Ann Thorac Surg 2007;83:312-314
© 2007 The Society of Thoracic Surgeons
Case Reports
11C-Acetate and 18F-Fluorodeoxyglucose Positron Emission Tomography of Pulmonary Adenocarcinoma
Masahiro Kaji, MD, PhDa,*,
Hiroaki Nomori, MD, PhDb,
Kenichi Watanabe, MD, PhDa,
Takashi Ohtsuka, MD, PhDa,
Tsuguo Naruke, MD, PhDa,
Keiichi Suemasu, MD, PhDa,
Kimiichi Uno, MD, PhDc
a Department of Thoracic Surgery, Saiseikai Central Hospital, Tokyo, Japan
b Graduate School of Medicine, Kumamoto University, Tokyo, Japan
c Nishidai Clinic, Tokyo, Japan
Accepted for publication May 16, 2006.
* Address correspondence to Dr Kaji, Department of Thoracic Surgery, Saiseikai Central Hospital, 1-4-7, Mita, Minato-ku, Tokyo, 108-0073 Japan (Email: mkaji{at}saichu.jp).
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Abstract
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Positron emission tomography (PET) with 11C-acetate has been recently reported in detection of slow-growing tumors, such as well-differentiated adenocarcinomas of the lung, which are often negative with 18F-fluorodeoxyglucose (FDG) PET. Here we present findings of acetate-PET and FDG-PET in a case of adenocarcinoma that was comprised of peripheral ground glass opacity and solid central components, and was histologically comprised of both a well-differentiated and a moderately-differentiated adenocarcinoma, respectively. Acetate-PET was positive in both components, whereas FDG-PET was only positive in the solid central component. The present case demonstrates the figurative findings of acetate-PET and FDG-PET in lung adenocarcinoma.
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Introduction
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Although positron emission tomography (PET) with 18F-fluorodeoxyglucose (FDG) has contributed significantly to the diagnosis of lung cancers, well-differentiated adenocarcinomas are well known to frequently be falsely negative with FDG-PET, owing to their low rate of glucose metabolism [1]. Recently, we reported that PET with 11C-acetate (AC) was able to detect well-differentiated adenocarcinomas exhibiting a ground-glass opacity (GGO) appearance more frequently than FDG-PET [2]. Here we present the figurative findings of AC-PET and FDG-PET in a case of lung adenocarcinoma that was comprised of peripheral GGO and solid central components that exhibited the histologic characteristics of both a well-differentiated and moderately-differentiated adenocarcinoma, respectively.
The patient was a 76-year-old woman with adenocarcinoma of the left lung that was detected by a routine annual examination. Computed tomography showed a mass shadow (5.5 x 4.5 cm) that consisted of a peripheral GGO component and a solid central component (Fig 1). The size of the solid central compartment was 4.2 x 1.5 cm. The AC-PET and FDG-PET was conducted according to the following protocol. The AC-PET and FDG-PET demonstrated the following findings: the AC-PET was positive in both the solid and GGO components (Fig 2A) and the FDG-PET was positive in the solid component but negative in the GGO (Fig 2B). A left upper lobectomy with mediastinal lymph node dissection was performed on January 11, 2006. Histologic findings revealed that the peripheral GGO component was a well-differentiated adenocarcinoma and that the solid central component was a moderately-differentiated adenocarcinoma.
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Fig 1. Computed tomography showing the lesion composed of the peripheral ground glass opacity and the central solid components.
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Fig 2. Fusion findings of computed tomography and positron emission tomography. (A) Acetate-positron emission tomography (AC-PET) was positive in both the peripheral ground-glass opacity and the central solid components. (B) The 18F-fluorodeoxyglucose (FDG)-PET was positive in the central solid component but negative in the peripheral ground-glass opacity component.
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The 11C-acetate was produced using an HM-18 cyclotron (Sumitomo Heavy Industries Co, Tokyo, Japan) by proton bombardment of 14N2. The resultant 11CO2 was then reacted with methyl magnesium bromide by a modified method of Pike and colleagues [3]. The AC-PET was performed before FDG-PET on the same day. The dosage of 11C-acetate administered was 125 µCi/kg (4.6 MBq/kg). The PET imaging was performed approximately 10 minutes after the administration of AC using a PosiCam.HZL mPower scanner (Positron Co, Houston, TX). Approximately 30 minutes after AC-PET imaging, fluorine-18 FDG was administered (ie, more than 120 minutes after administration of the AC). The dosage of FDG was 125 µCi/kg (4.6 MBq/kg) for nondiabetic patients and 150 µCi/kg (5.6 MBq/kg) for diabetic patients, as we previously reported [1]. The FDG-PET imaging was performed approximately 45 minutes after administration of the FDG. The cost for one study of AC-PET is less than $100.
