Comparison of 99mTc-3PRGD2 integrin receptor imaging with 99mTc-MDP bone scan in diagnosis of bone metastasis in patients with lung cancer: a multicenter study

Weibing Miao, Shan Zheng, Haojie Dai, Feng Wang, Xiaona Jin, Zhaohui Zhu, Bing Jia, Weibing Miao, Shan Zheng, Haojie Dai, Feng Wang, Xiaona Jin, Zhaohui Zhu, Bing Jia

Abstract

Purpose: 99mTc-3PRGD2, a promising tracer targeting integrin receptor, may serve as a novel tumor-specific agent for single photon emission computed tomography (SPECT). A multi-center study was prospectively designed to evaluate the diagnostic accuracy of 99mTc-3PRGD2 imaging for bone metastasis in patients with lung cancer in comparison with the conventional 99mTc-MDP bone scan.

Methods: The patients underwent whole-body scan and chest tomography successively at both 1 h and 4 h after intravenous injection of 11.1 MBq/Kg 99mTc-3PRGD2. 99mTc-MDP whole-body bone scan was routinely performed within 1 week for comparison. Three experienced nuclear medicine physicians blindly read the 99mTc-3PRGD2 and 99mTc-MDP images. The final diagnosis was established based on the comprehensive assessment of all available data.

Results: A total of 44 patients (29 male, 59±10 years old) with suspected lung cancer were recruited from 4 centers. Eighty-nine bone lesions in 18 patients were diagnosed as metastases and 23 bone lesions in 9 patients were benign. In a lesion-based analysis, 99mTc-3PRGD2 imaging demonstrated a sensitivity, specificity, and accuracy of 92.1%, 91.3%, and 92.0%, respectively. The corresponding diagnostic values for 99mTc-MDP bone scan were 87.6%, 60.9%, and 82.1%, respectively in the same patients. 99mTc-MDP bone scan had better contrast in most lesions, whereas the 99mTc-3PRGD2 imaging seemed to be more effective to exclude pseudo-positive lesions and detect bone metastases without osteogenesis.

Conclusion: 99mTc-3PRGD2 is a novel tumor-specific agent based on SPECT technology with a promising value in diagnosis of bone metastasis in patients with lung cancer.

Trial registration: ClinicalTrials.gov NCT01737112.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Comparison of 99m Tc-3PRGD2 SPECT,…
Figure 1. Comparison of 99mTc-3PRGD2 SPECT, 99mTc-MDP bone scan (posterior), and CT scan in a 62 year-old woman with left upper lung adenocarcinoma (green arrow) and costal metastasis (red arrow).
A: 99mTc -3PRGD2 WB(+), B: 99mTc -3PRGD2 SPECT (+), C: 99mTc -MDP bone scan (+), D: CT (+). WB: whole body.
Figure 2. Comparison of 99m Tc-3PRGD2 SPECT,…
Figure 2. Comparison of 99mTc-3PRGD2 SPECT, 99mTc -MDP bone scan, and 18F-FDG PET in a 60 year-old patient with a recent fall-down trauma.
The99mTc -MDP bone scan was positive (red arrows), whereas both 99mTc-3PRGD2 SPECT and 18F-FDG PET were negative. A: 99mTc-3PRGD2 WB (-), B: 99mTc-3PRGD2 SPECT (−), C: 99mTc-MDP bone scan (+), D: 18F-FDG PET (−). WB: whole body.
Figure 3. Comparison of 99m Tc-3PRGD2 integrin…
Figure 3. Comparison of 99mTc-3PRGD2 integrin receptor imaging with 99mTc-MDP bone scan in a patient with multiple bone metastases.
A: The 99mTc-3PRGD2 imaging showed the lung cancer (green arrow), lymph node metastases (blue arrow), and bone metastases (red arrow) at the same time. The 1-h imaging is better than the 4-h imaging because of the relatively lower background in bone marrow, liver, and spleen. B. 99mTc-MDP bone scan demonstrated better contrast, facilitating the detection of small bone lesions. However, 99mTc-MDP accumulated for the bone repair with limited specificity, whereas 99mTc-3PRGD2 targeted the metastatic tumor directly.
Figure 4. A 48 year-old man with…
Figure 4. A 48 year-old man with right lung adenocarcinoma (green arrow) and multiple bone metastases (red and blue arrows).
99mTc-3PRGD2 scans showed two more bone metastases (blue arrows) than the 99mTc-MDP bone scan. The lesions were confirmed by MRI (lower row). A: 1-h 99mTc-3PRGD2, B: 4-h 99mTc-3PRGD2, C: 99mTc-MDP, D–F: MRI.

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