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Chan KM, Lee WC. Liver transplantation for advanced hepatocellular carcinoma: Controversy over portal vein tumor thrombosis. Biomed J 2024:100757. [PMID: 38942384 DOI: 10.1016/j.bj.2024.100757] [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: 03/18/2024] [Revised: 05/22/2024] [Accepted: 06/25/2024] [Indexed: 06/30/2024] Open
Abstract
Liver transplantation (LT) is considered the ideal treatment for hepatocellular carcinoma (HCC) concurrent with underlying cirrhotic liver disease. As well-known, LT for HCC based on the Milan criteria has shown satisfactory outcomes. However, numerous expanded transplantation criteria were proposed to benefit more patients for LT and showed comparable survivals as well. In addition, a modest expansion of transplantation criteria for HCC may be acceptable on the basis of the consensus within the transplantation community. Nonetheless, LT in patients with advanced HCC and portal vein tumor thrombosis (PVTT) recently has received attention and has been reported by many transplantation centers despite being contraindicated. Of those, the LT outcomes in certain HCC patients with PVTT were favorable. Additionally, the advancement of multimodality treatments and the evolution of systemic therapies have emerged as promising therapeutic options for downstaging advanced HCC prior to LT. Somehow, advanced HCC with PVTT could be downstaged to become eligible for LT through these multidisciplinary approaches. Although the available evidence of LT for HCC with PVTT is limited, it is hoped that LT may soon be more widely indicated for these patients. Nevertheless, several unknown factors associated with LT for HCC remain to be explored. Herein, this review aimed to update the developments in LT for patients with advanced HCC.
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Affiliation(s)
- Kun-Ming Chan
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Wei-Chen Lee
- Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Wang G, Zhang W, Luan X, Wang Z, Liu J, Xu X, Zhang J, Xu B, Lu S, Wang R, Ma G. The role of 18F-FDG PET in predicting the pathological response and prognosis to unresectable HCC patients treated with lenvatinib and PD-1 inhibitors as a conversion therapy. Front Immunol 2023; 14:1151967. [PMID: 37215117 PMCID: PMC10196479 DOI: 10.3389/fimmu.2023.1151967] [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: 01/27/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023] Open
Abstract
Purpose To investigate the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), as an imaging biomarker, for predicting pathological response and prognosis of unresectable hepatocellular carcinoma (HCC) patients treated with Lenvatinib and programmed cell death protein 1 (PD-1) inhibitors as a conversion therapy. Methods A total of 28 unresectable HCC patients with BCLC stage B or C were treated with Lenvatinib and PD-1 inhibitors before surgery. The 18F-FDG PET/CT scans were acquired before pre- (scan-1) and post-conversion therapy (scan-2). The maximum standardized uptake value (SUVmax), TLR (tumor-to-normal liver standardized uptake value ratio), and the percentages of post-treatment changes in metabolic parameters (ΔSUVmax [%] and ΔTLR [%]) were calculated. Major pathological response (MPR) was identified based on the residual viable tumor in the resected primary tumor specimen (≤10%). Differences in the progression-free survival (PFS) and overall survival (OS) stratified by ΔTLR were examined by the Kaplan-Meier method. Results 11 (11/28, 39.3%) patients were considered as MPR responders and 17 (17/28, 60.7%) patients as non-MPR responders after conversion therapy. ΔSUVmax (-70.0 [-78.8, -48.8] vs. -21.7 [-38.8, 5.7], respectively; P<0.001) and ΔTLR (-67.6 [-78.1, -56.8] vs. -18.6 [-27.9, 4.0], respectively; P<0.001) were reduced in the responder group than those in the non-responder group. According to the results of the receiver operating characteristic curve analysis, ΔTLR showed an excellent predictive value for the MPR of primary HCC lesions (area under curve=0.989, with the optimal diagnostic threshold of -46.15). When using ΔTLR of -21.36% as a threshold, patients with ΔTLR-based metabolic response had superior PFS (log-rank test, P=0.001) and OS (log-rank test, P=0.016) compared with those without ΔTLR-based metabolic response. Conclusion 18F-FDG PET is a valuable tool for predicting pathological response and prognosis of unresectable HCC patients treated by Lenvatinib combined with PD-1 as a conversion therapy.
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Affiliation(s)
- Guanyun Wang
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Nuclear Medicine Department, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wenwen Zhang
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People's Liberation Army (PLA) General Hospital/Institute of Hepatobiliary Surgery of Chinese People's Liberation Army/Key Laboratory of Digital Hepetobiliary Surgery, People's Liberation Army, Beijing, China
| | - Xiaohui Luan
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
- Graduate School, Medical School of Chinese People's Liberation Army (PLA), Beijing, China
| | - Zhanbo Wang
- Department of Pathology, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaodan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jinming Zhang
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Shichun Lu
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese People's Liberation Army (PLA) General Hospital/Institute of Hepatobiliary Surgery of Chinese People's Liberation Army/Key Laboratory of Digital Hepetobiliary Surgery, People's Liberation Army, Beijing, China
| | - Ruimin Wang
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Guangyu Ma
- Department of Nuclear Medicine, The First Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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Bülbül HM, Bülbül O, Sarıoğlu S, Özdoğan Ö, Doğan E, Karabay N. Relationships Between DCE-MRI, DWI, and 18F-FDG PET/CT Parameters with Tumor Grade and Stage in Patients with Head and Neck Squamous Cell Carcinoma. Mol Imaging Radionucl Ther 2021; 30:177-186. [PMID: 34658826 PMCID: PMC8522517 DOI: 10.4274/mirt.galenos.2021.25633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives Properties of head and neck squamous cell carcinoma (HNSCC) such as cellularity, vascularity, and glucose metabolism interact with each other. This study aimed to investigate the associations between diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and positron emission tomography/computed tomography (PET/CT) in patients with HNSCC. Methods Fourteen patients who were diagnosed with HNSCC were investigated using DCE-MRI, DCE, and 18fluoride-fluorodeoxyglucose PET/CT and evaluated retrospectively. Ktrans, Kep, Ve, and initial area under the curve (iAUC) parameters from DCE-MRI, ADCmax, ADCmean, and ADCmin parameters from DWI, and maximum standardized uptake value (SUVmax), SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) parameters from PET were obtained. Spearman's correlation coefficient was used to analyze associations between these parameters. In addition, these parameters were grouped according to tumor grade and T and N stages, and the difference between the groups was evaluated using the Mann-Whitney U test. Results Correlations at varying degrees were observed in the parameters investigated. ADCmean moderately correlated with Ve (p=0.035; r=0.566). Ktrans inversely correlated with SUVmax (p=0.017; r=-0.626). iAUC inversely correlated with SUVmax, SUVmean, TLG, and MTV (p<0.05, r≤-0.700). MTV (40% threshold) was significantly higher in T4 tumors than in T1-3 tumors (p=0.020). No significant difference was found in the grouping made according to tumor grade and N stage in terms of these parameters. Conclusion Tumor cellularity, vascular permeability, and glucose metabolism had significant correlations at different degrees. Furthermore, MTV may be useful in predicting T4 tumors.
