Diagnosis of maxillofacial tumor withl-3-[18F]-fluoro-α-methyltyrosine (FMT) PET: a comparative study with FDG-PET

Objectives: To comparel-3-[18F]-fluoro-α-methyltyrosine (FMT)-positron emission tomography (PET) and 2-[18F]-fluoro-2-deoxy-d-glucose (FDG)-PET in the differential diagnosis of maxillofacial tumors.Methods: This study included 36 patients (16 males, 20 females; 31–90 years old) with untreated malignant tumors (34 squamous cell carcinoma, one mucoepidermoid carcinoma, one rhabdomyosarcoma) and seven patients (five males, two females; 32–81 years old) with benign lesions. In all patients, both FMT-PET and FDG-PET were performed within two weeks before biopsy or treatment of the lesions. To evaluate the diagnostic usefulness of FMT-PET and FDG-PET, visual interpretation and semiquantitative analysis were performed. PET images were rated according to the contrast of tumor uptake as compared with background, and were statistically analyzed. As a semiquantitative analysis, standardized uptake values (SUV) of the primary tumors were measured, and the SUV data were analyzed using receiver operating characteristic (ROC) curves.Results: The mean SUV of the malignant lesions were significantly higher than those of the benign lesions in both FMT-PET (2.62±1.58 vs. 1.20±0.30, p<0.01) and FDG-PET (9.17±5.06 vs. 3.14±1.34, p<0.01). A positive correlation (r=0.567, p<0.0001, n=46) was noted between FMT and FDG. ROC analysis revealed that there was no statistically significant difference in SUVs between FMT and FDG for differentiating malignant tumors. In 27 of 36 patients, FMT-PET had better contrast of malignant tumor visualization to the surrounding normal structures by visual assessment (p<0.005, binomial proportion test).Conclusions: Differential diagnosis of FMT-PET based on the uptake in maxillofacial tumors is equivalent to FDG-PET. However, the contrast of FMT uptake between maxillofacial tumors and the surrounding normal structures is higher than that of FDG, indicating the possibility of accurate diagnosis of maxillofacial tumors by FMT-PET.

[1]  H. Hanaoka,et al.  PET and PET/CT using 18F-FDG in the diagnosis and management of cancer patients , 2006, International Journal of Clinical Oncology.

[2]  David J. Yang,et al.  Synthesis of isomers of 18F‐labelled amino acid radiopharmaceutical: Position 2− and 3‐L‐18F-α‐methyltyrosine using a separation and purification system , 1997, Nuclear medicine communications.

[3]  W. Vaalburg,et al.  18F-FLT PET for visualization of laryngeal cancer: comparison with 18F-FDG PET. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[4]  Ho-Fai Wong,et al.  18F-FDG PET and CT/MRI in oral cavity squamous cell carcinoma: a prospective study of 124 patients with histologic correlation. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[5]  J Aoki,et al.  Detection of malignant tumors: whole-body PET with fluorine 18 alpha-methyl tyrosine versus FDG--preliminary study. , 2001, Radiology.

[6]  A. Krüger,et al.  O-(2-[18F]Fluoroethyl)-L-tyrosine (FET): a tracer for differentiation of tumour from inflammation in murine lymph nodes , 2002, European Journal of Nuclear Medicine and Molecular Imaging.

[7]  T. Higuchi,et al.  Positron emission tomographic imaging with11C-choline in differential diagnosis of head and neck tumors: comparison with18F-FDG PET , 2004, Annals of nuclear medicine.

[8]  Jonas T. Johnson,et al.  Development of distant metastasis after treatment of advanced‐stage head and neck cancer , 1997, Head & neck.

[9]  Emilija Veljkovic,et al.  SPECT and PET amino acid tracer influx via system L (h4F2hc-hLAT1) and its transstimulation. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[10]  R. Lufkin,et al.  Change induced by radiation therapy in FDG uptake in normal and malignant structures of the head and neck: quantitation with PET. , 1993, Radiology.

[11]  Keigo Endo,et al.  Present role and future prospects of positron emission tomography in clinical oncology , 2006, Cancer science.

[12]  G. Stoffels,et al.  18F-FET PET compared with 18F-FDG PET and CT in patients with head and neck cancer. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[13]  T Ido,et al.  Intratumoral distribution of fluorine-18-fluorodeoxyglucose in vivo: high accumulation in macrophages and granulation tissues studied by microautoradiography. , 1992, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[14]  Tomio Inoue,et al.  The role of whole-body FDG-PET in preoperative assessment of tumor staging in oral cancers , 2001, Annals of nuclear medicine.

[15]  J. Aoki,et al.  Gliomatosis cerebri evaluated by 18Fα-methyl tyrosine positron-emission tomography , 2003, Neuroradiology.

[16]  P. Armitage,et al.  Statistical methods in medical research , 1971 .

[17]  C. Metz.  ROC Methodology in Radiologic Imaging , 1986, Investigative radiology.

[18]  Xavier Geets,et al.  Role of 11-C-methionine positron emission tomography for the delineation of the tumor volume in pharyngo-laryngeal squamous cell carcinoma: comparison with FDG-PET and CT. , 2004, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[19]  Y. Kanai,et al.  Isoform selectivity of 3-125I-iodo-alpha-methyl-L-tyrosine membrane transport in human L-type amino acid transporters. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  M. Černý,et al.  Synthesis of 2-deoxy-2-fluoro-D-glucose , 1969 .

[21]  K. Hamacher,et al.  Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-D-glucose using aminopolyether supported nucleophilic substitution. , 1986, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[22]  Tomio Inoue,et al.  PET imaging of musculoskeletal tumours with fluorine-18 α-methyltyrosine: comparison with fluorine-18 fluorodeoxyglucose PET , 2000, European Journal of Nuclear Medicine.