Positron lymphography: Multimodal, high-resolution, dynamic mapping and resection of lymph nodes after intradermal injection of 18F-FDG

Daniel L.J. Thorek; Diane S. Abou; Bradley J. Beattie; Rachel M. Bartlett; Ruimin Huang; Pat B. Zanzonico; Jan Grimm

doi:10.2967/jnumed.112.104349

Positron lymphography: Multimodal, high-resolution, dynamic mapping and resection of lymph nodes after intradermal injection of ¹⁸F-FDG

Daniel L.J. Thorek, Diane S. Abou, Bradley J. Beattie, Rachel M. Bartlett, Ruimin Huang, Pat B. Zanzonico, Jan Grimm

Research output: Contribution to journal › Article › peer-review

48 Scopus citations

Abstract

The lymphatic system plays a critical role in the maintenance of healthy tissues. Its function is an important indicator of the presence and extent of disease. In oncology, metastatic spread to local lymph nodes (LNs) is a strong predictor of poor outcome. Clinical methods for the visualization of LNs involve regional injection and tracking of ^99mTc-sulfur colloid ( ^99mTc-SC) along with absorbent dyes. Intraoperatively, these techniques suffer from the requirement of administration of multiple contrast media ( ^99mTc-SC and isosulfan blue), unwieldy g-probes, and a short effective surgical window for dyes. Preclinically, imaging of transport through the lymphatics is further hindered by the resolution of lymphoscintigraphy and SPECT. We investigated multimodal imaging in animal models using intradermal administration of ¹⁸F-FDG for combined diagnostic and intraoperative use. PET visualizes LNs with high sensitivity and resolution and low background. Cerenkov radiation (CR) from ¹⁸F-FDG was evaluated to optically guide surgical resection of LNs. Methods: Imaging of ¹⁸F-FDG uptake used PET and sensitive luminescent imaging equipment (for CR). Dynamic PET was performed in both sexes and multiple strains (NCr Nude, C57BL/6, and Nu/Nu) of mice. Biodistribution confirmed the uptake of ¹⁸F-FDG and was compared with that of ^99mTc-SC. Verification of uptake and the ability to use ¹⁸F-FDG CR to guide nodal removal were confirmed histologically. Results: Intradermal injection of ¹⁸F-FDG clearly revealed lymphatic vessels and LNs by PET. Dynamic imaging revealed rapid and sustained labeling of these structures. Biodistribution of the radiotracer confirmed the active transport of radioglucose in the lymphatics to the local LNs and over time into the general circulation. ¹⁸F-FDG also enabled visualization of LNs through CR, even before surgically revealing the site, and guided LN resection. Conclusion: Intradermal ¹⁸F-FDG can enhance the preclinical investigation of the lymphatics through dynamic, high-resolution, and quantitative tomographic imaging. Clinically, combined PET/Cerenkov imaging has significant potential as a single-dose, dual-modality tracer for diagnostics (PET/CT) and guided resection of LNs (Cerenkov optical). COPYRIGHT

Original language	English (US)
Pages (from-to)	1438-1445
Number of pages	8
Journal	Journal of Nuclear Medicine
Volume	53
Issue number	9
DOIs	https://doi.org/10.2967/jnumed.112.104349
State	Published - Sep 1 2012
Externally published	Yes

Keywords

Cerenkov
Intraoperative
Lymph node mapping
PET/CT

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

Access to Document

10.2967/jnumed.112.104349

Cite this

@article{e1e1e1b8501a471b9818da2400934cbe,

title = "Positron lymphography: Multimodal, high-resolution, dynamic mapping and resection of lymph nodes after intradermal injection of 18F-FDG",

abstract = "The lymphatic system plays a critical role in the maintenance of healthy tissues. Its function is an important indicator of the presence and extent of disease. In oncology, metastatic spread to local lymph nodes (LNs) is a strong predictor of poor outcome. Clinical methods for the visualization of LNs involve regional injection and tracking of 99mTc-sulfur colloid ( 99mTc-SC) along with absorbent dyes. Intraoperatively, these techniques suffer from the requirement of administration of multiple contrast media ( 99mTc-SC and isosulfan blue), unwieldy g-probes, and a short effective surgical window for dyes. Preclinically, imaging of transport through the lymphatics is further hindered by the resolution of lymphoscintigraphy and SPECT. We investigated multimodal imaging in animal models using intradermal administration of 18F-FDG for combined diagnostic and intraoperative use. PET visualizes LNs with high sensitivity and resolution and low background. Cerenkov radiation (CR) from 18F-FDG was evaluated to optically guide surgical resection of LNs. Methods: Imaging of 18F-FDG uptake used PET and sensitive luminescent imaging equipment (for CR). Dynamic PET was performed in both sexes and multiple strains (NCr Nude, C57BL/6, and Nu/Nu) of mice. Biodistribution confirmed the uptake of 18F-FDG and was compared with that of 99mTc-SC. Verification of uptake and the ability to use 18F-FDG CR to guide nodal removal were confirmed histologically. Results: Intradermal injection of 18F-FDG clearly revealed lymphatic vessels and LNs by PET. Dynamic imaging revealed rapid and sustained labeling of these structures. Biodistribution of the radiotracer confirmed the active transport of radioglucose in the lymphatics to the local LNs and over time into the general circulation. 18F-FDG also enabled visualization of LNs through CR, even before surgically revealing the site, and guided LN resection. Conclusion: Intradermal 18F-FDG can enhance the preclinical investigation of the lymphatics through dynamic, high-resolution, and quantitative tomographic imaging. Clinically, combined PET/Cerenkov imaging has significant potential as a single-dose, dual-modality tracer for diagnostics (PET/CT) and guided resection of LNs (Cerenkov optical). COPYRIGHT",

