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Dynamic Imaging of Chimeric Antigen Receptor T Cells with [18F]Tetrafluoroborate Positron Emission Tomography/Computed Tomography
Published on: February 17, 2022
First demonstration of leukemia imaging with the proliferation marker 18F-fluorodeoxythymidine
Andreas K Buck1, Martin Bommer, Malik E Juweid
1Department of Nuclear Medicine, University of Ulm, Ulm, Germany. andreas.buck@tum.de
Insights
This study shows that 18F-FLT PET imaging can visualize extramedullary sites of Acute Myeloid Leukemia (AML) and indicates disease activity. While bone marrow uptake was higher in AML patients, it did not correlate with leukemic blast infiltration.
Area of Science:
- Nuclear Medicine
- Oncology
- Hematology
Background:
- Acute Myeloid Leukemia (AML) is a cancer of hematopoietic stem cells characterized by impaired differentiation and preserved proliferation.
- Identifying extramedullary disease sites and monitoring disease activity are crucial in AML management.
Purpose of the Study:
- To assess the utility of 3'-deoxy-3'-18F-fluorothymidine (FLT) Positron Emission Tomography (PET) for visualizing AML manifestation sites.
- To determine if 18F-FLT can serve as a surrogate marker for AML disease activity.
Main Methods:
- A pilot study involving 10 AML patients who underwent pretherapeutic 18F-FLT PET or PET/CT imaging.
- Biodistribution and standardized uptake values (SUVs) of 18F-FLT were analyzed in bone marrow, spleen, and normal organs.
- 10 patients with benign pulmonary nodules served as controls.
Main Results:
- 18F-FLT retention was significantly higher in the bone marrow and spleen of AML patients compared to controls.
- Focal 18F-FLT uptake identified extramedullary AML sites in 4 patients, including meningeal, pericardial, abdominal, testicular, and lymph node involvement.
- Correlation between bone marrow 18F-FLT uptake and leukemic blast infiltration was not statistically significant.
Conclusions:
- 18F-FLT PET is effective in visualizing extramedullary AML manifestation sites.
- 18F-FLT PET can reflect AML disease activity.
- Bone marrow 18F-FLT uptake reflects both neoplastic and normal hematopoietic cells, limiting its specificity for leukemic infiltration.
Unlabelled:
Acute myeloid leukemia (AML) is a neoplasm of hematopoietic stem cells with partial or complete loss of the ability to differentiate but with preserved proliferation capacity. The aim of our study was to evaluate if the in vivo proliferation marker 3'-deoxy-3'-18F-fluorothymidine (FLT) is suitable for visualizing leukemia manifestation sites and if 18F-FLT is a surrogate marker for disease activity.
Methods:
In this pilot study, 10 patients with AML underwent pretherapeutic imaging with 18F-FLT PET or 18F-FLT PET/CT. The biodistribution of 18F-FLT was assessed 60 min after intravenous injection of the radiotracer. Standardized uptake values were calculated for reference segments of bone marrow, spleen, and normal organs. 18F-FLT PET in 10 patients with benign pulmonary nodules and the absence of malignant or inflammatory disease served as controls.
Results:
Retention of 18F-FLT was observed predominantly in bone marrow and spleen and was significantly higher in AML patients than in controls (mean 18F-FLT SUV in bone marrow, 11.5 and 6.6, P < 0.05; mean 18F-FLT SUV in spleen, 6.1 and 1.8, P < 0.05). Outside bone marrow, focal 18F-FLT uptake showed extramedullary manifestation sites of leukemia in 4 patients (meningeal disease, pericardial, abdominal, testicular, and lymph node), proven by other diagnostic procedures.
Conclusion:
This pilot study indicated that PET using 18F-FLT is able to visualize extramedullary manifestation sites of AML and reflects disease activity. Because 18F-FLT uptake in bone marrow is caused by a combination of both neoplastic and normal hematopoietic cells, the correlation of 18F-FLT uptake in bone marrow and leukemic blast infiltration did not reach statistical significance.
