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Guo W, Lv B, Yang T, Tian M, Liu M, Lin X, Zhao P. Role of Dynamic Contrast-Enhanced Magnetic Resonance Imaging Parameters and Extracellular Volume Fraction as Predictors of Lung Cancer Subtypes and Lymph Node Status in Non-Small-Cell Lung Cancer Patients. J Cancer 2023; 14:3108-3116. [PMID: 37859821 PMCID: PMC10583593 DOI: 10.7150/jca.88367] [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: 07/23/2023] [Accepted: 09/05/2023] [Indexed: 10/21/2023] Open
Abstract
Objective: The aim of this study is to determine whether dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)-based quantitative parameters and the extracellular volume fraction (ECV) can differentiate small-cell lung cancer (SCLC) from non-small-cell lung cancer (NSCLC), squamous-cell carcinoma (SCC) from adenocarcinoma (Adeno-Ca), and NSCLC with lymph node metastasis from NSCLC without lymph node metastasis. Materials and methods: We prospectively enrolled patients with lung cancer (41 Adeno-Ca, 29 SCC, and 23 SCLC) who underwent DCE-MRI and enhanced T1 mapping prior to histopathological confirmation. Quantitative parameters based on DCE-MRI and ECV based on T1 mapping were compared between SCLC and NSCLC patients, between SCC and Adeno-Ca patients, and between NSCLC patients with and without lymph node metastasis. The area under the receiver-operating characteristic curve (AUC) was used to evaluate the diagnostic performance of each parameter. Spearman rank correlation was used to clarify the associations between ECV and DCE-MRI-derived parameters. Results: Ktrans, Kep, Ve, and ECV all performed well in differentiating SCLC from NSCLC (AUC > 0.729). Ktrans showed the best performance in differentiating SCC from Adeno-Ca (AUC = 0.836). ECV could differentiate NSCLCs with and without lymph node metastases (AUC = 0.764). ECV showed a significant positive correlation with both Ktrans and Ve. Conclusions: Ktrans is the most promising imaging parameter to differentiate SCLC from NSCLC, and Adeno-Ca from SCC. ECV was helpful in detecting lymph node metastasis in NSCLC. These imaging parameters may help guide the selection of lung cancer treatment.
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Affiliation(s)
- Wenxiu Guo
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, China
| | - Binglin Lv
- Department of Radiology, QiLu Hospital of Shandong University, Jinan, Shandong Province, 250012, China
| | - Tao Yang
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, 250021, China
| | - Mimi Tian
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, China
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, 250021, China
| | - MengXiao Liu
- MR Scientific Marketing, Diagnostic Imaging, Siemens Healthineers Ltd., Shanghai, 200126, China
| | - XiangTao Lin
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, China
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, 250021, China
| | - Peng Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, 250021, China
- Department of Radiology, Shandong Provincial Hospital, Shandong University, Jinan, Shandong Province, 250021, China
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Stanzione A, Cuocolo R, Bombace C, Pesce I, Mainolfi CG, De Giorgi M, Delli Paoli G, La Selva P, Petrone J, Camera L, Klain M, Del Vecchio S, Cuocolo A, Maurea S. Prediction of 2-[ 18F]FDG PET-CT SUVmax for Adrenal Mass Characterization: A CT Radiomics Feasibility Study. Cancers (Basel) 2023; 15:3439. [PMID: 37444549 DOI: 10.3390/cancers15133439] [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: 04/17/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Indeterminate adrenal masses (AM) pose a diagnostic challenge, and 2-[18F]FDG PET-CT serves as a problem-solving tool. Aim of this study was to investigate whether CT radiomics features could be used to predict the 2-[18F]FDG SUVmax of AM. METHODS Patients with AM on 2-[18F]FDG PET-CT scan were grouped based on iodine contrast injection as CT contrast-enhanced (CE) or CT unenhanced (NCE). Two-dimensional segmentations of AM were manually obtained by multiple operators on CT images. Image resampling and discretization (bin number = 16) were performed. 919 features were calculated using PyRadiomics. After scaling, unstable, redundant, and low variance features were discarded. Using linear regression and the Uniform Manifold Approximation and Projection technique, a CT radiomics synthetic value (RadSV) was obtained. The correlation between CT RadSV and 2-[18F]FDG SUVmax was assessed with Pearson test. RESULTS A total of 725 patients underwent PET-CT from April 2020 to April 2021. In 150 (21%) patients, a total of 179 AM (29 bilateral) were detected. Group CE consisted of 84 patients with 108 AM (size = 18.1 ± 4.9 mm) and Group NCE of 66 patients with 71 AM (size = 18.5 ± 3.8 mm). In both groups, 39 features were selected. No statisticallyf significant correlation between CT RadSV and 2-[18F]FDG SUVmax was found (Group CE, r = 0.18 and p = 0.058; Group NCE, r = 0.13 and p = 0.27). CONCLUSIONS It might not be feasible to predict 2-[18F]FDG SUVmax of AM using CT RadSV. Its role as a problem-solving tool for indeterminate AM remains fundamental.
