Quantitative (18)F-fluorodeoxyglucose positron emission tomography/computed tomography to assess pulmonary inflammation in COPD

RATIONALE: COPD and smoking are characterised by pulmonary inflammation. (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging may improve knowledge of pulmonary inflammation in COPD patients and aid early development of novel therapies as an imaging biomarker. OBJECTIVES: To evaluate pulmonary inflammation, assessed by FDG uptake, in whole and regional lung in “usual” (smoking-related) COPD patients, alpha-1 antitrypsin deficiency (α(1)ATD) COPD patients, smokers without COPD and never-smokers using FDG PET/CT. Secondly, to explore cross-sectional associations between FDG PET/CT and systemic inflammatory markers in COPD patients and repeatability of the technique in COPD patients. METHODS: Data from two imaging studies were evaluated. Pulmonary FDG uptake (normalised K(i); nK(i)) was measured by Patlak graphical analysis in four subject groups: 84 COPD patients, 11 α(1)ATD-COPD patients, 12 smokers and 10 never-smokers. Within the COPD group, associations between nK(i) and systemic markers of inflammation were assessed. Repeatability was evaluated in 32 COPD patients comparing nK(i) values at baseline and at 4-month follow-up. RESULTS: COPD patients, α(1)ATD-COPD patients and smokers had increased whole lung FDG uptake (nK(i)) compared with never-smokers (0.0037±0.001, 0.0040±0.001, 0.0040±0.001 versus 0.0028±0.001 mL·cm(−3)·min(−1), respectively, p<0.05 for all). Similar results were observed in upper and middle lung regions. In COPD participants, plasma fibrinogen was associated with whole lung nK(i) (β=0.30, p=0.02) in multivariate analysis adjusted for current smoking, forced expiratory volume in 1 s % predicted, systemic neutrophils and C-reactive protein levels. Mean percentage difference in nK(i) between the baseline and follow-up was 3.2%, and the within subject coefficient of variability was 7.7%. CONCLUSIONS: FDG PET/CT has potential as a noninvasive tool to enable whole lung and regional quantification of FDG uptake to assess smoking- and COPD-related pulmonary inflammation.