Abstract
During a first-in-humans clinical trial investigating electron paramagnetic resonance tumor oximetry, a patient injected with the particulate oxygen sensor Printex ink was found to have unexpected fluorodeoxyglucose (FDG) uptake in a dermal nodule via positron emission tomography (PET). This nodule co-localized with the Printex ink injection; biopsy of the area, due to concern for malignancy, revealed findings consistent with ink and an associated inflammatory reaction. Investigations were subsequently performed to assess the impact of oxygen sensors on FDG-PET/CT imaging. A retrospective analysis of three clinical tumor oximetry trials involving two oxygen sensors (charcoal particulates and LiNc-BuO microcrystals) in 22 patients was performed to evaluate FDG imaging characteristics. The impact of clinically used oxygen sensors (carbon black, charcoal particulates, LiNc-BuO microcrystals) on FDG-PET/CT imaging after implantation in rat muscle (n = 12) was investigated. The retrospective review revealed no other patients with FDG avidity associated with particulate sensors. The preclinical investigation found no injected oxygen sensor whose mean standard uptake values differed significantly from sham injections. The risk of a false-positive FDG-PET/CT scan due to oxygen sensors appears low. However, in the right clinical context the potential exists that an associated inflammatory reaction may confound interpretation.
Highlights
During a first-in-humans clinical trial investigating electron paramagnetic resonance tumor oximetry, a patient injected with the particulate oxygen sensor Printex ink was found to have unexpected fluorodeoxyglucose (FDG) uptake in a dermal nodule via positron emission tomography (PET)
In July 2017, the investigators involved in a set of clinical Electron paramagnetic resonance (EPR) oximetry studies that used all three types of particulate materials were alerted to the possible role of an EPR oxygen sensor resulting in a false-positive fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) examination
A retrospective study was performed investigating all patients enrolled in clinical trials of ink-based oxygen sensors injected into human tumors who received FDG-PET/CT imaging
Summary
During a first-in-humans clinical trial investigating electron paramagnetic resonance tumor oximetry, a patient injected with the particulate oxygen sensor Printex ink was found to have unexpected fluorodeoxyglucose (FDG) uptake in a dermal nodule via positron emission tomography (PET) This nodule co-localized with the Printex ink injection; biopsy of the area, due to concern for malignancy, revealed findings consistent with ink and an associated inflammatory reaction. The widespread use of tattoos for cosmetic purposes raises the possible importance for determining whether carbon particulates may lead to artifactual findings on PET/CT imaging For these reasons this case prompted further analysis of the potential impact of the injection of EPR oxygen sensors on FDG imaging characteristics in tissues. A retrospective study was performed investigating all patients enrolled in clinical trials of ink-based oxygen sensors injected into human tumors who received FDG-PET/CT imaging. All four oxygen sensors used in clinical trials (i.e., carbon black particulates [Printex, approved for use at Dartmouth College and Emory University], charcoal particulates [Carlo Erba, approved for use at Dartmouth College, Emory University and West Virginia University; CARBO-REP, approved for use in Belgium], and LiNc-BuO microcrystals embedded in the polymer polydimethylsiloxane [aka “OxyChip”, approved for use at Dartmouth College]) were assessed
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