1
|
Mirshahvalad SA, Farag A, Thiessen J, Wong R, Veit-Haibach P. Current Applications of PET/MR: Part I: Technical Basics and Preclinical/Clinical Applications. Can Assoc Radiol J 2024:8465371241255903. [PMID: 38813998 DOI: 10.1177/08465371241255903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Positron emission tomography/magnetic resonance (PET/MR) imaging has gone through major hardware improvements in recent years, making it a reliable state-of-the-art hybrid modality in clinical practice. At the same time, image reconstruction, attenuation correction, and motion correction algorithms have significantly evolved to provide high-quality images. Part I of the current review discusses technical basics, pre-clinical applications, and clinical applications of PET/MR in radiation oncology and head and neck imaging. PET/MR offers a broad range of advantages in preclinical and clinical imaging. In the preclinic, small and large animal-dedicated devices were developed, making PET/MR capable of delivering new insight into animal models in diseases and facilitating the development of methods that inform clinical PET/MR. Regarding PET/MR's clinical applications in radiation medicine, PET and MR already play crucial roles in the radiotherapy process. Their combination is particularly significant as it can provide molecular and morphological characteristics that are not achievable with other modalities. In addition, the integration of PET/MR information for therapy planning with linear accelerators is expected to provide potentially unique biomarkers for treatment guidance. Furthermore, in clinical applications in the head and neck region, it has been shown that PET/MR can be an accurate modality in head and neck malignancies for staging and resectability assessment. Also, it can play a crucial role in diagnosing residual or recurrent diseases, reliably distinguishing from oedema and fibrosis. PET/MR can furthermore help with tumour characterization and patient prognostication. Lastly, in head and neck carcinoma of unknown origin, PET/MR, with its diagnostic potential, may obviate multiple imaging sessions in the near future.
Collapse
Affiliation(s)
- Seyed Ali Mirshahvalad
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Adam Farag
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
| | - Jonathan Thiessen
- Imaging Program, Lawson Health Research Institute, London, ON, Canada
- Medical Biophysics, Medical Imaging, Western University, London, ON, Canada
| | - Rebecca Wong
- Department of Radiation Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Patrick Veit-Haibach
- University Medical Imaging Toronto, Toronto Joint Department Medical Imaging, University Health Network, Sinai Health System, Women's College Hospital, University of Toronto, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
2
|
Utility of mono-exponential, bi-exponential, and stretched exponential signal models of intravoxel incoherent motion (IVIM) to predict prognosis and survival risk in laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) patients after chemoradiotherapy. Jpn J Radiol 2023:10.1007/s11604-023-01399-x. [PMID: 36847996 DOI: 10.1007/s11604-023-01399-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 02/03/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE To investigate the predictive power of mono-exponential, bi-exponential, and stretched exponential signal models of intravoxel incoherent motion (IVIM) in prognosis and survival risk of laryngeal and hypopharyngeal squamous cell carcinoma (LHSCC) patients after chemoradiotherapy. MATERIALS AND METHODS Forty-five patients with laryngeal or hypopharyngeal squamous cell carcinoma were retrospectively enrolled. All patients had undergone pretreatment IVIM examination, subsequently, mean apparent diffusion coefficient (ADCmean), maximum ADC (ADCmax), minimum ADC (ADCmin) and ADCrange (ADCmax - ADCmean) by mono-exponential model, true diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f) by bi-exponential model, distributed diffusion coefficient (DDC), and diffusion heterogeneity index (α) by stretched exponential model were measured. Survival data were collected for 5 years. RESULTS Thirty-one cases were in the treatment failure group and fourteen cases were in the local control group. Significantly lower ADCmean, ADCmax, ADCmin, D, f, and higher D* values were observed in the treatment failure group than in the local control group (p < 0.05). D* had the greatest AUC of 0.802, with sensitivity and specificity of 77.4 and 85.7% when D* was 38.85 × 10-3 mm2/s. Kaplan-Meier survival analysis showed that the curves of N stage, ADCmean, ADCmax, ADCmin, D, D*, f, DDC, and α values were significant. Multivariate Cox regression analysis showed ADCmean and D* were independently correlated with progression-free survival (PFS) (hazard ratio [HR] = 0.125, p = 0.001; HR = 1.008, p = 0.002, respectively). CONCLUSION The pretreatment parameters of mono-exponential and bi-exponential models were significantly correlated with prognosis of LHSCC, ADCmean and D* values were independent factors for survival risk prediction.
