Comparison of 18F-FDG and 67Ga-citrate in sarcoidosis imaging

E. Prager; M. Wehrschuetz; B. Bisail; M. Woltsche; T. Schwarz; H. Lanz; E. Sorantin; R. M. Aigner

doi:10.3413/nukmed-0085

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2008; 47(01): 18-23
DOI: 10.3413/nukmed-0085

Originalarbeiten

Schattauer GmbH

Comparison of ¹⁸F-FDG and ⁶⁷Ga-citrate in sarcoidosis imaging

¹⁸F-FDG und ⁶⁷Ga-Zitrat im Vergleich bei Sarkoidose

Authors

E. Prager

¹Division of Nuclear Medicine
M. Wehrschuetz

²Department of General and Pediatric Radiology, Medical University of Graz, Austria
B. Bisail

¹Division of Nuclear Medicine
M. Woltsche

³Division of Pulmonology, LKH Hoergas/Enzenbach, Austria
T. Schwarz

¹Division of Nuclear Medicine
H. Lanz

¹Division of Nuclear Medicine
E. Sorantin

²Department of General and Pediatric Radiology, Medical University of Graz, Austria
R. M. Aigner

¹Division of Nuclear Medicine

Abstract

Summary

Aim: ⁶⁷Ga citrate has been used long and successfully to diagnose and stage sarcoidosis. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) has been suggested as a positron emission tomography (PET) tracer for sarcoidosis imaging. This study aimed to analyze possible advantages of ¹⁸F-FDG-PET over ⁶⁷Ga citrate scintigraphy during the primary assessment of patients with sarcoidosis. Patients and methods: Twentyfour patients (11 men, 13 women, aged 52 years ±12.4) with histologically proven sarcoidosis were investigated with ¹⁸F-FDG and ⁶⁷Ga citrate. Equipment included a fullring PET scanner (ECAT EXACT HR+, Siemens/CTI, Knoxville TN, USA) and a double-headed gamma camera (ECAM, Siemens, Illinois, USA) for scintigraphy. The mean time difference between the two studies was 6.5 days (range: 5–8 days). Results: There was a significant difference in the detection of pulmonary and nonpulmonary sarcoidosis lesions between planar ⁶⁷Ga citrate scans and ¹⁸F-FDG-PET images (<0.0021). A total of 64 lesions were detected with ⁶⁷Ga citrate scans in the thorax and elsewhere with a mean of 2.6 lesions (4%) per patient, while 85 lesions were found with ¹⁸F-FDG-PET, with a mean of 3.5 lesions (4.1%) per patient. There was complete agreement between ¹⁸F-FDG and ⁶⁷Ga citrate in thoracic manifestations in four (16.6%) patients, and in non-thoracic manifestations in five (20.8%) patients. The interobserver variability showed a kappa value of 0.79. Conclusion: ⁶⁷Ga citrate and ¹⁸F-FDG are useful tracers for diagnostic evaluation of thoracic sarcoidosis. ¹⁸F-FDG seems to be more suitable for imaging the mediastinum, the bi-hilar lymph nodes, the posterior regions of the lungs and non-thoracic lesions. Further prospective studies are needed to clarify the role of both tracers in early diagnosis and staging of sarcoidosis, and to resolve questions concerning medical treatment and follow-up.

Zusammenfassung

⁶⁷Ga-Zitrat wird seit Jahren erfolgreich zur Diagnose und zur Stadieneinteilung von Sarkoidose verwendet. ¹⁸F-Fluordeoxyglukose wird auch als Tracer zur Positronenemissionstomographie (PET) für die Diagnostik der Sarkoidose vorgeschlagen. Ziel dieser Studie ist es, die möglichen Vorteile von ¹⁸F-FDG-PET gegenüber ⁶⁷Ga-Zitrat-Szintigraphie bei Patienten mit Sarkoidose zu analysieren. Patienten und Methode: Vierundzwanzig Patienten (11 Männer, 13 Frauen: 52 ±12,4 Jahre) mit histologisch verifizierter Sarkoidose sind unter Verwendung von ¹⁸F-FDG und ⁶⁷Ga-Zitrat untersucht worden. Die Studie ist an einem dedizierten PET-Scanner (ECAT EXACT HR+, Siemens/CTI, Knoxville TN, USA) und an einer Doppelkopf Gammakamera (ECAM, Siemens, Illinois, USA) durchgeführt worden. Das Zeitintervall zwischen beiden Untersuchungen hat 6,5 Tage (fünf bis acht Tage) betragen. Ergebnisse: Es konnte ein signifikantes Ergebnis (<0,0021) in der Analyse pulmonaler und extrapulmonaler Läsionen zwischen planaren ⁶⁷Ga-Zitrat- und ¹⁸F-FDG-Aufnahmen gezeigt werden. Eine komplette übereinstimmung zwischen ¹⁸F-FDG und ⁶⁷Ga-Zitrat bei thorakalen Manifestationen kann bei vier (16,6%) Patienten, bei extrathorakalen Manifestationen bei fünf (20,8%) Patienten beobachtet werden. Die Interobservervariabilität beider Untersucher zeigt einen kappa Wert von 0,79. Schlussfolgerung: ⁶⁷Ga-Zitrat und ¹⁸F-FDG sind sensitive Tracer zur diagnostischen Evaluierung von Sarkoidose. ¹⁸F-FDG erscheint vorteilhaft in der Diagnostik des Mediastinums, bihilärer Lymphknotengruppen und pathologisch speichernder Herde der dorsalen Lungenregionen und extrathorakaler Manifestationen. Weitere prospektive Studien sind jedoch erforderlich, um die Rolle beider Tracer in der Frühdiagnose und Stadieneinteilung von Sarkoidose zu klären und die Fragen bezüglich Nachfolgeuntersuchungen unter medikamentöser Behandlung zu lösen.

