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LetterLetters to the Editor

Reply: Respiratory Muscle 18F-FDG Uptake

Razi Muzaffar and Medhat M. Osman
Journal of Nuclear Medicine Technology September 2012, 40 (3) 210; DOI: https://doi.org/10.2967/jnmt.112.104646
Razi Muzaffar
*Saint Louis University Hospital 3635 Vista Ave., FDT-2 Saint Louis, MO 63110
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Medhat M. Osman
*Saint Louis University Hospital 3635 Vista Ave., FDT-2 Saint Louis, MO 63110
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This article has a correction. Please see:

  • Errata - September 01, 2012

REPLY: Thank you for your interest in our article (1). You have brought up very good and valid points we would like to address.

Patterns of uptake in the respiratory muscles are secondary to labored breathing regardless of the cause. Although it is true that this is not limited to chronic obstructive pulmonary disease (COPD), most patients in our study with this pattern were diagnosed with COPD (73%). Also, the inclusion bias of our study was limited to patients with suspected or established lung cancer. In addition, many of the patients with lung cancer present with pleural effusion at the time of imaging. However, in patients with pleural effusion, benign or malignant, there should not be the same respiratory muscle uptake as what is seen in COPD patients. To the best of our knowledge, none of the patients presented with an underlying restrictive process. Overall, we agree that labored breathing will cause this pattern of uptake whether it is restrictive, obstructive, or of other causes.

To remain consistent, we used the intensity of uptake in the mediastinum as the internal reference point. Given the diffuse and variable uptake in large muscles, we elected not to use another muscle as a reference. Several studies have been performed on various types of cancers showing that both the liver and the mediastinum are the most stable over time (2,3).

Footnotes

  • Published online May 9, 2012.

REFERENCES

  1. 1.↵
    1. Osman MM,
    2. Tran IT,
    3. Muzaffar R,
    4. Parkar N,
    5. Sachdeva A,
    6. Ruppel GL
    . Does 18F-FDG uptake by respiratory muscles on PET/CT correlate with chronic obstructive pulmonary disease? J Nucl Med Technol. 2011;39:252–257.
    OpenUrlAbstract/FREE Full Text
  2. 2.↵
    1. Paquet N,
    2. Albert A,
    3. Foidart J,
    4. Hustinx R
    . Within-patient variability of 18F-FDG: standardized uptake values in normal tissues. J Nucl Med. 2004;45:784–788.
    OpenUrlAbstract/FREE Full Text
  3. 3.↵
    1. Wahl RL,
    2. Jacene H,
    3. Kasamon Y,
    4. Lodge M
    . From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50(suppl):122S–150S.
    OpenUrlAbstract/FREE Full Text
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Journal of Nuclear Medicine Technology: 40 (3)
Journal of Nuclear Medicine Technology
Vol. 40, Issue 3
September 1, 2012
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Reply: Respiratory Muscle 18F-FDG Uptake
Razi Muzaffar, Medhat M. Osman
Journal of Nuclear Medicine Technology Sep 2012, 40 (3) 210; DOI: 10.2967/jnmt.112.104646

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Reply: Respiratory Muscle 18F-FDG Uptake
Razi Muzaffar, Medhat M. Osman
Journal of Nuclear Medicine Technology Sep 2012, 40 (3) 210; DOI: 10.2967/jnmt.112.104646
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