Collapse
|
3
|
Prospective Investigation of 18FDG-PET/MRI with Intravoxel Incoherent Motion Diffusion-Weighted Imaging to Assess Survival in Patients with Oropharyngeal or Hypopharyngeal Carcinoma. Cancers (Basel) 2022; 14:cancers14246104. [PMID: 36551590 PMCID: PMC9775681 DOI: 10.3390/cancers14246104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
To prospectively investigate the prognostic value of 18F-FDG PET/MRI in patients with oropharyngeal or hypopharyngeal squamous cell carcinomas (OHSCC) treated by chemoradiotherapy. The study cohort consisted of patients with OHSCC who had undergone integrated PET/MRI prior to chemoradiotherapy or radiotherapy. Imaging parameters derived from intravoxel incoherent motion (IVIM), dynamic contrast-enhanced MRI (DCE-MRI), and 18F-FDG PET were analyzed in relation to overall survival (OS) and recurrence-free survival (RFS). In multivariable analysis, T classification (p < 0.001), metabolic tumor volume (p = 0.013), and pseudo-diffusion coefficient (p = 0.008) were identified as independent risk factors for OS. The volume transfer rate constant (p = 0.015), initial area under the curve (p = 0.043), T classification (p = 0.018), and N classification (p = 0.018) were significant predictors for RFS. The Harrell’s c-indices of OS and RFS obtained from prognostic models incorporating clinical and PET/MRI predictors were significantly higher than those derived from the traditional TNM staging system (p = 0.001). The combination of clinical risk factors with functional parameters derived from IVIM and DCE-MRI plus metabolic PET parameters derived from 18F-FDG PET in integrated PET/MRI outperformed the information provided by traditional TNM staging in predicting the survival of patients with OHSCC.
Collapse
|
4
|
Husby T, Johansen H, Bogsrud TV, Hustad KV, Evensen BV, Boellaard R, Giskeødegård GF, Fagerli UM, Eikenes L. Prognostic value of combined MTV and ADC derived from baseline FDG PET/MRI in aggressive non-Hodgkins lymphoma. BMC Cancer 2022; 22:1117. [PMID: 36319985 PMCID: PMC9623965 DOI: 10.1186/s12885-022-10194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
PURPOSE The aim of this prospective study was to investigate the prognostic value of metabolic tumor volume (MTV) and apparent diffusion coefficient (ADC) from baseline FDG PET/MRI compared to established clinical risk factors in terms of progression free survival (PFS) at 2 years in a cohort of diffuse large B-cell Lymphoma (DLBCL) and high-grade-B-cell lymphoma (HGBCL). METHODS Thirty-three patients and their baseline PET/MRI examinations were included. Images were read by two pairs of nuclear medicine physicians and radiologists for defining lymphoma lesions. MTV was computed on PET, and up to six lymphoma target lesions with restricted diffusion was defined for each PET/MRI examination. Minimum ADC (ADCmin) and the corresponding mean ADC (ADCmean) from the target lesion with the lowest ADCmin were included in the analyses. For the combined PET/MRI parameters, the ratio between MTV and the target lesion with the lowest ADCmin (MTV/ADCmin) and the corresponding ADCmean (MTV/ADCmean) was calculated for each patient. Clinical, histological, and PET/MRI parameters were compared between the treatment failure and treatment response group, while survival analyses for each variable was performed by using univariate Cox regression. In case of significant variables in the Cox regression analyses, Kaplan-Meier survival analyses with log-rank test was used to study the effect of the variables on PFS. RESULTS ECOC PS scale ≥2 (p = 0.05) and ADCmean (p = 0.05) were significantly different between the treatment failure group (n = 6) and those with treatment response (n = 27). Survival analyses showed that ADCmean was associated with PFS (p = 0.02, [HR 2.3 for 1 SD increase]), while combining MTV and ADC did not predict outcome. In addition, ECOG PS ≥2 (p = 0.01, [HR 13.3]) and histology of HGBCL (p = 0.02 [HR 7.6]) was significantly associated with PFS. CONCLUSIONS ADCmean derived from baseline MRI could be a prognostic imaging biomarker for DLBCL and HGBCL. Baseline staging with PET/MRI could therefore give supplementary prognostic information compared to today's standard PET/CT.
Collapse
Affiliation(s)
- Trine Husby
- grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks, 8905 Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Oncology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Håkon Johansen
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Trond Velde Bogsrud
- grid.412244.50000 0004 4689 5540PET-Centre, University Hospital of North Norway, Tromsø, Norway ,grid.154185.c0000 0004 0512 597XPET-Centre, Aarhus University Hospital, Aarhus, Denmark
| | - Kari Vekseth Hustad
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Birte Veslemøy Evensen
- grid.52522.320000 0004 0627 3560Department of Radiology and Nuclear Medicine, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway
| | - Ronald Boellaard
- grid.4494.d0000 0000 9558 4598Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Radiology and Nuclear Medicine, Cancer Center Amsterdam, University Medical Centers Amsterdam, VUMC, Amsterdam, The Netherlands
| | - Guro F. Giskeødegård
- grid.5947.f0000 0001 1516 2393Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Unn-Merete Fagerli
- grid.52522.320000 0004 0627 3560Department of Oncology, St. Olavs hospital, Trondheim University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Live Eikenes
- grid.5947.f0000 0001 1516 2393Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Postboks, 8905 Trondheim, Norway
| |
Collapse
|
5
|
Thormann M, Surov A, Pech M, March C, Hass P, Damm R, Omari J. Local ablation of hepatocellular carcinoma by interstitial brachytherapy: prediction of outcome by diffusion-weighted imaging. Acta Radiol 2022; 64:1331-1340. [PMID: 36262039 DOI: 10.1177/02841851221129714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interstitial brachytherapy (iBT) has become a viable treatment option in the therapy of early and intermediate stage hepatocellular carcinoma (HCC). Prognostic imaging tools to predict patient outcome are missing. PURPOSE To assess the predictive value of baseline diffusion-weighted imaging in HCC before iBT with regard to local tumor control and overall survival (OS). MATERIAL AND METHODS We retrospectively identified 107 patients who underwent iBT for HCC from 2011 to 2018 from our database. Apparent diffusion coefficient (ADC) values for each treated lesion were analyzed in region of interest measurements. Additionally, explorative combined ratios adjusting total measured lesion area and mean measured lesion area per patient by ADC values were calculated. Measurements underwent a univariate and multivariate Cox regression analysis. The log rank test was then used to verify prognostic cutoff levels for median survival time. RESULTS A total of 189 lesions in 81 patients were measured. Median survival of patients was 46.0 months. Neither ADC parameter was indicative of local tumor control. Lesion size >5 cm was associated with lower local tumor control (hazard ratio [HR]=4.292, 95% confidence interval [CI]=1.285-14.331; P = 0.018). Average measured lesion area divided by ADCmin (ADCarea mean, min) was identified to independently predict OS (HR=1.994, 95% CI=1.172-3.392; P = 0.011). A cutoff based on the variable's median (0.29 × 10-4 AU) identified patients with poor outcome (OS 36 vs. 61 months) for lower ADCarea mean, min values as verified by the log-rank test (P = 0.040). CONCLUSION Pre-treatment ADCarea mean, min may serve as an independent predictor of OS in patients with HCC undergoing iBT.
