进行性核上性麻痹的临床表现和神经影像学特点

目的探讨进行性核上性麻痹(progressive supranuclear palsy,PSP)的临床特点及头颅MRI、正电子发射体层扫描(PET)检查在本病中的诊断价值。方法回顾性分析19例PSP患者临床特点、神经影像学特征。结果19例PSP患者中,12例患者以走路不稳、反复向后跌倒为首发.17例患音出现垂直性核上性眼肌麻痹,假性球麻痹出现较早,还伴有轴性肌张力障碍、轻度痴呆等症状。19例患者均行头颅MRI检查,10例患者正中矢状位可见中脑上端萎缩,呈"蜂鸟征",水平位可见中脑前后径变小,呈"鼠耳征",1例患者中脑被盖和顶盖部T_2加权像显示弥散性高信号,中脑萎缩随病程加重。13例患者PET检查,均可见中脑葡萄糖代谢降低,双侧额叶葡萄糖代谢降低比较明显,部分合并顶叶或顶枕联合区葡萄糖代谢降低。结论 PSP临床表现变异较大,但通过头颅MRI、PET等辅助检查的特征性表现,可为诊断及鉴别诊断提供依据。     

帕金森病不同临床阶段静态脱氧葡萄糖代谢模式的正电子发射断层扫描

目的研究帕金森病(PD)在不同临床阶段脱氧葡萄糖(FDG)代谢特征和变化过程。方法对33例PD患者(PD组)以及8例无神经系统疾病患者(正常对照组)进行了18F-FDG-正电子发射断层扫描(PET)检查。PD患者中H-Y分期:Ⅰ期3例,Ⅱ期18例,Ⅲ期10例,Ⅳ期2例。分别取豆状核、尾状核、丘脑、小脑、双侧额叶、双侧顶叶、双侧颞叶和双侧枕叶为感兴趣区(ROI)进行放射性显像强度比较。结果与正常对照组比较,PD组不同临床阶段FDG代谢的共同点是:颅内结构FDG脑代谢呈现不对称性,以豆状核代谢不对称为主;丘脑、尾状核、额顶叶交界区FDG代谢降低;豆状核代谢高于尾状核以及丘脑。随着病情进展FDG脑代谢逐渐变化:H-YⅠ期时症状首发肢体对侧豆状核代谢高于同侧豆状核,H-YⅡ~Ⅳ期时症状首发肢体同侧豆状核代谢也逐渐增高接近于对侧的豆状核;H-YⅠ期的额顶交界区皮质代谢降低,Ⅱ、Ⅲ期低代谢范围逐渐扩大,Ⅳ期则发展到额、顶、颞叶广泛低代谢。结论PD的FDG代谢随着病情进展既有共性,也有不同的特征性改变。这种FDG代谢的变化有助于PD的诊断和鉴别诊断。     

帕金森病多巴胺转运体代谢和葡萄糖代谢相关性研究

目的 研究帕金森病(PD)患者脑内多巴胺转运体(DAT)代谢和葡萄糖代谢特征的相关性.方法 选择2006年7月至2008年7月在北京天坛医院神经内科住院,临床诊断为原发性PD患者11例和原发性震颤(ET)患者3例.分别接受了18氟-脱氧葡萄糖(18F-FDG)和DAT示踪剂11C-CFT 2种示踪剂的正电子发射扫描检查.应用半定量法计算壳核前部、壳核后部、尾状核头、丘脑、额叶后部、项叶前部和枕叶皮层等脑部感兴趣区的18F-FDG和11C-CFT的摄取强度.以感兴趣区与枕叶皮层的局灶性示踪剂摄取强度比值作为主要参数进行比较和相关性分析.结果 PD患者壳核后部可见18F-FDG和11C-CFT等示踪剂摄取信号缺如.其中首发症状肢体对侧壳核后部示踪剂摄取缺如更显著,低于首发症状肢体同侧(P<0.01);首发症状对侧壳核后部、壳核前部18F-FDG和11C-CFT代谢有显著相关性(P<0.01和P<0.05).首发症状同侧壳核后部18F-FDG和11C-CFT代谢有显著相关性(P<0.05).ET患者纹状体区18F-FDG和11C-CFT等示踪剂摄取信号未见缺如.结论 PD纹状体区的DAT代谢和葡萄糖代谢障碍具有相关性,可用于PD的诊断、鉴别诊断和判断病情进展等.     

