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Brose A, Michalski K, Ruf J, Tosch M, Eschmann SM, Schreckenberger M, König J, Nestle U, Miederer M. PET/CT reading for relapse in non-small cell lung cancer after chemoradiotherapy in the PET-Plan trial cohort. Cancer Imaging 2023; 23:45. [PMID: 37198668 DOI: 10.1186/s40644-023-00567-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 05/09/2023] [Indexed: 05/19/2023] Open
Abstract
BACKGROUND Current studies indicate that fluorine-18-fluorodeoxyglucose positron emission tomography/ computed tomography ([18F]FDG PET/CT) is the most accurate imaging modality for the detection of relapsed locally advanced non-small cell lung cancer (NSCLC) after curatively intended chemoradiotherapy. To this day, there is no objective and reproducible definition for the diagnosis of disease recurrence in PET/CT, the reading of which is relevantly influenced by post radiation inflammatory processes. The aim of this study was to evaluate and compare visual and threshold-based semi-automated evaluation criteria for the assessment of suspected tumor recurrence in a well-defined study population investigated during the randomized clinical PET-Plan trial. METHODS This retrospective analysis comprises 114 PET/CT data sets of 82 patients from the PET-Plan multi-center study cohort who underwent [18F]FDG PET/CT imaging at different timepoints for relapse, as suspected by CT. Scans were first analyzed visually by four blinded readers using a binary scoring system for each possible localization and the associated reader certainty of the evaluation. Visual evaluations were conducted repeatedly without and with additional knowledge of the initial staging PET and radiotherapy delineation volumes. In a second step, uptake was measured quantitatively using maximum standardized uptake value (SUVmax), peak standardized uptake value corrected for lean body mass (SULpeak), and a liver threshold-based quantitative assessment model. Resulting sensitivity and specificity for relapse detection were compared to the findings in the visual assessment. The gold standard of recurrence was independently defined by prospective study routine including external reviewers using CT, PET, biopsies and clinical course of the disease. RESULTS Overall interobserver agreement (IOA) of the visual assessment was moderate with a high difference between secure (ĸ = 0.66) and insecure (ĸ = 0.24) evaluations. Additional knowledge of the initial staging PET and radiotherapy delineation volumes improved the sensitivity (0.85 vs 0.92) but did not show significant impact on the specificity (0.86 vs 0.89). PET parameters SUVmax and SULpeak showed lower accuracy compared to the visual assessment, whereas threshold-based reading showed similar sensitivity (0.86) and higher specificity (0.97). CONCLUSION Visual assessment especially if associated with high reader certainty shows very high interobserver agreement and high accuracy that can be further increased by baseline PET/CT information. The implementation of a patient individual liver threshold value definition, similar to the threshold definition in PERCIST, offers a more standardized method matching the accuracy of experienced readers albeit not providing further improvement of accuracy.
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Affiliation(s)
- Alexander Brose
- Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany.
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Giessen, Germany.
| | - Kerstin Michalski
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
- Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juri Ruf
- Department of Nuclear Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marco Tosch
- Department of Nuclear Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany
- Department of Medicine, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - Susanne M Eschmann
- Department of Nuclear Medicine, Marienhospital Stuttgart, Stuttgart, Germany
| | - Mathias Schreckenberger
- Department of Nuclear Medicine, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jochem König
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ursula Nestle
- Department of Radiation Oncology, Kliniken Maria Hilf, Mönchengladbach, Germany
- Department of Radiation Oncology, University Hospital Freiburg, Freiburg, Germany
| | - Matthias Miederer
- Department of Translational Imaging in Oncology, National Center for Tumor Diseases (NCT/UCC) Dresden, Germany: German Cancer Research Center (DKFZ), Heidelberg, Faculty of Medicine and University Hospital Carl Gustav Carus, University of Technology Dresden (TUD), Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany
- Department of Nuclear Medicine, University Medical Center Mainz, Johannes Gutenberg-University Mainz, Mainz, Germany
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Gillman JA, Pantel AR, Mankoff DA, Edmonds CE. Update on Quantitative Imaging for Predicting and Assessing Response in Oncology. Semin Nucl Med 2020; 50:505-517. [PMID: 33059820 PMCID: PMC9788668 DOI: 10.1053/j.semnuclmed.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Molecular imaging has revolutionized clinical oncology by imaging-specific facets of cancer biology. Through noninvasive measurements of tumor physiology, targeted radiotracers can serve as biomarkers for disease characterization, prognosis, response assessment, and predicting long-term response/survival. In turn, these imaging biomarkers can be utilized to tailor therapeutic regimens to tumor biology. In this article, we review biomarker applications for response assessment and predicting long-term outcomes. 18F-fluorodeoxyglucose (FDG), a measure of cellular glucose metabolism, is discussed in the context of lymphoma and breast and lung cancer. FDG has gained widespread clinical acceptance and has been integrated into the routine clinical care of several malignancies, most notably lymphoma. The novel radiotracers 16α-18F-fluoro-17β-estradiol and 18F-fluorothymidine are reviewed in application to the early prediction of response assessment of breast cancer. Through illustrative examples, we explore current and future applications of molecular imaging biomarkers in the advancement of precision medicine.
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Affiliation(s)
- Jennifer A Gillman
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Austin R Pantel
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David A Mankoff
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Christine E Edmonds
- Department of Radiology, Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA.
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Blautzik J, Grelich L, Schramm N, Henkel R, Bartenstein P, Pfluger T. What and how should we measure in paediatric oncology FDG-PET/CT? Comparison of commonly used SUV metrics for differentiation between paediatric tumours. EJNMMI Res 2019; 9:115. [PMID: 31872312 PMCID: PMC6928180 DOI: 10.1186/s13550-019-0577-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background In clinical routine, SUVmax and SUVpeak are most often used to determine the glucose metabolism in tumours by 18F-FDG PET/CT. Both metrics can be further normalised to SUVs in reference regions resulting in a SUV ratio (SUVratio). The aim of the study was to directly compare several widely used SUVs/SUVratios with regard to differentiation between common tumours in paediatric patients; a special focus was put on characteristics of reference region SUVs. Methods The final study population consisted of 61 children and adolescents with diagnoses of non-Hodgkin lymphoma (NHL, n = 25), Hodgkin lymphoma (HL, n = 14), and sarcoma (n = 22). SUV metrics included SUVmax and SUVpeak as well as both parameters normalised to liver and mediastinal blood pool, respectively, yielding the SUVratios SUVmax/liver, SUVmax/mediastinum, SUVpeak/liver, and SUVpeak/mediastinum. Results The metrics SUVmax, SUVpeak, SUVmax/liver, and SUVpeak/liver all proved to be sensitive for tumour differentiation (p ≤ 0.008); in contrast, SUVmax/mediastinum and SUVpeak/mediastinum revealed to be non-sensitive approaches. Correlation analyses showed inverse associations between reference region SUVs and SUVratios (p < 0.05). Multiple regression analyses demonstrated significant effects of factors as bodyweight and uptake time on reference region SUVs (p < 0.01), and thus indirectly on the corresponding SUVratios. Conclusions In the paediatric population, the ability to differentiate between common tumours remarkably varies between SUV metrics. When using SUVratios, the choice of reference region is crucial. Factors potentially influencing reference region SUVs (and thus SUVratios) should be taken into account in order to avoid erroneous conclusions. When not possible, SUVmax and SUVpeak represent less complex, more robust alternatives.
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Affiliation(s)
- Janusch Blautzik
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany. .,Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Institute for Radiology and Nuclear Medicine, Hirslanden Klinik St. Anna, Lucerne, Switzerland.
| | - Leonie Grelich
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Nicolai Schramm
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Nuclear Medicine, University Hospital, Würzburg, Germany
| | - Rebecca Henkel
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany.,Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Pfluger
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
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Rahmim A, Lodge MA, Karakatsanis NA, Panin VY, Zhou Y, McMillan A, Cho S, Zaidi H, Casey ME, Wahl RL. Dynamic whole-body PET imaging: principles, potentials and applications. Eur J Nucl Med Mol Imaging 2018; 46:501-518. [PMID: 30269154 DOI: 10.1007/s00259-018-4153-6] [Citation(s) in RCA: 126] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 08/28/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE In this article, we discuss dynamic whole-body (DWB) positron emission tomography (PET) as an imaging tool with significant clinical potential, in relation to conventional standard uptake value (SUV) imaging. BACKGROUND DWB PET involves dynamic data acquisition over an extended axial range, capturing tracer kinetic information that is not available with conventional static acquisition protocols. The method can be performed within reasonable clinical imaging times, and enables generation of multiple types of PET images with complementary information in a single imaging session. Importantly, DWB PET can be used to produce multi-parametric images of (i) Patlak slope (influx rate) and (ii) intercept (referred to sometimes as "distribution volume"), while also providing (iii) a conventional 'SUV-equivalent' image for certain protocols. RESULTS We provide an overview of ongoing efforts (primarily focused on FDG PET) and discuss potential clinically relevant applications. CONCLUSION Overall, the framework of DWB imaging [applicable to both PET/CT(computed tomography) and PET/MRI (magnetic resonance imaging)] generates quantitative measures that may add significant value to conventional SUV image-derived measures, with limited pitfalls as we also discuss in this work.