Collapse
Affiliation(s)
- Maximilian Thormann
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Alexey Surov
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Maciej Pech
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Christine March
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Peter Hass
- Clinic for Radiation Oncology, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Damm
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| | - Jazan Omari
- Clinic for Radiology and Nuclear Medicine, 39067University Hospital Magdeburg, Magdeburg, Germany
| |
Collapse
|
6
|
Creff G, Jegoux F, Palard X, Depeursinge A, Abgral R, Marianowski R, Leclere JC, Eugene T, Malard O, Crevoisier RD, Devillers A, Castelli J. 18F-FDG PET/CT-Based Prognostic Survival Model After Surgery for Head and Neck Cancer. J Nucl Med 2022; 63:1378-1385. [PMID: 34887336 PMCID: PMC9454462 DOI: 10.2967/jnumed.121.262891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
The aims of this multicenter study were to identify clinical and preoperative PET/CT parameters predicting overall survival (OS) and distant metastasis-free survival (DMFS) in a cohort of head and neck squamous cell carcinoma patients treated with surgery, to generate a prognostic model of OS and DMFS, and to validate this prognostic model with an independent cohort. Methods: A total of 382 consecutive patients with head and neck squamous cell carcinoma, divided into training (n = 318) and validation (n = 64) cohorts, were retrospectively included. The following PET/CT parameters were analyzed: clinical parameters, SUVmax, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis, and distance parameters for the primary tumor and lymph nodes defined by 2 segmentation methods (relative SUVmax threshold and absolute SUV threshold). Cox analyses were performed for OS and DMFS in the training cohort. The concordance index (c-index) was used to identify highly prognostic parameters. These prognostic parameters were externally tested in the validation cohort. Results: In multivariable analysis, the significant parameters for OS were T stage and nodal MTV, with a c-index of 0.64 (P < 0.001). For DMFS, the significant parameters were T stage, nodal MTV, and maximal tumor-node distance, with a c-index of 0.76 (P < 0.001). These combinations of parameters were externally validated, with c-indices of 0.63 (P < 0.001) and 0.71 (P < 0.001) for OS and DMFS, respectively. Conclusion: The nodal MTV associated with the maximal tumor-node distance was significantly correlated with the risk of DMFS. Moreover, this parameter, in addition to clinical parameters, was associated with a higher risk of death. These prognostic factors may be used to tailor individualized treatment.
Collapse
Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology-Head and Neck Surgery (HNS), University Hospital, Rennes, France;
| | - Franck Jegoux
- Department of Otolaryngology–Head and Neck Surgery (HNS), University Hospital, Rennes, France
| | - Xavier Palard
- Department of Nuclear Medicine, Cancer Institute, Rennes, France
| | | | - Ronan Abgral
- Department of Nuclear Medicine, University Hospital, Brest, France
| | - Remi Marianowski
- Department of Otolaryngology–HNS, University Hospital, Brest, France
| | | | - Thomas Eugene
- Department of Nuclear Medicine, University Hospital, Nantes, France
| | - Olivier Malard
- Department of Otolaryngology–HNS, University Hospital, Nantes, France
| | - Renaud De Crevoisier
- Department of Radiation Oncology, Cancer Institute, Rennes, France; and,LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Cancer Institute, Rennes, France
| | - Joel Castelli
- Department of Radiation Oncology, Cancer Institute, Rennes, France; and,LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| |
Collapse
|
7
|
Bielak L, Henrik Nicolay N, Ludwig U, Lottner T, Rühle A, Grosu AL, Bock M. Improvement of diffusion weighted MRI by practical B 0 homogenization for head & neck cancer patients undergoing radiation therapy. Phys Med 2022; 97:59-65. [PMID: 35413606 DOI: 10.1016/j.ejmp.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 02/08/2022] [Accepted: 04/04/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND MRI is a frequently used tool in radiation therapy planning. For MR-based tumor segmentation, diffusion weighted imaging plays a major role, which can fail due to excessive image artifacts for head and neck cancer imaging. Here, an easy-to-use setup is presented for imaging of head and neck cancer patients in a radiotherapy thermoplastic fixation mask. METHODS In a prospective head and neck cancer study, MRI data of 29 patients has been acquired at 3 different time points during radiation treatment. The data was analyzed with respect to Nyquist ghosting artifacts in the diffusion images in conventional single shot and readout segmented EPI sequences. For 9 patients, an improved setup with water bags for B0 homogenization was used, and the impact on artifact frequency was analyzed. Additionally, volunteer measurements with B0 fieldmaps are presented. RESULTS The placement of water bags to the sides of the head during MRI measurements significantly reduces artefacts in diffusion MRI. The number of artifact-free images in readout segmented EPI increased from 74% to 95% of the cases. Volunteer measurements showed a significant increase in B0 homogeneity across slices (head foot direction) as well as within each slice. CONCLUSIONS The placement of water bags for B0 homogenization is easy to implement, cost-efficient and does not impact patient comfort. Therefore, if very sophisticated soft- or hardware solutions are not present at a given site, or cannot be implemented due to restrictions from the thermoplastic mask, this is an excellent alternative to reduce artifacts in diffusion weighted imaging.