keywords = "Cerenkov, Intraoperative, Lymph node mapping, PET/CT",

author = "Thorek, {Daniel L.J.} and Abou, {Diane S.} and Beattie, {Bradley J.} and Bartlett, {Rachel M.} and Ruimin Huang and Zanzonico, {Pat B.} and Jan Grimm",

year = "2012",

month = sep,

day = "1",

doi = "10.2967/jnumed.112.104349",

language = "English (US)",

volume = "53",

pages = "1438--1445",

journal = "Journal of Nuclear Medicine",

issn = "0161-5505",

publisher = "Society of Nuclear Medicine Inc.",

number = "9",

}

TY - JOUR

T1 - Positron lymphography

T2 - Multimodal, high-resolution, dynamic mapping and resection of lymph nodes after intradermal injection of 18F-FDG

AU - Thorek, Daniel L.J.

AU - Abou, Diane S.

AU - Beattie, Bradley J.

AU - Bartlett, Rachel M.

AU - Huang, Ruimin

AU - Zanzonico, Pat B.

AU - Grimm, Jan

PY - 2012/9/1

Y1 - 2012/9/1

N2 - The lymphatic system plays a critical role in the maintenance of healthy tissues. Its function is an important indicator of the presence and extent of disease. In oncology, metastatic spread to local lymph nodes (LNs) is a strong predictor of poor outcome. Clinical methods for the visualization of LNs involve regional injection and tracking of 99mTc-sulfur colloid ( 99mTc-SC) along with absorbent dyes. Intraoperatively, these techniques suffer from the requirement of administration of multiple contrast media ( 99mTc-SC and isosulfan blue), unwieldy g-probes, and a short effective surgical window for dyes. Preclinically, imaging of transport through the lymphatics is further hindered by the resolution of lymphoscintigraphy and SPECT. We investigated multimodal imaging in animal models using intradermal administration of 18F-FDG for combined diagnostic and intraoperative use. PET visualizes LNs with high sensitivity and resolution and low background. Cerenkov radiation (CR) from 18F-FDG was evaluated to optically guide surgical resection of LNs. Methods: Imaging of 18F-FDG uptake used PET and sensitive luminescent imaging equipment (for CR). Dynamic PET was performed in both sexes and multiple strains (NCr Nude, C57BL/6, and Nu/Nu) of mice. Biodistribution confirmed the uptake of 18F-FDG and was compared with that of 99mTc-SC. Verification of uptake and the ability to use 18F-FDG CR to guide nodal removal were confirmed histologically. Results: Intradermal injection of 18F-FDG clearly revealed lymphatic vessels and LNs by PET. Dynamic imaging revealed rapid and sustained labeling of these structures. Biodistribution of the radiotracer confirmed the active transport of radioglucose in the lymphatics to the local LNs and over time into the general circulation. 18F-FDG also enabled visualization of LNs through CR, even before surgically revealing the site, and guided LN resection. Conclusion: Intradermal 18F-FDG can enhance the preclinical investigation of the lymphatics through dynamic, high-resolution, and quantitative tomographic imaging. Clinically, combined PET/Cerenkov imaging has significant potential as a single-dose, dual-modality tracer for diagnostics (PET/CT) and guided resection of LNs (Cerenkov optical). COPYRIGHT

AB - The lymphatic system plays a critical role in the maintenance of healthy tissues. Its function is an important indicator of the presence and extent of disease. In oncology, metastatic spread to local lymph nodes (LNs) is a strong predictor of poor outcome. Clinical methods for the visualization of LNs involve regional injection and tracking of 99mTc-sulfur colloid ( 99mTc-SC) along with absorbent dyes. Intraoperatively, these techniques suffer from the requirement of administration of multiple contrast media ( 99mTc-SC and isosulfan blue), unwieldy g-probes, and a short effective surgical window for dyes. Preclinically, imaging of transport through the lymphatics is further hindered by the resolution of lymphoscintigraphy and SPECT. We investigated multimodal imaging in animal models using intradermal administration of 18F-FDG for combined diagnostic and intraoperative use. PET visualizes LNs with high sensitivity and resolution and low background. Cerenkov radiation (CR) from 18F-FDG was evaluated to optically guide surgical resection of LNs. Methods: Imaging of 18F-FDG uptake used PET and sensitive luminescent imaging equipment (for CR). Dynamic PET was performed in both sexes and multiple strains (NCr Nude, C57BL/6, and Nu/Nu) of mice. Biodistribution confirmed the uptake of 18F-FDG and was compared with that of 99mTc-SC. Verification of uptake and the ability to use 18F-FDG CR to guide nodal removal were confirmed histologically. Results: Intradermal injection of 18F-FDG clearly revealed lymphatic vessels and LNs by PET. Dynamic imaging revealed rapid and sustained labeling of these structures. Biodistribution of the radiotracer confirmed the active transport of radioglucose in the lymphatics to the local LNs and over time into the general circulation. 18F-FDG also enabled visualization of LNs through CR, even before surgically revealing the site, and guided LN resection. Conclusion: Intradermal 18F-FDG can enhance the preclinical investigation of the lymphatics through dynamic, high-resolution, and quantitative tomographic imaging. Clinically, combined PET/Cerenkov imaging has significant potential as a single-dose, dual-modality tracer for diagnostics (PET/CT) and guided resection of LNs (Cerenkov optical). COPYRIGHT

KW - Cerenkov

KW - Intraoperative

KW - Lymph node mapping

KW - PET/CT

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C2 - 22872741

AN - SCOPUS:84866182584

SN - 0161-5505

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JO - Journal of Nuclear Medicine

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