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Cheung AHY, Wu VWC, Cheung ALY, Cai J. Respiratory 4D-Gating F-18 FDG PET/CT Scan for Liver Malignancies: Feasibility in Liver Cancer Patient and Tumor Quantitative Analysis. Front Oncol 2022; 12:789506. [PMID: 35223472 PMCID: PMC8864173 DOI: 10.3389/fonc.2022.789506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the potential clinical role and effectiveness of respiratory 4D-gating F-18 FDG PET/CT scan for liver malignancies, relative to routine (3D) F-18 FDG PET/CT scan. Materials and Methods This study presented a prospective clinical study of 16 patients who received F-18 FDG PET/CT scan for known or suspected malignant liver lesions. Ethics approvals were obtained from the ethics committees of the Hong Kong Baptist Hospital and The Hong Kong Polytechnic University. Liver lesions were compared between the gated and ungated image sets, in terms of 1) volume measurement of PET image, 2) accuracy of maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), and 3) accuracy of total lesion glycoses (TLG). Statistical analysis was performed by using a two-tailed paired Student t-test and Pearson correlation test. Results The study population consisted of 16 patients (9 males and 7 females; mean age of 65) with a total number of 89 lesions. The SUVmax and SUVmean measurement of the gated PET images was more accurate than that of the ungated PET images, compared to the static reference images. An average of 21.48% (p < 0.001) reduction of the tumor volume was also observed. The SUVmax and SUVmean of the gated PET images were improved by 19.81% (p < 0.001) and 25.53% (p < 0.001), compared to the ungated PET images. Conclusions We have demonstrated the feasibility of implementing 4D PET/CT scan for liver malignancies in a prospective clinical study. The 4D PET/CT scan for liver malignancies could improve the quality of PET image by improving the SUV accuracy of the lesions and reducing image blurring. The improved accuracy in the classification and identification of liver tumors with 4D PET image would potentially lead to its increased utilization in target delineation of GTV, ITV, and PTV for liver radiotherapy treatment planning in the future.
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Affiliation(s)
- Anson H Y Cheung
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Radiotherapy and Oncology Department, Hong Kong Baptist Hospital, Hong Kong, Hong Kong SAR, China
| | - Vincent W C Wu
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
| | - Andy L Y Cheung
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, Hong Kong SAR, China
| | - Jing Cai
- Department of Health Technology & Informatics, The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
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Jiang C, Ma G, Liu Q, Song S. The value of preoperative 18F-FDG PET metabolic and volumetric parameters in predicting microvascular invasion and postoperative recurrence of hepatocellular carcinoma. Nucl Med Commun 2022; 43:100-107. [PMID: 34456318 DOI: 10.1097/mnm.0000000000001478] [Citation(s) in RCA: 1] [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
BACKGROUND Microvascular invasion (MVI) is very important in the evaluation of hepatocellular carcinoma (HCC), but diagnosis is determined by postoperative pathology; thus, preoperative noninvasive methods will play an active role. The purpose of the study was to assess the performance of metabolic parameters of preoperative 18F-fluorodeoxyglucose PET/computerized tomography (18F-FDG PET/CT) in the prediction of MVI and postoperative recurrence in primary hepatocellular carcinoma. METHODS We retrospectively collected 72 patients with HCC who have performed 18F-FDG PET/CT scan before partial hepatectomy between 2016 and 2019. We used both normal liver tissue and inferior vena cava as the reference background and combined with clinicopathological features, 18F-FDG PET/CT metabolic and volumetric indices to predict MVI and postoperative recurrence of primary HCC before surgery. RESULTS Twenty-one of the 72 patients recurred, in recurrent cases showed higher maximum standard uptake value (SUVmax), TNR (ratio of tumor SUVmax to mean SUV [SUVmean] of the background tissue), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) than nonrecurrence cases (P < 0.001). All 18F-FDG PET metabolic and volumetric indices for predicting postoperative HCC recurrence were significant on receiver-operating-characteristic (ROC) curve analyses (P < 0.05). TNRIVC, TNRNL, MTVIVC, MTVNL TLGIVC and TLGNL were significant factors for predicting MVI in HCC (P < 0.05). On multivariate analyses, MVI, SUVmax, TNRIVC, TNRNL, MTVIVC, MTVNL, TLGIVC and TLGNL (P < 0.05) are independent risk factors for predicting postoperative HCC recurrence. TNRIVC is the most relevant PET/CT parameter for predicting MVI in HCC, and MTVIVC is the most valuable for predicting postoperative HCC recurrence. Moreover, the PET/CT parameters are more accurate for prognosis with inferior vena cava as a reference background than with normal liver tissue. CONCLUSION 18F-FDG PET/CT metabolic and volumetric indices are effective predictors, and could noninvasively provide more comprehensive predictive information on MVI and postoperative recurrence of primary HCC before surgery.