Collapse
Affiliation(s)
- Lars Bielak
- Dept. of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany.
| | - Nils Henrik Nicolay
- Dept. of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Ute Ludwig
- Dept. of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Thomas Lottner
- Dept. of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alexander Rühle
- Dept. of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anca-Ligia Grosu
- Dept. of Radiation Oncology, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Michael Bock
- Dept. of Radiology, Medical Physics, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| |
Collapse
|
8
|
Marcus C, Sheikhbahaei S, Shivamurthy VKN, Avey G, Subramaniam RM. PET Imaging for Head and Neck Cancers. Radiol Clin North Am 2021; 59:773-788. [PMID: 34392918 DOI: 10.1016/j.rcl.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Head and neck cancers are commonly encountered cancers in clinical practice in the United States. Fluorine-18-fluorodeoxyglucose (18F-FDG) PET/CT has been clinically applied in staging, occult primary tumor detection, treatment planning, response assessment, follow-up, recurrent disease detection, and prognosis prediction in these patients. Alternative PET tracers remain investigational and can provide additional valuable information such as radioresistant tumor hypoxia. The recent introduction of 18F-FDG PET/MR imaging has provided the advantage of combining the superior soft tissue resolution of MR imaging with the functional information provided by 18F-FDG PET. This article is a concise review of recent advances in PET imaging in head and neck cancer.
Collapse
Affiliation(s)
- Charles Marcus
- Department of Nuclear Medicine and Molecular Imaging, Emory University Hospital, Atlanta, GA, USA.
| | - Sara Sheikhbahaei
- Department of Radiology, Johns Hopkins Medical Institutions, 601 N. Caroline Street, JHOC 3235, Baltimore, MD 21287, USA
| | - Veeresh Kumar N Shivamurthy
- Epilepsy Center, St. Francis Hospital and Medical Center, Trinity Health of New England, 114 Woodland Street, Hartford, CT 06105, USA
| | - Greg Avey
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave #3284, Madison, WI 53792, USA
| | - Rathan M Subramaniam
- Dean's Office, Otago Medical School, University of Otago, 201 Great King Street, Dunedin 9016, New Zealand
| |
Collapse
|
9
|
Pace L, Nicolai E, Cavaliere C, Basso L, Garbino N, Spinato G, Salvatore M. Prognostic value of 18F-FDG PET/MRI in patients with advanced oropharyngeal and hypopharyngeal squamous cell carcinoma. Ann Nucl Med 2021; 35:479-484. [PMID: 33575927 PMCID: PMC7981313 DOI: 10.1007/s12149-021-01590-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the prognostic value of combined positron emission tomography (PET)/magnetic resonance imaging (MRI) parameters provided by simultaneous 18F-fluorodeoxyglucose (FDG) PET/MRI in patients with locally advanced oropharyngeal and hypopharyngeal squamous cell carcinomas (OHSCC). METHODS Forty-five patients with locally advanced OHSCC who underwent simultaneous FDG PET/MRI before (chemo)radiotherapy were retrospectively enrolled. Peak standardized uptake value (SULpeak), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of the primary lesion were obtained on PET data. On MRI scans, primary tumor size, diffusion and perfusion parameters were assessed using pre-contrast and high-resolution post-contrast images. Ratios between metabolic/metabolo-volumetric parameters and ADC were calculated. Comparisons between groups were performed by Student's t test. Survival analysis was performed by univariate Cox proportional hazard regression analysis. Overall survival curves were obtained by the Kaplan-Meier method and compared with the log-rank test. Survivors were censored at the time of the last clinical control. p < 0.05 was considered statistically significant RESULTS: During follow-up (mean 31.4 ± 21 months), there were 15 deaths. Univariate analysis shows that SULpeak and SULpeak/ADCmean were significant predictors of overall survival (OS). At multivariate analysis, only SULpeak remained a significant predictor of OS. Kaplan-Meier survival analyses showed that patients with higher SULpeak had poorer outcome compared to those with lower values (HR: 3.7, p = 0.007). CONCLUSION Pre-therapy SULpeak of the primary site was predictive of overall survival in patients with oropharyngeal or hypopharyngeal cancer treated with (chemo)radiotherapy.