血管性帕金森综合征与帕金森病的脑多巴胺转运体代谢比较

目的比较血管性帕金森综合征(vascular parkinsonism,VP)与帕金森病(Parkinson's disease,PD)患者在脑多巴胺转运体代谢方面的差异以及鉴别诊断价值。方法筛选临床诊断VP患者12例(VP组)和Hohen-Yahr分期匹配的PD患者12例(PD组)。分别应用多巴胺转运体示踪剂~(11)C-CFT正电子发射断层显像(PET)进行脑多巴胺转运体代谢的显像,并应用感兴趣区法测定和比较基底节多巴胺转运体示踪剂摄取指数。应用急性左旋多巴负荷试验测评和比较患者的急性多巴反应性,采用国际通用PD统一评分量表(UPDRS)运动分量表,计算最大改善率。结果 VP组患者两侧壳核后部~(11)C-CFT摄取信号轻度减低,~(11)C-CFT摄取信号降低范围小于壳核横断面的后1/4区域;壳核后部信号降低的范围基本对称,左侧与右侧壳核前部、壳核后部以及尾状核头部的示踪剂摄取指数比值为0.969、1.023、0.995,两侧比较差异无统计学意义(P0.05)。Hohen-Yahr分期匹配的PD组患者首发症状,肢体对侧的壳核前部、壳核后部~(11)C-CFT摄取信号强度明显低于首发症状肢体同侧(P0.01);首发症状肢体,对侧的壳核横断面后1/2区域~(11)C-CFT摄取信号缺损。在左旋多巴-苄丝肼200/50 mg剂量水平下,VP组患者的平均UPDRS运动评分最大改善率为(13.6±7.2)%,明显低于PD组患者的平均UPDRS运动评分最大改善率(42.6±13.9)%,差异有统计学意义(P0.05)。结论 VP和PD在脑多巴胺转运体代谢和急性多巴反应性方面存在显著差异。可应用脑多巴胺转运体代谢的PET作为这2种疾病鉴别诊断的生物学标记物。     

帕金森病~(99m)TC-TRODAT-1多巴胺转运体单光子计算机断层摄影脑显像研究

目的应用~(99m)Tc-TRODAT-1多巴胺转运体(DAT)单光子计算机断层摄影(SPECT)脑显像,研究不同运动障碍亚型帕金森病(Parkinson's diseas e,PD)纹状体生化改变。方法选择不同运动障碍亚型PD患者68例,其中震颤为主型PD患者36例(震颤PD组),姿势异常步态障碍(PIGD)为主型PD患者32例(PIGD PD组),分别行~(99m)Tc-TRODAT-1 DAT SPECT脑显像,利用感兴趣区技术计算首发症状对侧纹状体与小脑的特异性放射性比值。结果 PIGD PD组患者首发症状对侧纹状体、小脑较震颤PD组患者明显降低(1.43±0.92) vs (1.49±0.10),P0.05]。纹状体、小脑下降与PIGD评分呈负相关(r=-0.73,P0.05),而与震颤评分无明显相关性(r=-0.21,P0.05)。结论不同运动障碍亚型PD患者~(99m)Tc-TRODAT-1 DAT SPECT脑显像存在明显的异质性,PIGD为主型PD患者纹状体DAT的功能降低更明显,提示不同运动障碍亚型PD有不同的生化病理基础。     