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Affiliation(s)
- Chunjuan Jiang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
- Center for Biomedical Imaging
- Department of Oncology, Shanghai Medical College, Fudan University
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Guang Ma
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
- Center for Biomedical Imaging
- Department of Oncology, Shanghai Medical College, Fudan University
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Qiufang Liu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
- Center for Biomedical Imaging
- Department of Oncology, Shanghai Medical College, Fudan University
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
| | - Shaoli Song
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center
- Center for Biomedical Imaging
- Department of Oncology, Shanghai Medical College, Fudan University
- Shanghai Engineering Research Center of Molecular Imaging Probes, Shanghai, China
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ALTUNTUZCU Ş, GUZEL F, UYAR A, KAPLAN İ, GÜZEL Y, TAŞDEMİR B, YALÇIN K. Is there a relationship between the liver SUVmax values in FDG-PET/CT imaging and non-alcoholic fatty liver disease score? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.990487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Keramida G, Peters AM. FDG PET/CT of the non‐malignant liver in an increasingly obese world population. Clin Physiol Funct Imaging 2020; 40:304-319. [DOI: 10.1111/cpf.12651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Georgia Keramida
- Department of Nuclear Medicine Royal Brompton and HarefieldNHS Foundation Trust London UK
| | - A. Michael Peters
- Department of Nuclear Medicine King’s College HospitalNHS Foundation Trusts London UK
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Scintigraphy of the Liver, Spleen, and Biliary Tree. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Relationship between regional hepatic glucose metabolism and regional distribution of hepatic fat. Nucl Med Commun 2019; 40:212-218. [DOI: 10.1097/mnm.0000000000000968] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Tan GJS, Berlangieri SU, Lee ST, Scott AM. FDG PET/CT in the liver: lesions mimicking malignancies. ACTA ACUST UNITED AC 2015; 39:187-95. [PMID: 24233161 DOI: 10.1007/s00261-013-0043-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE 18F-fluorodeoxyglucose (FDG) PET/CT is invaluable in managing liver lesions, in particular in the evaluation of suspected liver metastases. It is both sensitive and specific in detecting liver metastases from a wide range of primary cancers, and may change clinical management, most commonly by detecting additional lesions and decreasing the number of futile surgeries. However, some benign lesions may also show increased metabolic activity which can lead to false positive PET findings. We describe some of these lesions and their imaging characteristics that may help in differentiating them from malignant metastases. METHODS e reviewed all whole body FDG PET/CT studies performed over a 5-year period in our institution, and identified those with focal liver lesions showing increased FDG uptake for which histological results were available. RESULTS majority of lesions showing increased metabolic activity were due to malignant disease, such as metastases or primary liver tumours. However, we also found increased FDG uptake in non-neoplastic lesions such as Cryptococcosis, abscesses, and secondary inflammation from cholecystitis. Increased metabolic activity was also seen in some benign neoplasms such as hepatic adenomas and hemangioendotheliomas. CONCLUSION DG PET/CT is currently the most sensitive non-invasive imaging modality for the detection of hepatic metastases, particularly from the gastrointestinal tract. False positive results are rare, and have been described mainly in abscesses. However, other lesions can also show increased metabolic activity, and failure to differentiate these from metastases may result in inappropriate treatment.
