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Muheremu A, Wen T, Niu X. PET-CT for the diagnosis and treatment of primary musculoskeletal tumors in Chinese patients - experience from 255 patients in a single center. Br J Radiol 2021; 94:20210785. [PMID: 34591688 PMCID: PMC8631037 DOI: 10.1259/bjr.20210785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The current study was carried out to assess the value of positron emission tomography (PET)/CT on the diagnosis and staging of primary musculoskeletal tumors. METHODS PET-CT test results and histopathological study reports of all the patients with primary musculoskeletal tumors in our department from January 2006 to July 2015 were retrospectively reviewed. Maximum standardized uptake value (SUVmax) in these PET-CT reports were recorded and analyzed respectively for each type of sarcoma. RESULTS A total of 255 patients were included in the final analysis. Sensitivity of SUVmax based diagnosis was 96.6% for primary malignant osseous sarcomas and 91.2% for soft tissue sarcomas. SUVmax of high-grade osseous sarcomas (average 8.4 ± 5.5) was significantly higher (p < 0.001) than low-grade osseous sarcomas (average 3.9 ± 1.8); based on current case series, SUVmax of high-grade soft tissue sarcomas (7.5 ± 5.1) was not significantly different (p = 0.229) from that of low-grade soft tissue sarcomas (5.3 ± 3.7). Significant decrease of SUVmax value after chemotherapy was associated with favorable prognosis in patients with osteosarcoma. CONCLUSION Results of the current study indicate that, the SUVmax based application of PET-CT can be a valuable supplementary method to histopathological tests regarding the diagnosis and staging of primary musculoskeletal sarcomas. ADVANCES IN KNOWLEDGE SUVmax based application of PET-CT is a highly sensitive method in diagnosis of primary osseous and soft tissue sarcomas in Chinese patients.
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Affiliation(s)
| | - Tianlin Wen
- Department of Orthopaedics, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaohui Niu
- Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Beijing, China
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Abstract
PET/CT has become a preferred imaging modality over PET-only scanners in clinical practice. However, along with the significant improvement in diagnostic accuracy and patient throughput, pitfalls on PET/CT are reported as well. This review provides a general overview on the potential influence of the limitations with respect to PET/CT instrumentation and artifacts associated with the modality integration on the image appearance and quantitative accuracy of PET. Approaches proposed in literature to address the limitations or minimize the artifacts are discussed as well as their current challenges for clinical applications. Although the CT component can play an important role in assisting clinical diagnosis, we concentrate on the imaging scenarios where CT is used to provide auxiliary information for attenuation compensation and scatter correction in PET.
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Affiliation(s)
- Yu-Jung Tsai
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University, New Haven, CT; Department of Biomedical Engineering, Yale University, New Haven, CT.
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Abstract
International colon cancer guidelines suggest F-FDG PET/CT in a few circumstances: (1) at disease presentation in case of suspected or proven metastatic synchronous adenocarcinoma; (2) in the workup of recurrent colon cancer with metachronous metastases documented by CT, MRI, or biopsy and in case of serial CEA elevation with negative colonoscopy and negative CT; and (3) in case of contraindication to iodine- and gadolinium-based contrast agents. However, review of the literature has shown that PET/CT can also be used in other scenarios with significant levels of diagnostic advantage. This review aims to emphasize differences between guidelines and scientific literature for the use of PET/CT in colon cancer.
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Noninvasive evaluation of 18F-FDG/ 18F-FMISO-based Micro PET in monitoring hepatic metastasis of colorectal cancer. Sci Rep 2018; 8:17832. [PMID: 30546057 PMCID: PMC6292879 DOI: 10.1038/s41598-018-36238-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 11/15/2018] [Indexed: 12/19/2022] Open
Abstract
This study aimed to explore the application of two radiotracers (18F-fluorodeoxyglucose (FDG) and 18F-fluoromisonidazole (FMISO)) in monitoring hepatic metastases of human colorectal cancer (CRC). Mouse models of CRC hepatic metastases were established by implantation of the human CRC cell lines LoVo and HT29 by intrasplenic injection. Wound healing and Transwell assays were performed to examine cell migration and invasion abilities. Radiotracer-based cellular uptake in vitro and micro-positron emission tomography imaging of liver metastases in vivo were performed. The incidence of liver metastases in LoVo-xenografted mice was significantly higher than that in HT29-xenografted ones. The SUVmax/mean values of 18F-FMISO, but not 18F-FDG, in LoVo xenografts were significantly greater than in HT29 xenografts. In vitro, LoVo cells exhibited stronger metastatic potential and higher radiotracer uptake than HT29 cells. Mechanistically, the expression of HIF-1α and GLUT-1 in LoVo cells and LoVo tumor tissues was remarkably higher than in HT29 cells and tissues. Linear regression analysis demonstrated correlations between cellular 18F-FDG/18F-FMISO uptake and HIF-1α/GLUT-1 expression in vitro, as well as between 18F-FMISO SUVmax and GLUT-1 expression in vivo. 18F-FMISO uptake may serve as a potential biomarker for the detection of liver metastases in CRC, whereas its clinical use warrants validation.