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Affiliation(s)
- Hande Melike Bülbül
- Recep Tayyip Erdoğan Training and Research Hospital, Clinic of Radiology, Rize, Turkey
| | - Ogün Bülbül
- Recep Tayyip Erdoğan Training and Research Hospital, Clinic of Nuclear Medicine, Rize, Turkey
| | - Sülen Sarıoğlu
- Dokuz Eylül University Faculty of Medicine, Department of Medical Pathology, İzmir, Turkey
| | - Özhan Özdoğan
- Dokuz Eylül University Faculty of Medicine, Department of Nuclear Medicine, İzmir, Turkey
| | - Ersoy Doğan
- Dokuz Eylül University Faculty of Medicine, Department of Otorhinolaryngology, İzmir, Turkey
| | - Nuri Karabay
- Dokuz Eylül University Faculty of Medicine, Department of Radiology, İzmir, Turkey
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Ippoliti M, Lukas M, Brenner W, Schatka I, Furth C, Schaeffter T, Makowski MR, Kolbitsch C. Respiratory motion correction for enhanced quantification of hepatic lesions in simultaneous PET and DCE-MR imaging. Phys Med Biol 2021; 66. [PMID: 33823503 DOI: 10.1088/1361-6560/abf51e] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 04/06/2021] [Indexed: 11/11/2022]
Abstract
Simultaneous positron-emission tomography (PET)-magnetic resonance (MR) imaging is a hybrid technique in oncological hepatic imaging combining soft-tissue and functional contrast of dynamic contrast enhanced MR (DCE-MR) with metabolic information from PET. In this context, respiratory motion represents a major challenge by introducing blurring, artifacts and misregistration in the liver. In this work, we propose a free-breathing 3D non-rigid respiratory motion correction framework for simultaneously acquired DCE-MR and PET data, which makes use of higher spatial resolution MR data to derive motion information used directly during image reconstruction to minimize image blurring and motion artifacts. The main aim was to increase contrast of hepatic metastases to improve their detection and characterization. DCE-MR data were acquired at 3T through a golden radial phase encoding scheme, enabling derivation of motion fields. These were used in the motion compensated image reconstruction of DCE-MR time-series (48 time-points, 6 s temporal resolution, 1.5 mm isotropic spatial resolution) and 3D PET activity map, which was subsequently interpolated to the DCE-MR resolution. The extended Tofts model was fitted to DCE-MR data, obtaining functional parametric maps related to perfusion such as the endothelial permeability (Kt). Fifty-seven hepatic metastases were identified and analyzed. Quantitative evaluations of motion correction in PET images demonstrated average percentage increases of 16% ± 5% (mean ± SD) in Contrast (C), 18% ± 6% in SUVmeanand 14% ± 2% in SUVmax, while DCE-MR andKtscored contrast-to-noise-ratio increases of 64% ± 3% and 90% ± 6%, respectively. Motion-corrected data visually showed improved image contrast of hepatic metastases and effectively reduced blurring and motion artefacts. Scatter plots of SUVmeanversusKtsuggested that the proposed framework improved differentiation ofKtmeasurements. The presented motion correction framework for simultaneously acquired PET-DCE-MR data provides accurately aligned images with increased contrast of hepatic lesions allowing for improved detection and characterization.
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Affiliation(s)
- Matteo Ippoliti
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Mathias Lukas
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany.,Siemens Healthcare GmbH, Berlin, Germany
| | - Winfried Brenner
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Imke Schatka
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Furth
- Department of Nuclear Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Schaeffter
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany.,Technische Universität Berlin, Berlin, Germany.,King's College London, London, United Kingdom
| | - Marcus R Makowski
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany.,Klinikum rechts der Isar der TU München, Munich, Germany
| | - Christoph Kolbitsch
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig and Berlin, Germany
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The Role of 18F-FDG PET/MRI in the Assessment of Primary Intrahepatic Neoplasms. Acad Radiol 2021; 28:189-198. [PMID: 32111468 DOI: 10.1016/j.acra.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/18/2020] [Accepted: 01/18/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE AND OBJECTIVES To evaluate the results of 18F-FDG PET/MRI in relation to the histopathologic subtypes and histologic grades of mass-forming primary intrahepatic neoplasms. MATERIALS AND METHODS We retrospectively evaluated 18F-FDG positron emission tomography/magnetic resonance imaging (PET/MRI) results for 39 patients with histopathologically confirmed primary hepatic neoplasms, 15 with mass-forming intrahepatic cholangiocarcinoma (ICC) and 24 with hepatocellular carcinoma (HCC). The apparent diffusion coefficient (ADC) and standardized uptake value (SUV) were analyzed in relation to the histopathologic diagnosis and histologic grade, including calculating the sensitivity and specificity of the imaging findings. RESULTS The median SUV of ICC (6.0 [interquartile range, 5-10]) was significantly higher than that of HCC (4.0 [2.62-6.50]) (p = 0.002). An area under the curve (AUC) of 0.79 (95% confidence interval 0.649-0.932) had a sensitivity of 86.7% and a specificity of 67% at the best cut-off SUV of 4.41 to differentiate between ICC and HCC. ADC values did not differ significantly between HCCs and ICCs (p = 0.283). Both SUV and ADC values differed significantly between low-grade (well- and moderately differentiated) and high-grade (poorly differentiated) HCCs. Combining ADC and SUV further improved differentiation of low- from high-grade HCCs to a significant level (0.929). The SUV did not differ significantly between ICC histologic grades (p = 0.280), while the ADC differed significantly only between well and poorly differentiated ICCs (p = 0.004). CONCLUSION Assessing primary hepatic neoplasms with 18F-Fluorodeoxyglucose PET/MRI may help to predict tumor grade and differentiate between types of intrahepatic neoplasms.