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Keramida G, Dizdarevic S, Bush J, Peters AM. Quantification of tumour (18) F-FDG uptake: Normalise to blood glucose or scale to liver uptake? Eur Radiol 2015; 25:2701-8. [PMID: 25899414 DOI: 10.1007/s00330-015-3659-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/07/2015] [Accepted: 02/04/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE To compare normalisation to blood glucose (BG) with scaling to hepatic uptake for quantification of tumour (18) F-FDG uptake using the brain as a surrogate for tumours. METHODS Standardised uptake value (SUV) was measured over the liver, cerebellum, basal ganglia, and frontal cortex in 304 patients undergoing (18) F-FDG PET/CT. The relationship between brain FDG clearance and SUV was theoretically defined. RESULTS Brain SUV decreased exponentially with BG, with similar constants between cerebellum, basal ganglia, and frontal cortex (0.099-0.119 mmol/l(-1)) and similar to values for tumours estimated from the literature. Liver SUV, however, correlated positively with BG. Brain-to-liver SUV ratio therefore showed an inverse correlation with BG, well-fitted with a hyperbolic function (R = 0.83), as theoretically predicted. Brain SUV normalised to BG (nSUV) displayed a nonlinear correlation with BG (R = 0.55); however, as theoretically predicted, brain nSUV/liver SUV showed almost no correlation with BG. Correction of brain SUV using BG raised to an exponential power of 0.099 mmol/l(-1) also eliminated the correlation between brain SUV and BG. CONCLUSION Brain SUV continues to correlate with BG after normalisation to BG. Likewise, liver SUV is unsuitable as a reference for tumour FDG uptake. Brain SUV divided by liver SUV, however, shows minimal dependence on BG. KEY POINTS • FDG standard uptake value in tumours helps clinicians assess response to treatment. • SUV is influenced by blood glucose; normalisation to blood glucose is recommended. • An alternative approach is to scale tumour SUV to liver SUV. • The brain used as a tumour surrogate shows that neither approach is valid. • Applying both approaches, however, appropriately corrects for blood glucose.
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Affiliation(s)
- Georgia Keramida
- Clinical Imaging Sciences Centre, Brighton and Sussex Medical School, Brighton, UK,
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Kaya B, Dostbil Z, Ismailoglu M, Tasdemir B, Sahin O. Effect of R-CHOP chemotherapy on liver and mediastinal blood pool (18)F-FDG standardized uptake values in patients with non-Hodgkin's lymphoma. Clin Imaging 2015; 39:632-5. [PMID: 25709112 DOI: 10.1016/j.clinimag.2015.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 02/03/2015] [Indexed: 10/24/2022]
Abstract
AIM We aimed to investigate the impact of chemotherapy on (18)F-FDG uptake in the liver and mediastinal blood pool (MBP) among patients with non-Hodgkin's lymphoma. METHODS Twenty-three patients with NHL underwent baseline, interim, and postchemotherapy (18)F-FDG PET/CT. SUVmax and SUVmean values of the liver and MBP at imaging time were compared statistically. RESULTS We did not find any significant differences between the liver and mediastinum SUVmean and SUVmax values (P>.05). CONCLUSIONS Our study demonstrates that the (18)F-FDG uptake in the liver and MBP are not significantly affected by R-CHOP chemotherapy in patients with NHL.