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Mena E, Taghipour M, Sheikhbahaei S, Jha AK, Rahmim A, Solnes L, Subramaniam RM. Value of Intratumoral Metabolic Heterogeneity and Quantitative 18F-FDG PET/CT Parameters to Predict Prognosis in Patients With HPV-Positive Primary Oropharyngeal Squamous Cell Carcinoma. Clin Nucl Med 2017; 42:e227-e234. [PMID: 28195905 PMCID: PMC5380578 DOI: 10.1097/rlu.0000000000001578] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of intratumoral metabolic heterogeneity and quantitative FDG PET/CT imaging parameters for predicting patient outcomes in primary oropharyngeal squamous cell cancer (OPSCC). PATIENTS AND METHODS We retrospectively investigated 105 patients with HPV-positive OPSCC. SUVmax and metabolic tumor volume (MTV) were measured for the primary tumors and when available for the metastatic sites. Primary tumor intratumoral metabolic heterogeneity was calculated as the area under a cumulative SUV volume histograms curve (AUC-CSH). The median follow-up time was 35.4 months (range, 3-92 months). Outcome end point was event-free survival (EFS). Kaplan-Meier survival plots and Cox regression analyses were performed. RESULTS Of the 105 patients included, 19 patients relapsed and 11 deceased during the study period. AUC-CSH indexes were associated with EFS using PET gradient-based (P = 0.034) and 50% threshold (P = 0.02) segmentation methods, on multivariate analysis. Kaplan-Meier survival analysis using optimum cutoff of 16.7 SUVmax and 12.7 mL total MTV were significant predictors of EFS. Combining SUVmax and AUC-CSH index in 3 subgroups, patients with higher intratumoral heterogeneity and higher SUVmax were associated with worse outcome (log-rank, P = 0.026). Similarly, patients with higher intratumoral heterogeneity tumors and higher MTV had worse prognosis (log-rank, P = 0.022). CONCLUSIONS Intratumoral metabolic heterogeneity using FDG PET was a prognostic factor for EFS in patients with primary HPV (+) OPSCC. The combined predictive effect of FDG avidity, metabolic tumor burden, and intratumoral heterogeneity provided prognostic survival information in these patients.
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Affiliation(s)
- Esther Mena
- From the *Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, MD; †Department of Radiology, ‡Department Clinical Sciences, §Advanced Imaging Research Center, and ∥Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
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Taghipour M, Sheikhbahaei S, Trahan TJ, Subramaniam RM. Value of fourth and subsequent post-therapy follow-up 18F-FDG PET/CT scans in patients with breast cancer. Nucl Med Commun 2017; 37:602-8. [PMID: 27110955 DOI: 10.1097/mnm.0000000000000491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To evaluate the accuracy and value of the fourth and subsequent post-therapy follow-up fluorine-18 fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) scans in the clinical assessment of breast cancer patients. MATERIALS AND METHODS Ninety-two female patients, with a total of 426 fourth and subsequent follow-up PET/CT scans, were retrospectively included. Patients were followed for a median of 23.7 months (range, 0.7-124.4) from the fourth follow-up PET/CT. The diagnostic accuracy of PET/CT, its impact on clinical assessment, patients' management, and survival outcome were established. RESULT Of the 426 follow-up PET/CT scans, 264 (62%) were interpreted as positive and 162 (38%) were interpreted as negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the fourth and subsequent follow-up PET/CT scans were 97.7, 98.1, 98.8, 96.3, and 97.9%, respectively. Fourth and subsequent follow-up PET/CT were useful in excluding a tumor in 13.4% (39/292) of patients with a clinical suspicion of recurrence and identifying suspected recurrence in 10.5% (14/134) of patients without previous clinical suspicion. A change in management was noted in 6.7% (9/134) of scan times when the scans were performed without previous clinical suspicion of recurrence or therapy response and was 27.7% (81/292) when the scans were performed with clinical suspicion. Overall survival differed significantly between patients with all negative follow-up scans (n=23) and those who had at least one positive follow-up scan (n=69) (hazard ratio of 4.65, P<0.001). CONCLUSION The fourth and subsequent PET/CT scans performed after the completion of primary treatment led to a change in management in 27.7% of patients when the scans were performed with clinical suspicion and only in 6.7% of patients when performed without clinical suspicion or context.