Collapse
Affiliation(s)
- Leonardo Pace
- Dipartimento di Medicina Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, via M. de Vito Piscicelli 44, 80128, Naples, Italy.
| | | | | | | | | | - Giacomo Spinato
- Dipartimento di Neuroscienze Sezione di Otorinolaringoiatria e Centro Regionale Tumori Testa Collo, Università degli Studi di Padova, Treviso, Italy
- Dipartimento di ChirurgiaOncologia e GastroenterologiaSezione di Oncologia ed Immunologia, Università degli Studi di Padova, Padua, Italy
| | | |
Collapse
|
10
|
Creff G, Devillers A, Depeursinge A, Palard-Novello X, Acosta O, Jegoux F, Castelli J. Evaluation of the Prognostic Value of FDG PET/CT Parameters for Patients With Surgically Treated Head and Neck Cancer: A Systematic Review. JAMA Otolaryngol Head Neck Surg 2021; 146:471-479. [PMID: 32215611 DOI: 10.1001/jamaoto.2020.0014] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Head and neck squamous cell cancer (HNSCC) represents the seventh most frequent cancer worldwide. More than half of the patients diagnosed with HNSCC are treated with primary surgery. Objective To report the available evidence on the value of quantitative parameters of fluorodeoxyglucose F 18-labeled positron emission tomography and computed tomography (FDG-PET/CT) performed before surgical treatment of HNSCC to estimate overall survival (OS), disease-free survival (DFS), and distant metastasis (DM) and to discuss their limitations. Evidence Review A systematic review of the English-language literature in PubMed/MEDLINE and ScienceDirect published between January 2003 and February 15, 2019, was performed between March 1 and July 27, 2019, to identify articles addressing the association between preoperative FDG-PET/CT parameters and oncological outcomes among patients with HNSCC. Articles included those that addressed the following: (1) cancer of the oral cavity, oropharynx, hypopharynx, or larynx; (2) surgically treated (primary or for salvage); (3) pretreatment FDG-PET/CT; (4) quantitative or semiquantitative evaluation of the FDG-PET/CT parameters; and (5) the association between the value of FDG-PET/CT parameters and clinical outcomes. Quality assessment was performed using the Oxford Centre for Evidence-Based Medicine level of evidence. Findings A total of 128 studies were retrieved from the databases, and 36 studies met the inclusion criteria; these studies comprised 3585 unique patients with a median follow-up of 30.6 months (range, 16-53 months). Of these 36 studies, 32 showed an association between at least 1 FDG-PET/CT parameter and oncological outcomes (OS, DFS, and DM). The FDG-PET/CT volumetric parameters (metabolic tumor volume [MTV] and total lesion glycolysis [TLG]) were independent prognostic factors in most of the data, with a higher prognostic value than the maximum standard uptake value (SUVmax). For example, in univariate analysis of OS, the SUVmax was correlated with OS in 5 of 11 studies, MTV in 11 of 12 studies, and TLG in 6 of 9 studies. The spatial distribution of metabolism via textural indices seemed promising, although that factor is currently poorly evaluated: only 3 studies analyzed data from radiomics indices. Conclusions and Relevance The findings of this study suggest that the prognostic effectiveness of FDG-PET/CT parameters as biomarkers of OS, DFS, and DM among patients with HNSCC treated with surgery may be valuable. The volumetric parameters (MTV and TLG) seemed relevant for identifying patients with a higher risk of postsurgical disease progression who could receive early therapeutic intervention to improve their prognosis. However, further large-scale studies including exclusively surgery-treated patients stratified according to localization and further analysis of the textural indices are required to define a reliable FDG-PET/CT-based prognostic model of mortality and recurrence risk for these patients.
Collapse
Affiliation(s)
- Gwenaelle Creff
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | - Anne Devillers
- Department of Nuclear Medicine, Centre Eugène Marquis, Rennes, France
| | - Adrien Depeursinge
- University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Oscar Acosta
- LTSI (Image and Signal Processing Laboratory), INSERM, U1099, Rennes, France
| | - Franck Jegoux
- Department of Otolaryngology-Head and Neck Surgery, Rennes University Hospital, Rennes, France
| | - Joel Castelli
- Department of Radiation Oncology, Cancer Institute Eugène Marquis, Rennes, France
| |
Collapse
|
11
|
Positron Emission Tomography for Response Evaluation in Microenvironment-Targeted Anti-Cancer Therapy. Biomedicines 2020; 8:biomedicines8090371. [PMID: 32972006 PMCID: PMC7556039 DOI: 10.3390/biomedicines8090371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/31/2022] Open
Abstract
Therapeutic response is evaluated using the diameter of tumors and quantitative parameters of 2-[18F] fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET). Tumor response to molecular-targeted drugs and immune checkpoint inhibitors is different from conventional chemotherapy in terms of temporal metabolic alteration and morphological change after the therapy. Cancer stem cells, immunologically competent cells, and metabolism of cancer are considered targets of novel therapy. Accumulation of FDG reflects the glucose metabolism of cancer cells as well as immune cells in the tumor microenvironment, which differs among patients according to the individual immune function; however, FDG-PET could evaluate the viability of the tumor as a whole. On the other hand, specific imaging and cell tracking of cancer cell or immunological cell subsets does not elucidate tumor response in a complexed interaction in the tumor microenvironment. Considering tumor heterogeneity and individual variation in therapeutic response, a radiomics approach with quantitative features of multimodal images and deep learning algorithm with reference to pathologic and genetic data has the potential to improve response assessment for emerging cancer therapy.
