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Chao YK, Chang CB, Chang YC, Chan SC, Chiu CH, Ng SH, Hsieh JCH, Wang JH. Baseline and interim [18F]FDG-PET/MRI to assess treatment response and survival in patients with M0 esophageal squamous cell carcinoma treated by curative-intent therapy. Cancer Imaging 2023; 23:109. [PMID: 37932848 PMCID: PMC10629192 DOI: 10.1186/s40644-023-00630-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 11/01/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To investigate the value of [18F]FDG-PET/MRI in predicting treatment response and survival in patients with primary M0 esophageal squamous cell carcinoma. METHODS Patients with esophageal squamous cell carcinoma received [18F]FDG-PET/MRI at baseline and during neoadjuvant or definitive chemoradiotherapy. The treatment response was classified according to the Response Evaluation Criteria for Solid Tumors 1.1. We used Kaplan-Meier and Cox regression analyses to assess the association between PET/MRI parameters and overall survival (OS) or progression-free survival (PFS). RESULTS We included 40 M0 patients in the final analysis. The volume transfer constant (Ktrans) from baseline PET/MRI (area under the curve (AUC) = 0.688, P = 0.034) and total lesion glycolysis (TLG) from baseline PET/MRI (AUC = 0.723, P = 0.006) or interim PET/MRI (AUC = 0.853, P < 0.001) showed acceptable AUC for predicting treatment response. The TLG from interim PET/MRI (interim TLG, P < 0.001) and extracellular volume fraction (Ve) on interim PET/MRI (interim Ve, P = 0.001) were identified as independent prognostic factors for OS. Baseline Ve (P = 0.044) and interim TLG (P = 0.004) were significant predictors of PFS. The c-indices of the prognostic models combining interim TLG with Ve for predicting OS, and baseline Ve and interim TLG for predicting PFS were 0.784 and 0.699, respectively. These values were significantly higher than the corresponding c-indices of the TNM staging system (P = 0.002 and P = 0.047, respectively). CONCLUSIONS Combining the baseline and interim [18F]FDG-PET/MRI qualitative imaging parameters aids in predicting the prognosis of patients with M0 esophageal squamous cell carcinoma. TRIAL REGISTRATION The study was registered at Clinicaltrials.gov (identifier: NCT05855291 and NCT05855278).
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Affiliation(s)
- Yin-Kai Chao
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, 333423, Taiwan
| | - Chun-Bi Chang
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, 333423, Taiwan
| | - Yu-Chuan Chang
- Department of Nuclear Medicine and Molecular Imaging Center, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, 333423, Taiwan
| | - Sheng-Chieh Chan
- Department of Nuclear Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970423, Taiwan.
- School of Medicine, Tzu Chi University, Hualien, 970423, Taiwan.
| | - Chien-Hung Chiu
- Division of Thoracic Surgery, Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, 333423, Taiwan
| | - Shu-Hang Ng
- Department of Diagnostic Radiology, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, 333423, Taiwan
| | - Jason Chia-Hsun Hsieh
- Division of Hematology/Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, 333423, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, 970423, Taiwan
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Mori M, Palumbo D, De Cobelli F, Fiorino C. Does radiomics play a role in the diagnosis, staging and re-staging of gastroesophageal junction adenocarcinoma? Updates Surg 2023; 75:273-279. [PMID: 36114920 DOI: 10.1007/s13304-022-01377-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 09/04/2022] [Indexed: 01/24/2023]
Abstract
Radiomics is an emerging field of investigation in medicine consisting in the extraction of quantitative features from conventional medical images and exploring their potentials in improving diagnosis, prognosis and outcome prediction after therapy. Clinical applications are still limited, mostly due to reproducibility and repeatability issues as well as to limited interpretability of predictive radiomic-based features/signatures. In the specific case of gastroesophageal junction (GEJ) adenocarcinoma, the expectancies are particularly high, mainly due to its increasing incidence and to the limited performance of conventional imaging techniques in assessing correct diagnosis and accurate pre-surgical tumor characterization. Accordingly, current literature was reviewed, emphasizing the methodological quality. In addition, papers were scored according to the Radiomic Quality Score (RQS), weighting more the clinical applicability and generalizability of the resulting models. According to the criteria of the search, only two papers were retained: the resulting technical quality was relatively high for both, while the corresponding RQS were 15 and 19 (on a scale of 31). Although the potentials of radiomics in the setting of GEJ adenocarcinoma are relevant, they remain largely unexplored, warranting an urgent need of high-quality, possibly prospective, multicenter studies.
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Affiliation(s)
- Martina Mori
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.,Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Diego Palumbo
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, San Raffaele Scientific Institute, Milan, Italy.,School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudio Fiorino
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy. .,Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Froelich MF, Capoluongo E, Kovacs Z, Patton SJ, Lianidou ES, Haselmann V. The value proposition of integrative diagnostics for (early) detection of cancer. On behalf of the EFLM interdisciplinary Task and Finish Group "CNAPS/CTC for early detection of cancer". Clin Chem Lab Med 2022; 60:821-829. [PMID: 35218176 DOI: 10.1515/cclm-2022-0129] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 12/12/2022]
Abstract
Disruptive imaging and laboratory technologies can improve clinical decision processes and outcomes in oncology. However, certain obstacles must be overcome before these technologies can be fully implemented as part of the standard for care. An integrative diagnostic approach represents a unique opportunity to unleash the full diagnostic potential and paves the way towards personalized cancer diagnostics. To meet this demand, an interdisciplinary Task Force of the EFLM was initiated as a consequence of an EFLM/ESR during the CELME 2019 meeting in order to evaluate the clinical value of CNAPS/CTC (circulating nucleic acids in plasma and serum/circulating tumor cells) in early detection of cancer. Here, an overview of current disruptive techniques, their clinical implications and potential value of an integrative diagnostic approach is provided. Furthermore, requirements such as the establishment of diagnostic tumor boards, development of adequate software solutions and a change of mindset towards a new generation of diagnosticians providing actionable health information are presented. This development has the potential to elevate the position and clinical recognition of diagnosticians.
