A Multicenter Clinical Trial on the Diagnostic Value of Dual-Tracer PET/CT in Pulmonary Lesions Using 3′-Deoxy-3′-18F-Fluorothymidine and 18F-FDG

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Abstract
Some new radiotracers might add useful information and improve diagnostic confidence of 18F-FDG imaging in tumors. A multicenter clinical trial was designed to investigate the diagnostic performance of dual-tracer (18F-FDG and 3′-deoxy-3′-18F-fluorothymidine [18F-FLT]) PET/CT in pulmonary nodules. Methods: Fifty-five patients underwent dual-tracer imaging in 6 imaging centers using the same models of equipment and standardized protocols. The images were interpreted by a collective group of readers who were unaware of the clinical data. The diagnostic performance using either tracer alone or dual-tracers together, with or without CT, was compared. The histological diagnosis or clinical findings in a 12-mo follow-up period served as the standard of truth. Results: In 16 patients with malignant tumor, 16 with tuberculosis, and 23 with other benign lesions, the sensitivity and specificity of 18F-FDG and 18F-FLT were 87.5% and 58.97% and 68.75% and 76.92%, respectively. The combination of dual-tracer PET/CT improved the sensitivity and specificity up to 100% and 89.74%. The 3 subgroups of patients could be best separated when the 18F-FLT/18F-FDG standardized uptake value ratio of 0.4–0.90 was used as the threshold. Conclusion: By reflecting different biologic features, the dual-tracer PET/CT using 18F-FDG and 18F-FLT favorably affected the diagnosis of lung nodules.

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