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Prognostic Value of Metabolic Imaging Data of 11C-choline PET/CT in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma. Cancers (Basel) 2021; 13:cancers13030472. [PMID: 33530520 PMCID: PMC7865313 DOI: 10.3390/cancers13030472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/14/2021] [Accepted: 01/22/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Few data are available for the use of 11C-choline positron emission tomography/computed tomography (PET/CT) in patients with hepatocellular carcinoma (HCC). The aim of the study was to analyze the clinical impact of this metabolic imaging in patients with HCC candidates for hepatectomy. Seven parameters were recorded for PET/CT in 60 patients. The Cox regression for overall survival (OS) showed that Barcelona stages (p = 0.003) and metabolic tumor volume (MTV) (p = 0.026) were the only factors independently associated with OS and furthermore, curve analysis revealed MTV ability in predicting OS. Patients with MTV ≥ 380 had worse OS (p = 0.015). The use of 11C-choline PET/CT allows for better prognostic refinement in patients undergoing hepatectomy for HCC: integration of such metabolic modality into HCC staging system should be considered. Abstract 11C-choline positron emission tomography/computed tomography (PET/CT) has been used for patients with some types of tumors, but few data are available for hepatocellular carcinoma (HCC). We queried our prospective database for patients with HCC staged with 11C-choline PET/CT to assess the clinical impact of this imaging modality. Seven parameters were recorded: maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), liver standardized uptake value (SUVliver), metabolic tumor volume (MTV), photopenic area, metabolic tumor burden (MTB = MTVxSUVmean), and SUVratio (SUVmax/SUVliver). Analysis was performed to identify parameters that could be predictors of overall survival (OS). Sixty patients were analyzed: fourteen (23%) were in stage 0-A, 37 (62%) in stage B, and 9 (15%) in stage C of the Barcelona classification. The Cox regression for OS showed that Barcelona stages (HR = 2.94; 95%CI = 1.41–4.51; p = 0.003) and MTV (HR = 2.11; 95%CI = 1.51–3.45; p = 0.026) were the only factors independently associated with OS. Receiver operating characteristics curve analysis revealed MTV ability in discriminating survival (area under the curve (AUC) = 0.77; 95%CI = 0.57–097; p < 0.001: patients with MTV ≥ 380 had worse OS (p = 0.015)). The use of 11C-choline PET/CT allows for better prognostic refinement in patients undergoing hepatectomy for HCC. Incorporation of such modality into HCC staging system should be considered.
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Wu B, Zhang Y, Tan H, Shi H. Value of 18F-FDG PET/CT in the diagnosis of portal vein tumor thrombus in patients with hepatocellular carcinoma. Abdom Radiol (NY) 2019; 44:2430-2435. [PMID: 30944961 DOI: 10.1007/s00261-019-01997-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the usefulness of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for the diagnosis of a portal vein tumor thrombus (PVTT) in patients with hepatocellular carcinoma (HCC). METHODS One hundred fifty-four patients with histologically proven HCC underwent 18F-FDG PET/CT imaging. The maximum standardized uptake value (SUVmax) was calculated, and the change in SUVmax (retention index, RI) was defined as the ratio of the increase in SUVmax between early and delayed scans to the SUVmax in the early scan. The circular region of interest was placed on the transaxial images according to the corresponding CT images. The final diagnoses of a PVTT were confirmed by histopathology. RESULTS Of the patients examined, 101 (65.6%) had no confirmed instances of a PVTT, whereas 53 (34.4%) had a confirmed PVTT. The sensitivity of 18F-FDG PET/CT imaging was 62.3%, the specificity was 97.0%, the accuracy was 85.1%, the positive predictive value was 91.7%, and the negative predictive value was 83.1%. The SUVmax of the PVTT was 4.32 ± 1.96 and the SUVmax of the HCC lesions for these patients was 5.38 ± 2.79, but these differences were insignificant (t = 1.78, p = 0.08). For dual-time-point imaging, the SUV1 of the PVTT lesions was 3.75 ± 1.48, and SUV2 was 3.63 ± 1.41, but these differences were insignificant (t = 0.82, p = 0.42). The SUV1 of the HCC lesions was 4.47 ± 2.03, and the SUV2 was 4.90 ± 2.07, which were both also insignificant (t = - 1.81, p = 0.09). The RI of the PVTT lesions was - 2.05 ± 19.96%, and the RI of the HCC lesions was 11.87 ± 26.20%, with no significant differences between them (t = 1.58, p = 0.13). CONCLUSIONS 18F-FDG PET/CT may potentially improve the accurate diagnoses of a PVTT in patients with HCC.