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Affiliation(s)
- Arman Rahmim
- Department of Radiology and Radiological Science, Johns Hopkins University, JHOC Building Room 3245, 601 N. Caroline St, Baltimore, MD, 21287, USA. .,Departments of Radiology and Physics & Astronomy, University of British Columbia, Vancouver, BC, V5Z 1M9, Canada.
| | - Martin A Lodge
- Department of Radiology and Radiological Science, Johns Hopkins University, JHOC Building Room 3245, 601 N. Caroline St, Baltimore, MD, 21287, USA
| | | | | | - Yun Zhou
- Department of Radiology and Radiological Science, Johns Hopkins University, JHOC Building Room 3245, 601 N. Caroline St, Baltimore, MD, 21287, USA
| | - Alan McMillan
- Department of Radiology, University of Wisconsin, Madison, WI, 53705, USA
| | - Steve Cho
- Department of Radiology, University of Wisconsin, Madison, WI, 53705, USA
| | - Habib Zaidi
- Division of Nuclear Medicine and Molecular Imaging, Geneva University Hospital, CH-1211, Geneva, Switzerland
| | | | - Richard L Wahl
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, 63110, USA
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Zhang J, Liu X, Knopp MI, Ramaswamy B, Knopp MV. How Long of a Dynamic 3'-Deoxy-3'-[ 18F]fluorothymidine ([ 18F]FLT) PET Acquisition Is Needed for Robust Kinetic Analysis in Breast Cancer? Mol Imaging Biol 2018; 21:382-390. [PMID: 29987617 DOI: 10.1007/s11307-018-1231-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To quantitatively evaluate the minimally required scanning time of 3'-deoxy-3'-[18F]fluorothymidine ([18F]FLT) positron emission tomography (PET) dynamic acquisition for accurate kinetic assessment of the proliferation in breast cancer tumors. PROCEDURES Within a therapeutic intervention trial, 26 breast tumors of 8 breast cancer patients were analyzed from 30-min dynamic [18F]FLT-PET acquisitions. PET/CT was acquired on a Gemini TF 64 system (Philips Healthcare) and reconstructed into 26 frames (8 × 15 s, 6 × 30 s, 5 × 1 min, 5 × 2 min, and 2 × 5 min). Maximum activity concentrations (Bq/ml) of volume of interests over tumors and plasma in descending aorta were obtained over time frames. Kinetic parameters were estimated using in-house developed software with the two-tissue three-compartment irreversible model (2TCM) (K1, k2, k3, and Ki; k4 = 0) and Patlak model (Ki) based on different acquisition durations (Td) (10, 12, 14, 16, 20, 25, and 30 min, separately). Different linear regression onset time (T0) points (1, 2, 3, 4, and 5 min) were applied in Patlak analysis. Ki of the 30-min data set was taken as the gold standard for comparison. Pearson product-moment correlation coefficient (R) of 0.9 was chosen as a limit for the correlation. RESULTS The correlation of kinetic parameters between the gold standard and the abbreviated dynamic data series increased with longer Td from 10 to 30 min. k2 and k3 using 2TCM and Ki using Patlak model revealed poor correlations for dynamic PET with Td ≤ 14 min (k2: R = 0.84, 0.85, 0.86; k3: R = 0.67, 0.67, 0.67; Ki: R = 0.72, 0.78, 0.87 at Td = 10, 12, and 14 min, respectively). Excellent correlations were shown for all kinetic parameters when Td ≥ 16 min regardless of the kinetic model and T0 value (R > 0.9). CONCLUSIONS This study indicates that a 16-min dynamic PET acquisition appears to be sufficient to provide accurate [18F]FLT kinetics to quantitatively assess the proliferation in breast cancer lesions.
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Affiliation(s)
- Jun Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Xiaoli Liu
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Michelle I Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA.
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Effects of blood glucose level on 18F-FDG uptake for PET/CT in normal organs: A systematic review. PLoS One 2018; 13:e0193140. [PMID: 29486008 PMCID: PMC5828444 DOI: 10.1371/journal.pone.0193140] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 02/05/2018] [Indexed: 11/19/2022] Open
Abstract
Purpose To perform a systematic review of the effect of blood glucose levels on 2-Deoxy-2-[18F]fluoro-D-glucose (18F-FDG) uptake in normal organs. Methods We searched the MEDLINE, EMBASE and Cochrane databases through 22 April 2017 to identify all relevant studies using the keywords “PET/CT” (positron emission tomography/computed tomography), “standardized uptake value” (SUV), “glycemia,” and “normal.” Analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations. Maximum and mean SUVs and glycemia were the main parameters analyzed. To objectively measure the magnitude of the association between glycemia and 18F-FDG uptake in different organs, we calculated the effect size (ES) and the coefficient of determination (R2) whenever possible. Results The literature search yielded 225 results, and 14 articles met the inclusion criteria; studies included a total of 2714 (range, 51–557) participants. The brain SUV was related significantly and inversely to glycemia (ES = 1.26; R2 0.16–0.58). Although the liver and mediastinal blood pool were significantly affected by glycemia, the magnitudes of these associations were small (ES = 0.24–0.59, R2 = 0.01–0.08) and negligible (R2 = 0.02), respectively. Lung, bone marrow, tumor, spleen, fat, bowel, and stomach 18F-FDG uptakes were not influenced by glycemia. Individual factors other than glycemia can also affect 18F-FDG uptake in different organs, and body mass index appears to be the most important of these factors. Conclusion The impact of glycemia on SUVs in most organs is either negligible or too small to be clinically significant. The brain SUV was the only value largely affected by glycemia.
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7
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Pulmonary 18F-FDG uptake helps refine current risk stratification in idiopathic pulmonary fibrosis (IPF). Eur J Nucl Med Mol Imaging 2018; 45:806-815. [PMID: 29335764 PMCID: PMC5978900 DOI: 10.1007/s00259-017-3917-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/14/2017] [Indexed: 12/11/2022]
Abstract
Purpose There is a lack of prognostic biomarkers in idiopathic pulmonary fibrosis (IPF) patients. The objective of this study is to investigate the potential of 18F-FDG-PET/ CT to predict mortality in IPF. Methods A total of 113 IPF patients (93 males, 20 females, mean age ± SD: 70 ± 9 years) were prospectively recruited for 18F-FDG-PET/CT. The overall maximum pulmonary uptake of 18F-FDG (SUVmax), the minimum pulmonary uptake or background lung activity (SUVmin), and target-to-background (SUVmax/ SUVmin) ratio (TBR) were quantified using routine region-of-interest analysis. Kaplan–Meier analysis was used to identify associations of PET measurements with mortality. We also compared PET associations with IPF mortality with the established GAP (gender age and physiology) scoring system. Cox analysis assessed the independence of the significant PET measurement(s) from GAP score. We investigated synergisms between pulmonary 18F-FDG-PET measurements and GAP score for risk stratification in IPF patients. Results During a mean follow-up of 29 months, there were 54 deaths. The mean TBR ± SD was 5.6 ± 2.7. Mortality was associated with high pulmonary TBR (p = 0.009), low forced vital capacity (FVC; p = 0.001), low transfer factor (TLCO; p < 0.001), high GAP index (p = 0.003), and high GAP stage (p = 0.003). Stepwise forward-Wald–Cox analysis revealed that the pulmonary TBR was independent of GAP classification (p = 0.010). The median survival in IPF patients with a TBR < 4.9 was 71 months, whilst in those with TBR > 4.9 was 24 months. Combining PET data with GAP data (“PET modified GAP score”) refined the ability to predict mortality. Conclusions A high pulmonary TBR is independently associated with increased risk of mortality in IPF patients. Electronic supplementary material The online version of this article (10.1007/s00259-017-3917-8) contains supplementary material, which is available to authorized users.
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Mansor S, Pfaehler E, Heijtel D, Lodge MA, Boellaard R, Yaqub M. Impact of PET/CT system, reconstruction protocol, data analysis method, and repositioning on PET/CT precision: An experimental evaluation using an oncology and brain phantom. Med Phys 2017; 44:6413-6424. [PMID: 28994465 PMCID: PMC5734628 DOI: 10.1002/mp.12623] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 10/03/2017] [Accepted: 10/03/2017] [Indexed: 12/02/2022] Open
Abstract
Purpose In longitudinal oncological and brain PET/CT studies, it is important to understand the repeatability of quantitative PET metrics in order to assess change in tracer uptake. The present studies were performed in order to assess precision as function of PET/CT system, reconstruction protocol, analysis method, scan duration (or image noise), and repositioning in the field of view. Methods Multiple (repeated) scans have been performed using a NEMA image quality (IQ) phantom and a 3D Hoffman brain phantom filled with 18F solutions on two systems. Studies were performed with and without randomly (< 2 cm) repositioning the phantom and all scans (12 replicates for IQ phantom and 10 replicates for Hoffman brain phantom) were performed at equal count statistics. For the NEMA IQ phantom, we studied the recovery coefficients (RC) of the maximum (SUVmax), peak (SUVpeak), and mean (SUVmean) uptake in each sphere as a function of experimental conditions (noise level, reconstruction settings, and phantom repositioning). For the 3D Hoffman phantom, the mean activity concentration was determined within several volumes of interest and activity recovery and its precision was studied as function of experimental conditions. Results The impact of phantom repositioning on RC precision was mainly seen on the Philips Ingenuity PET/CT, especially in the case of smaller spheres (< 17 mm diameter, P < 0.05). This effect was much smaller for the Siemens Biograph system. When exploring SUVmax, SUVpeak, or SUVmean of the spheres in the NEMA IQ phantom, it was observed that precision depended on phantom repositioning, reconstruction algorithm, and scan duration, with SUVmax being most and SUVpeak least sensitive to phantom repositioning. For the brain phantom, regional averaged SUVs were only minimally affected by phantom repositioning (< 2 cm). Conclusion The precision of quantitative PET metrics depends on the combination of reconstruction protocol, data analysis methods and scan duration (scan statistics). Moreover, precision was also affected by phantom repositioning but its impact depended on the data analysis method in combination with the reconstructed voxel size (tissue fraction effect). This study suggests that for oncological PET studies the use of SUVpeak may be preferred over SUVmax because SUVpeak is less sensitive to patient repositioning/tumor sampling.
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Affiliation(s)
- Syahir Mansor
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Elisabeth Pfaehler
- Faculty of Medical Sciences, Nuclear Medicine and Molecular Imaging, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Dennis Heijtel
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Martin A Lodge
- PET Center, Johns Hopkins Hospital, Nelson B1125, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Ronald Boellaard
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Faculty of Medical Sciences, Nuclear Medicine and Molecular Imaging, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Maqsood Yaqub
- Department of Radiology & Nuclear Medicine, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Olin A, Ladefoged CN, Langer NH, Keller SH, Löfgren J, Hansen AE, Kjær A, Langer SW, Fischer BM, Andersen FL. Reproducibility of MR-Based Attenuation Maps in PET/MRI and the Impact on PET Quantification in Lung Cancer. J Nucl Med 2017; 59:999-1004. [PMID: 29123008 DOI: 10.2967/jnumed.117.198853] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 10/30/2017] [Indexed: 11/16/2022] Open
Abstract
Quantitative PET/MRI is dependent on reliable and reproducible MR-based attenuation correction (MR-AC). In this study, we evaluated the quality of current vendor-provided thoracic MR-AC maps and further investigated the reproducibility of their impact on 18F-FDG PET quantification in patients with non-small cell lung cancer. Methods: Eleven patients with inoperable non-small cell lung cancer underwent 2-5 thoracic PET/MRI scan-rescan examinations within 22 d. 18F-FDG PET data were acquired along with 2 Dixon MR-AC maps for each examination. Two PET images (PETA and PETB) were reconstructed using identical PET emission data but with MR-AC from these intrasubject repeated attenuation maps. In total, 90 MR-AC maps were evaluated visually for quality and the occurrence of categorized artifacts by 2 PET/MRI-experienced physicians. Each tumor was outlined by a volume of interest (40% isocontour of maximum) on PETA, which was then projected onto the corresponding PETB SUVmean and SUVmax were assessed from the PET images. Within-examination coefficients of variation and Bland-Altman analyses were conducted for the assessment of SUV variations between PETA and PETBResults: Image artifacts were observed in 86% of the MR-AC maps, and 30% of the MR-AC maps were subjectively expected to affect the tumor SUV. SUVmean and SUVmax resulted in coefficients of variation of 5.6% and 6.6%, respectively, and scan-rescan SUV variations were within ±20% in 95% of the cases. Substantial SUV variations were seen mainly for scan-rescan examinations affected by respiratory motion. Conclusion: Artifacts occur frequently in standard thoracic MR-AC maps, affecting the reproducibility of PET/MRI. These, in combination with other well-known sources of error associated with PET/MRI examinations, lead to inconsistent SUV measurements in serial studies, which may affect the reliability of therapy response assessment. A thorough visual inspection of the thoracic MR-AC map and Dixon images from which it is derived remains crucial for the detection of MR-AC artifacts that may influence the reliability of SUV.