情志因素对功能性消化不良患者脑葡萄糖代谢的影响

目的:观察功能性消化不良(FD)患者焦虑抑郁情绪对脑葡萄糖代谢的影响.方法:分别对7例伴有轻度焦虑抑郁(抑郁焦虑组)和8例不伴有焦虑抑郁(非抑郁焦虑组)的FD患者行脑18氟脱氧葡萄糖(18F-FDG)正电子发射型计算机断层扫描(PET-CT),用统计参数图软件(SPM2)比较两组间脑葡萄糖代谢的差别.结果:抑郁焦虑组与非抑郁焦虑组比较,脑葡萄糖代谢下降的脑区集中于右侧大脑半球,主要位于颞叶、额叶及边缘系统,左侧大脑半球较少,主要位于额下回和中央前回;脑葡萄糖代谢升高的脑区集中于右侧大脑半球的颞叶、枕叶和左侧大脑半球的顶叶,枕叶及边缘系统.结论:FD患者抑郁焦虑情绪的加工和调节涉及广泛的脑区,左右大脑半球均参与,主要集中于额叶、颞叶和边缘系统,枕叶和顶叶也参与了抑郁焦虑的调节.     

进行性核上性麻痹的脑葡萄糖代谢研究

 目的 探讨进行性核上性麻痹（PSP）患者¹⁸F-脱氧葡萄糖正电子发射体层 (¹⁸F-FDG PET)脑显像特点及与临床特征的相关性。方法 对13例PSP患者和30例相匹配的健康对照者进行脑¹⁸F-FDG PET检查,应用视觉分析法与统计参数图（SPM）分析法比较2组脑葡萄糖代谢的差异。结果 与对照组相比,PSP患者脑¹⁸F-FDG PET显像视觉分析法显示双侧额叶皮质、中脑、皮质下核团如基底节、丘脑示踪剂摄取减少,SPM分析显示双侧双侧额上、中回、额叶内侧部皮质、扣带回、中脑及皮质下结构,基底节、丘脑葡萄糖代谢减低,与患者眼球垂直运动障碍、姿势障碍、肌张力增高及认知功能障碍等临床症状相一致。结论 结合临床症状,应用¹⁸F-FDG PET脑显像有助于PSP的早期诊断。     

统计参数图软件对Alzheimer病患者脑PET图像的初步分析

目的 探讨阿尔茨海默病(AD)患者脑葡萄糖代谢特点及正电子发射计算机断层扫描(PET)对AD的诊断价值。方法 应用统计参数图(SPM)软件对13例AD患者和13例年龄、性别和文化程度相匹配的健康对照者脑PET检查结果进行处理分析。结果 (1)健康老年人可出现顶叶葡萄糖代谢的减低，但程度较轻；AD组全脑葡萄糖代谢减低，以顶叶为最明显，其次为颞叶，再次为额叶；(2)AD组扣带回31、23、7、30区，顶枕40、39区，颞叶20区和额叶9、6、8区等部位葡萄糖代谢减退较明显，差异有显著性(P＜0．05、0．001)。降低区域双侧基本对称，但额叶和颞叶的降低区左侧明显大于右侧。结论 AD患者脑葡萄糖代谢普遍性降低，个别脑区较为明显。扣带回的31、23、7、30区，顶枕的40、39区，颞叶的20区和额叶的9、6、8区等部位的葡萄糖代谢半定量指标降低可作为诊断AD的重要依据之一。     