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Affiliation(s)
- Arnaldo Stanzione
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84084 Baronissi, Italy
| | - Claudia Bombace
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Ilaria Pesce
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Ciro Gabriele Mainolfi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Marco De Giorgi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Gregorio Delli Paoli
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Pasquale La Selva
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Jessica Petrone
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Luigi Camera
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Michele Klain
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Silvana Del Vecchio
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
| | - Simone Maurea
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", 80131 Naples, Italy
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3
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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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4
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Guberina M, Pöttgen C, Metzenmacher M, Wiesweg M, Schuler M, Aigner C, Ploenes T, Umutlu L, Gauler T, Darwiche K, Stamatis G, Theegarten D, Hautzel H, Jentzen W, Guberina N, Herrmann K, Eberhardt WE, Stuschke M. PROGNOSTIC VALUE OF POST-INDUCTION CHEMOTHERAPY VOLUMETRIC PET/CT PARAMETERS FOR STAGE IIIA/B NON-SMALL CELL LUNG CANCER PATIENTS RECEIVING DEFINITIVE CHEMORADIOTHERAPY. J Nucl Med 2021; 62:jnumed.120.260646. [PMID: 34016730 PMCID: PMC8612197 DOI: 10.2967/jnumed.120.260646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose/Objective(s): The aim of this follow-up analysis of the ESPATUE phase-3 trial was to explore the prognostic value of post-induction chemotherapy PET metrics in patients with stage III non-small cell lung cancer (NSCLC) who were assigned to receive definitive chemoradiotherapy. Materials/Methods: All eligible patients stage IIIA (cN2) and stage IIIB of the trial received induction chemotherapy consisting of 3 cycles of cisplatin/paclitaxel and chemoradiotherapy up to 45 Gy/1.5 Gy per fraction twice-a-day, followed by a radiation-boost with 2 Gy once per day with concurrent cisplatin/vinorelbine. The protocol definition prescribed a total dose of 65-71 Gy. 18F-FDG-PET/CT (PETpre) was performed at study entry and before concurrent chemoradiotherapy (interim-PET; PETpost). Interim PETpost metrics and known prognostic clinical parameters were correlated in uni- and multivariable survival analyses. Leave-one-out cross-validation was used to show internal validity. Results: Ninety-two patients who underwent 18F-FDG-PET/CT after induction chemotherapy were enrolled. Median MTVpost value was 5.9 ml. Altogether 85 patients completed the whole chemoradiation with the planned total dose of 60-71 Gy. In univariable proportional hazard analysis, each of the parameters MTVpost, SUVmax(post) and TLGmax(post) was associated with overall survival (P < 0.05). Multivariable survival analysis, including clinical and post-induction PET parameters, found TLGmax(post) (hazard ratio: 1.032 (95%-CI: 1.013-1.052) per 100 ml increase) and total radiation dose (hazard ratio: 0.930 (0.902-0.959) per Gray increase) significantly related with overall survival in the whole group of patients, and also in patients receiving a total dose ≥ 60 Gy. The best leave-one-out cross-validated 2 parameter classifier contained TLGmax(post) and total radiation dose. TLGmax(post) was associated with time to distant metastases (P = 0.0018), and SUVmax(post) with time to loco-regional relapse (P = 0.039) in multivariable analysis of patients receiving a total dose ≥ 60 Gy. Conclusion: Post-induction chemotherapy PET parameters demonstrated prognostic significance. Therefore, an interim 18F-FDG-PET/CT is a promising diagnostic modality for guiding individualized treatment intensification.