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Affiliation(s)
- Anders Olin
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Claes N Ladefoged
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Natasha H Langer
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Sune H Keller
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Johan Löfgren
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Adam E Hansen
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Andreas Kjær
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Seppo W Langer
- Department of Oncology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Barbara M Fischer
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
| | - Flemming L Andersen
- Department of Clinical Physiology, Nuclear Medicine, and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; and
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Sakane M, Tatsumi M, Hori M, Onishi H, Tsuboyama T, Nakamoto A, Ota T, Eguchi H, Wakasa K, Hatazawa J, Tomiyama N. Volumetric parameters of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography can predict histopathologic treatment response after neoadjuvant chemoradiotherapy in pancreatic adenocarcinoma. Eur J Radiol 2017; 94:64-69. [PMID: 28712692 DOI: 10.1016/j.ejrad.2017.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/06/2017] [Accepted: 05/18/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE The purpose of this study was to investigate the clinical potential of 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (FDG PET/CT) to evaluate histopathologic effects of preoperative chemoradiotherapy (CRT) in pancreatic adenocarcinoma, with particular focus on volumetric PET/CT parameters. MATERIAL AND METHODS This study included 25 patients with pancreatic adenocarcinoma who underwent radical surgery after gemcitabine- and S-1-based preoperative-CRT. The extent of residual tumor was graded using the Evans grading systems, and patients with more than 50% destruction of tumor cells were defined as responder. Peak SUV corrected for lean body mass (SULpeak), metabolic tumor volume (MTV) with a threshold of SUV=2.0, total lesion glycolysis (TLG) of pre- and post-CRT, and reduction rates of SULpeak in those parameters were assessed by PET/CT. These parameters were compared using the student's t-test between responder and non-responder. The treatment effect was also assessed by contingency table analysis divided with median value of each parameter using chi-square tests. RESULTS Eight patients (32%) showed histopathologic poor response (Evans grade I), 11 cases (44%) had mild response (Evans grade IIa), and six cases (24%) had moderate response (Evans grade IIb); therefore, six cases (24%) were assigned to responders and others 19 cases (76%) were non-responders. With regards to volumetric PET parameters, post-CRT SULpeak of responders was significantly lower than that of non-responders (p=0.013). Post-CRT MTV and TLG were negative for all six cases of responders. There were significant differences between responder and non-responder on the contingency table analysis of post-CRT MTV and TLG status (p=0.014 for both). CONCLUSIONS This study demonstrated that the volumetric PET/CT parameters, higher post-treatment SULpeak and positive MTV/TLG could predict the unfavorable histopathological effects of CRT in patients with pancreatic adenocarcinoma.
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Affiliation(s)
- Makoto Sakane
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Mitsuaki Tatsumi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan; Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan.
| | - Masatoshi Hori
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Hiromitsu Onishi
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Takahiro Tsuboyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Atsushi Nakamoto
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Takashi Ota
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Japan.
| | - Kenichi Wakasa
- Department of Diagnostic Pathology, Ishikiriseiki Hospital, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Japan.
| | - Noriyuki Tomiyama
- Department of Diagnostic and Interventional Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita-shi, Osaka, 565-0871, Japan.
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11
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Schmitz J, Schwab J, Schwenck J, Chen Q, Quintanilla-Martinez L, Hahn M, Wietek B, Schwenzer N, Staebler A, Kohlhofer U, Aina OH, Hubbard NE, Reischl G, Borowsky AD, Brucker S, Nikolaou K, la Fougère C, Cardiff RD, Pichler BJ, Schmid AM. Decoding Intratumoral Heterogeneity of Breast Cancer by Multiparametric In Vivo Imaging: A Translational Study. Cancer Res 2016; 76:5512-22. [PMID: 27466286 PMCID: PMC5414858 DOI: 10.1158/0008-5472.can-15-0642] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 07/06/2016] [Indexed: 01/20/2023]
Abstract
Differential diagnosis and therapy of heterogeneous breast tumors poses a major clinical challenge. To address the need for a comprehensive, noninvasive strategy to define the molecular and functional profiles of tumors in vivo, we investigated a novel combination of metabolic PET and diffusion-weighted (DW)-MRI in the polyoma virus middle T antigen transgenic mouse model of breast cancer. The implementation of a voxelwise analysis for the clustering of intra- and intertumoral heterogeneity in this model resulted in a multiparametric profile based on [(18)F]Fluorodeoxyglucose ([(18)F]FDG)-PET and DW-MRI, which identified three distinct tumor phenotypes in vivo, including solid acinar, and solid nodular malignancies as well as cystic hyperplasia. To evaluate the feasibility of this approach for clinical use, we examined estrogen receptor-positive and progesterone receptor-positive breast tumors from five patient cases using DW-MRI and [(18)F]FDG-PET in a simultaneous PET/MRI system. The postsurgical in vivo PET/MRI data were correlated to whole-slide histology using the latter traditional diagnostic standard to define phenotype. By this approach, we showed how molecular, structural (microscopic, anatomic), and functional information could be simultaneously obtained noninvasively to identify precancerous and malignant subtypes within heterogeneous tumors. Combined with an automatized analysis, our results suggest that multiparametric molecular and functional imaging may be capable of providing comprehensive tumor profiling for noninvasive cancer diagnostics. Cancer Res; 76(18); 5512-22. ©2016 AACR.
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Affiliation(s)
- Jennifer Schmitz
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Julian Schwab
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Johannes Schwenck
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany. Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Qian Chen
- Center for Comparative Medicine, University of California, Davis, California
| | | | - Markus Hahn
- Department of Women's Health, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Beate Wietek
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany
| | - Nina Schwenzer
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany
| | - Annette Staebler
- Department of Pathology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Ursula Kohlhofer
- Department of Pathology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Olulanu H Aina
- Center for Comparative Medicine, University of California, Davis, California
| | - Neil E Hubbard
- Center for Comparative Medicine, University of California, Davis, California
| | - Gerald Reischl
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | | | - Sara Brucker
- Department of Women's Health, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University, Tuebingen, Germany. German Cancer Consortium, German Cancer Research Center, Tuebingen, Germany
| | - Christian la Fougère
- Department of Nuclear Medicine and Clinical Molecular Imaging, Eberhard Karls University Tuebingen, Tuebingen, Germany. German Cancer Consortium, German Cancer Research Center, Tuebingen, Germany
| | - Robert D Cardiff
- Center for Comparative Medicine, University of California, Davis, California
| | - Bernd J Pichler
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany. German Cancer Consortium, German Cancer Research Center, Tuebingen, Germany
| | - Andreas M Schmid
- Department of Preclinical Imaging and Radiopharmacy, Werner Siemens Imaging Center, Eberhard Karls University Tuebingen, Tuebingen, Germany.
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12
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18F-FDG PET/CT quantification in head and neck squamous cell cancer: principles, technical issues and clinical applications. Eur J Nucl Med Mol Imaging 2016; 43:1360-75. [DOI: 10.1007/s00259-015-3294-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/14/2015] [Indexed: 01/28/2023]
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13
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Karakatsanis NA, Zhou Y, Lodge MA, Casey ME, Wahl RL, Zaidi H, Rahmim A. Generalized whole-body Patlak parametric imaging for enhanced quantification in clinical PET. Phys Med Biol 2015; 60:8643-73. [PMID: 26509251 DOI: 10.1088/0031-9155/60/22/8643] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
We recently developed a dynamic multi-bed PET data acquisition framework to translate the quantitative benefits of Patlak voxel-wise analysis to the domain of routine clinical whole-body (WB) imaging. The standard Patlak (sPatlak) linear graphical analysis assumes irreversible PET tracer uptake, ignoring the effect of FDG dephosphorylation, which has been suggested by a number of PET studies. In this work: (i) a non-linear generalized Patlak (gPatlak) model is utilized, including a net efflux rate constant kloss, and (ii) a hybrid (s/g)Patlak (hPatlak) imaging technique is introduced to enhance contrast to noise ratios (CNRs) of uptake rate Ki images. Representative set of kinetic parameter values and the XCAT phantom were employed to generate realistic 4D simulation PET data, and the proposed methods were additionally evaluated on 11 WB dynamic PET patient studies. Quantitative analysis on the simulated Ki images over 2 groups of regions-of-interest (ROIs), with low (ROI A) or high (ROI B) true kloss relative to Ki, suggested superior accuracy for gPatlak. Bias of sPatlak was found to be 16-18% and 20-40% poorer than gPatlak for ROIs A and B, respectively. By contrast, gPatlak exhibited, on average, 10% higher noise than sPatlak. Meanwhile, the bias and noise levels for hPatlak always ranged between the other two methods. In general, hPatlak was seen to outperform all methods in terms of target-to-background ratio (TBR) and CNR for all ROIs. Validation on patient datasets demonstrated clinical feasibility for all Patlak methods, while TBR and CNR evaluations confirmed our simulation findings, and suggested presence of non-negligible kloss reversibility in clinical data. As such, we recommend gPatlak for highly quantitative imaging tasks, while, for tasks emphasizing lesion detectability (e.g. TBR, CNR) over quantification, or for high levels of noise, hPatlak is instead preferred. Finally, gPatlak and hPatlak CNR was systematically higher compared to routine SUV values.