18F-脱氧葡萄糖单光子发射计算机断层显像鉴别阿尔茨海默病及额颞叶痴呆的临床研究

目的 探讨阿尔茨海默病(Alzheimers disease,AD)及额颞叶痴呆(Frontotemporal dementia,FTD)患者18 F-脱氧葡萄糖(18F-deoxyglucose,18F-FDG)单光子发射计算机断层显像(SPECT)的特点。方法 选择2014年12月~2015年10月在首都医科大学宣武医院核医学科就诊并诊断为AD和FTD的患者29例,按诊断分为AD组19例,其中男性8例,女性11例,平均年龄(61.57±7.46)岁;FTD组10例,其中男性6例,女性4例,平均年龄(62.80±7.53)岁。同期选健康老年人9例为对照组,其中男性4例,女性5例,平均年龄(60.11±10.79)岁。所有研究对象行18F-FDG的SPECT检查。结果 对照组双侧大脑皮质、丘脑和基底节区未见异常放射性浓聚、稀疏或缺损。AD组和FTD组患者与对照组相比,18F-FDG的SPECT检查均表现为皮质代谢减低。AD组15例双侧大脑皮质对称性减低,其中40.00%顶、颞叶皮质代谢对称性明显减低;33.3%双侧顶叶皮质代谢对称性明显减低;13.33%伴有双侧额叶皮质代谢对称性减低。FTD组8例对称性减低,其中50%双侧额叶皮质代谢对称性明显减低。Fisher确切概率法检验显示,AD组和FTD组患者的SPECT脑代谢表现具有显著统计学差异(P0.05)。结论18F-FDG的SPECT能够为临床鉴别诊断AD和FTD提供客观的影像学依据。     

~(18)F氟脱氧葡萄糖正电子发射断层显像鉴别阿尔茨海默病和额颞叶痴呆的价值

目的探讨~(18)F-氟脱氧葡萄糖(~(18)F-FDG)正电子发射断层显像(positron emission tomography,PET)/CT对阿尔茨海默病(AD)和额颞叶痴呆(FTD)的鉴别诊断价值。方法回顾性分析临床诊断为AD 20例和FTD 10例的~(18)F-FDG PET/CT脑代谢显像资料,采用脑代谢影像进行视觉分析,测量相应部位的标准摄取值(standard up take value,SUV),以小脑为参考脑区,以放射性摄取减低脑区的SUV与小脑SUV的比值(SUVr)表示。采用NeuroQ脑分析软件进行定量分析其代谢模式特点。结果 20例AD患者视觉分析显示,16例(80.0%)伴有双侧顶叶代谢减低,8例(40.0%)伴有双侧颞叶代谢减低,5例(25.0%)伴有单侧额叶代谢减低,2例(10.0%)伴有单侧颞叶代谢减低;定量分析显示,全部患者(100.0%)均伴有双侧顶叶代谢减低,18例(90.0%)伴有后扣带回代谢减低,17例(85.0%)伴有双侧颞叶代谢减低,7例(35.0%)伴有单侧额叶代谢减低。10例FTD患者视觉分析显示,8例(80.0%)患者伴有颞叶代谢减低,6例(60.0%)患者伴有额叶代谢减低,3例(30.0%)伴有双侧顶叶代谢减低;定量分析显示,10例患者(100.0%)均伴有额叶代谢减低,8例(80.0%)伴有颞叶代谢减低,4例(40.0%)伴有双侧顶叶代谢减低,4例(40.0%)伴有基底节代谢减低,3例(30.0%)伴有后扣带回代谢减低。AD患者和FTD患者额叶、顶叶和颞叶SUVr比较,差异有统计学意义(1.08±0.13 vs 0.75±0.09,0.78±0.14 vs 1.06±0.05,0.81±0.14 vs 0.95±0.12,P<0.01)。结论 ~(18)F-FDG PET/CT脑显像显示的AD和FTD患者不同的代谢减低模式,有助于临床进行鉴别诊断。     

Fluorine-18 FDG positron emission tomography for imaging of hepatocellular carcinoma

