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Imaging Bone and Soft Tissue Tumors with the Proliferation Marker [¹⁸F]Fluorodeoxythymidine

Authors' Affiliations: Departments of ¹ Nuclear Medicine, ² Internal Medicine III, and ³ Pathology, Technische Universitat Munchen, Munich, Germany; ⁴ Department of Radiology and Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa; and Departments of ⁵ Traumatology, Hand, Plastic, and Reconstructive Surgery, ⁶ Nuclear Medicine, and ⁷ Pathology, Ulm University, Ulm, Germany

Requests for reprints: Andreas K. Buck, Department of Nuclear Medicine, Technical University Munich, Ismaninger Strasse 22, D-81675 Munich, Germany. Phone: 49-89-4140-2984; Fax: 49-89-4140-4950; E-mail: andreas.buck{at}tum.de.

Purpose: We have determined the ability of positron emission tomography (PET) with the thymidine analogue 3`-deoxy-3'[¹⁸F]fluorothymidine (FLT) to detect manifestation sites of bone and soft tissue tumors, to assess tumor grading, and to differentiate malignant from benign tumors.

Materials and Methods: In this prospective bicenter trial, FLT-PET was done in 22 patients with established or suspected soft or bone tissue lesions. Routine diagnostic procedures included incisional biopsy, magnetic resonance imaging, and/or contrast-enhanced spiral computed tomography in all patients and [¹⁸F]fluorodeoxyglucose (FDG)-PET in 15 patients. Forty-five to 60 minutes after i.v. injection of 350 to 425 MBq FLT, emission and transmission scanning was done. Tracer uptake in the tumor was evaluated semiquantitatively by calculation of mean and maximum standardized uptake values (FLT-SUV) and compared with respective values of FDG. Results were correlated to histopathology and tumor grading.

Results: FLT-PET detected all malignant bone or soft tissue tumors (17 of 17). Mean FLT-SUV in benign lesions was 0.7 (range, 0.3-1.3), and 1.3 in low-grade sarcoma (grade 1; range, 1.0-1.6), 4.1 (range, 2.2-6.0; P = 0.002) and 6.1 (range, 2.5-8.3; P = 0.001) in grade 2 and grade 3 tumors, respectively. FLT but not FDG uptake correlated significantly with tumor grading (r = 0.71 versus r = 0.01), and a cutoff value of 2.0 for FLT-SUV discriminated between low- and high-grade tumors.

Conclusion: In this clinical study, the proliferation marker FLT was suitable for imaging malignant bone or soft tissue tumors. FLT but not FDG uptake correlated significantly with the tumor grade, suggesting FLT as superior PET tracer for noninvasive grading of sarcomas.