Keywords

Sarcoidosis - 67 gallium citrate - ¹⁸F-FDG

Schlüsselwörter

Sarkoidose - Gallium-67-zitrat - ¹⁸F-FDG

Full Text

References

References
1 Alavi A, Gupta N, Alberini JL. et al. Positron emission tomography imaging in nonmalignant thoracic disorders. Semin Nucl Med 2002; 32: 293-321.
2 Alberts C, van der Schoot JB, Groen AS. ⁶⁷Ga scintigraphy as an index of disease activity in pulmonary sarcoidosis. Eur J Nucl Med 1981; 6: 205-212.
3 Bakheet SM, Saleem M, Powe J. et al. ¹⁸F-fluorodeoxyglucose chest uptake in lung inflammation and infection. Clin Nucl Med 2000; 25: 273-278.
4 Bar-Shalom R, Guralnik L, Tsalic M. et al. The additional value of PET/CT over PET in FDG imaging of oesophageal cancer. Eur J Nucl Med Mol Imaging 2005; 32: 918-924.
5 Bar-Shalom R, Yefremov N, Haim N. et al. Camera-based FDG PET and ⁶⁷Ga SPECT in evaluation of lymphoma: comparative study. Radiology 2003; 227: 353-360.
6 Belhocine T, Spaepen K, Dusart M. et al. ¹⁸FDG PET in oncology: the best and the worst. Int J Oncol 2006; 28: 1249-1261.
7 Bekerman C, Szidon JP, Pinsky S. The role of gallium-67 in the clinical evaluation of sarcoidosis. Semin Roentgenol 1985; 20: 400-409.
8 Bekerman C, Hoffer PB, Bitran JD. et al. Gallium-67 citrate imaging studies of the lung. Semin Nucl Med 1980; 10: 286-301.
9 Brix G, Beyer T. PET/CT: dose-escalated image fusion?. Nuklearmedizin 2005; 44: S51-S57.
10 Brudin LH, Valind SO, Rhodes CG. et al. Fluorine-18 deoxyglucose uptake in sarcoidosi measured with positron emission tomography. Eur J Nucl Med 1994; 21: 297-305.
11 De Winter F, Vogelaers D, Gemmel F. et al. Promising role of ¹⁸F-fluoro-D-deoxyglucose positron emission tomography in clinical infectious diseases. Eur J Clin Microbiol Infect Dis 2002; 21: 247-257.
12 El-Haddad G, Zhuang H, Gupta N. et al. Evolving role of positron emission tomography in the management of patients with inflammatory and other benign disorders. Semin Nucl Med 2004; 34: 313-329.
13 Kluge R, Genser M, Wirtz H. et al. ¹⁸F-FDG-PET for the diagnosis of inflammatory activity and extramediastinal manifestations in sarcoidosis. Nuklearmedizin. 2005 44. A205.
14 Kostakoglu L, Leonard JP, Kuji I. et al. Comparison of fluorine-18 fluorodeoxyglucose positron emission tomography and ⁶⁷Ga scintigraphy in evaluation of lymphoma. Cancer 2002; 94: 879-888.
15 Kovacic K. Sarcoidosis whole body gallium imaging. Acta Clin Croat 2001; 40: 43-45.
16 Koyama T, Ueda H, Togashi K. et al. Radiologic manifestations of sarcoidosis in various organs. Radiographics 2004; 24: 87-104.
17 Larson SM, Schall GL. Gallium 67 concentration in human breast milk. JAMA 1971; 218: 257.
18 Milder MS. Scintigraphic Interpretation. In: Atlas of gallium-67 scintigraphy. Johnston GS, Jones AE. (eds) New York, London: Plenum Press; 1973: 11-29.
19 MIRD Dose Estimate Report No.2. J Nucl Med 1973; 14: 755-756.
20 Nishiyama Y, Yamamoto Y, Fukunaga K. et al. Comparative evaluation of ¹⁸F-FDG PET and ⁶⁷Ga scintigraphy in patients with sarcoidosis. J Nucl Med 2006; 47: 1571-1576.
21 Nunes H, Soler P, Valeyre D. Pulmonary sarcoidosis. Allergy 2005; 60: 565-582.
22 Pierce TB, Margolis M, Razzuk MA. Sarcoidosis: still amystery?. Proc (Bayl Univ Med Cent) 2001; 14: 8-12.
23 Prager E, Bisail B, Woltsche M. et al. Sarcoidosis: Comparison between ¹⁸F-FDG and ⁶⁷Ga in thoracic imaging. Nuklearmedizin. 2005 44. A205.
24 Seabold JE, Palestro CJ, Brown ML. et al. Procedure guideline for gallium scintigraphy in inflammation. JNucl Med 1997; 38: 994-997.
25 Weiner R. The role of transferrin and other receptors in the mechanism of ⁶⁷Ga localization. Int J Rad Appl Instrum B 1990; 17: 141-149.
26 Wirth A, Seymour JF, Hicks RJ. et al. Flourine-18 fluorodeoxyglucose positron emission tomography, gallium-67 scintigraphy, and conventional staging for Hodgkin's disease and non-Hodgkin's lymphoma. Am J Med 2002; 112: 262-268.
27 Wu JJ, SchiffK R. Sarcoidosis. Am Fam Physician 2004; 70: 312-322.
28 Zhuang H, Alavi A. 18-fluorodeoxyglucose positron emission tomographic imaging in the detection and monitoring of infection and inflammation. Semin Nucl Med 2002; 32: 47-59.