Collapse
|
12
|
Rijo-Cedeño J, Mucientes J, Álvarez O, Royuela A, Seijas Marcos S, Romero J, García-Berrocal JR. Metabolic tumor volume and total lesion glycolysis as prognostic factors in head and neck cancer: Systematic review and meta-analysis. Head Neck 2020; 42:3744-3754. [PMID: 32914474 DOI: 10.1002/hed.26461] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/17/2020] [Accepted: 08/26/2020] [Indexed: 12/18/2022] Open
Abstract
The role of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) in head and neck cancer (HNC) prognosis is not well established. We conducted a systematic review focusing on MTV and TLG measured by 18 F-FDG positron-emission tomography in HNC. Meta-analyses were developed, estimating hazard ratios (HRs) for overall survival (OS) and disease-free survival (DFS). Eighteen studies were found with a total of 1512 patients. MTV-adjusted analysis had an HR of 4.65 (95% CI = 2.04-10.6) for DFS and 3.89 (95% CI = 1.47-10.30) for OS. TLG-unadjusted analysis had an HR of 3.19 (95% CI = 2.33-4.37) for DFS and 2.48 (95% CI = 1.82-3.39) for OS. TLG-adjusted analysis for DFS obtained an HR of 2.05 (95% CI = 0.96-4.39). MTV and TLG are good prognostic factors in HNC, as high values predict a worse OS and DFS. Given the important information they provide, these parameters may be considered in clinical practice, as they are easily obtainable with current technology.
Collapse
Affiliation(s)
- Jefferson Rijo-Cedeño
- Department of Otorhinolaryngology-Head and Neck Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Jorge Mucientes
- Department of Nuclear Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Oscar Álvarez
- Department of Otorhinolaryngology-Head and Neck Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Ana Royuela
- Biostatistics Unit, Biomedical Research Institute IDIPHISA, CIBERESP, Madrid, Spain
| | - Sara Seijas Marcos
- Department of Nuclear Medicine, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - Jesús Romero
- Department of Radiation Oncology, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| | - José Ramón García-Berrocal
- Department of Otorhinolaryngology-Head and Neck Surgery, Puerta de Hierro University Hospital, Majadahonda, Madrid, Spain
| |
Collapse
|
13
|
Abstract
In academic centers, PET/MR has taken the road to clinical nuclear medicine in the past 6 years since the last review on its applications in head and neck cancer patients in this journal. Meanwhile, older sequential PET + MR machines have largely vanished from clinical sites, being replaced by integrated simultaneous PET/MR scanners. Evidence from several studies suggests that PET/MR overall performs equally well as PET/CT in the staging and restaging of head and neck cancer and in radiation therapy planning. PET/MR appears to offer advantages in the characterization and prognostication of head and neck malignancies through multiparametric imaging, which demands an exact preparation and validation of imaging modalities, however. The majority of available clinical PET/MR studies today covers FDG imaging of squamous cell carcinoma arising from a broad spectrum of locations in the upper aerodigestive tract. In the future, specific PET/MR studies are desired that address specific histopathological tumor entities, nonepithelial malignancies, such as major salivary gland tumors, squamous cell carcinomas arising in specific locations, and malignancies imaged with non-FDG radiotracers. With the advent of digital PET/CT scanners, PET/MR is expected to partake in future technical developments, such as novel iterative reconstruction techniques and deviceless motion correction for respiration and gross movement in the head and neck region. Owing to the still comparably high costs of PET/MR scanners and facility requirements on the one hand, and the concentration of multidisciplinary head and neck cancer treatment mainly at academic centers on the other hand, a more widespread use of this imaging modality outside major hospitals is currently limited.
Collapse
|
14
|
Dang H, Chen Y, Zhang Z, Shi X, Chen X, Zhu X, Hou B, Xing H, Xue H, Jin Z. Application of integrated positron emission tomography/magnetic resonance imaging in evaluating the prognostic factors of head and neck squamous cell carcinoma with positron emission tomography, diffusion-weighted imaging, dynamic contrast enhancement and combined model. Dentomaxillofac Radiol 2020; 49:20190488. [PMID: 32202922 DOI: 10.1259/dmfr.20190488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study was designed to investigate the distribution of the independent parameters of PET and MR in tumour differentiation and staging and to evaluate the diagnostic efficiency of the independent parameters and combined model of PET/MR in the tumour differentiation of head and neck squamous cell carcinoma (HNSCC). METHODS The patients with the preliminary diagnosis of HNSCC were included and underwent the integrated PET/MR The parameters included the diffusion-weighted imaging, dynamic contrast enhancement and PET. The correlations between different parameters and the distribution in groups of tumour differentiation and staging were analysed. The combined model was established with complementary PET/MR parameters. The diagnostic efficiency of the independent parameters and combined model in the tumour differentiation were analysed by receiver operating characteristic curve. RESULTS The correlations between the parameters of dynamic contrast enhancement and PET were most significant. There were significant differences between the well-differentiated group and the moderately/poorly differentiated group in terms of the mean values of apparent diffusion coefficient (ADC) and standardised uptake value (SUV) (p < 0.05). The distributions among different tumour stage groups were not statistically different in all the parameters. The diagnostic efficiency of tumour differentiation increased in the order of Kepmean, SUVmean, ADCmean, and the combined model. CONCLUSIONS Compared with the independent parameter, the combination of multiple parameters with PET/MR can further improve the diagnostic performance of tumour differentiation in HNSCC.
