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Germ Cell Tumor: Differentiation of Viable Tumor, Mature Teratoma, and Necrotic Tissue with FDG PET and Kinetic Modeling¹

¹ From the Departments of Internal Medicine, Division of Nuclear Medicine (Y.S., K.R.Z., M.F.C., R.L.W.), Urology (H.B.G.), and Radiology (I.R.F., R.L.W.), University of Michigan Medical Center, 1500 E Medical Center Dr, B1G 505C, Box 0028, Ann Arbor, MI 48109-0028. Received April 30, 1998; revision requested July 6; revision received August 10; accepted October 14. Supported in part by National Institutes of Health grants CA53172, CA56731, and CA52880, and University of Michigan Clinical Research Center grant M01RR00042 from the Hi-Tech Funding Initiative. Address reprint requests to R.L.W.

PURPOSE: To evaluate the feasibility of positron emission tomography (PET) with 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) in patients with germ cell tumor (GCT) to monitor treatment and differentiate residual masses after chemotherapy.

MATERIALS AND METHODS: Twenty-six FDG PET studies were performed in 21 patients with GCT. FDG uptake of tumors was interpreted visually, and the lean standardized uptake value (SUV_lean) was determined. Tumor kinetic rate constants (K1, k2, k3) and net rate of FDG phosphorylation (K = [K1 · k3]/[k2 + k3]) in tumors were calculated from the dynamic data by means of a three-compartment model, assuming k4 = 0.

RESULTS: Viable tumors (n = 10) showed intense FDG uptake and could easily be differentiated visually from mature teratoma (n = 6) and necrosis or scar (n = 10). The SUV_lean of residual viable tumors (4.51 ± 1.34 [mean ± SD]) was higher than that of mature teratoma (1.38 ± 0.71) and necrosis or scar (1.05 ± 0.29) (P < .05). Although neither the visual interpretation nor SUV_lean differentiated mature teratoma from necrosis or scar, there were statistically significant differences in the kinetic rate constants K1 and K between mature teratoma and necrosis or scar as follows: K1, 0.113 mL/min/g ± 0.026 versus 0.036 mL/min/g ± 0.005 (P < .05); K, 0.005 mL/min/g ± 0.003 versus 0.0008 mL/min/g ± 0.0001 (P < .05).

CONCLUSION: FDG PET with kinetic analysis appears to be a promising method for management of disease in patients with GCT after treatment.

Index terms: Emission CT (ECT), 60.12163 • Fluorine, 60.12163 • Germ cell neoplasm, 60.3153 • Glucose, 60.12163

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