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Affiliation(s)
- Bugra Kaya
- Necmettin Erbakan University, Meram Medical Faculty, Department of Nuclear Medicine, Konya, Turkey.
| | - Zeki Dostbil
- Dicle University, Medical Faculty, Department of Nuclear Medicine, Diyarbakir, Turkey.
| | - Murat Ismailoglu
- Dr. I. Sevki Atasagun Nevsehir State Hospital, Department of Nuclear Medicine, Nevsehir, Turkey.
| | - Bekir Tasdemir
- Dicle University, Medical Faculty, Department of Nuclear Medicine, Diyarbakir, Turkey.
| | - Ozlem Sahin
- Afyonkarahisar State Hospital, Department of Nuclear Medicine, Afyonkarahisar, Turkey.
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PARK JUHUI, KANG JOOHYUN, LEE YONGJIN, KIM KWANGIL, LEE TAESUP, KIM KYEONGMIN, PARK JIAE, KO YINOHK, YU DAEYEUL, NAHM SANGSOEP, JEON TAEJOO, PARK YOUNGSEO, LIM SANGMOO. Evaluation of diethylnitrosamine- or hepatitis B virus X gene-induced hepatocellular carcinoma with 18F-FDG PET/CT: A preclinical study. Oncol Rep 2014; 33:347-53. [DOI: 10.3892/or.2014.3575] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 10/07/2014] [Indexed: 11/06/2022] Open
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Hepatic steatosis is associated with increased hepatic FDG uptake. Eur J Radiol 2014; 83:751-5. [PMID: 24581596 DOI: 10.1016/j.ejrad.2014.01.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 01/27/2014] [Accepted: 01/30/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The use of liver as a reference tissue for semi-quantification of tumour FDG uptake may not be valid in hepatic steatosis (HS). Previous studies on the relation between liver FDG uptake and HS have been contradictory probably because they ignored blood glucose (BG). Because hepatocyte and blood FDG concentrations equalize, liver FDG uptake parallels BG, which must therefore be considered when studying hepatic FDG uptake. We therefore re-examined the relation between HS and liver uptake taking BG into account. METHODS This was a retrospective study of 304 patients undergoing routine PET/CT with imaging 60min post-FDG. Average standard uptake value (SUVave), maximum SUV (SUVmax) and CT density (index of HS) were measured in a liver ROI. Blood pool SUV was based on the left ventricular cavity (SUVLV). Correlations were assessed using least squares fitting of continuous data. Patients were also divided into BG subgroups (<4, 4-5, 5-6, 6-8, 8-10 and 10+mmol/l). RESULTS SUVave, SUVmax and SUVLV displayed similar relations with BG. SUVmax/SUVLV, but not SUVave/SUVLV, correlated significantly with BG. SUVmax, but not SUVave, correlated inversely with CT density before and after adjusting for BG. SUVmax/SUVave correlated more strongly with CT density than SUVmax. CT density correlated inversely with SUVmax/SUVLV but positively with SUVave/SUVLV. CONCLUSIONS Hepatic SUV is more influenced by BG than by HS. Its relation with BG renders it unsuitable as a reference tissue. Nevertheless, hepatic fat does correlate positively with liver SUV, although this is seen only with SUVmax because SUVave is 'diluted' by hepatic fat.
