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Original Research: CHEST IMAGING |

Diagnostic Usefulness of Fluorine–18-α–Methyltyrosine Positron Emission Tomography in Combination With 18F-Fluorodeoxyglucose in Sarcoidosis Patients*

Kyoichi Kaira, MD; Noboru Oriuchi, MD; Yoshimi Otani, MD; Noriko Yanagitani, MD; Noriaki Sunaga, MD; Takeshi Hisada, MD; Tamotsu Ishizuka, MD; Keigo Endo, MD; Masatomo Mori, MD
Author and Funding Information

*From the Department of Medicine and Molecular Science (Drs. Kaira, Yanagitani, Sunaga, Hisada, Ishizuka, and Mori), Department of Diagnostic Radiology and Nuclear Medicine (Drs. Oriuchi and Endo), and Thoracic and Visceral Organ Surgery (Dr. Otani), Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Japan.

Correspondence to: Kyoichi Kaira, MD, Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Showa-machi, Maebashi, Gunma 371-8511, Japan; e-mail: kkaira1970@yahoo.co.jp



Chest. 2007;131(4):1019-1027. doi:10.1378/chest.06-2160
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Objectives: L-[3-18F]-α–methyltyrosine (18F-FMT) is an amino-acid tracer for positron emission tomography (PET) and is used for tumor detection because malignant tumor cells accumulate 18F-FMT based on the increased expression of an amino-acid transporter. This study was conducted to investigate the usefulness of 18F-FMT PET in combination with fluorine-18-fluorodeoxyglucose (18F-FDG) PET for the diagnosis of sarcoidosis in patients with suspected malignancy.

Setting: Twenty-four sarcoidosis patients with suspected malignancy underwent 18F-FDG and 18F-FMT PET. The study included 17 patients with extrapulmonary manifestation mimicking malignant disease (13 patients with systemic lymphadenopathy, 3 of them with concomitant hepatosplenic processes; 3 patients with hepatosplenic processes without concomitant lymphadenopathy; and 1 patient with multiple bone lesions), 3 patients with occurrence of bilateral hilar lymphadenopathy in cancer patients, and 4 patients with multiple nodules mimicking pulmonary metastasis.

Results: All patients showed increased uptake of 18F-FDG and no increase in the accumulation of 18F-FMT in their lymphadenopathy. Standardized uptake values (SUVs) of 18F-FDG and 18F-FMT were 5.01 ± 2.15 and 0.77 ± 0.24, respectively (mean ± SD). All extranodal lesions such as liver, spleen, and bone were visually positive on 18F-FDG PET and negative on 18F-FMT PET. No neoplasm was confirmed in all patients. In a control group of patients with lung cancer, SUVs for 18F-FDG and 18F-FMT were 6.34 ± 2.52 and 1.54 ± 0.82, respectively.

Conclusion: The uptake of 18F-FDG was positive in the sarcoid lesions, and therefore 18F-FDG PET could not differentiate sarcoidosis from malignant disease. Use of 18F-FMT PET in combination with 18F-FDG PET may be the effective method to distinguish sarcoidosis from malignancy.

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