99mTc-labelled glucosamine in the assessment of systemic sclerosis inflammatory lung disease: a novel inexpensive investigative tool with predictive value

H Englert; B L Richards; S Angelides; V Kumar; D Spencer; G Howe; N Manolios

doi:10.1007/s12149-021-01653-0

^99mTc-labelled glucosamine in the assessment of systemic sclerosis inflammatory lung disease: a novel inexpensive investigative tool with predictive value

Ann Nucl Med. 2021 Oct;35(10):1157-1166. doi: 10.1007/s12149-021-01653-0. Epub 2021 Jul 28.

Authors

H Englert^#^{1

2}, B L Richards^#³, S Angelides^{4

5}, V Kumar^{6

7}, D Spencer^{2

7}, G Howe⁸, N Manolios^{6

8}

Affiliations

¹ Staff Specialist Blacktown Hospital, Sydney, Australia.
² Visiting Medical Officer Westmead Hospital, Sydney, NSW, Australia.
³ Staff Specialist Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁴ Nuclear Medicine Dept, Westmead Hospital, Westmead, Sydney, Australia. socrates.angelides@health.nsw.gov.au.
⁵ Faculty Medical Health, University of Sydney, Sydney, NSW, Australia. socrates.angelides@health.nsw.gov.au.
⁶ Nuclear Medicine Dept, Westmead Hospital, Westmead, Sydney, Australia.
⁷ Faculty Medical Health, University of Sydney, Sydney, NSW, Australia.
⁸ Rheumatology Department, Westmead Hospital, Sydney, Australia.

^# Contributed equally.

PMID: 34319547
DOI: 10.1007/s12149-021-01653-0

Abstract

Objective: To evaluate the role of ^99mTc-labelled glucosamine [^99mTc-ECDG] as a clinical biomarker for the early detection of interstitial lung disease (ILD) in systemic sclerosis (SSc).

Methods: In this prospective pilot study, glucosamine scanning (GS) was performed in 15 SSc patients, with and without ILD. Collected data included patient disease characteristics, autoantibody profile, GS results, high-resolution computerised tomography [HRCT], pulmonary function tests [PFT], and transthoracic echocardiogram [TTE]. Glucosamine results were correlated with patient clinical profile, HRCT, and PFT's findings.

Results: Lung uptake of ^99mTc-ECDG was high in 4 patients, moderate in 3, mild in 5, and normal in 3 with SSc, respectively. Of the patients with high and moderate uptake there was a 100% correlation between ^99mTc-ECDG uptake and HRCT showing ILD. Of the 5 patients with mild ^99mTc-ECDG uptake, 4 patients had aspiration pneumonia, and 1 had early ILD using HRCT. Of the 3 patients with normal ^99mTc-ECDG, 2 had normal HRCTs; the third had severe pulmonary arterial hypertension with minimal HRCT changes of ILD. High and moderate ^99mTc-ECDG lung uptake predicted abnormal PFT's in 100% of cases. In 3 patients, there was less extensive disease depicted on the ^99mTc-ECDG scans than on the HRCT. These patients demonstrated a more favourable outcome than would have been expected from the HRCT scans alone. Mild ^99mTc-ECDG lung uptake correlated with abnormal PFT's in 60% of cases. The pattern of ^99mTc-ECDG uptake was excellent (100%) at distinguishing metabolically active ILD from aspiration pneumonia. Diffuse uptake was noted in the former and patchy uptake in the latter disease entity.

Conclusion: Increased ^99mTc-ECDG uptake in scleroderma lung correlated positively with both structural and functional changes. ^99mTc-ECDG is a useful adjunct helping elucidate inflammation secondary to aspiration pneumonia and/or other causes of abnormal PFT's.

Keywords: Glucosamine; Glucosamine scan; Inflammatory lung disease; Interstitial lung disease; Nuclear scan; Systemic sclerosis.

MeSH terms

Adult
Glucosamine*
Humans
Lung Diseases, Interstitial*
Middle Aged
Pilot Projects
Respiratory Function Tests

Substances

Glucosamine