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Affiliation(s)
- Bing Wu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
- Nuclear Medicine Institute of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
- Nuclear Medicine Institute of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China
- Nuclear Medicine Institute of Fudan University, Shanghai, China
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, No. 180, Fenglin Road, Xuhui District, Shanghai, China.
- Nuclear Medicine Institute of Fudan University, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
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Multiparametric FDG-PET/MRI of Hepatocellular Carcinoma: Initial Experience. CONTRAST MEDIA & MOLECULAR IMAGING 2018; 2018:5638283. [PMID: 30402045 PMCID: PMC6192124 DOI: 10.1155/2018/5638283] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/30/2018] [Accepted: 09/06/2018] [Indexed: 12/16/2022]
Abstract
Purpose To compare multiparametric (mp)FDG-PET/MRI metrics between hepatocellular carcinoma (HCC) and liver parenchyma and to assess the correlation between mpMRI and FDG-PET standard uptake values (SUVs) in liver parenchyma and HCC. Methods This prospective, institutional review board-approved study enrolled 15 patients (M/F 12/3; mean age 61 y) with HCC. mpMRI including blood-oxygen-level-dependent (BOLD) MRI, intravoxel incoherent motion diffusion-weighted imaging (IVIM-DWI), and dynamic contrast-enhanced-(DCE-) MRI was performed simultaneously with 18F-FDG-PET on a 3T PET/MRI hybrid system. Quantitative BOLD, IVIM and DCE-MRI parameters (Tofts model (TM) and shutter-speed model (SSM)), and PET parameters (SUVmean and SUVmax) were quantified and compared between HCC lesions and liver parenchyma using Wilcoxon signed-rank tests. SUV ratios between HCCs and liver were also calculated (SUVmean T/L and SUVmax T/L). Diagnostic performance of (combined) mp-PET/MRI parameters for characterization of HCC was assessed using ROC analysis. Spearman correlations between PET and mpMRI parameters in HCC tumors and liver parenchyma were evaluated. Results 21 HCC lesions (mean size 4.0 ± 2.4 cm; range 2-13 cm) were analyzed. HCCs exhibited significantly higher arterial fraction (from DCE-MRI) and lower R 2 ∗ pre-O2 and post-O2 (from BOLD-MRI) versus liver parenchyma (P < 0.032). The highest diagnostic performance for differentiation between HCC and liver parenchyma was achieved for combined ART SSM and R 2 ∗ post-O2 (AUC = 0.91). SUVmax showed reasonable performance for differentiation of HCC versus liver (AUC = 0.75). In HCC, DCE-MRI parameters K trans (TM and SSM) and v e TM exhibited significant negative correlations with SUVmax T/L (r ranges from -0.624 to -0.566; FDR-adjusted P < 0.050). Conclusions Despite the observed reasonable diagnostic performance of FDG-PET SUVmax for HCC detection and several significant correlations between FDG-PET SUV and DCE-MRI parameters, FDG-PET did not provide clear additional value for HCC characterization compared to mpMRI in this pilot study.
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Kong E, Chun KA, Cho IH. Quantitative assessment of simultaneous F-18 FDG PET/MRI in patients with various types of hepatic tumors: Correlation between glucose metabolism and apparent diffusion coefficient. PLoS One 2017; 12:e0180184. [PMID: 28672016 PMCID: PMC5495334 DOI: 10.1371/journal.pone.0180184] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 06/12/2017] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Metabolism and water diffusion may have a relationship or an effect on each other in the same tumor. Knowledge of their relationship could expand the understanding of tumor biology and serve the field of oncologic imaging. This study aimed to evaluate the relationship between metabolism and water diffusivity in hepatic tumors using a simultaneous positron emission tomography/magnetic resonance imaging (PET/MRI) system with F-18 fluorodeoxyglucose (FDG) and to reveal the metabolic and diffusional characteristics of each type of hepatic tumor. METHODS Forty-one patients (mean age 63 ± 13 years, 31 male) with hepatic tumors (18 hepatocellular carcinoma [HCC], six cholangiocarcinoma [CCC], 10 metastatic tumors, one neuroendocrine malignancy, and six benign lesions) underwent FDG PET/MRI before treatment. Maximum standard uptake (SUVmax) values from FDG PET and the apparent diffusion coefficient (ADC) from the diffusion-weighted images were obtained for the tumor and their relationships were examined. We also investigated the difference in SUVmax and ADC for each type of tumor. RESULTS SUVmax showed a negative correlation with ADC (r = -0.404, p = 0.009). The median of SUVmax was 3.22 in HCC, 6.99 in CCC, 6.30 in metastatic tumors, and 1.82 in benign lesions. The median of ADC was 1.039 × 10-3 mm/s2 in HCC, 1.148 × 10-3 mm/s2 in CCC, 0.876 × 10-3 mm/s2 in metastatic tumors, and 1.323 × 10-3 mm/s2 in benign lesions. SUVmax was higher in metastatic tumors than in benign lesions (p = 0.023). Metastatic tumors had a lower ADC than CCC (p = 0.039) and benign lesions (p = 0.004). HCC had a lower ADC than benign lesions, with a suggestive trend (p = 0.06). CONCLUSION Our results indicate that SUVmax is negatively correlated with ADC in hepatic tumors, and each group of tumors has different metabolic and water diffusivity characteristics. Evaluation of hepatic tumors by PET/MRI could be helpful in understanding tumor characteristics.