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Affiliation(s)
- Maja Guberina
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Christoph Pöttgen
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Martin Metzenmacher
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Marcel Wiesweg
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | | | - Clemens Aigner
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Lung Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Till Ploenes
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Lung Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Lale Umutlu
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Thomas Gauler
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Kaid Darwiche
- Section of Interventional Pneumology, Department of Pulmonary Medicine, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Georgios Stamatis
- Department of Thoracic Surgery and Thoracic Endoscopy, West German Lung Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Dirk Theegarten
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany; and
| | - Hubertus Hautzel
- Department for Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Walter Jentzen
- Department for Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Nika Guberina
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Ken Herrmann
- German Cancer Consortium, Partner Site University Hospital Essen, Essen
- Department for Nuclear Medicine, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
| | - Wilfried E.E. Eberhardt
- Department of Medical Oncology, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- Division of Thoracic Oncology, West German Cancer Center, University Medicine Essen–Ruhrlandklinik, University Duisburg–Essen, Essen, Germany
| | - Martin Stuschke
- Department for Radiotherapy, West German Cancer Center, University Hospital Essen, University Duisburg–Essen, Essen, Germany
- German Cancer Consortium, Partner Site University Hospital Essen, Essen
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5
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饶 孙, 叶 联, 崔 欣, 孙 芩, 曹 润, 肖 寿, 杨 继, 王 维, 赵 光, 黄 云. [Progress in Survival Prognosis of Segmentectomy for
Early-stage Non-small Cell Lung Cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2020; 23:830-836. [PMID: 32957171 PMCID: PMC7519961 DOI: 10.3779/j.issn.1009-3419.2020.102.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/17/2020] [Accepted: 04/24/2020] [Indexed: 12/24/2022]
Abstract
Surgery is currently the most appropriate treatment for early-stage non-small cell lung cancer (NSCLC). Increasing unilateral or bilateral multiple primary lung cancer being found, segmentectomy has attracted wide attention for its unique advantages in the treatment for such tumors. Ground glass opacity dominant early-stage NSCLC is associated with a good prognosis and can be cured by segmentectomy, however, the treatment of solid-dominant NSCLC remains controversial owing to the invasive nature. With the in-depth study on the lymph node metastasis pathway, radiological characteristics and molecular biology of NSCLC, a large part of solid nodules with certain characteristics can also be cured by segmentectomy. This paper reviews the research status and progress about the indication of segmentectomy.
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Affiliation(s)
- 孙银 饶
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 联华 叶
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 欣 崔
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 芩玲 孙
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 润 曹
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 寿勇 肖
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 继琛 杨
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 维 王
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 光强 赵
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
| | - 云超 黄
- />650105 昆明,昆明医科大学第三附属医院,云南省肿瘤医院 胸外一科Department of Thoracic Surgery, the Third Affiliated Hospital of Kunming Medical University, Kunming 650105, China
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6
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Smolle E, Leko P, Stacher-Priehse E, Brcic L, El-Heliebi A, Hofmann L, Quehenberger F, Hrzenjak A, Popper HH, Olschewski H, Leithner K. Distribution and prognostic significance of gluconeogenesis and glycolysis in lung cancer. Mol Oncol 2020; 14:2853-2867. [PMID: 32777161 PMCID: PMC7607181 DOI: 10.1002/1878-0261.12780] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/07/2020] [Indexed: 12/24/2022] Open
Abstract
Inhibition of glycolysis has been considered as a therapeutic approach in aggressive cancers including lung cancer. Abbreviated gluconeogenesis, mediated by phosphoenolpyruvate carboxykinase (PEPCK), was recently discovered to partially circumvent the need for glycolysis in lung cancer cells. However, the interplay of glycolysis and gluconeogenesis in lung cancer is still poorly understood. Here, we analyzed the expression of GLUT1, the prime glucose transporter, and of PCK1 and PCK2, the cytoplasmic and mitochondrial isoforms of PEPCK, in 450 samples of non‐small cell lung cancer (NSCLC) and in 54 NSCLC metastases using tissue microarrays and whole tumor sections. Spatial distribution was assessed by automated image analysis. Additionally, glycolytic and gluconeogenic gene expression was inferred from The Cancer Genome Atlas (TCGA) datasets. We found that PCK2 was preferentially expressed in the lung adenocarcinoma subtype, while GLUT1 expression was higher in squamous cell carcinoma. GLUT1 and PCK2 were inversely correlated, GLUT1 showing elevated expression in larger tumors while PCK2 was highest in smaller tumors. However, a mixed phenotype showing the presence of both, glycolytic and gluconeogenic cancer cells was frequent. In lung adenocarcinoma, PCK2 expression was associated with significantly improved overall survival, while the opposite was found for GLUT1. The metabolic tumor microenvironment and the 3‐dimensional context play an important role in modulating both pathways, since PCK2 expression preferentially occurred at the tumor margin and hypoxia regulated both, glycolysis and gluconeogenesis, in NSCLC cells in vitro, albeit in opposite directions. PCK1/2 expression was enhanced in metastases compared to primary tumors, possibly related to the different environment. The results of this study show that glycolysis and gluconeogenesis are activated in NSCLC in a tumor size and oxygenation modulated manner and differentially correlate with outcome. The frequent co‐activation of gluconeogenesis and glycolysis in NSCLC should be considered in potential future therapeutic strategies targeting cancer cell metabolism.