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Affiliation(s)
- Mehdi Taghipour
- aRussell H Morgan Department of Radiology and Radiological SciencesbDepartment of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of MedicinecDepartment of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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The value of fourth and subsequent post-treatment 18F-FDG PET/CT scans in the management of patients with non-Hodgkin's lymphoma. Nucl Med Commun 2017; 37:699-704. [PMID: 26990623 DOI: 10.1097/mnm.0000000000000504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the impact of fourth and subsequent follow-up PET/computed tomography (PET/CT) scans in patients with non-Hodgkins lymphoma (NHL). MATERIALS AND METHODS This retrospective study evaluated all biopsy-proven NHL patients who had more than three follow-up scans after completion of primary treatment from 2000 to 2013 at our academic center. Among 586 patients with NHL who had at least one fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT scan at our institution, a total of 77 patients with 208 fourth and subsequent follow-up F-FDG PET/CT scans, were included in the study. The impact of these follow-up scans on the clinical assessment and the management of the patients was evaluated. RESULTS Among 208 fourth and subsequent follow-up scans, 33 were performed with a previous clinical suspicion of recurrence and 175 were performed without a previous clinical suspicion of recurrence. Fourth and subsequent follow-up PET/CT results were useful in excluding tumor in 27.3% of scan times when there was a clinical suspicion of recurrence and in identifying recurrence in 5.1% of scan times when there was no previous clinical suspicion of recurrence. Clinicians changed management after 36.4% (12/33) scans that were performed with previous clinical suspicion of recurrence and 9.2% (16/175) scans that were performed without previous clinical suspicion (P=0.001). CONCLUSION Fourth and subsequent follow-up PET/CT scans affect the treatment and management of patients with NHL and add value to clinical assessment and management, especially in patients with a previous clinical suspicion of recurrence.
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JOURNAL CLUB: Value of Quantitative FDG PET/CT Volumetric Biomarkers in Recurrent Colorectal Cancer Patient Survival. AJR Am J Roentgenol 2017; 207:257-65. [PMID: 27447341 DOI: 10.2214/ajr.15.15806] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the impact of quantitative PET parameters in the overall survival of patients with recurrent colorectal cancer. MATERIALS AND METHODS A total of 105 patients with a biopsy-proven recurrence of colorectal cancer who underwent PET/CT were included in the study. A gradient segmentation method was used to calculate maximum and peak standardized uptake values (SUVmax, SUVpeak), total lesion glycolysis (TLGtotal), and metabolic tumor volume (MTVtotal). These parameters were measured for each recurrent lesion at the primary, locoregional, and distant sites. The median follow-up time was 31.3 months. Overall survival (OS) was the primary outcome and was calculated using Kaplan-Meier survival plots and Cox regression analyses. RESULTS The mean ± SD for SUVmax, SUVpeak, TLGtotal, and MTVtotal of the included patients was 7.3 ± 5.3, 5.3 ± 3.3, 280.8 ± 1181 g, and 79.8 ± 294 mL, respectively. The median OS for patients who were alive was 50 months in comparison with 23.4 months among patients who died. Age (p = 0.041), tumor grade (p = 0.010), median TLG (p = 0.031), and median MTV (p = 0.009) remained significantly associated with OS in the multivariate Cox regression analysis. Kaplan-Meier survival analysis performed on the basis of the median PET/CT parametric values showed that SUVmax (threshold, 5.63; hazard ratio [HR] = 1.7; 95% CI, 1-2.8; p = 0.02), MTVtotal (threshold, 13.85 mL; HR = 2.2; 95% CI, 1.3-3.9; p = 0.003), and TLGtotal (threshold, 36.14 g; HR = 1.9; 95% CI, 1.1-3.3; p = 0.01) were significant predictors of OS during follow-up. An integrated risk stratification model with SUVmax and MTVtotal into three subgroups predicted patient survival outcomes (HR = 1.8; 95% CI, 1.25-2.65; log-rank p = 0.003). CONCLUSION SUVmax, MTVtotal, TLGtotal, and integrated score with FDG avidity and total tumor burden provide survival information for patients with biopsy-proven recurrent colorectal cancer.