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Affiliation(s)
- Nicolas A Karakatsanis
- Division of Nuclear Medicine and Molecular Imaging, School of Medicine, University of Geneva, Geneva, CH-1211, Switzerland
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14
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Wangerin KA, Muzi M, Peterson LM, Linden HM, Novakova A, O'Sullivan F, Kurland BF, Mankoff DA, Kinahan PE. Effect of 18F-FDG uptake time on lesion detectability in PET imaging of early stage breast cancer. Tomography 2015; 1:53-60. [PMID: 26807443 PMCID: PMC4721230 DOI: 10.18383/j.tom.2015.00151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Prior reports have suggested that delayed FDG-PET oncology imaging can improve the contrast-to-noise ratio (CNR) for known lesions. Our goal was to estimate realistic bounds for lesion detectability for static measurements with one to four hours between FDG injection and image acquisition. Tumor and normal tissue kinetic model parameters were estimated from dynamic PET studies of patients with early stage breast cancer. These were used to generate time-activity curves (TACs) out to four hours, for which we assumed both nonreversible and reversible models with different rates of FDG dephosphorylation (k4). For each pair of tumor and normal tissue TACs, 600 PET sinogram realizations were generated, and images were reconstructed using OSEM. Test statistics for each tumor and normal tissue region of interest were output from the computer model observers and evaluated using an ROC analysis with the calculated AUC providing a measure of lesion detectability. For the nonreversible model (k4 = 0), the AUC increased in 11/23 (48%) of patients for one to two hours after the current standard post-radiotracer injection imaging window of one hour. This improvement was driven by increased tumor/normal tissue contrast before the impact of increased noise due to radiotracer decay began to dominate the imaging signal. As k4 was increased from 0 to 0.01 min-1, the time of maximum detectability shifted earlier, as the decreasing FDG concentration in the tumor lowered the CNR. These results imply that delayed PET imaging may reveal low-conspicuity lesions that would have otherwise gone undetected.
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Affiliation(s)
- Kristen A Wangerin
- Department of Bioengineering, University of Washington, Seattle, Washington
| | - Mark Muzi
- Department of Radiology, University of Washington, Seattle, Washington
| | - Lanell M Peterson
- Department of Radiology, University of Washington, Seattle, Washington
| | - Hannah M Linden
- Department of Medicine, University of Washington, Seattle, Washington
| | - Alena Novakova
- Department of Medicine, University of Washington, Seattle, Washington
| | | | - Brenda F Kurland
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David A Mankoff
- Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paul E Kinahan
- Department of Bioengineering, University of Washington, Seattle, Washington; Department of Radiology, University of Washington, Seattle, Washington
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15
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Huang B, Wong CYO, Lai V, Kwong DLW, Khong PL. Prognostic Value of (18)F-FDG PET-CT in Nasopharyngeal Carcinoma: Is Dynamic Scanning Helpful? BIOMED RESEARCH INTERNATIONAL 2015; 2015:582614. [PMID: 26064927 PMCID: PMC4431179 DOI: 10.1155/2015/582614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 03/24/2015] [Accepted: 03/25/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate the differences in prognostic values of static and dynamic PET-CT in nasopharyngeal carcinoma (NPC). MATERIAL AND METHODS Forty-five patients who had static scan were recruited. Sixteen had dynamic scan. The primary lesions were delineated from standardized uptake value (SUV) maps from static scan and K i maps from dynamic scan. The average follow-up lasted for 34 months. The patients who died or those with recurrence/residual disease were considered "poor outcome"; otherwise they were considered "good outcome." Fisher's exact test and ROC analysis were used to evaluate the prognostic value of various factors. RESULTS Tumor volume thresholded by 40% of maximal SUV (VOLSUV40) significantly predicted treatment outcome (p = 0.024) in the whole cohort. In 16 patients with dynamic scan, all parameters by dynamic scan were insignificant in predicting the outcome. The combination of maximal SUV, maximal K i , VOLSUV40, and VOL K i 37 (the tumor volume thresholded by 37% maximal K i ) achieved the highest predicting accuracy for treatment outcome with sensitivity, specificity, and accuracy of 100% in these 16 patients; however this improvement compared to VOLSUV40 was insignificant. CONCLUSION Tumor volume from static scan is useful in NPC prognosis. However, the role of dynamic scanning was not justified in this small cohort.
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Affiliation(s)
- Bingsheng Huang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | - Ching-Yee Oliver Wong
- Department of Diagnostic Radiology and Molecular Imaging, Oakland University William Beaumont School of Medicine, Royal Oak, MI 48073, USA
| | - Vincent Lai
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
| | | | - Pek-Lan Khong
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
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16
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Andersen FL, Ladefoged CN, Beyer T, Keller SH, Hansen AE, Højgaard L, Kjær A, Law I, Holm S. Combined PET/MR imaging in neurology: MR-based attenuation correction implies a strong spatial bias when ignoring bone. Neuroimage 2014; 84:206-16. [PMID: 23994317 DOI: 10.1016/j.neuroimage.2013.08.042] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 08/09/2013] [Accepted: 08/16/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Flemming Littrup Andersen
- Dept. of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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17
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Bai B, Bading J, Conti PS. Tumor quantification in clinical positron emission tomography. Am J Cancer Res 2013; 3:787-801. [PMID: 24312151 PMCID: PMC3840412 DOI: 10.7150/thno.5629] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/11/2013] [Indexed: 12/18/2022] Open
Abstract
Positron emission tomography (PET) is used extensively in clinical oncology for tumor detection, staging and therapy response assessment. Quantitative measurements of tumor uptake, usually in the form of standardized uptake values (SUVs), have enhanced or replaced qualitative interpretation. In this paper we review the current status of tumor quantification methods and their applications to clinical oncology. Factors that impede quantitative assessment and limit its accuracy and reproducibility are summarized, with special emphasis on SUV analysis. We describe current efforts to improve the accuracy of tumor uptake measurements, characterize overall metabolic tumor burden and heterogeneity of tumor uptake, and account for the effects of image noise. We also summarize recent developments in PET instrumentation and image reconstruction and their impact on tumor quantification. Finally, we offer our assessment of the current development needs in PET tumor quantification, including practical techniques for fully quantitative, pharmacokinetic measurements.
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18
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Sha W, Ye H, Iwamoto KS, Wong KP, Wilks MQ, Stout D, McBride W, Huang SC. Factors affecting tumor (18) F-FDG uptake in longitudinal mouse PET studies. EJNMMI Res 2013; 3:51. [PMID: 23841937 PMCID: PMC3718724 DOI: 10.1186/2191-219x-3-51] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/19/2013] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Many biological factors of 2-[(18) F]fluoro-2-deoxy-d-glucose ((18) F-FDG) in blood can affect (18) F-FDG uptake in tumors. In this study, longitudinal (18) F-FDG positron emission tomography (PET) studies were performed on tumor-bearing mice to investigate the effect of blood glucose level and tumor size on (18) F-FDG uptake in tumors. METHODS Six- to eight-week-old severe combined immunodeficiency mice were implanted with glioblastoma U87 (n = 8) or adenocarcinoma MDA-MB-231 (MDA) (n = 11) in the shoulder. When the tumor diameter was approximately 2.5 mm, a 60-min dynamic (18) F-FDG PET scan was performed weekly until the tumor diameter reached 10 mm. Regions of interests were defined in major organs and tumor. A plasma curve was derived based on a modeling method that utilizes the early heart time-activity curve and a late-time blood sample. The (18) F-FDG uptake constant K i was calculated using Patlak analysis on the tumors without an apparent necrotic center shown in the PET images. For each tumor type, the measured K i was corrected for partial volume (PV), and multivariate regression analysis was performed to examine the effects of blood glucose level ([Glc]) and tumor growth. Corrected Akaike's information criterion was used to determine the best model. RESULTS The regression model that best fit the PV-corrected K i for U87 data was K i /RC = (1/[Glc]) × (0.27 ± 0.027) mL/min/mL (where [Glc] is in mmol/L), and for MDA, it was K i /RC = (0.04 ± 0.005) mL/min/mL, where K i /RC denotes the PV-corrected K i using an individual recovery coefficient (RC). The results indicated that (18) F-FDG K i /RC for U87 was inversely related to [Glc], while [Glc] had no effect on (18) F-FDG K i /RC of MDA. After the effects of PV and [Glc] were accounted for, the data did not support any increase of (18) F-FDG K i as the tumor (of either type) grew larger in size. CONCLUSIONS The effect of [Glc] on the tumor (18) F-FDG K i was tumor-dependent. PV- and [Glc]-corrected (18) F-FDG K i did not show significant increase as the tumor of either type grew in size.
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Affiliation(s)
- Wei Sha
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Rm. B2-085H CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Hu Ye
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Rm. B2-085H CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Keisuke S Iwamoto
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Koon-Pong Wong
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Rm. B2-085H CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - Moses Quinn Wilks
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Rm. B2-085H CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA ; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - David Stout
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Rm. B2-085H CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA
| | - William McBride
- Department of Radiation Oncology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Sung-Cheng Huang
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Rm. B2-085H CHS, 10833 Le Conte Avenue, Los Angeles, CA 90095, USA ; Department of Biomathematics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
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Lubberink M, Direcks W, Emmering J, van Tinteren H, Hoekstra OS, van der Hoeven JJ, Molthoff CFM, Lammertsma AA. Validity of simplified 3'-deoxy-3'-[18F]fluorothymidine uptake measures for monitoring response to chemotherapy in locally advanced breast cancer. Mol Imaging Biol 2013; 14:777-82. [PMID: 22392642 PMCID: PMC3492702 DOI: 10.1007/s11307-012-0547-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Purpose Positron emission tomography using 3′-deoxy-3′-[18F]fluorothymidine ([18F]FLT) has been suggested as a means for monitoring response to chemotherapy. The aim of this study was to evaluate the validity of simplified uptake measures for assessing response to chemotherapy using [18F]FLT in locally advanced breast cancer (LABC). Procedures Fifteen LABC patients underwent dynamic [18F]FLT scans both prior to and after the first cycle of chemotherapy with fluorouracil, epirubicin or doxorubicin, and cyclophosphamide. The net uptake rate constant of [18F]FLT, Ki, determined by non-linear regression (NLR) of an irreversible two-tissue compartment model was used as the gold standard. In addition to Patlak graphical analysis, standardised uptake values (SUV) and tumour-to-whole blood ratio (TBR) were used for analysing [18F]FLT data. Correlations and relationships between simplified uptake measures and NLR before and after chemotherapy were assessed using regression analysis. Results No significant differences in both pre- and post-chemotherapy relationships between any of the simplified uptake measures and NLR were found. However, changes in SUV between baseline and post-therapy scans showed a significant negative bias and slope less than one, while TBR did not. Conclusions In LABC, TBR instead of SUV may be preferred for monitoring response to chemotherapy with [18F]FLT.