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Affiliation(s)
- Elisabeth Smolle
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Petra Leko
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | | | - Luka Brcic
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Austria
| | - Amin El-Heliebi
- Gottfried Schatz Research Center, Department of Cell Biology, Histology and Embryology, Medical University of Graz, Austria.,Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Lilli Hofmann
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Franz Quehenberger
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Austria
| | - Andelko Hrzenjak
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Helmut H Popper
- Diagnostic and Research Institute of Pathology, Medical University of Graz, Austria
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria.,Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Katharina Leithner
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
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7
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Besson FL, Fernandez B, Faure S, Mercier O, Seferian A, Mignard X, Mussot S, le Pechoux C, Caramella C, Botticella A, Levy A, Parent F, Bulifon S, Montani D, Mitilian D, Fadel E, Planchard D, Besse B, Ghigna-Bellinzoni MR, Comtat C, Lebon V, Durand E. 18F-FDG PET and DCE kinetic modeling and their correlations in primary NSCLC: first voxel-wise correlative analysis of human simultaneous [18F]FDG PET-MRI data. EJNMMI Res 2020; 10:88. [PMID: 32734484 PMCID: PMC7392998 DOI: 10.1186/s13550-020-00671-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/14/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To decipher the correlations between PET and DCE kinetic parameters in non-small-cell lung cancer (NSCLC), by using voxel-wise analysis of dynamic simultaneous [18F]FDG PET-MRI. MATERIAL AND METHODS Fourteen treatment-naïve patients with biopsy-proven NSCLC prospectively underwent a 1-h dynamic [18F]FDG thoracic PET-MRI scan including DCE. The PET and DCE data were normalized to their corresponding T1-weighted MR morphological space, and tumors were masked semi-automatically. Voxel-wise parametric maps of PET and DCE kinetic parameters were computed by fitting the dynamic PET and DCE tumor data to the Sokoloff and Extended Tofts models respectively, by using in-house developed procedures. Curve-fitting errors were assessed by computing the relative root mean square error (rRMSE) of the estimated PET and DCE signals at the voxel level. For each tumor, Spearman correlation coefficients (rs) between all the pairs of PET and DCE kinetic parameters were estimated on a voxel-wise basis, along with their respective bootstrapped 95% confidence intervals (n = 1000 iterations). RESULTS Curve-fitting metrics provided fit errors under 20% for almost 90% of the PET voxels (median rRMSE = 10.3, interquartile ranges IQR = 8.1; 14.3), whereas 73.3% of the DCE voxels showed fit errors under 45% (median rRMSE = 31.8%, IQR = 22.4; 46.6). The PET-PET, DCE-DCE, and PET-DCE voxel-wise correlations varied according to individual tumor behaviors. Beyond this wide variability, the PET-PET and DCE-DCE correlations were mainly high (absolute rs values > 0.7), whereas the PET-DCE correlations were mainly low to moderate (absolute rs values < 0.7). Half the tumors showed a hypometabolism with low perfused/vascularized profile, a hallmark of hypoxia, and tumor aggressiveness. CONCLUSION A dynamic "one-stop shop" procedure applied to NSCLC is technically feasible in clinical practice. PET and DCE kinetic parameters assessed simultaneously are not highly correlated in NSCLC, and these correlations showed a wide variability among tumors and patients. These results tend to suggest that PET and DCE kinetic parameters might provide complementary information. In the future, this might make PET-MRI a unique tool to characterize the individual tumor biological behavior in NSCLC.
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Affiliation(s)
- Florent L Besson
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France.
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270, Le Kremlin-Bicêtre, France.