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Pak K, Kim SJ, Koo PJ, Chang S. Estimation of Recurrence Risk After Normal (18)F-FDG PET/CT in Nonsmall-Cell Lung Cancer. Cancer Biother Radiopharm 2017; 31:174-9. [PMID: 27310304 DOI: 10.1089/cbr.2016.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The authors aimed to assess the risk of recurrence in patients with nonsmall-cell lung cancer after surgery with no evidence of disease (NED) demonstrated on (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). A total of 140 subjects with adenocarcinoma or squamous cell carcinoma of the lung were included in this study. Patients had FDG PET/CT scans within a year after surgery between January 2007 and December 2014. Patients with PET/CT scans with NED were included. Following an NED PET/CT scan, recurrence or metastasis was found in 14 patients (10.0%), and deaths in 4 (2.9%) during a median follow-up of 636 days. Although the rates of recurrence or metastasis were very low, the risk for recurrence continuously increased after 600 days up to 0.03%. The risk was higher in patients with positive margin at surgery, lymphovascular invasion, N2 stage, and TNM stage III/IV. In conclusion, according to the smoothed hazard functions, there was a very low risk of recurrence until 600 days after normal (18)F-FDG PET scans. The risk was higher in patients with positive margin at surgery, lymphovascular invasion, N2 stage, and TNM stage III/IV.
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Affiliation(s)
- Kyoungjune Pak
- 1 Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital , Busan, Korea
| | - Seong-Jang Kim
- 2 Department of Nuclear Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital , Yangsan, Korea
| | - Phillip J Koo
- 3 Department of Radiology, University of Colorado School of Medicine , Aurora, Colorado
| | - Samuel Chang
- 3 Department of Radiology, University of Colorado School of Medicine , Aurora, Colorado
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18F-FDG PET/CT and Melanoma: Value of Fourth and Subsequent Posttherapy Follow-up Scans for Patient Management. Clin Nucl Med 2017; 41:e403-9. [PMID: 27355846 DOI: 10.1097/rlu.0000000000001275] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We aimed to evaluate the added value of performing fourth and subsequent follow-up F-FDG-PET/CT scans to clinical assessment and impact on the patient's management in patients with melanoma. METHODS This was a retrospective study of 232 biopsy-proven melanoma patients who underwent F-FDG-PET/CT scans. Of these, 71 patients had 4 or more follow-up F-FDG-PET/CT scans after completion of primary treatment, with a total of 246 fourth or subsequent follow-up PET/CT scans. The added value of each follow-up PET/CT scan to the patient's clinical assessment and treatment management was established. Kaplan-Meier plots with a Mantel-Cox log-rank test were used to establish the patient's overall survival. RESULTS Of the 246 fourth and subsequent follow-up PET/CT scans, 61% (150/246) were negative for malignancy, and 39.0% (96/246) were positive for recurrence/metastases. FDG-PET/CT was helpful in identifying malignancy in 6.5% of the scans performed without prior clinical suspicion, which ruled out malignancy in 28.5% of the scans obtained with prior clinical signs suggestive of recurrence or for secondary therapy assessment. The PET/CT scan resulted in change of the patient's management in approximately 16.7% (41/246) of the scans. Change in management was significantly greater in patients whose scans were done with prior clinical signs suggestive of malignancy, or for therapy assessment than without prior clinical suspicion (29.3% vs 4.1%; P < 0.0001). Statistically significant difference was seen in the overall survival between patients with at least 1 positive and all negative fourth and subsequent follow-up PET/CT scans at patient level (P = 0.001). CONCLUSIONS The fourth and subsequent F-FDG-PET/CT scans obtained after completion of primary treatment added value to clinical assessment in patients with melanoma. Patients with clinical signs suggestive of recurrence or metastases or being monitored for treatment response are more likely to benefit from the fourth or subsequent FDG PET/CT than those without prior clinical suspicion.