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Affiliation(s)
- Mark Lubberink
- Department of Nuclear Medicine & PET Research, VU University Medical Centre, Amsterdam, The Netherlands.
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20
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Skougaard K, Nielsen D, Jensen BV, Hendel HW. Comparison of EORTC criteria and PERCIST for PET/CT response evaluation of patients with metastatic colorectal cancer treated with irinotecan and cetuximab. J Nucl Med 2013; 54:1026-31. [PMID: 23572497 DOI: 10.2967/jnumed.112.111757] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED The study aim was to compare European Organization for Research and Treatment of Cancer (EORTC) criteria with PET Response Criteria in Solid Tumors (PERCIST) for response evaluation of patients with metastatic colorectal cancer treated with a combination of the chemotherapeutic drug irinotecan and the monoclonal antibody cetuximab. METHODS From 2006 to 2009, patients with metastatic colorectal cancer were prospectively included in a phase II trial evaluating the combination of irinotecan and cetuximab every second week, as third-line treatment. (18)F-FDG PET/CT was performed between 1 and 14 d before the first treatment and after every fourth treatment cycle until progression was identified by CT with Response Evaluation Criteria in Solid Tumors (RECIST). Response evaluation with (18)F-FDG PET/CT was retrospectively performed according to both EORTC criteria and PERCIST, classifying the patients into 4 response categories: complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD). Individual best overall metabolic response (BOmR) was registered with both sets of criteria, as well as survival within response categories, and compared. RESULTS A total of 61 patients and 203 PET/CT scans were eligible for response evaluation. With EORTC criteria, 38 had PMR, 16 had SMD, and 7 had PMD as their BOmR. With PERCIST, 34 had PMR, 20 had SMD, and 7 had PMD as their BOmR. None of the patients had CMR. There was agreement between EORTC criteria and PERCIST in 87% of the patients, and the corresponding κ-coefficient was 0.76. Disagreements were confined to PMR and SMD. Median overall survival (OS) in months with EORTC criteria was 14.2 in the PMR group and 7.2 in the combined SMD + PMD group. With PERCIST, it was 14.5 in the PMR group and 7.9 in the SMD + PMD group. CONCLUSION Response evaluation with EORTC criteria and PERCIST gave similar responses and OS outcomes with good agreement on BOmR (κ-coefficient, 0.76) and similar significant differences in median OS between response groups. Compared with EORTC criteria, we find PERCIST unambiguous because of clear definitions and therefore more straightforward to use.
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Affiliation(s)
- Kristin Skougaard
- Department of Oncology, Copenhagen University Hospital Herlev, Herlev, Denmark.
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Büsing KA, Schönberg SO, Brade J, Wasser K. Impact of blood glucose, diabetes, insulin, and obesity on standardized uptake values in tumors and healthy organs on 18F-FDG PET/CT. Nucl Med Biol 2012; 40:206-13. [PMID: 23228852 DOI: 10.1016/j.nucmedbio.2012.10.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 10/03/2012] [Accepted: 10/20/2012] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Chronically altered glucose metabolism interferes with (18)F-FDG uptake in malignant tissue and healthy organs and may therefore lower tumor detection in (18)F-FDG PET/CT. The present study assesses the impact of elevated blood glucose levels (BGL), diabetes, insulin treatment, and obesity on (18)F-FDG uptake in tumors and biodistribution in normal organ tissues. METHODS (18)F-FDG PET/CT was analyzed in 90 patients with BGL ranging from 50 to 372 mg/dl. Of those, 29 patients were diabetic and 21 patients had received insulin prior to PET/CT; 28 patients were obese with a body mass index >25. The maximum standardized uptake value (SUV(max)) of normal organs and the main tumor site was measured. Differences in SUV(max) in patients with and without elevated BGLs, diabetes, insulin treatment, and obesity were compared and analyzed for statistical significance. RESULTS Increased BGLs were associated with decreased cerebral FDG uptake and increased uptake in skeletal muscle. Diabetes and insulin diminished this effect, whereas obesity slightly enhanced the outcome. Diabetes and insulin also increased the average SUV(max) in muscle cells and fat, whereas the mean cerebral SUV(max) was reduced. Obesity decreased tracer uptake in several healthy organs by up to 30%. Tumoral uptake was not significantly influenced by BGL, diabetes, insulin, or obesity. CONCLUSIONS Changes in BGLs, diabetes, insulin, and obesity affect the FDG biodistribution in muscular tissue and the brain. Although tumoral uptake is not significantly impaired, these findings may influence the tumor detection rate and are therefore essential for diagnosis and follow-up of malignant diseases.
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Affiliation(s)
- Karen A Büsing
- Institute for Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, 68167 Mannheim, Germany.
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22
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Feng ST, Cui M, Gao J, Wu B, Sha W, Huang B. Image-derived arterial input function in dynamic positron emission tomography-computed tomography: a method using both positron emission tomographic and computed tomographic images. J Comput Assist Tomogr 2012; 36:762-767. [PMID: 23192217 DOI: 10.1097/rct.0b013e31826bdd09] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to study the feasibility of measuring the arterial input function (AIF) in dynamic positron emission tomography (PET) studies using both PET and computed tomographic (CT) images. MATERIAL AND METHODS Eighteen newly diagnosed patients with head and neck cancer were recruited, and dynamic PET-CT scan was performed with contrast-enhanced CT. Phantom study with PET-CT scan was also performed for partial volume effect (PVE) correction. The PET-CT AIF was measured from both PET-CT images and corrected for PVE, together with the PET AIF, which was calculated from PET images. Both AIFs were used for calculating the net flux of [18F]fluoro-2-deoxy-D-glucose, Ki, and the correlation between these 2 sets of Ki was studied by Spearman correlation. RESULTS The PET-CT AIF was much larger than the PET AIF, whereas the Ki's by PET-CT AIF were much lower than the Ki's by PET AIF. However, the 2 sets of Ki were highly correlated (r = 0.969, P < 0.001). CONCLUSIONS It is feasible to measure AIF in PET-CT images without blood sampling. The PET-CT AIF is very different from the PET AIF calculated by PET images only without PVE correction. The PET-CT AIF may be a better choice because the Ki by PET AIF can be overestimated.
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Affiliation(s)
- Shi-Ting Feng
- Department of Radiology, The First Affiliated Hospital, Guangzhou, China
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23
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Tomasi G, Turkheimer F, Aboagye E. Importance of quantification for the analysis of PET data in oncology: review of current methods and trends for the future. Mol Imaging Biol 2012; 14:131-46. [PMID: 21842339 DOI: 10.1007/s11307-011-0514-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In oncology, positron emission tomography (PET) is an important tool for tumour diagnosis and staging, assessment of response to treatment and evaluation of the pharmacokinetic properties and efficacy of new drugs. Despite its quantitative potential, however, in daily clinical practice PET is used almost exclusively with 2-deoxy-2-[(18)F]fluoro-D-glucose ([(18)F]FDG) and, in addition, [(18)F]FDG data are normally assessed visually or using simple indices as the standardised uptake value (SUV). After explaining why more sophisticated quantification methods can be useful in oncology, the paper reviews the approaches that are commonly used and those available but not routinely employed. Particular emphasis is addressed to the SUV, for its importance in clinical practice. Issues specific to PET quantification in oncology and related examples are then discussed. Finally, some ideas for the development of new quantitative methods for analysing PET data in oncology and for the application of approaches already existing but not commonly employed are presented.
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Affiliation(s)
- Giampaolo Tomasi
- Comprehensive Cancer Imaging Center, Imperial College, Hammersmith Hospital London, London W120NN, UK
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Huang B, Khong PL, Kwong DLW, Hung B, Wong CS, Wong CYO. Dynamic PET-CT studies for characterizing nasopharyngeal carcinoma metabolism: comparison of analytical methods. Nucl Med Commun 2012; 33:191-197. [PMID: 22107997 DOI: 10.1097/mnm.0b013e32834dfa0c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the optimal PET protocol and analytical method to characterize the glucose metabolism in nasopharyngeal carcinoma (NPC). METHODS Newly diagnosed NPC patients were recruited and a dynamic PET-CT scan was performed. The optimized threshold to derive the arterial input function (AIF) was studied. Two-tissue compartmental kinetic modeling using three, four, and five parameters, Patlak graphical analysis, and time sensitivity (S-factor) analysis were performed. The best compartmental model was determined in terms of goodness of fit, and correlated with Ki from Patlak graphical analysis and the S-factor. The methods with R>0.9 and P<0.05 were considered acceptable. The protocols using two static scans with its retention index (RI=(SUV(2)/SUV(1)-1)×100%, where SUV is the standardized uptake value) were also studied and compared with S-factor analysis. RESULTS The best threshold of 0.6 was determined and used to derive AIF. The kinetic model with five parameters yields the best statistical results, but the model with k4=0 was used as the gold standard. All Ki values and some S-factors from data between various intervals (10-30, 10-45, 15-30, 15-45, 20-30, and 20-45 min) fulfilled the criteria. The RIs calculated from the S-factor were highly correlated to RI derived from simple two-point static scans at 10 and 30 min (R=0.9, P<0.0001). CONCLUSION The Patlak graphical analyses and even a 20-min-interval S-factor analysis or simple two-point static scans were shown to be sufficient to characterize NPC metabolism, confirming the clinical feasibility of applying a short dynamic with image-derived AIF or simple two-point static PET scans for studying NPC.