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
| | | | - Sylvain Faure
- Laboratoire de Mathématiques d'Orsay, CNRS, Université Paris-Saclay, 91405, Orsay, France
| | - Olaf Mercier
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Andrei Seferian
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Xavier Mignard
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
| | - Sacha Mussot
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Cecile le Pechoux
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Caroline Caramella
- Department of Radiology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Angela Botticella
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Florence Parent
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Sophie Bulifon
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - David Montani
- Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, 94270, Le Kremlin-Bicêtre, France
- Inserm UMR_S999, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Delphine Mitilian
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - Elie Fadel
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Marie Lannelongue Hospital, 92350, Le Plessis Robinson, France
| | - David Planchard
- Department of Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | - Benjamin Besse
- Department of Oncology, Institut d'Oncologie Thoracique (IOT), Gustave Roussy, Université Paris Saclay, Villejuif, France
| | | | - Claude Comtat
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Vincent Lebon
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Emmanuel Durand
- Université Paris-Saclay, CEA, CNRS, Inserm, BioMAPs, 91401, Orsay, France
- Department of Biophysics and Nuclear Medicine-Molecular Imaging, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, CHU Bicêtre, 94270, Le Kremlin-Bicêtre, France
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
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Rao S, Ye L, Min L, Zhao G, Chen Y, Huang Y, Yang J, Xiao S, Cao R. Meta-analysis of segmentectomy versus lobectomy for radiologically pure solid or solid-dominant stage IA non-small cell lung cancer. J Cardiothorac Surg 2019; 14:197. [PMID: 31722726 PMCID: PMC6854787 DOI: 10.1186/s13019-019-0996-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/16/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Whether segmentectomy can be used to treat radiologically determined pure solid or solid-dominant lung cancer remains controversial owing to the invasive pathologic characteristics of these tumors despite their small size. This meta-analysis compared the oncologic outcomes after lobectomy and segmentectomy regarding relapse-free survival (RFS) and overall survival (OS) in patients with radiologically determined pure solid or solid-dominant clinical stage IA non-small cell lung cancer (NSCLC). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane Central databases for information from the date of database inception to March 2019. Studies were selected according to predefined eligibility criteria. The hazard ratio (HR) and associated 95% confidence interval (CI) were extracted or calculated as the outcome measure for data combining. RESULTS Seven eligible studies published between 2014 and 2018 enrolling 1428 patients were included in the current meta-analysis. Compared with lobectomy, segmentectomy had a significant benefit on the RFS of radiologically determined pure solid or solid-dominant clinical stage IA NSCLC patients (combined HR: 1.46; 95% CI, 1.05-2.03; P = 0.024) and there were no significant differences on the OS of these patients (HR: 1.52; 95% CI, 0.95-2.43; P = 0.08). CONCLUSIONS Segmentectomy leads to lower survival than lobectomy for clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors. Moreover, applying lobectomy to clinical stage IA NSCLC patients with radiologically determined pure solid or solid-dominant tumors (≤2 cm) could lead to an even bigger survival advantage. However, there are some limitations in the present study, and more evidence is needed to support the conclusion.
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Affiliation(s)
- Sunyin Rao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lianhua Ye
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China.
| | - Li Min
- Department of Respiratory Medicine, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Guangqiang Zhao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Ya Chen
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yunchao Huang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jichen Yang
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shouyong Xiao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Run Cao
- Department of Thoracic Surgery, The Third Affiliated Hospital of Kunming Medical University, Kunming, China
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9
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Outcomes and predictive factors for pathological node-positive in radiographically pure-solid, small-sized lung adenocarcinoma. Gen Thorac Cardiovasc Surg 2019; 67:544-550. [PMID: 30627979 DOI: 10.1007/s11748-018-01059-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The indication of limited resection for radiographically pure-solid, small-sized lung adenocarcinoma is controversial. This study aimed to reveal the long-term outcome of standard surgical treatment and determine the predictive factors for pathological lymph node metastasis in optimal candidates undergoing limited surgical resection for pure-solid, small-sized lung adenocarcinoma. METHODS The medical records of 107 consecutive patients were retrospectively reviewed at our hospital between December 2002 and December 2013. Inclusion criteria were histopathological diagnosis of lung adenocarcinoma, radiographically pure-solid tumor, ≤ 2 cm tumor size measured using thin-section computed tomography, clinical N0M0, patients who underwent lobectomy with systematic or lobe-specific lymph node dissection, and R0 resection. Overall and disease-free survival curves were calculated using the Kaplan-Meier method. Clinicopathological factors predicting pathological node-positive metastasis were identified by univariate and multivariate analysis. RESULTS The 5-year overall and disease-free survival rates were 91.4% and 87.3%, respectively. Multivariate analysis demonstrated maximum standardized uptake value > 5 as the independent predictor of pathological node-positive metastasis (odds ratio 3.81; 95% confidence interval 1.25-12.3; p = 0.02). In all patients, the pathological node-positive rate was 16.7%; in patients who had a maximum standardized uptake value of ≤ 5, the rate was 7.9%. CONCLUSION The long-term outcome of standard surgical treatment was favorable. Maximum standardized uptake value was a significant predictor of pathological node-positive metastasis; however, diagnostic accuracy was not favorable. Therefore, the selection of optimal candidates is difficult, and limited surgical resection may not be applicable in pure-solid, small-sized lung adenocarcinoma.
