Published ahead of print on March 16, 2006, doi:10.1164/rccm.200506-934OC
Am. J. Respir. Crit. Care Med., Volume 173, Number 12, June 2006, 1363-1369
A more recent version of this article appeared on June 15, 2006
Submitted on June 16, 2005
Accepted on March 16, 2006
Quantifying Pulmonary Inflammation in Cystic Fibrosis with Positron Emission Tomography
Delphine L Chen1*, Thomas W Ferkol2, Mark A Mintun1, Jessica E Pittman1, Daniel B Rosenbluth3, and Daniel P Schuster3
1 Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA,
2 Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA,
3 Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
* To whom correspondence should be addressed. E-mail: chend{at}mir.wustl.edu.
Rationale: Although infection contributes to morbidity in patients with cystic fibrosis, the host inflammatory response is also an important cause of progressive pulmonary function deterioration. However, quantifying the inflammatory burden in these patients is challenging, often requiring invasive procedures. Positron emission tomographic imaging with [18F]fluorodeoxyglucose could be used as a non-invasive alternative to quantify lung inflammation.
Objective: To determine the relationships among lung [18F]fluorodeoxyglucose uptake, bronchoalveolar lavage neutrophil concentrations, and pulmonary function in patients with cystic fibrosis.
Methods: 20 patients and 7 healthy volunteers were studied. A subset of 7 patients also consented to undergo bronchoalveolar lavage. The uptake of [18F]fluorodeoxyglucose by the lungs was measured as the net influx rate constant Ki. Patients were stratified by rate of decline in pulmonary function into stable, intermediate, and rapidly declining groups. Ki was compared among groups and was correlated against neutrophil concentrations in bronchoalveolar lavage fluid.
Results: Ki, was significantly elevated (p<0.05) among cystic fibrosis patients as a whole compared with healthy controls (0.0015±0.0009 vs 0.0007±0.0002 ml blood/ml lung/min), but especially in patients with rapidly declining pulmonary function (0.0022±0.0011 ml blood/ml lung/min). Ki correlated positively with the number of neutrophils present in lavage fluid.
Conclusion: Imaging with [18F]fluorodeoxyglucose and positron emission tomography can be used to assess inflammatory burden in patients with cystic fibrosis. Elevations in Ki may be able to identify patients with more aggressive disease, and may be useful in monitoring changes in inflammatory burden in response to novel treatments.
Key words: [18F]fluorodeoxyglucose, neutrophils, pulmonary function
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