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Dostbil Z, Varoğlu E, Serdengeçti M, Kaya B, Önder H, Sari O. Evaluation of hepatic metabolic activity in non-alcoholic fatty livers on 18FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remn.2012.04.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Evaluation of hepatic metabolic activity in non-alcoholic fatty livers on 18FDG PET/CT. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Roivainen A, Naum A, Nuutinen H, Leino R, Nurmi H, Någren K, Parkkola R, Virtanen J, Kallajoki M, Kujari H, Ovaska J, Roberts P, Seppänen M. Characterization of hepatic tumors using [11C]metomidate through positron emission tomography: comparison with [11C]acetate. EJNMMI Res 2013; 3:13. [PMID: 23442595 PMCID: PMC3598556 DOI: 10.1186/2191-219x-3-13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 02/15/2013] [Indexed: 12/14/2022] Open
Abstract
Background Using positron emission tomography (PET), we compared two tracers, [11C]metomidate ([11C]MTO) and [11C]acetate ([11C]ACE), for the characterization of hepatic tumors. Methods Thirty-three patients underwent PET with [11C]MTO and [11C]ACE and magnetic resonance imaging (MRI). Based on the histology of the tumor biopsy, 14 patients had hepatocellular carcinoma (HCC), 9 patients had focal nodular hyperplasia (FNH), and 10 patients had other types of hepatic tumors. Tumor uptake was evaluated by calculating the maximum and mean standardized uptake value and tumor-to-liver ratio. Results Altogether, 120 hepatic lesions (59 HCC, 18 FNH, 30 metastases of different primaries, 9 adenomas, and 4 regenerating nodules of liver cirrhosis) were detected by MRI. The overall tumor detection rate was slightly higher for [11C]MTO (39%) than for [11C]ACE (33%). [11C]ACE was more sensitive for HCC detection (50% versus 43%, respectively), whereas [11C]MTO was more sensitive for FNH detection (78% versus 44%, respectively). In HCC patients, the tumor grade correlated with [11C]ACE, but not with [11C]MTO. All of the patients with liver metastases, from various primary tumors (n = 10), were negative for both tracers. Conclusions Due to low sensitivity, [11C]MTO and [11C]ACE PET have only limited value in diagnosing hepatic tumors.
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Affiliation(s)
- Anne Roivainen
- Turku PET Centre, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, Turku 20521, Finland.
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Pak K, Kim SJ, Kim IJ, Kim K, Kim H, Kim SJ. Hepatic FDG Uptake is not Associated with Hepatic Steatosis but with Visceral Fat Volume in Cancer Screening. Nucl Med Mol Imaging 2012; 46:176-81. [PMID: 24900057 DOI: 10.1007/s13139-012-0143-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 05/17/2012] [Accepted: 05/18/2012] [Indexed: 11/29/2022] Open
Abstract
PURPOSE We aimed to evaluate the relation between visceral fat volume and fluorodeoxyglucose (FDG) uptake of the liver measured by maximum or mean standardized uptake value. METHODS We retrospectively analyzed 96 consecutive records of positron emission tomography/computed tomography (PET/CT) performed for cancer screening between May 2011 and December 2011. Subjects were divided into 2 groups according to Hounsfield unit (HU) of the liver comparing with that of the spleen. The control group (20 women, 56 men) demonstrating HU of the liver equal or greater than that of the spleen included 76 patients, while the fatty liver group (2 women, 18 men) showing HU of the liver less than that of the spleen included 20 patients. We compared FDG uptake of the liver and visceral fat volume between two groups. We evaluated correlation of hepatic FDG uptake measured by maximum or mean standardized uptake value (SUV) with visceral fat volume and attenuation. RESULTS The fatty liver disease group showed higher aspartate aminotransferase (AST)of (24.42 ± 7.22, p = 0.012), alanine aminotransferase (ALT) of (25.16 ± 11.68, p = 0.001), body mass index (BMI) of (24.58 ± 3.29, p = 0.021), and visceral fat volume (3063.53 ± 1561.43, p = 0.011) than the control group. There were no statistically significant differences of mean standardized uptake value of the liver (liver SUVmean) (2.73 ± 0.19, p = 0.723), maximum standardized uptake value of the liver (liver SUVmax) (3.39 ± 0.53, p = 0.8248) and liver SUVmean/spleen SUVmean (1.13 ± 0.10, p = 0.081) between the two groups. Strong correlations were shown between liver SUVmean and BMI (r = 0.609, p < 0.001) and between liver SUVmean and visceral fat volume (r = 0.457, p < 0.001). Liver SUVmax was also strongly correlated with BMI (r = 0.622, p = 0.001) and visceral fat volume (r = 0.547, p < 0.001). There was no significant association of mean attenuation value of the liver (liver HUmean) with liver SUVmean (r = -0.003, p = 0.979) or liver SUVmax (r = -0.120, p = 0.244). CONCLUSION Hepatic FDG uptake quantified as SUVmean or SUVmax is not correlated with hepatic steatosis but with visceral fat volume in cancer screening.