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10
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Chen L, Liu D, Zhang J, Xie B, Zhou X, Grimm R, Huang X, Wang J, Feng L. Free-breathing dynamic contrast-enhanced MRI for assessment of pulmonary lesions using golden-angle radial sparse parallel imaging. J Magn Reson Imaging 2018; 48:459-468. [PMID: 29437281 DOI: 10.1002/jmri.25977] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/30/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has been shown to be a promising technique for assessing lung lesions. However, DCE-MRI often suffers from motion artifacts and insufficient imaging speed. Therefore, highly accelerated free-breathing DCE-MRI is of clinical interest for lung exams. PURPOSE To test the performance of rapid free-breathing DCE-MRI for simultaneous qualitative and quantitative assessment of pulmonary lesions using Golden-angle RAdial Sparse Parallel (GRASP) imaging. STUDY TYPE Prospective. POPULATION Twenty-six patients (17 males, mean age = 55.1 ± 14.4) with known pulmonary lesions. FIELD STRENGTH/SEQUENCE 3T MR scanner; a prototype fat-saturated, T1 -weighted stack-of-stars golden-angle radial sequence for data acquisition and a Cartesian breath-hold volumetric-interpolated examination (BH-VIBE) sequence for comparison. ASSESSMENT After a dual-mode GRASP reconstruction, one with 3-second temporal resolution (3s-GRASP) and the other with 15-second temporal resolution (15s-GRASP), all GRASP and BH-VIBE images were pooled together for blind assessment by two experienced radiologists, who independently scored the overall image quality, lesion delineation, overall artifact level, and diagnostic confidence of each case. Perfusion analysis was performed for the 3s-GRASP images using a Tofts model to generate the volume transfer coefficient (Ktrans ) and interstitial volume (Ve ). STATISTICAL TESTS Nonparametric paired two-tailed Wilcoxon signed-rank test; Cohen's kappa; unpaired Student's t-test. RESULTS 15s-GRASP achieved comparable image quality with conventional BH-VIBE (P > 0.05), except for the higher overall artifact level in the precontrast phase (P = 0.018). The Ktrans and Ve in inflammation were higher than those in malignant lesions (Ktrans : 0.78 ± 0.52 min-1 vs. 0.37 ± 0.22 min-1 , P = 0.020; Ve : 0.36 ± 0.16 vs. 0.26 ± 0.1, P = 0.177). Also, the Ktrans and Ve in malignant lesions were also higher than those in benign lesions (Ktrans : 0.37 ± 0.22 min-1 vs. 0.04 ± 0.04 min-1 , P = 0.001; Ve : 0.26 ± 0.12 vs. 0.10 ± 0.00, P = 0.063). DATA CONCLUSION This feasibility study demonstrated the performance of high spatiotemporal resolution free-breathing DCE-MRI of the lung using GRASP for qualitative and quantitative assessment of pulmonary lesions. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 1 J. MAGN. RESON. IMAGING 2018;48:459-468.