OBJECTIVE: The detection of increased fluorine-18 fluorodeoxyglucose (18F-FDG) uptake by positron emission tomography (PET) is based on the enhanced glucose metabolism of tumor cells. Because the detection and staging of hepatocellular carcinoma (HCC) in patients with liver cirrhosis can be difficult, we prospectively evaluated the sensitivity of 18F-FDG PET in 14 consecutive patients with HCC. METHODS: Whole body and regional 18F-FDG PET of the liver were obtained. The results were compared with ultrasonography, contrast-enhanced, helical CT, histological grading, p53 protein expression of HCC, and serum alpha-fetoprotein (AFP) level. RESULTS: In 7 patients PET demonstrated increased tumor 18F-FDG uptake, whereas HCC was not distinguishable from nonmalignant liver tissue in 7 other patients. Hepatic lesions were detected by ultrasonography in all patients, whereas only 11 of 14 HCCs could be identified by CT. In 3 patients extrahepatic spread was demonstrated by 18F-FDG PET. Patients with increased tumor 18F-FDG uptake had significantly larger hepatic lesions and higher serum AFP levels than those with normal 18F-FDG uptake. Lesions could be visualized by 18F-FDG PET in 7 of 8 patients with moderately or poorly differentiated HCC, whereas none of the six well-differentiated tumors was detected. Two patients with strong p53 expression demonstrated increased tumor 18F-FDG uptake and extrahepatic metastases. CONCLUSIONS: The sensitivity of 18F-FDG PET for the imaging of HCC is low. Nevertheless, in patients with moderately or poorly differentiated HCC, tumors >5 cm, or with markedly elevated AFP levels 18F-FDG PET may contribute to an effective noninvasive staging.     

Highly metabolic thrombus of the portal vein： ^18F fluorodeoxyglucose positron emission tomography/computer tomography demonstration and clinical significance in hepatocellular carcinoma

AIM： To assess the ability of ^18F-fluorodeoxyglucose positron emission tomography/computer tomography （^18F-FDG PET/CT） to differentiate between benign and malignant portal vein thrombosis in hepatocellular carcinoma （HCC） patients.
METHODS： Five consecutive patients who had HBV cirrhosis, biopsy-proven HCC, and thrombosis of the main portal vein and/or left/right portal vein on ultrasound （US）, computer tomography （CT） or magnetic resonance imaging （MRI） were studied with ^18F-FDG PET/CT. The presence or absence of a highly metabolic thrombus on ^18F-FDG PET/CT was considered diagnostic for malignant or benign portal vein thrombosis, respectively. All patients were followed-up monthly with US, CT or MRI. Shrinkage of the thrombus or recanalization of the vessels on US, CT or MRI during follow-up was considered to be definitive evidence of the benign nature of the thrombosis, whereas enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered to be consistent with malignancy. ^18SF-FDG PET/CT, and US, CT or MRI results were compared.
RESULTS： Follow-up （1 to 10 mo） showed signs of malignant thrombosis in 4 of the 5 patients. US, CT or MRI produced a true-positive result for malignancy in 4 of the patients, and a false-positive result in 1. ^18F-FDG PET/CT showed a highly metabolic thrombus in 4 of the 5 patients. ^18F-FDG PET/CT achieved a true-positive result in all 4 of these patients, and a true-negative result in the other patient. No false-positive result was observed using ^18F-FDG PET/CT.
CONCLUSION： ^18F-FDG PET/CT may be helpful in discriminating between benign and malignant portal vein thrombi. Patients may benefit from ^18F-FDG PET/CT when portal vein thrombi can not be diagnosed exactly by US, CT or MRI.     

Positron emission tomography in patients with fibromyalgia syndrome and healthy controls

OBJECTIVE: Abnormal brain findings have previously been described in fibromyalgia syndrome (FMS) by single-photon-emission computed tomography. Our goal was to investigate change in regional cerebral glucose metabolism in people with FMS by positron emission tomography (PET) using 18F-fluorodeoxyglucose (FDG). METHODS: Twelve patients with FMS and no comorbid psychiatric diagnosis and 7 healthy pain-free controls were studied with FDG-PET in a blinded manner. Those with a psychiatric diagnosis were excluded. Brain scans were obtained using a PET scanner. Semiquantitative analysis of regional 18F-FDG uptake was performed in both cortical and subcortical brain structures. RESULTS: In the resting state, there were no significant differences in 18F-FDG uptake between patients and controls for all brain structures measured. CONCLUSION: FDG-PET scan findings in FMS were not significantly different from healthy controls. Normal results in our study may be explained by discordance between regional cerebral blood flow and regional cerebral glucose metabolism.     

