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Dual-time-point 18F-FDG PET imaging for diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Individual clinical courses of idiopathic interstitial pneumonia (IIP) are variable and difficult to predict because the pathology and disease activity are contingent, and chest computed tomography (CT) provides little information about disease activity. In this study, we applied dual-time-point [18F]-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography (PET), commonly used for diagnosis of malignant tumours, to the differential diagnosis and prediction of disease progression in IIP patients.

Methods

Fifty patients with IIP, including idiopathic pulmonary fibrosis (IPF, n = 21), non-specific interstitial pneumonia (NSIP, n = 18) and cryptogenic organizing pneumonia (COP, n = 11), underwent 18F-FDG PET examinations at two time points: scan 1 at 60 min (early imaging) and scan 2 at 180 min (delayed imaging) after 18F-FDG injection. The standardized uptake values (SUV) at the two points and the retention index (RI-SUV) calculated from them were evaluated and compared with chest CT findings, disease progression and disease types. To evaluate short-term disease progression, all patients were examined by pulmonary function test every 3 months for 1 year after 18F-FDG PET scanning.

Results

The early SUV for COP (2.47 ± 0.74) was significantly higher than that for IPF (0.99 ± 0.29, p = 0.0002) or NSIP (1.22 ± 0.44, p= 0.0025). When an early SUV cut-off value of 1.5 and greater was used to distinguish COP from IPF and NSIP, the sensitivity, specificity and accuracy were 90.9, 94.3 and 93.5%, respectively. The RI-SUV for IPF and NSIP lesions was significantly greater in patients with deteriorated pulmonary function after 1 year of follow-up (progressive group, 13.0 ± 8.9%) than in cases without deterioration during the 1-year observation period (stable group, −16.8 ± 5.9%, p < 0.0001). However, the early SUV for all IIP types provided no additional information of disease progression. When an RI-SUV cut-off value of 0% and greater was used to distinguish progressive IIPs from stable IIPs, the sensitivity, specificity and accuracy were 95.5, 100 and 97.8%, respectively.

Conclusion

Early SUV and RI-SUV obtained from dual-time-point 18F-FDG PET are useful parameters for the differential diagnosis and prediction of disease progression in patients with IIP.

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Acknowledgments

We thank Dr. Norihiro Naiki (Department of Molecular Pathology, University of Fukui) for valuable advice regarding pathological diagnosis.

This work was supported by the 21st Century COE program “Biomedical Imaging Technology Integration Program” from the Japan Society for the Promotion of Science (JSPS).

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Authors and Affiliations

  1. Department of Respiratory Medicine, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Yukihiro Umeda, Yoshiki Demura, Takeshi Ishizaki & Shingo Ameshima

  2. Third Department of Internal Medicine, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Isamu Miyamori

  3. Division of Respirology & Allergology, Department of Internal Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Yuji Saito

  4. Department of Radiology, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Tatsuro Tsuchida

  5. Biomedical Imaging Research Center, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Yasuhisa Fujibayashi & Hidehiko Okazawa

Authors
  1. Yukihiro Umeda
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  2. Yoshiki Demura
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  3. Takeshi Ishizaki
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  9. Hidehiko Okazawa
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Correspondence to Yoshiki Demura.

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Umeda, Y., Demura, Y., Ishizaki, T. et al. Dual-time-point 18F-FDG PET imaging for diagnosis of disease type and disease activity in patients with idiopathic interstitial pneumonia. Eur J Nucl Med Mol Imaging 36, 1121–1130 (2009). https://doi.org/10.1007/s00259-009-1069-1

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  • DOI: https://doi.org/10.1007/s00259-009-1069-1

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