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Affiliation(s)
- Eunjung Kong
- Department of Nuclear Medicine, Yeungnam University Medical School and Hospital, Daegu, Republic of Korea
- * E-mail:
| | - Kyung Ah Chun
- Department of Nuclear Medicine, Yeungnam University Medical School and Hospital, Daegu, Republic of Korea
| | - Ihn Ho Cho
- Department of Nuclear Medicine, Yeungnam University Medical School and Hospital, Daegu, Republic of Korea
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Meta-Analysis of the Correlation between Apparent Diffusion Coefficient and Standardized Uptake Value in Malignant Disease. CONTRAST MEDIA & MOLECULAR IMAGING 2017; 2017:4729547. [PMID: 29097924 PMCID: PMC5612674 DOI: 10.1155/2017/4729547] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 01/15/2017] [Indexed: 12/19/2022]
Abstract
The objective of this meta-analysis is to explore the correlation between the apparent diffusion coefficient (ADC) on diffusion-weighted MR and the standard uptake value (SUV) of 18F-FDG on PET/CT in patients with cancer. Databases such as PubMed (MEDLINE included), EMBASE, and Cochrane Database of Systematic Review were searched for relevant original articles that explored the correlation between SUV and ADC in English. After applying Fisher's r-to-z transformation, correlation coefficient (r) values were extracted from each study and 95% confidence intervals (CIs) were calculated. Sensitivity and subgroup analyses based on tumor type were performed to investigate the potential heterogeneity. Forty-nine studies were eligible for the meta-analysis, comprising 1927 patients. Pooled r for all studies was −0.35 (95% CI: −0.42–0.28) and exhibited a notable heterogeneity (I2 = 78.4%; P < 0.01). In terms of the cancer type subgroup analysis, combined correlation coefficients of ADC/SUV range from −0.12 (lymphoma, n = 5) to −0.59 (pancreatic cancer, n = 2). We concluded that there is an average negative correlation between ADC and SUV in patients with cancer. Higher correlations were found in the brain tumor, cervix carcinoma, and pancreas cancer. However, a larger, prospective study is warranted to validate these findings in different cancer types.
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Boussouar S, Itti E, Lin SJ, Decaens T, Evangelista E, Chiaradia M, Chalaye J, Baranes L, Calderaro J, Laurent A, Pigneur F, Duvoux C, Azoulay D, Costentin C, Rahmouni A, Luciani A. Functional imaging of hepatocellular carcinoma using diffusion-weighted MRI and (18)F-FDG PET/CT in patients on waiting-list for liver transplantation. Cancer Imaging 2016; 16:4. [PMID: 26883745 PMCID: PMC4756529 DOI: 10.1186/s40644-016-0062-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/02/2016] [Indexed: 02/08/2023] Open
Abstract
Background To compare the apparent diffusion coefficient (ADC) on diffusion-weighted imaging (DWI) with the standardized uptake values (SUV) measured by18F-FDG-PET/CT in naïve hepatocellular carcinoma (HCC) nodules, and to determine whether these markers are associated with tumours at high-risk of aggressiveness. Methods From 2007 to 2010, all patients with HCC on the waiting list for liver transplantation and who underwent both FDG-PET/CT and 1.5-T DWI-MRI (b values: 0, 200, 400, and 800 s/mm2) were included in this institutional review board-approved retrospective study. Tumour size, tumour ADC, tumour-to-liver ADC ratio (ADCT/L), maximal tumour SUV and tumour-to-liver SUV ratio (SUVT/L) were measured and compared to serum alpha-fetoprotein (AFP) levels, tumour size and differentiation grade on explanted specimens. Results A total of 37 HCC nodules in 28 patients were available for correlation between MRI and PET/CT, 7 of which (in 7 patients) showed a SUVT/L > 1.15. We did not find any correlation between tumour ADC or ADCT/L and tumour SUV or SUVT/L. To note, SUVT/L was positively correlated with AFP levels (R = 0.95, P ≤ 0.0001), while ADCT/L was not (P = 0.73). Twenty-four patients (with 32 nodules) underwent liver transplantation. In this subgroup, an increased SUVT/L ratio was associated with larger tumours (average size, 32 ± 14 mm; range, 18–60 mm; P < 0.0001) and with poor differentiation on pathology (grades 3 and 4; P = 0.04), while ADCT/L was neither associated with tumour size or differentiation grade. Conclusions ADC and SUV measures in HCC nodules are not correlated. SUVT/L ratio correlates with AFP levels, tumour size and poor differentiation, and should probably be integrated as a co-variable in a predictive outcome model of patients on the waiting-list for liver transplantation.
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Affiliation(s)
- Samia Boussouar
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France.
| | - Emmanuel Itti
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France. .,INSERM Unité U 955, GRC Amyloid Research Institute, Créteil, F-94010, France. .,Service de Médecine Nucléaire, CHU Henri Mondor, 51 Avenue du Marechal de Lattre de Tassigny, 94010, Créteil, Cedex, France.
| | - Shih-Jui Lin
- Biomedical Informatics, Stanford University, Stanford, CA, 94305, USA.
| | - Thomas Decaens
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France.
| | - Eva Evangelista
- AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France.
| | - Melanie Chiaradia
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France.
| | - Julia Chalaye
- AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France.
| | - Laurence Baranes
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Médecine Nucléaire, Créteil, F-94010, France.
| | - Julien Calderaro
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Pathologie, Créteil, F-94010, France. .,INSERM Unité U 955, Equipe 18, Créteil, F-94010, France.
| | - Alexis Laurent
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,INSERM Unité U 955, Equipe 18, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Chirurgie hépatique, Créteil, F-94010, France.
| | - Frederic Pigneur
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France.
| | - Christophe Duvoux
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France.
| | - Daniel Azoulay
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Chirurgie hépatique, Créteil, F-94010, France.
| | - Charlotte Costentin
- Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,AP-HP, Hôpitaux Universitaires Henri Mondor, Hépatologie, Créteil, F-94010, France.
| | - Alain Rahmouni
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France.
| | - Alain Luciani
- AP-HP, Hôpitaux Universitaires Henri Mondor, Imagerie Médicale, Créteil, F-94010, France. .,Université Paris Est Créteil, Faculte de Médecine, Créteil, F-94010, France. .,INSERM Unité U 955, Equipe 18, Créteil, F-94010, France.
