atorvastatin 5 and 20 mg/d for reducing F-18 fluorodeoxyglucose uptake in atherosclerotic plaques on positron emission tomography/computed tomography: a randomized, investigator-blinded, open-label, 6-month study in Japanese adults scheduled for percutaneous coronary intervention. Clin Ther. 2010;32:2337–47.

    Article  PubMed  CAS  Google Scholar 

  22. Tixier F, Le Rest CC, Hatt M, Albarghach N, Pradier O, Metges JP, et al. Intratumor heterogeneity characterized by textural features on baseline 18F-FDG PET images predicts response to concomitant radiochemotherapy in esophageal cancer. J Nucl Med. 2011;52:369–78.

    Article  PubMed  Google Scholar 

  23. Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50 suppl 1:122S–50S.

    Article  PubMed  CAS  Google Scholar 

  24. Hofman MS, Hicks RJ. Restaging: should we percist without pattern recognition? J Nucl Med. 2010;51:1830–2.

    Article  PubMed  Google Scholar 

  25. Chua S, Dickson J, Groves AM. PET imaging for prediction of response to therapy and outcome in oesophageal carcinoma. Eur J Nucl Med Mol Imaging. 2011;38:1591–4

    Article  PubMed  Google Scholar 

  26. de Langen AJ, Klabbers B, Lubberink M, Boellaard R, Spreeuwenberg MD, Slotman BJ, et al. Reproducibility of quantitative 18F-3′-deoxy-3′-fluorothymidine measurements using positron emission tomography. Eur J Nucl Med Mol Imaging. 2009;36:389–95.

    Article  PubMed  Google Scholar 

  27. de Langen AJ, Lubberink M, Boellaard R, Spreeuwenberg MD, Smit EF, Hoekstra OS, et al. Reproducibility of tumor perfusion measurements using 15O-labeled water and PET. J Nucl Med. 2008;49:1763–8.

    Article  PubMed  Google Scholar 

  28. Rudd JH, Myers KS, Bansilal S, Machac J, Pinto CA, Tong C, et al. Atherosclerosis inflammation imaging with 18F-FDG PET: carotid, iliac, and femoral uptake reproducibility, quantification methods, and recommendations. J Nucl Med. 2008;49:871–8.

    Article  PubMed  Google Scholar 

  29. Jacene HA, Leboulleux S, Baba S, Chatzifotiadis D, Goudarzi B, Teytelbaum O, et al. Assessment of inter-observer reproducibility in quantitative 18F-FDG PET and CT measurements of tumor response to therapy. J Nucl Med. 2009;50:1760–9.

    Article  PubMed  Google Scholar 

  30. Robinson PJ, Kreel L. Pulmonary tissue attenuation with computed tomography: comparison of inspiration and expiration scans. J Comput Assist Tomogr. 1979;3:740–8.

    PubMed  CAS  Google Scholar 

  31. Verschakelen JA, Van-fraeyenhoven L, Laureys G, Demedts M, Baert AL. Differences in CT density between dependent and nondependent portions of the lung: influence of lung volume. AJR Am J Roentgenol. 1993;161:713–7.

    PubMed  CAS  Google Scholar 

  32. Nobuta M, Miyauchi M, Mimura K, Matsuoka A, Sugita M, Kitada O. Influence of body positions on phase IV in a single nitrogen breath method. Rinsho Byori. 1981;29:1062–6.

    PubMed  CAS  Google Scholar 

  33. Inoue K, Okada K, Taki Y, Goto R, Kinomura S, Fukuda H. 18FDG uptake associated with CT density on PET/CT in lungs with and without chronic interstitial lung diseases. Ann Nucl Med. 2009;23:277–81.

    Article  PubMed  CAS  Google Scholar 

  34. McQuaid SJ, Hutton BF. Sources of attenuation-correction arefacts in cardiac PET/CT and SPECT/CT. Eur J Nucl Med Mol Imaging. 2008;35:1117–23.

    Article  PubMed  Google Scholar 

  35. Dawood M, Lang N, Jiang X, Schafers KP. Lung motion correction on respiratory gated 3-D PET/CT images. IEEE Trans Med Imaging. 2006;25:476–85.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

A large proportion of funding for this work was provided by GSK. This work was undertaken at UCLH/UCL, which received a proportion of the funding from the UK Department of Health NIHR Biomedical Research Centres funding scheme. We acknowledge the input from GSK (CRT115549) Research and Developments in Stevenage, UK, and the GSK CRAFT consortium.

Conflicts of interest

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ashley M. Groves.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Win, T., Lambrou, T., Hutton, B.F. et al. 18F-Fluorodeoxyglucose positron emission tomography pulmonary imaging in idiopathic pulmonary fibrosis is reproducible: implications for future clinical trials. Eur J Nucl Med Mol Imaging 39, 521–528 (2012). https://doi.org/10.1007/s00259-011-1986-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00259-011-1986-7

Keywords

Navigation