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Affiliation(s)
- Bingsheng Huang
- Department of Diagnostic Radiology, The University of Hong Kong, Hong Kong
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25
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Osman MM, Muzaffar R, Altinyay ME, Teymouri C. FDG Dose Extravasations in PET/CT: Frequency and Impact on SUV Measurements. Front Oncol 2011; 1:41. [PMID: 22655246 PMCID: PMC3356044 DOI: 10.3389/fonc.2011.00041] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2011] [Accepted: 10/17/2011] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Positron emission tomography (PET)/CT with 18F-FDG has proven to be effective in detecting and assessing various types of cancers. However, due to cancer and/or its therapy, intravenous (IV) FDG injection may be problematic resulting in dose extravasations. In the most frequently used field of view (FOV), arms-up, and base of skull to upper thigh [limited whole body (LWB)], the injection site may not be routinely imaged. The purpose of this study was to evaluate the frequency of dose extravasations in FDG PET and the potential impact on standard uptake value (SUV) measurements. METHODS True whole body FDG PET/CT scans (including all extremities) of 400 patients were retrospectively reviewed. A log recorded cases of IV dose extravasations. When possible, SUVs were measured in two frequently used reference locations: mediastinum and liver. The SUVs were obtained in the same patients who had studies with and without FDG extravasations within an average of 3 months without interval therapy. RESULTS Of the 400 scans, 42 (10.5%) had extravasations on the maximum intensity projections images. In scans with or without dose infiltration, FDG injection site was at or distal to the antecubital fossa in 97% of studies. Of those 42 cases, dose infiltration was within the LWB FOV in 29/42 (69%) and outside in the remaining 13/42 (31%). Of those 42 patients, 5 had repeat PET studies with no interval therapy. For those 5 patients, liver maximum SUV was 11.7% less in patients with infiltration than those without (2.22 ± 0.54 vs. 2.48 ± 0.6). Mediastinum SUVmax was 9.3% less in patients with infiltration than those without (1.72 ± 0.54 vs. 1.88 ± 0.49). CONCLUSION We conclude dose extravasations were commonly encountered (10.5%) in PET/CT. However, it is underreported by at least 31% due to omitting injection site from the FOV. When present, extravasations may lead to underestimation of SUVmax. Therefore, it should not only be avoided but also reported in order to avoid false interpretations of the exam.
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Affiliation(s)
- Medhat M. Osman
- Division of Nuclear Medicine, Department of Radiology, Saint Louis UniversitySt. Louis, MO, USA
- Saint Louis VA Medical CenterSt. Louis, MO, USA
| | - Razi Muzaffar
- Division of Nuclear Medicine, Department of Radiology, Saint Louis UniversitySt. Louis, MO, USA
| | - M. Erkan Altinyay
- Division of Nuclear Medicine, Department of Radiology, Saint Louis UniversitySt. Louis, MO, USA
| | - Cyrus Teymouri
- Nuclear Medicine Technology Program, Medical Imaging and Radiation Therapeutics, Doisy College of Health Sciences, Saint Louis UniversitySt. Louis, MO, USA
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26
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Dunnwald LK, Doot RK, Specht JM, Gralow JR, Ellis GK, Livingston RB, Linden HM, Gadi VK, Kurland BF, Schubert EK, Muzi M, Mankoff DA. PET tumor metabolism in locally advanced breast cancer patients undergoing neoadjuvant chemotherapy: value of static versus kinetic measures of fluorodeoxyglucose uptake. Clin Cancer Res 2011; 17:2400-9. [PMID: 21364034 DOI: 10.1158/1078-0432.ccr-10-2649] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Changes in tumor metabolism from positron emission tomography (PET) in locally advanced breast cancer (LABC) patients treated with neoadjuvant chemotherapy (NC) are predictive of pathologic response. Serial dynamic [(18)F]-FDG (fluorodeoxyglucose) PET scans were used to compare kinetic parameters with the standardized uptake value (SUV) as predictors of pathologic response, disease-free survival (DFS), and overall survival (OS). EXPERIMENTAL DESIGN Seventy-five LABC patients underwent FDG PET prior to and at midpoint of NC. FDG delivery (K(1)), FDG flux (K(i)), and SUV measures were calculated and compared by clinical and pathologic tumor characteristics using regression methods and area under the receiver operating characteristic curve (AUC). Associations between K(1), K(i), and SUV and DFS and OS were evaluated using the Cox proportional hazards model. RESULTS Tumors that were hormone receptor negative, high grade, highly proliferative, or of ductal histology had higher FDG K(i) and SUV values; on an average, FDG K(1) did not differ systematically by tumor features. Predicting pathologic response in conjunction with estrogen receptor (ER) and axillary lymph node positivity, kinetic measures (AUC = 0.97) were more robust predictors than SUV (AUC = 0.84, P = 0.005). Changes in K(1) and K(i) predicted both DFS and OS, whereas changes in SUV predicted OS only. In multivariate modeling, only changes in K(1) remained an independent prognosticator of DFS and OS. CONCLUSION Kinetic measures of FDG PET for LABC patients treated with NC accurately measured treatment response and predicted outcome compared with static SUV measures, suggesting that kinetic analysis may hold advantage of static uptake measures for response assessment.
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Affiliation(s)
- Lisa K Dunnwald
- Division of Nuclear Medicine and Medical Oncology, University of Washington, Seattle, Washington 98109, USA.
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Fluorodeoxyglucose positron emission tomography for evaluating early response during neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer. Ann Surg 2011; 253:56-63. [PMID: 21233607 DOI: 10.1097/sla.0b013e3181f66596] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Neoadjuvant chemoradiotherapy before surgery can improve survival in patients with potentially curable esophageal cancer, but not all patients respond. Fluorodeoxyglucose positron emission tomography (FDG-PET) has been proposed to identify nonresponders early during neoadjuvant chemoradiotherapy. The aim of the present study was to determine whether FDG-PET could differentiate between responding and nonresponding esophageal tumors early in the course of neoadjuvant chemoradiotherapy. METHODS This clinical trial comprised serial FDG-PET before and 14 days after start of chemoradiotherapy in patients with potentially curable esophageal carcinoma. Histopathologic responders were defined as patients with no or less than 10% viable tumor cells (Mandard score on resection specimen). PET response was measured using the standardized uptake value (SUV). Receiver operating characteristic analysis was used to evaluate the ability of SUV in distinguishing between histopathologic responders and nonresponders. RESULTS In 100 included patients, 64 were histopathologic responders. The median SUV decrease 14 days after the start of therapy was 30.9% for histopathologic responders and 1.7% for nonresponders (P = 0.001). In receiver operating characteristic analysis, the area under the curve was 0.71 (95% CI = 0.60-0.82). Using a 0% SUV decrease cutoff value, PET correctly identified 58 of 64 responders (sensitivity 91%) and 18 of 36 nonresponders (specificity 50%). The corresponding positive and negative predictive values were 76% and 75%, respectively. CONCLUSIONS SUV decrease 14 days after the start of chemoradiotherapy was significantly associated with histopathologic tumor response, but its accuracy in detecting nonresponders was too low to justify the clinical use of FDG-PET for early discontinuation of neoadjuvant chemoradiotherapy in patients with potentially curable esophageal cancer.
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Performance evaluation of kinetic parameter estimation methods in dynamic FDG-PET studies. Nucl Med Commun 2011; 32:4-16. [DOI: 10.1097/mnm.0b013e32833f6c05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Abstract
OBJECTIVE There is growing interest in using PET/CT for evaluating early response to therapy in cancer treatment. Although widely available and convenient to use, standardized uptake value (SUV) measurements can be influenced by a variety of biologic and technologic factors. Many of these factors can be addressed with close attention to detail and appropriate quality control. This article will review factors potentially affecting SUV measurements and provide recommendations on ways to minimize when using serial PET to assess early response to therapy. CONCLUSION Scanner and reconstruction parameters can significantly affect SUV measurements. When using serial SUV measurements to assess early response to therapy, imaging should be performed on the same scanner using the same image acquisition and reconstruction protocols. In addition, attention to detail is required for accurate determination of the administered radiopharmaceutical dose.
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30
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Vriens D, Visser EP, de Geus-Oei LF, Oyen WJG. Methodological considerations in quantification of oncological FDG PET studies. Eur J Nucl Med Mol Imaging 2009; 37:1408-25. [PMID: 19936745 PMCID: PMC2886126 DOI: 10.1007/s00259-009-1306-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 10/15/2009] [Indexed: 11/26/2022]
Abstract
Purpose This review aims to provide insight into the factors that influence quantification of glucose metabolism by FDG PET images in oncology as well as their influence on repeated measures studies (i.e. treatment response assessment), offering improved understanding both for clinical practice and research. Methods Structural PubMed searches have been performed for the many factors affecting quantification of glucose metabolism by FDG PET. Review articles and references lists have been used to supplement the search findings. Results Biological factors such as fasting blood glucose level, FDG uptake period, FDG distribution and clearance, patient motion (breathing) and patient discomfort (stress) all influence quantification. Acquisition parameters should be adjusted to maximize the signal to noise ratio without exposing the patient to a higher than strictly necessary radiation dose. This is especially challenging in pharmacokinetic analysis, where the temporal resolution is of significant importance. The literature is reviewed on the influence of attenuation correction on parameters for glucose metabolism, the effect of motion, metal artefacts and contrast agents on quantification of CT attenuation-corrected images. Reconstruction settings (analytical versus iterative reconstruction, post-reconstruction filtering and image matrix size) all potentially influence quantification due to artefacts, noise levels and lesion size dependency. Many region of interest definitions are available, but increased complexity does not necessarily result in improved performance. Different methods for the quantification of the tissue of interest can introduce systematic and random inaccuracy. Conclusions This review provides an up-to-date overview of the many factors that influence quantification of glucose metabolism by FDG PET.
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Affiliation(s)
- Dennis Vriens
- Department of Nuclear Medicine (internal postal code 444), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
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31
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Tu DG, Yao WJ, Chang TW, Chiu NT, Chen YH. Flare phenomenon in positron emission tomography in a case of breast cancer—a pitfall of positron emission tomography imaging interpretation. Clin Imaging 2009; 33:468-70. [DOI: 10.1016/j.clinimag.2009.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Accepted: 02/27/2009] [Indexed: 10/20/2022]
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Velasquez LM, Boellaard R, Kollia G, Hayes W, Hoekstra OS, Lammertsma AA, Galbraith SM. Repeatability of 18F-FDG PET in a multicenter phase I study of patients with advanced gastrointestinal malignancies. J Nucl Med 2009; 50:1646-54. [PMID: 19759105 DOI: 10.2967/jnumed.109.063347] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
UNLABELLED (18)F-FDG PET is often used to monitor tumor response in multicenter oncology clinical trials. This study assessed the repeatability of several semiquantitative standardized uptake values (mean SUV [SUV(mean)], maximum SUV [SUV(max)], peak SUV [SUV(peak)], and the 3-dimensional isocontour at 70% of the maximum pixel value [SUV(70%)]) as measured by repeated baseline (18)F-FDG PET studies in a multicenter phase I oncology trial. METHODS Double-baseline (18)F-FDG PET studies were acquired for 62 sequentially enrolled patients. Tumor metabolic activity was assessed by SUV(mean), SUV(max), SUV(peak), and SUV(70%). The effect on SUV repeatability of compliance with recommended image-acquisition guidelines and quality assurance (QA) standards was assessed. Summary statistics for absolute differences relative to the average of baseline values and repeatability analysis were performed for all patients and for a subgroup that passed QA, in both a multi- and a single-observer setting. Intrasubject precision of baseline measurements was assessed by repeatability coefficients, intrasubject coefficients of variation (CV), and confidence intervals on mean baseline differences for all SUV parameters. RESULTS The mean differences between the 2 SUV baseline measurements were small, varying from -2.1% to 1.9%, and the 95% confidence intervals for these mean differences had a maximum half-width of about 5.6% across the SUV parameters assessed. For SUV(max), the intrasubject CV varied from 10.7% to 12.8% for the QA multi- and single-observer datasets and was 16% for the full dataset. The 95% repeatability coefficients ranged from -28.4% to 39.6% for the QA datasets and up to -34.3% to 52.3% for the full dataset. CONCLUSION Repeatability results of double-baseline (18)F-FDG PET scans were similar for all SUV parameters assessed, for both the full and the QA datasets, in both the multi- and the single-observer settings. Centralized quality assurance and analysis of data improved intrasubject CV from 15.9% to 10.7% for averaged SUV(max). Thresholds for metabolic response in the multicenter multiobserver non-QA settings were -34% and 52% and in the range of -26% to 39% with centralized QA. These results support the use of (18)F-FDG PET for tumor assessment in multicenter oncology clinical trials.