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Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, Republic of Korea 602-739
| | - Seong-Jang Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, Republic of Korea 602-739
| | - In Joo Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, Republic of Korea 602-739
| | - Keunyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, Republic of Korea 602-739
| | - Heeyoung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, Republic of Korea 602-739
| | - So Jung Kim
- Department of Nuclear Medicine, Pusan National University Hospital, 1-10, Ami-dong, Seo-gu, Busan, Republic of Korea 602-739
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Preis O, Blake MA, Scott JA. Neural network evaluation of PET scans of the liver: a potentially useful adjunct in clinical interpretation. Radiology 2011; 258:714-21. [PMID: 21339347 DOI: 10.1148/radiol.10100547] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To assess the performance of an artificial neural network in the evaluation of fluorine 18 fluorodeoxyglucose (FDG) uptake in the liver, compared with the results of expert interpretation of abdominal liver magnetic resonance (MR) images. MATERIALS AND METHODS The study was approved by the institutional human research committee and was HIPAA compliant, with waiver of informed consent. Digital data from positron emission tomographic (PET)/computed tomographic (CT) examinations, along with patient demographics, were obtained from 98 consecutive patients who underwent both whole-body PET/CT examinations and liver MR imaging examinations within 2 months. Interpretations of the scans from PET/CT examinations by trained neural networks were cross-classified with expert interpretations of the findings on images from MR examinations for intrahepatic benignity or malignancy. Receiver operating characteristic (ROC) curves were obtained for the designed networks. The significance of the difference between neural network ROC curves and the ROC curves detailing the performance of two expert blinded observers in the interpretation of liver FDG uptake was determined. RESULTS A neural network incorporating lesion data demonstrated an ROC curve with an area under the curve (AUC) of 0.905 (standard error, 0.0370). A network independent of lesion data demonstrated an ROC curve with an AUC of 0.896 (standard error, 0.0386). These results compare favorably with results of expert blinded observers 1 and 2 who demonstrated ROCs with AUCs of 0.786 (standard error, 0.0522) and 0.796 (standard error, 0.0514), respectively. Following unblinding to network data, the AUCs for readers 1 and 2 improved to 0.924 (standard error, 0.0335) and 0.881 (standard error, 0.0409), respectively. CONCLUSION Computers running artificial neural networks employing PET/CT scan data are sensitive and specific in the designation of the presence of intrahepatic malignancy, with comparison with interpretation by expert observers. When used in conjunction with human expertise, network data improve accuracy of the human interpreter.
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Affiliation(s)
- Ori Preis
- Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
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Abele JT, Fung CI. Effect of hepatic steatosis on liver FDG uptake measured in mean standard uptake values. Radiology 2010; 254:917-24. [PMID: 20177102 DOI: 10.1148/radiol.09090768] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate the association between diffuse fatty infiltration of the liver and average fluorine 18 fluorodeoxyglucose (FDG) uptake in the liver. MATERIALS AND METHODS Institutional review board approval was obtained for this study; the requirement for informed patient consent was waived. Consecutive nonenhanced whole-body hybrid FDG positron emission tomographic (PET)-computed tomographic (CT) scans obtained in 142 patients (mean age, 63.6 years; age range, 19-94 years) from October 1, 2008, to November 28, 2008, were retrospectively reviewed. Mean attenuation (in Hounsfield units) and standardized uptake value (SUV) measurements for the liver and spleen were obtained, with identical regions of interest used for the CT and PET examinations. The patients were assigned to three study groups: a control group-119 patients with a mean liver attenuation value greater than or equal to the mean spleen attenuation value, a diffuse fatty liver disease group-23 patients in whom the mean