Collapse
Affiliation(s)
- Haodan Dang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Department of Nuclear Medicine, The First Medical Center of Chinese PLA General Hospital, Beijing, China, 100853
| | - Yu Chen
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhuhua Zhang
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiaohua Shi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xingming Chen
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical Co llege, Beijing, China
| | - Xiaoli Zhu
- Department of Otolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical Co llege, Beijing, China
| | - Bo Hou
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Haiqun Xing
- Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Huadan Xue
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zhengyu Jin
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
15
|
Samolyk-Kogaczewska N, Sierko E, Dziemianczyk-Pakiela D, Nowaszewska KB, Lukasik M, Reszec J. Usefulness of Hybrid PET/MRI in Clinical Evaluation of Head and Neck Cancer Patients. Cancers (Basel) 2020; 12:cancers12020511. [PMID: 32098356 PMCID: PMC7072319 DOI: 10.3390/cancers12020511] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/17/2020] [Accepted: 02/17/2020] [Indexed: 12/22/2022] Open
Abstract
(1) Background: The novel hybrid of positron emission tomography/magnetic resonance (PET/MR) examination has been introduced to clinical practice. The aim of our study was to evaluate PET/MR usefulness in preoperative staging of head and neck cancer (HNC) patients (pts); (2) Methods: Thirty eight pts underwent both computed tomography (CT) and PET/MR examination, of whom 21 pts underwent surgical treatment as first-line therapy and were further included in the present study. Postsurgical tissue material was subjected to routine histopathological (HP) examination with additional evaluation of p16, human papillomavirus (HPV), Epstein-Barr virus (EBV) and Ki67 status. Agreement of clinical and pathological T staging, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of CT and PET/MR in metastatic lymph nodes detection were defined. The verification of dependences between standardized uptake value (SUV value), tumor geometrical parameters, number of metastatic lymph nodes in PET/MR and CT, biochemical parameters, Ki67 index, p16, HPV and EBV status was made with statistical analysis of obtained results; (3) Results: PET/MR is characterized by better agreement in T staging, higher specificity, sensitivity, PPV and NPV of lymph nodes evaluation than CT imaging. Significant correlations were observed between SUVmax and maximal tumor diameter from PET/MR, between SUVmean and CT tumor volume, PET/MR tumor volume, maximal tumor diameter assessed in PET/MR. Other correlations were weak and insignificant; (4) Conclusions: Hybrid PET/MR imaging is useful in preoperative staging of HNC. Further studies are needed.
Collapse
Affiliation(s)
| | - Ewa Sierko
- Department of Radiotherapy, Comprehensive Cancer Center, 15-027 Bialystok, Poland;
- Department of Oncology, Medical University of Bialystok, 15-027 Bialystok, Poland
- Correspondence: ; Tel.: +48-85-6646827
| | - Dorota Dziemianczyk-Pakiela
- Department of Otolaryngology and Maxillofacial Surgery, Jedrzej Sniadecki Memorial Regional Hospital, 15-950 Bialystok, Poland;
| | - Klaudia Beata Nowaszewska
- Department of Maxillofacial and Plastic Surgery, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Malgorzata Lukasik
- Department of Medical Pathology, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.L.); (J.R.)
| | - Joanna Reszec
- Department of Medical Pathology, Medical University of Bialystok, 15-089 Bialystok, Poland; (M.L.); (J.R.)