Localization of medullary thyroid carcinoma after surgery using (11)C-methionine PET/CT: comparison with (18)F-FDG PET/CT

Tumor localization is difficult in patients with medullary thyroid carcinoma (MTC) that have persistent hypercalcitoninemia after thyroidectomy. In this study, the (11)C-methionine positron emission tomography/computed tomography (PET/CT) was compared with the (18)F-FDG PET/CT for diagnostic sensitivity in detecting residual or metastatic disease. (11)C-methionine PET/CT and (18)F-FDG PET/CT were performed on 16 consecutive patients with MTC that had persistent hypercalcitoninemia after surgery in this prospective, single-center study. Patient- and lesion-based analyses were performed using a composite reference standard which was the sum of the lesions confirmed by all combined modalities, including neck ultrasonography (US) with or without fine needle aspiration cytology, CT, bone scan, magnetic resonance imaging (MRI), and surgery. By patient-based analysis, the sensitivities of (11)C-methionine PET/CT and (18)F-FDG PET/CT were both 63%. By lesion-based analysis, the sensitivity of (11)C-methionine PET/CT was similar to (18)F-FDG PET/CT (73% vs. 80%). Excluding hepatic lesions, which could not be detected because of physiological uptake of methionine by the liver, the sensitivity of (11)C-methionine PET/CT was better than (18)F-FDG PET/CT especially for detecting cervical lymph node lesions; however, it was not superior to US. All patients with serum calcitonin levels ≥370 pg/mL showed uptake by (11)C-methionine PET/CT and (18)F-FDG PET/CT. This preliminary data showed that despite its similar sensitivity to (18)F-FDG PET/CT for detecting residual or metastatic MTC, (11)C-methionine PET/CT provided minimal additional information compared to combined (18)F-FDG PET/CT and neck US.     

Positron emission tomography with (18)F-fluoro-2-deoxyglucose in cardiological diagnosis

This clinically oriented review presents main principles of metabolism of cardiac muscle, pathophysiology of myocardial hibernation and stunning, as well as methodological principles of positron emission tomography (PET) of the heart with (18)F-fluoro-2-deoxyglucose ((18)F-FDG). Diagnostic and prognostic value of (18)F-FDG PET and scintigraphic sings of disturbed myocardial viability, contractility and metabolism are also described. Efficacy of (18)F-FDG PET is compared with other imaging methods such as radionuclide, ultrasound and radiological. Literature data and clinical cases demonstrate importance of preoperative diagnosis of hibernating myocardium in patients with ischemic heart disease. (18)F-FDG PET is a basic method of detection of potentially reversible pathological states of the heart (hibernation and stunning); it has high sensitivity and specificity as well as predictive power in relation to forthcoming course of ischemic heart disease. This noninvasive method of investigation provides unique information on severity of ischemic heart disease for stratification of patients in risk groups and selection of candidates for coronary artery bypass surgery or cardiac transplantation.     

Glucose transport and phosphorylation in skeletal muscle in obesity: insight from a muscle-specific positron emission tomography model

A controversial area in understanding the contribution of obesity to skeletal muscle insulin resistance is the distribution of control of glucose metabolism across proximal steps of glucose delivery, trans-membrane transport, and intracellular trapping via phosphorylation. Dynamic positron emission tomography (PET) imaging of skeletal muscle [(18)F]2-deoxy-2-D-glucose ((18)F-FDG) uptake provides an in vivo method for assessment of these steps in humans. In the current study we have examined the application of a four-compartment skeletal muscle-specific model for assessment of (18)F-FDG metabolism that takes interstitial (18)F-FDG kinetics into account and compared this to the classic three-compartment model in lean and obese volunteers. We assessed the effects of insulin infusions at three rates (0, 40, and 120 mU/m(2).min). In comparison with the classic model, the skeletal muscle-specific model reveals more clearly definable effects of insulin on transmembrane glucose transport and an impairment of this response in obesity. Compared with the classic model for assessment of (18)F-FDG metabolism, both the skeletal muscle-specific and the classic model indicate that, with respect to distribution of control, glucose phosphorylation has an important effect at low to moderate levels of insulin stimulation in both lean and obese subjects.     