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Lee JW, Oh JK, Chung YA, Na SJ, Hyun SH, Hong IK, Eo JS, Song BI, Kim TS, Kim DY, Kim SU, Moon DH, Lee JD, Yun M. Prognostic Significance of ¹⁸F-FDG Uptake in Hepatocellular Carcinoma Treated with Transarterial Chemoembolization or Concurrent Chemoradiotherapy: A Multicenter Retrospective Cohort Study. J Nucl Med 2016; 57:509-16. [PMID: 26742711 DOI: 10.2967/jnumed.115.167338] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 11/20/2015] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED This study aimed to assess the prognostic value of (18)F-FDG uptake in hepatocellular carcinoma (HCC) patients who had transarterial chemoembolization (TACE) or concurrent intraarterial chemotherapy with external-beam radiotherapy (CCRT) and to compare the prognosis between patients treated with TACE and those with CCRT according to (18)F-FDG uptake. METHODS Two hundred fourteen intermediate-to-advanced-stage HCC patients without extrahepatic metastasis who underwent staging (18)F-FDG PET/CT before TACE (153 patients) or CCRT (61 patients) were recruited from 7 hospitals. Progression-free survival (PFS) and overall survival (OS) were compared using an optimal cutoff value for tumor-to-normal liver uptake ratio (TLR). Further, PFS and OS were compared according to treatment modalities (TACE vs. CCRT) using the same TLR cutoff value. RESULTS On multivariate analysis, age and TLR were independent prognostic factors for PFS (P< 0.050). For OS, Child-Pugh classification and TLR were independent prognostic factors (P< 0.050). When the TLR was greater than 2.0, patients treated with CCRT showed significantly better PFS and OS than those treated with TACE after adjusting for tumor size and number (P= 0.014, for all). In contrast, there was no significant difference in PFS and OS between patients treated with TACE or CCRT when the TLR was 2.0 or less. CONCLUSION (18)F-FDG uptake was an independent prognostic factor for PFS and OS in HCC patients treated with TACE or CCRT. Especially, in HCCs with high (18)F-FDG uptake, patients treated with CCRT showed better survival than those treated with TACE. (18)F-FDG PET/CT may help determine the treatment modality for intermediate-to-advanced-stage HCCs.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Jin Kyoung Oh
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Yong An Chung
- Department of Radiology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Sae Jung Na
- Department of Radiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seung Hyup Hyun
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Bong-Il Song
- Department of Nuclear Medicine, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Tae-sung Kim
- Department of Nuclear Medicine, National Cancer Center Research Institute and Hospital, Gyeonggi-do, Korea
| | - Do Young Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Up Kim
- Department of Internal Medicine, Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jong Doo Lee
- Department of Radiology, International St. Mary's Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea; and
| | - Mijin Yun
- Department of Nuclear Medicine, Yonsei University College of Medicine, Seoul, Korea
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Han M, Kim SY, Lee SJ, Choi JW. The Correlations Between MRI Perfusion, Diffusion Parameters, and 18F-FDG PET Metabolic Parameters in Primary Head-and-Neck Cancer: A Cross-Sectional Analysis in Single Institute. Medicine (Baltimore) 2015; 94:e2141. [PMID: 26632740 PMCID: PMC5059009 DOI: 10.1097/md.0000000000002141] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to investigate the relationships among parameters from dynamic contrast-enhanced (DCE) MRI, diffusion-weighted MRI (DWI), and F-fluorodeoxyglucose (F-FDG) PET in patients with primary head-and-neck squamous cell carcinoma (HNSCC).A total of 34 patients with primary HNSCC underwent DCE-MRI, DWI, and F-FDG PET before treatment. The perfusion parameters (Ktrans, Ktransmax, Kep, Ve, Vp, and AUC60) from DCE-MRI and ADC (ADCmean, ADCmin) values from DWI were calculated within the manually placed ROI around the main tumor. Standardized uptake value (SUVmax, SUVmean), metabolic tumor volume (MTV), and total lesion glycolysis (TLG = SUVmean × MTV) were calculated with thresholds of 3.0 SUV. The associations between parameters were evaluated by Pearson correlation analysis.Significant correlations were identified between Ktrans and Kep (r = 0.631), Ktrans and Ve (r = 0.603), Ktrans and ADCmean (r = 0.438), Ktransmax and Kep (r = 0.667), Ktransmax and Vp (r = 0.351), Ve and AUC60 (r = 0.364), Ve and ADCmean (r = 0.590), and Ve and ADCmin (r = 0.361). ADCmin was reversely correlated with TLG (r = -0.347). Tumor volume was significantly associated with Ktransmax (r = 0.348).The demonstrated relationships among parameters from DCE, DWI, and F-FDG PET suggest complex interactions among tumor biologic characteristics. Each diagnostic technique may provide complementary information for HNSCC.