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Comment
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Recent advances in FDG-PET have contributed significantly to the ability to differentiate between benign and malignant pulmonary nodules. However, FDG-PET sometimes provides false-negative findings, particularly for low-grade malignant tumors, such as bronchioloalveolar carcinoma and carcinoid, due to their low glucose metabolism [1, 4]. We previously reported that while FDG-PET did not exhibit false-negative results for squamous cell, large cell, or small cell carcinomas, 60% of well-differentiated adenocarcinomas (1 to 3 cm in size) failed to be identified by FDG-PET [1].
The 11C-acetate has been widely used as a PET tracer for evaluating myocardial oxidative metabolism [5]. Recently AC-PET has been reported to be a useful PET tracer in detecting slow-growing tumors that have failed to be identified by FDG-PET, such as well-differentiated lung adenocarcinomas, well-differentiated hepatocellular carcinomas, and prostate cancers [2, 6, 7].
It is well known that differentiated adenocarcinomas of the lung are often histologically heterogeneous [8] (ie, in the peripheral zone, tumor cells proliferate in a single layer along the alveolar septa, as in bronchioloalveolar carcinomas; whereas in the central zone, tumor cells proliferate in moderately-differentitated or poorly-differentiated papillary structures along with an increase of fibrovascular stroma). Here we present the findings of AC-PET and FDG-PET in a case of adenocarcinoma that consisted of peripheral GGO and solid central components, which exhibited the histologic characteristics of well-differentiated and moderately-differentiated adenocarcinomas, respectively. Although AC-PET was positive in both components, FDG-PET was only positive in the central component of the moderately-differentiated carcinoma, which are typical findings of AC-PET and FDG-PET. Our previous investigation demonstrated that 6 of 10 (60%) moderately-differentiated or poorly-differentiated adenocarcinomas were positive with both FDG-PET and AC-PET. Therefore we believe that differentiated adenocarcinomas with GGO images on CT should be examined with AC-PET rather than FDG-PET.
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References
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- Nomori H, Watanabe K, Ohtsuka T, et al. Evaluation of F-18 fluorodeoxyglucose (FDG) PET scanning for pulmonary nodules less than 3 cm in diameter, with special reference to the CT images Lung Cancer 2004;45:19-27.[Medline]
- Nomori H, Kosaka N, Watanabe K, et al.
11C-acetate positron emission tomography imaging for lung adenocarcinoma 1 to 3 cm in size with ground-glass opacity images on computed tomography Ann Thorac Surg 2005;80:2020-2025.[Abstract/Free Full Text]
- Pike VW, Eakins MN, Allan RM, et al. Preparation of [1-11C] acetate—an agent for the study of myocardial metabolism by positron emission tomography Int J Appl Radiat Isot 1982;33:505-512.[Medline]
- Nomori H, Watanabe K, Ohtsuka T, et al. Visual and semiquantitative analyses for F-18 fluorodeoxyglucose (FDG) PET scanning in pulmonary nodules 1 to 3 cm in size Ann Thorac Surg 2005;79:984-988.[Abstract/Free Full Text]
- Brown M, Marshall DR, Sobel BE, Bergmann SR. Delineation of myocardial oxygen utilization with carbon-11-labeled acetate Circulation 1987;76:687-696.[Abstract/Free Full Text]
- C, Yeung DW. C-11 acetate PET imaging in hepatocellular carcinoma and other liver masses J Nucl Med 2003;44:213-221.[Abstract/Free Full Text]
- Oyama N, Akino H, Kanamaru H, et al.
11C-acetate PET imaging of prostate cancer J Nucl Med 2002;43:181-186.[Abstract/Free Full Text]
- Shimosato Y, Hashimoto T, Kodama T, et al. Prognostic implications of fibrotic focus (scar) in small peripheral lung cancers Am J Surg Pathol 1980;4:365-373.[Medline]
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Abstract
Introduction