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Taghipour M, Marcus C, Sheikhbahaei S, Mena E, Prasad S, Jha AK, Solnes L, Subramaniam RM. Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up 18F-FDG PET/CT Scans in Oncology Patients. J Nucl Med 2016; 58:737-743. [PMID: 27811123 DOI: 10.2967/jnumed.116.183111] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 11/04/2016] [Indexed: 12/14/2022] Open
Abstract
The Centers for Medicare and Medicaid Services coverage includes 3 posttherapy 18F-FDG PET/CT scans per patient and per tumor type. Any additional follow-up 18F-FDG PET/CT scans will be reimbursed at the discretion of a local Medicare administrator, if deemed medically necessary. This study aimed to investigate common clinical indications for performing a fourth or additional follow-up 18F-FDG PET/CT scans that could affect the management of patients. Methods: This was a retrospective institutional review of 433 oncology patients (203 men; mean age, 55 y), including a total of 1,659 fourth or subsequent follow-up PET/CT scans after completion of primary treatment. Twelve indications for performing a fourth or subsequent follow-up PET/CT scan were determined, and the impact of each of the 12 indications on patients' management was evaluated. Results: The primary tumors were breast cancer (92 patients, 426 scans), non-Hodgkin lymphoma (77 patients, 208 scans), Hodgkin disease (41 patients, 182 scans), colorectal cancer (70 patients, 286 scans), melanoma (69 patients, 271 scans), and lung cancer (84 patients, 286 scans). The indications were categorized in 4 groups: PET/CT for diagnosis of tumor recurrence (303/1,659, 18.3%), PET/CT before starting therapy for tumor recurrence (64/1,659, 3.9%), PET/CT to assess therapy response for tumor recurrence (507/1,659, 30.6%), and follow-up PET/CT after completion of treatment for tumor recurrence (785/1,659, 47.3%). Overall, fourth and subsequent follow-up 18F-FDG PET/CT scans resulted in change in management in 31.6% of the scans (356 of 1,128) when the scans were obtained for medical necessities (indications 1-11), and in 5.6% of the scans (30/531) when the scans were obtained without any medical necessity (indication 12). Conclusion: The fourth and subsequent PET/CT scans obtained after completion of primary treatment led to a change in management in 31.6% of the scans when acquired for appropriate clinical reasons. Performing follow-up PET/CT without appropriate medical reason had a low impact on patients' management and should be avoided.
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Affiliation(s)
- Mehdi Taghipour
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charles Marcus
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Sara Sheikhbahaei
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Esther Mena
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Shwetha Prasad
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Abhinav K Jha
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lilja Solnes
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Rathan M Subramaniam
- Russell H Morgan Department of Radiology and Radiological Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland .,Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas.,Advanced Imaging Research Center, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.,Department of Biomedical Engineering, University of Texas Southwestern Medical Center, Dallas, Texas; and.,Harold C Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Surrogate Imaging Biomarkers of Response of Colorectal Liver Metastases After Salvage Radioembolization Using 90Y-Loaded Resin Microspheres. AJR Am J Roentgenol 2016; 207:661-70. [PMID: 27384594 DOI: 10.2214/ajr.15.15202] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The purpose of the present study is to evaluate Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, tumor attenuation criteria, Choi criteria, and European Organization for Research and Treatment of Cancer (EORTC) PET criteria as measures of response and subsequent predictors of liver progression-free survival (PFS) after radioembolization (RE) of colorectal liver metastases (CLM). The study also assesses interobserver variability for measuring tumor attenuation using a single 2D ROI on a simple PACS workstation. MATERIALS AND METHODS We performed a retrospective review of the clinical RE database at our institution, to identify patients treated in the salvage setting for CLM between December 2009 and March 2013. Response was evaluated on FDG PET scans, with the use of EORTC PET criteria, and on portal venous phase CT scans, with the use of RECIST 1.1, tumor attenuation criteria, and Choi criteria. Two independent blinded observers measured tumor attenuation using a single 2D ROI. The intraclass correlation coefficient (ICC) for interobserver variability was assessed. Kaplan-Meier methodology was used to calculate liver PFS, and the log-rank test was used to assess the response criteria as predictors of liver PFS. RESULTS A total of 25 patients with 46 target tumors were enrolled in the study. The ICC was 0.95 at baseline and 0.98 at response evaluation. Among the 25 patients, more responders (i.e., partial response) were identified on the basis of EORTC PET criteria (n = 14), Choi criteria (n = 15), and tumor attenuation criteria (n = 13) than on the basis of RECIST 1.1 (n = 2). The median liver PFS was 3.0 months (95% CI, 2.1-4.0 months). Response identified on the basis of EORTC PET criteria (p < 0.001), Choi criteria (p < 0.001), or tumor attenuation criteria (p = 0.01) predicted liver PFS; however, response identified by RECIST 1.1 did not (p = 0.1). CONCLUSION RECIST 1.1 has poor sensitivity for detecting metabolic responses classified by EORTC PET criteria. EORTC PET criteria, Choi criteria, and tumor attenuation criteria appear to be equally reliable surrogate imaging biomarkers of liver PFS after RE in patients with CLM.
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Sun C, Deng Y, Zhou H, Hu ZQ. Risk factors for the development of metachronous bone metastasis in colorectal cancer patients after curative resection. Int J Surg 2015; 21:145-9. [DOI: 10.1016/j.ijsu.2015.07.706] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 07/01/2015] [Accepted: 07/18/2015] [Indexed: 11/28/2022]
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