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Affiliation(s)
- Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
| | - Ettore Capoluongo
- Department of Molecular Medicine and Medical Biotechnologies, University of Naples Federico II, Naples, Italy
- CEINGE-Biotecnologie Avanzate, Napoli, Italy
| | - Zsolt Kovacs
- Department of Pathology, Clinical County Emergency Hospital, Targu-Mures, Romania
| | | | - Evi S Lianidou
- Department of Chemistry, Analysis of Circulating Tumor Cells Lab, Laboratory of Analytical Chemistry, University of Athens, Athens, Greece
| | - Verena Haselmann
- Medical Faculty Mannheim of the University of Heidelberg, Institute of Clinical Chemistry, University Hospital Mannheim, Mannheim, Germany
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4
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Sharkey AR, Sah BR, Withey SJ, Bhuva S, Neji R, Jeljeli S, Green A, Cook GJR, Goh V. Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI. Eur J Hybrid Imaging 2021; 5:23. [PMID: 34897589 PMCID: PMC8666393 DOI: 10.1186/s41824-021-00117-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/03/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastro-oesophageal cancer. Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastro-oesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324 ± 28 MBq 18F-FDG administration and 60-min uptake, PET/CT was performed, immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians and PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%. RESULTS Out of 26 participants, 22 (20 males; mean ± SD age 68.8 ± 8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p > 0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10). CONCLUSION In this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.
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Affiliation(s)
- Amy R Sharkey
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - Bert-Ram Sah
- Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
| | - Samuel J Withey
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Shaheel Bhuva
- King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, UK
| | - Radhouene Neji
- MR Research Collaborations, Siemens Healthcare, Frimley, UK
| | - Sami Jeljeli
- King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, UK
| | - Adrian Green
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Gary J R Cook
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- King's College London and Guy's and St Thomas' PET Centre, St Thomas' Hospital, London, UK
| | - Vicky Goh
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- Department of Radiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Xu JJ, Taudorf M, Ulriksen PS, Achiam MP, Resch TA, Nielsen MB, Lönn LB, Hansen KL. Gastrointestinal Applications of Iodine Quantification Using Dual-Energy CT: A Systematic Review. Diagnostics (Basel) 2020; 10:diagnostics10100814. [PMID: 33066281 PMCID: PMC7602017 DOI: 10.3390/diagnostics10100814] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/04/2020] [Accepted: 10/07/2020] [Indexed: 12/15/2022] Open
Abstract
Dual-energy computed tomography (DECT) can estimate tissue vascularity and perfusion via iodine quantification. The aim of this systematic review was to outline current and emerging clinical applications of iodine quantification within the gastrointestinal tract using DECT. The search was conducted with three databases: EMBASE, Pubmed and The Cochrane Library. This identified 449 studies after duplicate removal. From a total of 570 selected studies, 30 studies were enrolled for the systematic review. The studies were categorized into four main topics: gastric tumors (12 studies), colorectal tumors (8 studies), Crohn’s disease (4 studies) and miscellaneous applications (6 studies). Findings included a significant difference in iodine concentration (IC) measurements in perigastric fat between T1–3 vs. T4 stage gastric cancer, poorly and well differentiated gastric and colorectal cancer, responders vs. non-responders following chemo- or chemoradiotherapy treatment among cancer patients, and a positive correlation between IC and Crohn’s disease activity. In conclusion, iodine quantification with DECT may be used preoperatively in cancer imaging as well as for monitoring treatment response. Future studies are warranted to evaluate the capabilities and limitations of DECT in splanchnic flow.
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Affiliation(s)
- Jack Junchi Xu
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Correspondence:
| | - Mikkel Taudorf
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Peter Sommer Ulriksen
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Michael Patrick Achiam
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Timothy Andrew Resch
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Lars Birger Lönn
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
| | - Kristoffer Lindskov Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.B.N.); (L.B.L.); (K.L.H.)
- Department of Surgical Gastroenterology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark; (M.T.); (P.S.U.); (M.P.A.); (T.A.R.)
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Positron Emission Tomography-Based Response to Target and Immunotherapies in Oncology. ACTA ACUST UNITED AC 2020; 56:medicina56080373. [PMID: 32722205 PMCID: PMC7466359 DOI: 10.3390/medicina56080373] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/11/2020] [Accepted: 07/21/2020] [Indexed: 12/12/2022]
Abstract
2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is a promising tool to support the evaluation of response to either target therapies or immunotherapy with immune checkpoint inhibitors both in clinical trials and, in selected patients, at the single patient's level. The present review aims to discuss available evidence related to the use of [18F]FDG PET (Positron Emission Tomography) to evaluate the response to target therapies and immune checkpoint inhibitors. Criteria proposed for the standardization of the definition of the PET-based response and complementary value with respect to morphological imaging are commented on. The use of PET-based assessment of the response through metabolic pathways other than glucose metabolism is also relevant in the framework of personalized cancer treatment. A brief discussion of the preliminary evidence for the use of non-FDG PET tracers in the evaluation of the response to new therapies is also provided.
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