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Affiliation(s)
- Miran Han
- From the Department of Radiology (MH, SYK, JWC), and Nuclear Medicine (SJL), Ajou University School of Medicine, Ajou University Medical Center, Suwon, Republic of Korea
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Tarantino L, Ambrosino P, Minno MNDD. Contrast-enhanced ultrasound in differentiating malignant from benign portal vein thrombosis in hepatocellular carcinoma. World J Gastroenterol 2015; 21:9457-9460. [PMID: 26327753 PMCID: PMC4548106 DOI: 10.3748/wjg.v21.i32.9457] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 07/08/2015] [Accepted: 07/15/2015] [Indexed: 02/06/2023] Open
Abstract
Portal vein thrombosis (PVT) may occur in liver cirrhosis patients. Malignant PVT is a common complication in cirrhotic patients with concomitant hepatocellular carcinoma (HCC) and, in some cases, it may be even the initial sign of an undetected HCC. Detection of malignant PVT in a patient with liver cirrhosis heavily affects the therapeutic strategy. Gray-scale ultrasound (US) is widely unreliable for differentiating benign and malignant thrombi. Although effective for this differential diagnosis, fine-needle biopsy remains an invasive technique. Sensitivity of color-doppler US in detection of malignant thrombi is highly dependent on the size of the thrombus. Contrast-enhanced computed tomography (CT) and contrast-enhanced magnetic resonance (MRI) can be useful to assess the nature of portal thrombus, while limited data are currently available about the role of positron emission tomography (PET) and PET-CT. In contrast with CT, MRI, PET, and PET-CT, contrast-enhanced ultrasound (CEUS) is a fast, effective, well tolerated and cheap technique, that can be performed even in the same session in which the thrombus has been detected. CEUS can be performed bedside and can be available also in transplanted patients. Moreover, CT and MRI only yield a snapshot analysis during contrast diffusion, while CEUS allows for a continuous real-time imaging of the microcirculation that lasts several minutes, so that the whole arterial phase and the late parenchymal phase of the contrast diffusion can be analyzed continuously by real-time US scanning. Continuous real-time monitoring of contrast diffusion entails an easy detection of thrombus maximum enhancement. Moreover, continuous quantitative analyses of enhancement (wash in - wash out studies) by CEUS during contrast diffusion is nowadays available in most CEUS machines, thus giving a more sophisticated and accurate evaluation of the contrast distribution and an increased confidence in diagnosis in difficult cases. In conclusion, CEUS is a very reliable technique with a high intrinsic sensitivity for portal vein patency assessment. More expensive and sophisticated techniques (i.e., CT, MRI, PET, and PET-CT) should only be indicated in undetermined cases at CEUS.
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15
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Gawlitza M, Purz S, Kubiessa K, Boehm A, Barthel H, Kluge R, Kahn T, Sabri O, Stumpp P. In Vivo Correlation of Glucose Metabolism, Cell Density and Microcirculatory Parameters in Patients with Head and Neck Cancer: Initial Results Using Simultaneous PET/MRI. PLoS One 2015; 10:e0134749. [PMID: 26270054 PMCID: PMC4536035 DOI: 10.1371/journal.pone.0134749] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 06/30/2015] [Indexed: 12/20/2022] Open
Abstract
Objective To demonstrate the feasibility of simultaneous acquisition of 18F-FDG-PET, diffusion-weighted imaging (DWI) and T1-weighted dynamic contrast-enhanced MRI (T1w-DCE) in an integrated simultaneous PET/MRI in patients with head and neck squamous cell cancer (HNSCC) and to investigate possible correlations between these parameters. Methods 17 patients that had given informed consent (15 male, 2 female) with biopsy-proven HNSCC underwent simultaneous 18F-FDG-PET/MRI including DWI and T1w-DCE. SUVmax, SUVmean, ADCmean, ADCmin and Ktrans, kep and ve were measured for each tumour and correlated using Spearman’s ρ. Results Significant correlations were observed between SUVmean and Ktrans (ρ = 0.43; p ≤ 0.05); SUVmean and kep (ρ = 0.44; p ≤ 0.05); Ktrans and kep (ρ = 0.53; p ≤ 0.05); and between kep and ve (ρ = -0.74; p ≤ 0.01). There was a trend towards statistical significance when correlating SUVmax and ADCmin (ρ = -0.35; p = 0.08); SUVmax and Ktrans (ρ = 0.37; p = 0.07); SUVmax and kep (ρ = 0.39; p = 0.06); and ADCmean and ve (ρ = 0.4; p = 0.06). Conclusion Simultaneous 18F-FDG-PET/MRI including DWI and T1w-DCE in patients with HNSCC is feasible and allows depiction of complex interactions between glucose metabolism, microcirculatory parameters and cellular density.
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Affiliation(s)
- Matthias Gawlitza
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
- * E-mail:
| | - Sandra Purz
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Klaus Kubiessa
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Andreas Boehm
- ENT-Department, University Hospital of Leipzig, Liebigstraße 10–14, 04103 Leipzig, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Regine Kluge
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Thomas Kahn
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - Osama Sabri
- Department of Nuclear Medicine, University Hospital of Leipzig, Liebigstraße 18, 04103 Leipzig, Germany
| | - Patrick Stumpp
- Department of Diagnostic and Interventional Radiology, University Hospital of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
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De Robertis R, Tinazzi Martini P, Demozzi E, Puntel G, Ortolani S, Cingarlini S, Ruzzenente A, Guglielmi A, Tortora G, Bassi C, Pederzoli P, D’Onofrio M. Prognostication and response assessment in liver and pancreatic tumors: The new imaging. World J Gastroenterol 2015; 21:6794-6808. [PMID: 26078555 PMCID: PMC4462719 DOI: 10.3748/wjg.v21.i22.6794] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/25/2015] [Accepted: 05/04/2015] [Indexed: 02/06/2023] Open
Abstract
Diffusion-weighted imaging (DWI), dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and perfusion computed tomography (CT) are technical improvements of morphologic imaging that can evaluate functional properties of hepato-bilio-pancreatic tumors during conventional MRI or CT examinations. Nevertheless, the term “functional imaging” is commonly used to describe molecular imaging techniques, as positron emission tomography (PET) CT/MRI, which still represent the most widely used methods for the evaluation of functional properties of solid neoplasms; unlike PET or single photon emission computed tomography, functional imaging techniques applied to conventional MRI/CT examinations do not require the administration of radiolabeled drugs or specific equipments. Moreover, DWI and DCE-MRI can be performed during the same session, thus providing a comprehensive “one-step” morphological and functional evaluation of hepato-bilio-pancreatic tumors. Literature data reveal that functional imaging techniques could be proposed for the evaluation of these tumors before treatment, given that they may improve staging and predict prognosis or clinical outcome. Microscopic changes within neoplastic tissues induced by treatments can be detected and quantified with functional imaging, therefore these techniques could be used also for post-treatment assessment, even at an early stage. The aim of this editorial is to describe possible applications of new functional imaging techniques apart from molecular imaging to hepatic and pancreatic tumors through a review of up-to-date literature data, with a particular emphasis on pathological correlations, prognostic stratification and post-treatment monitoring.