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Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med 2009; 50 Suppl 1:122S-50S. [PMID: 19403881 DOI: 10.2967/jnumed.108.057307] [Citation(s) in RCA: 2658] [Impact Index Per Article: 177.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
UNLABELLED The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. METHODS PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. RESULTS Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. CONCLUSION Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments.
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Affiliation(s)
- Richard L Wahl
- Division of Nuclear Medicine, Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-0817, USA.
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Vriens D, de Geus-Oei LF, van Laarhoven HW, Timmer-Bonte JN, Krabbe PF, Visser EP, Oyen WJ. Evaluation of different normalization procedures for the calculation of the standardized uptake value in therapy response monitoring studies. Nucl Med Commun 2009; 30:550-7. [DOI: 10.1097/mnm.0b013e32832bdc80] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roses RE, Kumar R, Alavi A, Czerniecki BJ. The Role of Lymphatic Mapping and Sentinel Lymph Node Biopsy in the Staging of Breast Cancer. PET Clin 2009; 4:265-76. [PMID: 27157099 DOI: 10.1016/j.cpet.2009.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The widespread application of sentinel lymph node biopsy in the evaluation of patients with breast cancer has allowed for the more limited, selective treatment of regional lymph nodes and decreased the number of complete regional dissections performed in patients without nodal metastases. Surgical excision and pathologic evaluation of nodes for metastases allow for reliable staging and prediction of additional lymph node metastases. Sentinel lymph node biopsy also enables a meticulous histologic evaluation of multiple sections augmented by immunohistochemical staining. The current role of sentinel lymph node biopsy in the staging of breast cancer and ongoing controversies relating to the procedure are discussed.
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Affiliation(s)
- Robert E Roses
- Department of Surgery, University of Pennsylvania School of Medicine, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abass Alavi
- Department Section, Radiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Brian J Czerniecki
- Department of Surgery, University of Pennsylvania School of Medicine, 4 Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA; Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Izquierdo-Garcia D, Davies JR, Graves MJ, Rudd JH, Gillard JH, Weissberg PL, Fryer TD, Warburton EA. Comparison of Methods for Magnetic Resonance-Guided [18-F]Fluorodeoxyglucose Positron Emission Tomography in Human Carotid Arteries. Stroke 2009; 40:86-93. [PMID: 18927453 DOI: 10.1161/strokeaha.108.521393] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Inflammation is a major risk factor for atherosclerotic plaque rupture and clinical events. Previous studies have shown that plaque [
18
F]fluorodeoxyglucose (FDG) uptake correlates with macrophage content. In this study we examined the reproducibility of 3 methods of quantifying plaque FDG uptake in the carotid arteries using positron emission tomography (PET). The correlation between 2 simplified uptake parameters (standardized uptake value [SUV], vessel wall-to-blood ratio [VBR]) and a gold standard technique (influx rate [K
i
]) was also determined. We used MRI to correct carotid plaque FDG uptake for partial volume error.
Methods—
Seven patients with a recent carotid territory transient ischemic attack underwent imaging twice within 8 days using MR and FDG-PET. MR coregistered to PET was used to delineate regions of interest, and to facilitate partial volume correction (PVC).
Results—
SUV was the most reproducible parameter irrespective of whether it was normalized by body surface area (BSA), lean body mass, or weight (intraclass correlation coefficient=0.85, 0.88, and 0.90, respectively). VBR correlated better to K
i
than SUV (
r
=0.58 VBR,
r
=0.46 SUV
BSA
). PVC improved these correlations to
r
=0.81 VBR and
r
=0.76 SUV
BSA
, and only slightly degraded the reproducibility of SUV (intraclass correlation coefficient=0.83–0.85).
Conclusions—
MR-guided FDG-PET is a highly reproducible technique in the carotid artery and the excellent anatomic detail provided by MR facilitates PVC. Of the methods examined, SUV
BSA
PVC
appears to represent the best compromise between reproducible and accurate determination of FDG metabolism in carotid artery vessel wall.
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Affiliation(s)
- David Izquierdo-Garcia
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - John R. Davies
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Martin J. Graves
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - James H.F. Rudd
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Jonathan H. Gillard
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Peter L. Weissberg
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Tim D. Fryer
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
| | - Elizabeth A. Warburton
- From Wolfson Brain Imaging Centre (D.I.-G., T.D.F.), Division of Cardiovascular Medicine (J.R.D., J.H.F.R., P.L.W.), Department of Radiology (M.J.G., J.H.G.), Clinical Neurosciences (E.A.W.), University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK
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Krak N, van der Hoeven J, Hoekstra O, Twisk J, van der Wall E, Lammertsma A. Blood flow and glucose metabolism in stage IV breast cancer: heterogeneity of response during chemotherapy. Mol Imaging Biol 2008; 10:356-63. [PMID: 18709508 PMCID: PMC2696606 DOI: 10.1007/s11307-008-0163-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2007] [Revised: 03/23/2008] [Accepted: 03/26/2008] [Indexed: 11/30/2022]
Abstract
Objective The purpose of the study was to compare early changes in blood flow (BF) and glucose metabolism (MRglu) in metastatic breast cancer lesions of patients treated with chemotherapy. Methods Eleven women with stage IV cancer and lesions in breast, lymph nodes, liver, and bone were scanned before treatment and after the first course of chemotherapy. BF, distribution volume of water (Vd), MRglu/BF ratio, MRglu and its corresponding rate constants K1 and k3 were compared per tumor lesion before and during therapy. Results At baseline, mean BF and MRglu varied among different tumor lesions, but mean Vd was comparable in all lesions. After one course of chemotherapy, mean MRglu decreased in all lesions. Mean BF decreased in breast and node lesions and increased in bone lesions. Vd decreased in breast and nodes, but did not change in bone lesions. The MRglu/BF ratio decreased in breast and bone lesions and increased in node lesions. In patients with multiple tumor lesions BF and MRglu response could be very heterogeneous, even within similar types of metastases. BF and MRglu increased in lesions of patients who experienced early disease progression or showed no response during clinical follow-up. Conclusion BF and MRglu changes separately give unique information on different aspects of tumor response to chemotherapy. Changes in BF and MRglu parameters can be remarkably heterogeneous in patients with multiple lesions.
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Affiliation(s)
- Nanda Krak
- Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands.
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van Heijl M, Omloo JMT, van Berge Henegouwen MI, Busch ORC, Tilanus HW, Bossuyt PMM, Hoekstra OS, Stoker J, Hulshof MCCM, van der Gaast A, Nieuwenhuijzen GAP, Bonenkamp HJ, Plukker JTM, Bilgen EJS, Ten Kate FJW, Boellaard R, Pruim J, Sloof GW, van Lanschot JJB. NEOadjuvant therapy monitoring with PET and CT in Esophageal Cancer (NEOPEC-trial). BMC MEDICAL PHYSICS 2008; 8:3. [PMID: 18671847 PMCID: PMC3301128 DOI: 10.1186/1756-6649-8-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Accepted: 07/31/2008] [Indexed: 12/31/2022]
Abstract
Background Surgical resection is the preferred treatment of potentially curable esophageal cancer. To improve long term patient outcome, many institutes apply neoadjuvant chemoradiotherapy. In a large proportion of patients no response to chemoradiotherapy is achieved. These patients suffer from toxic and ineffective neoadjuvant treatment, while appropriate surgical therapy is delayed. For this reason a diagnostic test that allows for accurate prediction of tumor response early during chemoradiotherapy is of crucial importance. CT-scan and endoscopic ultrasound have limited accuracy in predicting histopathologic tumor response. Data suggest that metabolic changes in tumor tissue as measured by FDG-PET predict response better. This study aims to compare FDG-PET and CT-scan for the early prediction of non-response to preoperative chemoradiotherapy in patients with potentially curable esophageal cancer. Methods/design Prognostic accuracy study, embedded in a randomized multicenter Dutch trial comparing neoadjuvant chemoradiotherapy for 5 weeks followed by surgery versus surgery alone for esophageal cancer. This prognostic accuracy study is performed only in the neoadjuvant arm of the randomized trial. In 6 centers, 150 consecutive patients will be included over a 3 year period. FDG-PET and CT-scan will be performed before and 2 weeks after the start of the chemoradiotherapy. All patients complete the 5 weeks regimen of neoadjuvant chemoradiotherapy, regardless the test results. Pathological examination of the surgical resection specimen will be used as reference standard. Responders are defined as patients with < 10% viable residual tumor cells (Mandard-score). Difference in accuracy (area under ROC curve) and negative predictive value between FDG-PET and CT-scan are primary endpoints. Furthermore, an economic evaluation will be performed, comparing survival and costs associated with the use of FDG-PET (or CT-scan) to predict tumor response with survival and costs of neoadjuvant chemoradiotherapy without prediction of response (reference strategy). Discussion The NEOPEC-trial could be the first sufficiently powered study that helps justify implementation of FDG-PET for response-monitoring in patients with esophageal cancer in clinical practice. Trial registration ISRCTN45750457
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Affiliation(s)
- Mark van Heijl
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Hadi M, Bacharach SL, Whatley M, Libutti SK, Straus SE, Rao VK, Wesley R, Carrasquillo JA. Glucose and insulin variations in patients during the time course of a FDG-PET study and implications for the “glucose-corrected” SUV. Nucl Med Biol 2008; 35:441-5. [DOI: 10.1016/j.nucmedbio.2008.02.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 01/29/2008] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
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40
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Biersack HJ, Bender H, Palmedo H. FDG-PET in Monitoring Therapy of Breast Cancer. Breast Cancer 2007. [DOI: 10.1007/978-3-540-36781-9_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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41
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Advantages and Limitations of FDG PET 16 in the Follow-Up of Breast Cancer. Breast Cancer 2007. [DOI: 10.1007/978-3-540-36781-9_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Krak NC, Hoekstra OS, Lammertsma AA. Measuring Response to Chemotherapy in Locally Advanced Breast Cancer: Methodological Considerations. Breast Cancer 2007. [DOI: 10.1007/978-3-540-36781-9_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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43
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The Choice of the Correct Imaging Modality in Breast Cancer Management. Breast Cancer 2007. [DOI: 10.1007/978-3-540-36781-9_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Margolis DJA, Hoffman JM, Herfkens RJ, Jeffrey RB, Quon A, Gambhir SS. Molecular Imaging Techniques in Body Imaging. Radiology 2007; 245:333-56. [DOI: 10.1148/radiol.2452061117] [Citation(s) in RCA: 105] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Abstract
Magnetic resonance (MR) imaging is emerging as the most sensitive modality that is currently available for the detection of primary or recurrent breast cancer. Although this technique has been shown to be an extremely powerful diagnostic tool, it is still relatively rarely used in clinical practice, as compared with other applications of MR imaging such as for musculoskeletal or brain and spine imaging. This is the second of a two-part series on the current status of breast MR. Part two provides an overview of the use of breast MR imaging in clinical patient care, the body of evidence that supports its use. A discussion is provided on the many controversies that exist regarding breast MR imaging for preoperative staging and for screening.
