Rationale and Objectives
The aim of this study was to assess the feasibility of 18 F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) to systematically detect and quantify differential effects of chronic tobacco use in organs of the whole body.
Materials and Methods
Twenty healthy male subjects (10 nonsmokers and 10 chronic heavy smokers) were enrolled. Subjects underwent whole-body FDG-PET/CT, diagnostic unenhanced chest CT, mini-mental state examination, urine testing for oxidative stress, and serum testing. The organs of interest (thyroid, skin, skeletal muscle, aorta, heart, lung, adipose tissue, liver, spleen, brain, lumbar spinal bone marrow, and testis) were analyzed on FDG-PET/CT images to determine their metabolic activities using standardized uptake value (SUV) or metabolic volumetric product (MVP). Measurements were compared between subject groups using two-sample t tests or Wilcoxon rank-sum tests as determined by tests for normality. Correlational analyses were also performed.
Results
FDG-PET/CT revealed significantly decreased metabolic activity of lumbar spinal bone marrow (MVPmean: 29.8 ± 9.7 cc vs 40.8 ± 11.6 cc, P = 0.03) and liver (SUVmean: 1.8 ± 0.2 vs 2.0 ± 0.2, P = 0.049) and increased metabolic activity of visceral adipose tissue (SUVmean: 0.35 ± 0.10 vs 0.26 ± 0.06, P = 0.02) in chronic smokers compared to nonsmokers. Normalized visceral adipose tissue volume was also significantly decreased ( P = 0.04) in chronic smokers. There were no statistically significant differences in the metabolic activity of other assessed organs.
Conclusions
Subclinical organ effects of chronic tobacco use are detectable and quantifiable on FDG-PET/CT. FDG-PET/CT may, therefore, play a major role in the study of systemic toxic effects of tobacco use in organs of the whole body for clinical or research purposes.
Introduction
Smoking is one of the most important sources of toxic exposure in humans, and is a major cause of morbidity and mortality worldwide. It is associated with a wide variety of disease conditions that affect multiple organ systems of the body secondary to increased levels of cellular oxidative stress, receptor binding, genetic mutations, and release of proinflammatory chemical substances. However, the subclinical metabolic and proinflammatory effects of chronic tobacco use have not been systematically assessed body wide at the organ level in humans, largely due to the lack of available robust quantitative diagnostic techniques for this purpose. The ability to detect and to quantify the severity of the subclinical organ effects of chronic tobacco use may be important to determine individualized risk for development of various disease conditions, to foster smoking cessation, and to monitor the effects of interventions utilized to mitigate the adverse effects of smoking.
18 F-2-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is a molecular imaging technique that is available for accurate quantitative assessment of cellular metabolism in the whole body. Although FDG-PET/CT is predominantly used to assess patients with cancer in clinical practice, it is also useful to noninvasively detect and quantify inflammation, infection, and other etiologies of altered tissue metabolism in organs of the body . As such, it is reasonable to hypothesize that FDG-PET/CT can be used to assess the subclinical metabolic and proinflammatory effects of smoking. Yet, to our knowledge, no human studies with FDG-PET/CT have been performed to systematically study the effects of chronic tobacco use upon organs of the whole body. Therefore, in this pilot study, we assessed the feasibility of FDG-PET/CT to quantitatively assess the differential metabolic and inflammatory changes in organs of the whole body in relation to chronic tobacco use.
Materials and Methods
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Study Sample
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Whole-body FDG-PET/CT and Thoracic Diagnostic CT Image Acquisition
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Nonimaging-based Assessments
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Whole-body FDG-PET/CT and Thoracic Diagnostic CT Image Analysis
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Statistical Analysis
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Results
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TABLE 1
Subject MMSE and Urinary Laboratory Test Results Based on Smoking Status
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MMSE, mini-mental state examination.
Results are displayed as mean ± standard deviation with significant P values (<0.05) in the last column highlighted in gray.
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TABLE 2
Subject Serum Laboratory Test Results Based on Smoking Status
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Results are displayed as mean ± standard deviation with significant P values (<0.05) in the last column highlighted in gray.
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TABLE 3
Subject Organ Properties Measured on PET/CT and Diagnostic Thoracic CT Based on Smoking Status
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cSUVmean, partial volume corrected mean standardized uptake value; MVPmean, mean metabolic volumetric product; PET/CT, positron emission tomography/computed tomography; SAT, subcutaneous adipose tissue; SUVmean, mean standardized uptake value; VAT, visceral adipose tissue.
Results are displayed as mean ± standard deviation with significant P values (<0.05) in the last column highlighted in gray.
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Discussion
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Conclusion
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Acknowledgments
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