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Meng Z, Zhang G, Sun H, Tan J, Yu C, Tian W, Li W, Yang Z, Zhu M, He Q, Zhang Y, Han S. Differentiation between Graves' disease and painless thyroiditis by diffusion-weighted imaging, thyroid iodine uptake, thyroid scintigraphy and serum parameters. Exp Ther Med 2015; 9:2165-2172. [PMID: 26136954 DOI: 10.3892/etm.2015.2430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 04/13/2015] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to assess the apparent diffusion coefficient (ADC) in diffusion-weighted imaging (DWI), thyroid radioactive iodine uptake (RAIU), thyroid scintigraphy and thyrotropin receptor antibody (TRAb) levels in the differential diagnosis between Graves' disease (GD) and painless thyroiditis (PT). A total of 102 patients with GD and 37 patients with PT were enrolled in the study. DWI was obtained with a 3.0-T magnetic resonance scanner, and ADC values were calculated. RAIU and thyroid scintigraphy were performed. Tissue samples were obtained from patients with GD (6 cases) following thyroidectomy, and from patients with PT (2 cases) following biopsy. Receiver operating characteristic (ROC) curves were drawn, optimal cut-off values were selected, and the sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were assessed. It was found that the ADC, TRAb and RAIU were significantly higher in GD than in PT (P<0.05). ROC curves showed areas under the curves for RAIU, ADC and TRAb that were >0.900. RAIU was the reference method. Sensitivity, specificity, accuracy, PPV and NPV were 96.078, 91.892, 95.000, 97.059 and 89.474% for ADC, and 88.235, 75.676, 84.892, 90.909 and 70.000% for TRAb, after the optimal thresholds of 1.837×10-3 mm2/sec and 1.350 IU/ml were determined respectively. Histopathology showed that tissue cellularity in PT was much higher than in GD due to massive lymphocytic infiltration. The results of the present study indicate that RAIU, ADC and TRAb are of diagnostic value for differentiating between GD and PT. DWI has great potential for thyroid pathophysiological imaging because it reflects differences in tissue cellularity between GD and PT.
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Affiliation(s)
- Zhaowei Meng
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Guizhi Zhang
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Haoran Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Jian Tan
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Chunshun Yu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Weijun Tian
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Weidong Li
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Zhiqiang Yang
- Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Mei Zhu
- Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Qing He
- Department of Endocrinology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Yujie Zhang
- Department of Pathology, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China
| | - Shugao Han
- Department of Nuclear Medicine, Tianjin Medical University General Hospital, Tianjin 300052, P.R. China ; Department of Radiology, Second Affiliated Hospital of Zhejiang Medical University, Hangzhou, Zhejiang 310000, P.R. China
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Kim H, Keene KS, Sarver DB, Lee SK, Beasley TM, Morgan DE, Posey JA. Quantitative perfusion- and diffusion-weighted magnetic resonance imaging of gastrointestinal cancers treated with multikinase inhibitors: a pilot study. GASTROINTESTINAL CANCER RESEARCH : GCR 2014; 7:75-81. [PMID: 25276260 PMCID: PMC4171969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 12/09/2013] [Indexed: 06/03/2023]
Abstract
BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion-weighted imaging (DWI) are often used to detect the early response of solid tumors to an effective therapy. The early changes in intratumoral physiological parameters measured by DCE-MRI/DWI have been evaluated as surrogate biomarkers allowing a tailored treatment for the individual patient. METHODS Patients with newly diagnosed, biopsy-proven, treatment-naïve gastrointestinal stromal tumor (GIST) or hepatocellular carcinoma (HCC) were enrolled prospectively after institutional review board (IRB)-approved informed consent (5 patients per tumor type). Patients with GIST were treated with sunitinib over 6 weeks. DCE-MRI/DWI was applied before therapy (baseline imaging) and at 2 and 6 weeks after therapy initiation. Patients with HCC were treated with radiation during the first 2 weeks and then with sorafenib for the next 6 weeks. DCE-MRI/DWI was applied in all patients with HCC before and after radiation therapy and at the end of sorafenib therapy. Tumor volume, perfusion parameters (K (trans), the forward volume-transfer constant, and k ep, the reverse reflux-rate constant) and the apparent diffusion coefficient (ADC) were measured. RESULTS During 2 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 32 ± 13, 45 ± 24, and 42 ± 15%, respectively, whereas ADC increased 76 ± 24%. After 6 weeks of sunitinib therapy, GIST volume, K (trans), and k ep decreased 56 ± 7, 70 ± 7, and 50 ± 12%, respectively, whereas ADC increased 85 ± 33%. After completion of radiation therapy, HCC volume, K (trans), and k ep decreased 34 ± 14, 35 ± 12, and 4 ± 21%, respectively, but ADC increased 21 ± 9%. During the entire 10-week therapeutic period, HCC volume, K (trans), and k ep decreased 65 ± 15, 40 ± 9, and 26 ± 2%, respectively, whereas ADC increased 28 ± 10%. CONCLUSION DCE-MRI/DWI can measure the perfusion and diffusion changes in GISTs or HCCs treated with multikinase inhibitors.
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Affiliation(s)
| | | | - David B. Sarver
- Department of Radiology University of Arkansas for Medical Sciences Little Rock, AR
| | | | - T. Mark Beasley
- Department of Biostatistics University of Alabama Birmingham, AL
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