| |
Collapse
|
16
|
Surov A, Meyer HJ, Höhn AK, Wienke A, Sabri O, Purz S. Combined parameter SUVmax/ADCmean predicts microvessel density in head and neck squamous cell carcinoma. Preliminary results. Oral Oncol 2019; 101:104355. [PMID: 31279650 DOI: 10.1016/j.oraloncology.2019.06.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/21/2019] [Accepted: 06/29/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Anne-Kathrin Höhn
- Department of Pathology University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstr. 8, 06097 Halle, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| |
Collapse
|
17
|
Martens RM, Noij DP, Koopman T, Zwezerijnen B, Heymans M, de Jong MC, Hoekstra OS, Vergeer MR, de Bree R, Leemans CR, de Graaf P, Boellaard R, Castelijns JA. Predictive value of quantitative diffusion-weighted imaging and 18-F-FDG-PET in head and neck squamous cell carcinoma treated by (chemo)radiotherapy. Eur J Radiol 2019; 113:39-50. [PMID: 30927958 DOI: 10.1016/j.ejrad.2019.01.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/28/2018] [Accepted: 01/29/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND PURPOSE In head and neck squamous cell carcinoma (HNSCC) (chemo)radiotherapy is increasingly used to preserve organ functionality. The purpose of this study was to identify predictive pretreatment DWI- and 18F-FDG-PET/CT-parameters for treatment failure (TF), locoregional recurrence (LR) and death in HNSCC patients treated by (chemo)radiotherapy. MATERIALS AND METHODS We retrospectively included 134 histologically proven HNSCC patients treated with (chemo)radiotherapy between 2012-2017. In 58 patients pre-treatment DWI and 18F-FDG-PET/CT were performed, in 31 patients DWI only and in 45 patients 18F-FDG-PET/CT only. Primary tumor (PT) and largest lymph node (LN) metastasis were quantitatively assessed for TF, LR and death. Multivariate analysis was performed for 18F-FDG-PET/CT and DWI separately and thereafter combined. In patients with both imaging modalities, positive and negative predictive value in TF and differences in LR and death, were assessed. RESULTS Mean follow-up was 25.6 months (interquartile-range; 14.0-37.1 months). Predictors of treatment failure, corrected for TNM-stage and HPV-status, were SUVmax-PT, ADCmax-PT, total lesion glycolysis (TLG-LN), ADCp20-LN (P = 0.049, P = 0.024, P = 0.031, P = 0.047, respectively). TLG-PT was predictive for LR (P = 0.003). Metabolic active tumor volume (MATV-PT) (P = 0.003), ADCGTV-PT (P < 0.001), ADCSD (P = 0.048) were significant predictors for death. In patients with both imaging modalities SUVmax-PT remained predictive for treatment failure (P = 0.049), TLG-LN for LR (P = 0.003) and ADCGTV-PT for death (P < 0.001). Higher predictive value for treatment failure was found for the combination of SUVmax-PT and ADCmax-PT, compared to either one separately. CONCLUSION Both DWI- and 18F-FDG-PET/CT-parameters appear to have predictive value for treatment failure, locoregional recurrence and death. Combining SUVmax-PT and ADCmax-PT resulted in better prediction of treatment failure compared to single parameter assessment.
Collapse
Affiliation(s)
- Roland M Martens
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands.
| | - Daniel P Noij
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Thomas Koopman
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ben Zwezerijnen
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Martijn Heymans
- Department of Epidemiology and Biostatistics, the Netherlands
| | - Marcus C de Jong
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Marije R Vergeer
- Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Remco de Bree
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands; Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - C René Leemans
- Department of Otolaryngology - Head and Neck Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Jonas A Castelijns
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
18
|
Surov A, Meyer HJ, Höhn AK, Sabri O, Purz S. Combined Metabolo-Volumetric Parameters of 18F-FDG-PET and MRI Can Predict Tumor Cellularity, Ki67 Level and Expression of HIF 1alpha in Head and Neck Squamous Cell Carcinoma: A Pilot Study. Transl Oncol 2018; 12:8-14. [PMID: 30240972 PMCID: PMC6143720 DOI: 10.1016/j.tranon.2018.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/25/2018] [Accepted: 08/29/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND: Our purpose was to evaluate associations of combined 18F-FDG-PET and MRI parameters with histopathological features in head and neck squamous cell carcinoma (HNSCC). METHODS: Overall, 22 patients with HNSCC were acquired (10 with G1/2 tumors and 12 with G3 tumors).18F-FDG-PET/CT and MRI was performed and maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG) and metabolic tumor volume (MTV) were estimated. Neck MRI was obtained on a 3 T scanner. Diffusion weighted imaging was performed with estimation of apparent diffusion coefficient (ADC). Perfusion parameters Ktrans,Ve, and Kep were derived from dynamic contrast-enhanced (DCE) imaging. Different combined PET/MRI parameters were calculated as ratios: PET parameters divided by ADC or DCE MRI parameters. The following histopathological features were estimated: Ki 67, EGFR, VEGF, p53, hypoxia-inducible factor (HIF)-1α, and cell count. Spearman's correlation coefficient (p) was used for correlation analysis. P < .05 was taken to indicate statistical significance. RESULTS: In overall sample, cellularity correlated with SUVmax/ADCmin (P = .558, P = .007), TLG/ADCmin (P = .546, P = .009), and MTV/ADCmin (P = .468, P = .028). MTV/Kep correlated with expression of HIF-1α (P = .450, P = 0,047). In G1/2 tumors, SUVmax/ADCmin correlated with HIF-1α (P = −.648, P = .043); MTV/Kep (P = −.669, P = .034) and TLG/Kep (P = −.644, P = .044) with Ki67. In G3 tumors, cellularity correlated with SUVmax/ADCmin (P = .832, P = .001), SUVmax/ADCmean (P = .741, P = .006), and TLG/ADCmin (P = .678, P = .015). MTV/ADCmin and TLG/ADCmin tended to correlate with HIF-1α. CONCLUSION: Combined parameters of 18F-FDG-PET and MRI can reflect Ki 67, tumor cellularity and expression of HIF-1α in HNSCC. Associations between parameters of 18F-FDG-PET and MRI and histopathology depend on tumor grading.
Collapse
Affiliation(s)
- Alexey Surov
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany.
| | - Hans Jonas Meyer
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Anne Kathrin Höhn
- Department of Pathology University Hospital of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| |
Collapse
|