Positron emission tomography scanning in the evaluation of hepatocellular carcinoma

BACKGROUND/AIMS: 18F-fluorodeoxyglucose uptake allows estimation of glucose metabolism by tumor cells using positron emission tomography (PET). We evaluated the role of PET imaging in the diagnosis of hepatocellular carcinoma. METHODS: PET images were collected after intravenous injection of 8-12 mCi of 18F-FDG in 20 patients with hepatocellular carcinoma (HCC). PET tumor activity level was assessed on a scale of 1 to 4 compared to normal liver tissue. The PET score was compared with abdominal computerized tomography (CT) scan results and between tumors of different grades and differentiation. RESULTS: Of the 20 patients studied, 11 (55%) had positive PET scans (PET score: 3 or 4) while nine (45%) were negative (PET score: 1 or 2). CT scan was positive in 18 patients (90%) and negative in two (10%). PET, however, revealed metastases in three patients that were not seen on CT. On pathological review, well-differentiated and low-grade tumors had lower PET scores. Comparison of the well-differentiated with the moderately- and poorly-differentiated tumors revealed a statistically significant difference. No statistical significance was observed between the moderately- and poorly-differentiated tumors or between different tumor grades and PET scores. CONCLUSIONS: The sensitivity of PET in diagnosis of HCC was 55% compared to 90% for CT scanning, although only PET detected some tumors (including distant metastases). Well-differentiated and low tumor grades had lower activity on PET and correspondingly lower PET scores. PET imaging may help assess tumor differentiation and may be useful in the diagnosis and staging and prognostication of HCC as an adjunct to CT.     

Use of positron emission tomography with methyl-11C-choline and 2-18F-fluoro-2-deoxy-D-glucose in comparison with magnetic resonance imaging for the assessment of inflammatory proliferation of synovium

OBJECTIVE: To compare positron emission tomography (PET) and magnetic resonance imaging (MRI) in the evaluation of inflammatory proliferation of synovium. METHODS: Ten patients (mean +/- SD age 36 +/- 13 years) with inflammatory joint disease and with clinical signs of inflammation of the joint were studied. A new tracer for cellular proliferation, methyl-(11)C-choline ((11)C-choline), and a widely used tracer for the detection of inflammation and cancer, 2-(18)F-fluoro-2-deoxy-D-glucose ((18)F-FDG), were applied for PET imaging, and the results were compared with the findings from gadolinium diethylenetriaminepentaacetic acid-enhanced MR images. The uptake of (11)C-choline and (18)F-FDG in the inflamed synovium was measured and expressed as the standardized uptake value (SUV) and the kinetic influx constant (K(i)) obtained from graphic analysis, and these values were compared with quantitative values on MRI. Synovial volumes were measured on the coronal contrast-enhanced T1-weighted MR images using the standard software of the MR imager. RESULTS: All patients showed high accumulation of both (11)C-choline and (18)F-FDG at the site of arthritic changes, where quantification of the tracer uptake was performed. The SUV of (11)C-choline was 1.5 +/- 0.9 gm/ml (mean +/- SD; n = 10) and the SUV of (18)F-FDG was 1.9 +/- 0.9 gm/ml (n = 10) (P = 0.017). The K(i) of (11)C-choline (mean +/- SD 0.048 +/- 0.042 minute(-1)) was 8-fold higher than the K(i) of (18)F-FDG (0.006 +/- 0.003 minute(-1)) (P = 0.009). Both the uptake of (11)C-choline and the uptake of (18)F-FDG correlated highly with the volume of synovium; the highest correlation was observed with the K(i) of (11)C-choline (r = 0.954, P < 0.0001). CONCLUSION: In the use of PET scans,(11)C-choline can be regarded as a promising tracer for quantitative imaging of proliferative arthritis changes. Nevertheless, subsequent prospective studies with larger numbers of patients are necessary to further characterize the relationship between the findings on PET imaging and the clinical and functional measures of inflammation.