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Affiliation(s)
- Christiane K Kuhl
- Department of Radiology, University of Bonn, Sigmund-Freud-Str 25, D-53105 Bonn, Germany.
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Airley RE, Mobasheri A. Hypoxic regulation of glucose transport, anaerobic metabolism and angiogenesis in cancer: novel pathways and targets for anticancer therapeutics. Chemotherapy 2007; 53:233-56. [PMID: 17595539 DOI: 10.1159/000104457] [Citation(s) in RCA: 244] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2005] [Accepted: 05/09/2006] [Indexed: 12/15/2022]
Abstract
Cancer cells require a steady source of metabolic energy in order to continue their uncontrolled growth and proliferation. Accelerated glycolysis is one of the biochemical characteristics of cancer cells. Recent work indicates that glucose transport and metabolism are essential for the posttreatment survival of tumor cells, leading to poor prognosis. Glycolytic breakdown of glucose is preceded by the transport of glucose across the cell membrane, a rate-limiting process mediated by facilitative glucose transporter proteins belonging to the facilitative glucose transporter/solute carrier GLUT/SLC2A family. Tumors frequently show overexpression of GLUTs, especially the hypoxia-responsive GLUT1 and GLUT3 proteins. There are also studies that have reported associations between GLUT expression and proliferative indices, whilst others suggest that GLUT expression may be of prognostic significance. In this article we revisit Warburg's original hypothesis and review the recent clinical and basic research on the expression of GLUT family members in human cancers and in cell lines derived from human tumors. We also explore the links between hypoxia-induced genes, glucose transporters and angiogenic factors. Hypoxic tumors are significantly more malignant, metastatic, radio- and chemoresistant and have a poor prognosis. With the discovery the oxygen-sensitive transcription factor hypoxia-inducible factor (HIF-1) has come a new understanding of the molecular link between hypoxia and deregulated glucose metabolism. HIF-1 induces a number of genes integral to angiogenesis, e.g. vascular endothelial growth factor (VEGF), a process intimately involved with metastatic spread. This knowledge may enhance existing chemotherapeutic strategies so that treatment can be more rationally applied and personalized for cancer patients.
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Affiliation(s)
- Rachel E Airley
- Department of Developmental and Molecular Biology, Chanin Institute, Albert Einstein College of Medicine of Yeshiva University, Bronx, NY, USA
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Doot RK, Dunnwald LK, Schubert EK, Muzi M, Peterson LM, Kinahan PE, Kurland BF, Mankoff DA. Dynamic and static approaches to quantifying 18F-FDG uptake for measuring cancer response to therapy, including the effect of granulocyte CSF. J Nucl Med 2007; 48:920-5. [PMID: 17504870 PMCID: PMC2692656 DOI: 10.2967/jnumed.106.037382] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED The response of cancer to chemotherapy can be quantified using (18)F-FDG to indicate changes in tumor metabolism. Quantification using the standardized uptake value (SUV) is more feasible for clinical practice than is the metabolic rate of (18)F-FDG (MRFDG), which requires longer, dynamic scanning. The relationship between MRFDG and SUV depends in part on how each accounts for blood clearance of tracer. We tested whether chemotherapy and treatment with granulocyte colony-stimulating factor (CSF) changed the blood clearance curves and therefore affected the relationship between MRFDG and SUV. METHODS Thirty-nine patients with locally advanced breast cancer underwent (18)F-FDG PET before and after chemotherapy, including granulocyte CSF. The area under the curve (AUC) for blood clearance was determined before and after therapy. MRFDGs were determined by graphical analyses, whereas SUVs were calculated using the standard formula normalized by body weight. MRFDG and SUVs were compared with each other and with tumor response. Paired percentage changes in MRFDG and SUV were also divided into tertiles based on pretherapy SUV to investigate differences in the relative sensitivity of SUV changes to MRFDG changes due to baseline tumor uptake. RESULTS Despite a small but statistically significant 6% decrease in blood AUCs after therapy (P = 0.02), SUV and MRFDG did not differ significantly in slope (P = 0.53) or in correlation before and after therapy (r = 0.95 for both). Percentage changes in MRFDG and SUV between serial scans correlated with each other (r = 0.84) and with patient response (P <or= 0.06). The maximum detectable percentage change in SUV and the slope of percentage changes in MRFDG versus SUV for the patient tertile with the lowest baseline SUVs (65% +/- 5% [+/-SE], slope (m) = 0.40 +/- 0.12, n = 13) were significantly lower than for the other patients (86% +/- 3%, m = 0.85 +/- 0.10, n = 26, P = 0.01 for both). CONCLUSION Chemotherapy and granulocyte CSF treatment resulted in a lower (18)F-FDG blood AUC. The maximum detectable percentage change in (18)F-FDG uptake is less when quantifying via static SUV than via dynamic MRFDG. This effect is small in most patients but may have clinical significance for measuring the response of patients with a low pretherapy (18)F-FDG uptake.
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Affiliation(s)
- Robert K. Doot
- Department of Bioengineering, University of Washington, Seattle, Washington
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Lisa K. Dunnwald
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Erin K. Schubert
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Mark Muzi
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Lanell M. Peterson
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Paul E. Kinahan
- Department of Bioengineering, University of Washington, Seattle, Washington
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
| | - Brenda F. Kurland
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - David A. Mankoff
- Department of Bioengineering, University of Washington, Seattle, Washington
- Division of Nuclear Medicine, University of Washington, Seattle, Washington
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Lammertsma AA, Hoekstra CJ, Giaccone G, Hoekstra OS. How should we analyse FDG PET studies for monitoring tumour response? Eur J Nucl Med Mol Imaging 2007; 33 Suppl 1:16-21. [PMID: 16763817 DOI: 10.1007/s00259-006-0131-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
FDG PET is a promising technique for monitoring tumour response early during anticancer therapy. Progress, however, has been limited owing to the multitude of methods currently in use. Here, the most promising techniques for multi-centre trials are discussed briefly, with emphasis on the need for standardisation. In addition, an approach is presented for response monitoring studies using newly developed drugs. This approach makes use of a large database of response monitoring studies, which defines the relationship between simplified clinical methods and full quantitative analysis for classic cytotoxic drugs. For a new drug, first a pilot study is performed to assess whether it affects this relationship. Based on this pilot, it is decided whether or not a simplified clinical method can be used in further studies.
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Affiliation(s)
- Adriaan A Lammertsma
- Department of Nuclear Medicine and PET Research, VU University Medical Centre, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
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Tafra L. Positron Emission Tomography (PET) and Mammography (PEM) for Breast Cancer: Importance to Surgeons. Ann Surg Oncol 2006; 14:3-13. [PMID: 17066235 DOI: 10.1245/s10434-006-9019-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lorraine Tafra
- The Breast Center, Anne Arundel Medical Center, 2002 Medical Parkway, Suite 120, Annapolis, MD 21401, USA.
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McDermott GM, Welch A, Staff RT, Gilbert FJ, Schweiger L, Semple SIK, Smith TAD, Hutcheon AW, Miller ID, Smith IC, Heys SD. Monitoring primary breast cancer throughout chemotherapy using FDG-PET. Breast Cancer Res Treat 2006; 102:75-84. [PMID: 16897427 DOI: 10.1007/s10549-006-9316-7] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 06/19/2006] [Indexed: 12/29/2022]
Abstract
UNLABELLED We have compared 2-deoxy-2-[(18)F]-fluoro-D-glucose positron emission tomography (FDG-PET) images of large or locally advanced breast cancers (LABC) acquired during Anthracycline-based chemotherapy. The purpose was to determine whether there is an optimal method for defining tumour volume and an optimal imaging time for predicting pathologic chemotherapy response. METHOD PET data were acquired before the first and second cycles, at the midpoint and at the endpoint of neoadjuvant chemotherapy. FDG uptake was quantified using the mean and maximum standardized uptake values (SUV) and the coefficient of variation within a region of interest. Receiver-operator characteristic (ROC) analysis was used to determine the discrimination between tumours demonstrating a high pathological response (i.e. those with greater than 90% reduction in viable tumour cells) and low pathological response. RESULTS Only tumours with an initial tumour to background ratio (TBR) of greater than five showed a difference between response categories. In terms of response discrimination, there was no statistically significant advantage of any of the methods used for image quantification or any of the time points. The best discrimination was measured for mean SUV at the midpoint of therapy, which identified 77% of low responding tumours whilst correctly identifying 100% of high responding tumours and had an ROC area of 0.93. CONCLUSION FDG-PET is efficacious for predicting the pathologic response of most primary breast tumours throughout the duration of a neoadjuvant chemotherapy regimen. However, this technique is ineffective for tumours with low image contrast on pre-therapy PET scans.
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Affiliation(s)
- Garry M McDermott
- School of Medical Sciences, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
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