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Affiliation(s)
- Lihua Chen
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China.,Department of Radiology, PLA 101st Hospital, Wuxi Jiangsu, China
| | - Daihong Liu
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiuquan Zhang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Bing Xie
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Xiaoyue Zhou
- MR Collaboration, North East Asia, Siemens Healthcare, Shanghai, China
| | | | - Xuequan Huang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jian Wang
- Department of Radiology, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing, China
| | - Li Feng
- Center for Advanced Imaging Innovation and Research (CAI2R) and Bernard and Irene Schwartz Center for Biomedical Imaging, Department of Radiology, New York University School of Medicine, New York, New York, USA
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11
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Gu J, Xu S, Huang L, Li S, Wu J, Xu J, Feng J, Liu B, Zhou Y. Value of combining serum carcinoembryonic antigen and PET/CT in predicting EGFR mutation in non-small cell lung cancer. J Thorac Dis 2018; 10:723-731. [PMID: 29607142 DOI: 10.21037/jtd.2017.12.143] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background We sought to investigate the associations between pretreatment serum Carcinoembryonic antigen (CEA) level, 18F-Fluoro-2-deoxyglucose (18F-FDG) uptake value of primary tumor and epidermal growth factor receptor (EGFR) mutation status in non-small cell lung cancer (NSCLC). Methods We retrospectively reviewed medical records of 210 NSCLC patients who underwent EGFR mutation test and 18F-FDG positron emission tomography/computed tomography (PET/CT) scan before anti-tumor therapy. The associations between EGFR mutations and patients' characteristics, serum CEA, PET/CT imaging characteristics maximal standard uptake value (SUVmax) of the primary tumor were analyzed. Receiver-operating characteristic (ROC) curve was used to assess the predictive value of these factors. Results EGFR mutations were found in 70 patients (33.3%). EGFR mutations were more common in high CEA group (CEA ≥7.0 ng/mL) than in low CEA group (CEA <7.0 ng/mL) (40.4% vs. 27.6%; P=0.05). Females (P<0.001), non-smokers (P<0.001), patients with adenocarcinoma (P<0.001) and SUVmax <9.0 (P=0.001) were more likely to be EGFR mutation-positive. Multivariate analysis revealed that gender, tumor histology, pretreatment serum CEA level, and SUVmax were the most significant predictors for EGFR mutations. The ROC curve revealed that combining these four factors yielded a higher calculated AUC (0.80). Conclusions Gender, histology, pretreatment serum CEA level and SUVmax are significant predictors for EGFR mutations in NSCLC. Combining these factors in predicting EGFR mutations has a moderate diagnostic accuracy, and is helpful in guiding anti-tumor treatment.
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Affiliation(s)
- Jincui Gu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Siqi Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Lixia Huang
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Shaoli Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jian Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Junwen Xu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Jinlun Feng
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Baomo Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
| | - Yanbin Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
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12
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Feng F, Qiang F, Shen A, Shi D, Fu A, Li H, Zhang M, Xia G, Cao P. Dynamic contrast-enhanced MRI versus 18F-FDG PET/CT: Which is better in differentiation between malignant and benign solitary pulmonary nodules? Chin J Cancer Res 2018; 30:21-30. [PMID: 29545716 DOI: 10.21147/j.issn.1000-9604.2018.01.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Objective To prospectively compare the discriminative capacity of dynamic contrast enhanced-magnetic resonance imaging (DCE-MRI) with that of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in the differentiation of malignant and benign solitary pulmonary nodules (SPNs). Methods Forty-nine patients with SPNs were included in this prospective study. Thirty-two of the patients had malignant SPNs, while the other 17 had benign SPNs. All these patients underwent DCE-MRI and 18F-FDG PET/CT examinations. The quantitative MRI pharmacokinetic parameters, including the trans-endothelial transfer constant (Ktrans), redistribution rate constant (Kep), and fractional volume (Ve), were calculated using the Extended-Tofts Linear two-compartment model. The 18F-FDG PET/CT parameter, maximum standardized uptake value (SUVmax), was also measured. Spearman's correlations were calculated between the MRI pharmacokinetic parameters and the SUVmax of each SPN. These parameters were statistically compared between the malignant and benign nodules. Receiver operating characteristic (ROC) analyses were used to compare the diagnostic capability between the DCE-MRI and 18F-FDG PET/CT indexes. Results Positive correlations were found between Ktrans and SUVmax, and between Kep and SUVmax (P<0.05). There were significant differences between the malignant and benign nodules in terms of the Ktrans, Kep and SUVmax values (P<0.05). The areas under the ROC curve (AUC) of Ktrans, Kep and SUVmax between the malignant and benign nodules were 0.909, 0.838 and 0.759, respectively. The sensitivity and specificity in differentiating malignant from benign SPNs were 90.6% and 82.4% for Ktrans; 87.5% and 76.5% for Kep; and 75.0% and 70.6% for SUVmax, respectively. The sensitivity and specificity of Ktrans and Kep were higher than those of SUVmax, but there was no significant difference between them (P>0.05). Conclusions DCE-MRI can be used to differentiate between benign and malignant SPNs and has the advantage of being radiation free.