liver attenuation value was less than the mean spleen attenuation value, and a more strictly defined fatty liver disease group-a subset of 10 patients from the diffuse fatty liver disease group with a mean liver attenuation value minus mean spleen attenuation value difference of less than or equal to -10 HU. Mean SUV (SUV(m)) values were compared between the groups by using a two-sample t test for means. The association between mean liver attenuation and average FDG uptake was assessed with linear regression analysis. RESULTS The average SUV(m)for the control group was 2.18 (standard deviation [SD], 0.36; 95% confidence interval [CI]: 2.12, 2.24). No significant difference was identified when the average SUV(m)for the control group was compared with those for the fatty liver disease (SUV(m), 2.03; SD, 0.36; 95% CI: 1.90, 2.16) (P >.05) and more strictly defined fatty liver disease (SUV(m), 2.07; SD, 0.24; 95% CI: 1.92, 2.22) groups (P >.05). Linear regression analysis of liver SUV(m)as a function of mean liver attenuation revealed a mean slope of 0.005 (SD, 0.04; 95% CI: -0.005, 0.015) and a correlation coefficient of 0.02. CONCLUSION No association between liver attenuation and FDG uptake measured in terms of SUV(m)was observed. On the basis of these data, it is acceptable to use the liver as a comparator for extrahepatic foci of equivocal increased FDG activity in patients with fatty liver disease. (c) RSNA, 2010.
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Affiliation(s)
- Jonathan T Abele
- Department of Radiology and Diagnostic Imaging, University of Alberta, 8440-112 St, 2A2.41 WMC, Edmonton, AB, Canada T6G 2B7.
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Prospective evaluation of CECT and 18F-FDG-PET/CT in detection of hepatic metastases. Nucl Med Commun 2009; 30:117-25. [DOI: 10.1097/mnm.0b013e32831ec57b] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Zuckier LS, Freeman LM. Liver, Spleen and Biliary Tree. Clin Nucl Med 2008. [DOI: 10.1007/978-3-540-28026-2_6] [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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Miller FH, Keppke AL, Reddy D, Huang J, Jin J, Mulcahy MF, Salem R. Response of liver metastases after treatment with yttrium-90 microspheres: role of size, necrosis, and PET. AJR Am J Roentgenol 2007; 188:776-83. [PMID: 17312068 DOI: 10.2214/ajr.06.0707] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Yttrium-90 radioembolization is an emerging treatment for liver malignancies. The purpose of this study was to evaluate the imaging response of liver metastases to 90Y microspheres based on size and necrosis criteria using CT and comparing the results to PET and to describe imaging features related to 90Y therapy. MATERIALS AND METHODS We reviewed the imaging studies of 42 patients with unresectable liver metastases treated with lobar radioembolization with 90Y. CT response was determined using traditional size criteria (World Health Organization [WHO] and Response Evaluation Criteria in Solid Tumors [RECIST]), necrosis criteria, and combined criteria (RECIST and necrosis). We compared the response on CT with the response on PET. Complications of treatment were assessed. RESULTS The response rate was 19% (8/42) by WHO criteria, 24% (10/42) by RECIST, 45% (19/42) by necrosis criteria, and 50% (21/42) by combined criteria. Stabilization of lesion size occurred in 50% of patients. Necrosis and combined criteria identified responders earlier than RECIST and WHO criteria. Seven responders by combined criteria had an increase in lesion size on initial follow-up and would have been considered nonresponders. PET scans were obtained in 23 patients (33 treated lobes). PET detected significantly more responses to treatment (21/33, 63%) than CT using RECIST (2/33, 6%) or combined criteria (8/33, 24%) (p < 0.05, McNemar test). Complications of treatment included radiation cholecystitis (10 patients, 23%) and liver edema (18 patients, 42%). CONCLUSION The use of necrosis and size criteria on CT and correlation with PET may improve the accuracy of assessment of response to 90Y treatment in patients with liver metastases and detect response earlier than standard size criteria.
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Affiliation(s)
- Frank H Miller
- Department of Radiology, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 676 N St. Clair, Ste. 800, Chicago, IL 60611, USA
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