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Affiliation(s)
- Feng Feng
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Fulin Qiang
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Aijun Shen
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Donghui Shi
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Aiyan Fu
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Haiming Li
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Mingzhu Zhang
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Ganlin Xia
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
| | - Peng Cao
- Department of Radiology, Nantong Tumor Hospital, Nantong University, Nantong 226361, China
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13
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Assessment of Aggressiveness of Breast Cancer Using Simultaneous 18F-FDG-PET and DCE-MRI: Preliminary Observation. Clin Nucl Med 2017; 41:e355-61. [PMID: 27187730 DOI: 10.1097/rlu.0000000000001254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE This study aims to investigate the feasibility of using simultaneous breast MRI and PET to assess the synergy of MR pharmacokinetic and fluorine-18 fluorodeoxyglucose (F-FDG) uptake data to characterize tumor aggressiveness in terms of metastatic burden and Ki67 status. METHODS Twelve consecutive patients underwent breast and whole-body PET/MRI. During the MR scan, PET events were simultaneously accumulated. MR contrast kinetic model parametric maps were computed using the extended Tofts model, including the volume transfer constant between blood plasma and the interstitial space (K), the transfer constant from the interstitial space to the blood plasma (kep), and the plasmatic volume fraction (Vp). RESULTS Patients with systemic metastases had a significantly lower kep compared to those with local disease (0.45 vs. 0.99 min, P = 0.011). Metastatic burden correlated positively with K and standardized uptake value (SUV), and negatively with kep. Ki67 positive tumors had a significantly greater K compared to Ki67 negative tumors (0.29 vs. 0.45 min, P = 0.03). A negative correlation was found between metabolic tumor volume and transfer constant (K or Kep). CONCLUSION These preliminary results suggest that MR pharmacokinetic parameters and FDG-PET may aid in the assessment of tumor aggressiveness and metastatic potential. Future studies are warranted with a larger cohort to further assess the role of pharmacokinetic modeling in simultaneous PET/MRI imaging.
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14
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Meijer TWH, de Geus-Oei LF, Visser EP, Oyen WJG, Looijen-Salamon MG, Visvikis D, Verhagen AFTM, Bussink J, Vriens D. Tumor Delineation and Quantitative Assessment of Glucose Metabolic Rate within Histologic Subtypes of Non-Small Cell Lung Cancer by Using Dynamic 18F Fluorodeoxyglucose PET. Radiology 2016; 283:547-559. [PMID: 27846378 DOI: 10.1148/radiol.2016160329] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose To assess whether dynamic fluorine 18 (18F) fluorodeoxyglucose (FDG) positron emission tomography (PET) has added value over static 18F-FDG PET for tumor delineation in non-small cell lung cancer (NSCLC) radiation therapy planning by using pathology volumes as the reference standard and to compare pharmacokinetic rate constants of 18F-FDG metabolism, including regional variation, between NSCLC histologic subtypes. Materials and Methods The study was approved by the institutional review board. Patients gave written informed consent. In this prospective observational study, 1-hour dynamic 18F-FDG PET/computed tomographic examinations were performed in 35 patients (36 resectable NSCLCs) between 2009 and 2014. Static and parametric images of glucose metabolic rate were obtained to determine lesion volumes by using three delineation strategies. Pathology volume was calculated from three orthogonal dimensions (n = 32). Whole tumor and regional rate constants and blood volume fraction (VB) were computed by using compartment modeling. Results Pathology volumes were larger than PET volumes (median difference, 8.7-25.2 cm3; Wilcoxon signed rank test, P < .001). Static fuzzy locally adaptive Bayesian (FLAB) volumes corresponded best with pathology volumes (intraclass correlation coefficient, 0.72; P < .001). Bland-Altman analyses showed the highest precision and accuracy for static FLAB volumes. Glucose metabolic rate and 18F-FDG phosphorylation rate were higher in squamous cell carcinoma (SCC) than in adenocarcinoma (AC), whereas VB was lower (Mann-Whitney U test or t test, P = .003, P = .036, and P = .019, respectively). Glucose metabolic rate, 18F-FDG phosphorylation rate, and VB were less heterogeneous in AC than in SCC (Friedman analysis of variance). Conclusion Parametric images are not superior to static images for NSCLC delineation. FLAB-based segmentation on static 18F-FDG PET images is in best agreement with pathology volume and could be useful for NSCLC autocontouring. Differences in glycolytic rate and VB between SCC and AC are relevant for research in targeting agents and radiation therapy dose escalation. © RSNA, 2016 Online supplemental material is available for this article.
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Affiliation(s)
- Tineke W H Meijer
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Lioe-Fee de Geus-Oei
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Eric P Visser
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Wim J G Oyen
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Monika G Looijen-Salamon
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Dimitris Visvikis
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Ad F T M Verhagen
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Johan Bussink
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
| | - Dennis Vriens
- From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis)
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