1
|
Gilbert FJ, Harris S, Miles KA, Weir-McCall JR, Qureshi NR, Rintoul RC, Dizdarevic S, Pike L, Sinclair D, Shah A, Eaton R, Clegg A, Benedetto V, Hill JE, Cook A, Tzelis D, Vale L, Brindle L, Madden J, Cozens K, Little LA, Eichhorst K, Moate P, McClement C, Peebles C, Banerjee A, Han S, Poon FW, Groves AM, Kurban L, Frew AJ, Callister ME, Crosbie P, Gleeson FV, Karunasaagarar K, Kankam O, George S. Dynamic contrast-enhanced CT compared with positron emission tomography CT to characterise solitary pulmonary nodules: the SPUtNIk diagnostic accuracy study and economic modelling. Health Technol Assess 2022; 26:1-180. [PMID: 35289267 DOI: 10.3310/wcei8321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Current pathways recommend positron emission tomography-computerised tomography for the characterisation of solitary pulmonary nodules. Dynamic contrast-enhanced computerised tomography may be a more cost-effective approach. OBJECTIVES To determine the diagnostic performances of dynamic contrast-enhanced computerised tomography and positron emission tomography-computerised tomography in the NHS for solitary pulmonary nodules. Systematic reviews and a health economic evaluation contributed to the decision-analytic modelling to assess the likely costs and health outcomes resulting from incorporation of dynamic contrast-enhanced computerised tomography into management strategies. DESIGN Multicentre comparative accuracy trial. SETTING Secondary or tertiary outpatient settings at 16 hospitals in the UK. PARTICIPANTS Participants with solitary pulmonary nodules of ≥ 8 mm and of ≤ 30 mm in size with no malignancy in the previous 2 years were included. INTERVENTIONS Baseline positron emission tomography-computerised tomography and dynamic contrast-enhanced computer tomography with 2 years' follow-up. MAIN OUTCOME MEASURES Primary outcome measures were sensitivity, specificity and diagnostic accuracy for positron emission tomography-computerised tomography and dynamic contrast-enhanced computerised tomography. Incremental cost-effectiveness ratios compared management strategies that used dynamic contrast-enhanced computerised tomography with management strategies that did not use dynamic contrast-enhanced computerised tomography. RESULTS A total of 380 patients were recruited (median age 69 years). Of 312 patients with matched dynamic contrast-enhanced computer tomography and positron emission tomography-computerised tomography examinations, 191 (61%) were cancer patients. The sensitivity, specificity and diagnostic accuracy for positron emission tomography-computerised tomography and dynamic contrast-enhanced computer tomography were 72.8% (95% confidence interval 66.1% to 78.6%), 81.8% (95% confidence interval 74.0% to 87.7%), 76.3% (95% confidence interval 71.3% to 80.7%) and 95.3% (95% confidence interval 91.3% to 97.5%), 29.8% (95% confidence interval 22.3% to 38.4%) and 69.9% (95% confidence interval 64.6% to 74.7%), respectively. Exploratory modelling showed that maximum standardised uptake values had the best diagnostic accuracy, with an area under the curve of 0.87, which increased to 0.90 if combined with dynamic contrast-enhanced computerised tomography peak enhancement. The economic analysis showed that, over 24 months, dynamic contrast-enhanced computerised tomography was less costly (£3305, 95% confidence interval £2952 to £3746) than positron emission tomography-computerised tomography (£4013, 95% confidence interval £3673 to £4498) or a strategy combining the two tests (£4058, 95% confidence interval £3702 to £4547). Positron emission tomography-computerised tomography led to more patients with malignant nodules being correctly managed, 0.44 on average (95% confidence interval 0.39 to 0.49), compared with 0.40 (95% confidence interval 0.35 to 0.45); using both tests further increased this (0.47, 95% confidence interval 0.42 to 0.51). LIMITATIONS The high prevalence of malignancy in nodules observed in this trial, compared with that observed in nodules identified within screening programmes, limits the generalisation of the current results to nodules identified by screening. CONCLUSIONS Findings from this research indicate that positron emission tomography-computerised tomography is more accurate than dynamic contrast-enhanced computerised tomography for the characterisation of solitary pulmonary nodules. A combination of maximum standardised uptake value and peak enhancement had the highest accuracy with a small increase in costs. Findings from this research also indicate that a combined positron emission tomography-dynamic contrast-enhanced computerised tomography approach with a slightly higher willingness to pay to avoid missing small cancers or to avoid a 'watch and wait' policy may be an approach to consider. FUTURE WORK Integration of the dynamic contrast-enhanced component into the positron emission tomography-computerised tomography examination and the feasibility of dynamic contrast-enhanced computerised tomography at lung screening for the characterisation of solitary pulmonary nodules should be explored, together with a lower radiation dose protocol. STUDY REGISTRATION This study is registered as PROSPERO CRD42018112215 and CRD42019124299, and the trial is registered as ISRCTN30784948 and ClinicalTrials.gov NCT02013063. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 17. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Fiona J Gilbert
- Department of Radiology, University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Scott Harris
- Public Health Sciences and Medical Statistics, University of Southampton, Southampton, UK
| | - Kenneth A Miles
- Department of Radiology, University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, UK
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Jonathan R Weir-McCall
- Department of Radiology, University of Cambridge School of Clinical Medicine, Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Nagmi R Qureshi
- Department of Radiology, Royal Papworth Hospital, Cambridge, UK
| | - Robert C Rintoul
- Department of Thoracic Oncology, Royal Papworth Hospital, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Sabina Dizdarevic
- Departments of Imaging and Nuclear Medicine and Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Lucy Pike
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Donald Sinclair
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Andrew Shah
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Rosemary Eaton
- Radiation Protection Department, East and North Hertfordshire NHS Trust, Stevenage, UK
| | - Andrew Clegg
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Valerio Benedetto
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - James E Hill
- Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Andrew Cook
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Brindle
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Jackie Madden
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kelly Cozens
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Louisa A Little
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Kathrin Eichhorst
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Patricia Moate
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Chris McClement
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| | - Charles Peebles
- Department of Radiology and Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Anindo Banerjee
- Department of Radiology and Respiratory Medicine, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sai Han
- West of Scotland PET Centre, Gartnavel Hospital, Glasgow, UK
| | - Fat Wui Poon
- West of Scotland PET Centre, Gartnavel Hospital, Glasgow, UK
| | - Ashley M Groves
- Institute of Nuclear Medicine, University College London, London, UK
| | - Lutfi Kurban
- Department of Radiology, Aberdeen Royal Hospitals NHS Trust, Aberdeen, UK
| | - Anthony J Frew
- Departments of Imaging and Nuclear Medicine and Respiratory Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
- Brighton and Sussex Medical School, Brighton, UK
| | - Matthew E Callister
- Department of Respiratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Philip Crosbie
- North West Lung Centre, University Hospital of South Manchester, Manchester, UK
| | - Fergus V Gleeson
- Department of Radiology, Churchill Hospital, Oxford, UK
- University of Oxford, Oxford, UK
| | | | - Osei Kankam
- Department of Thoracic Medicine, East Sussex Healthcare NHS Trust, Saint Leonards-on-Sea, UK
| | - Steve George
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Southampton Clinical Trials Unit, University of Southampton, Southampton, UK
| |
Collapse
|
2
|
Cao X, Song J, Xu J, Gong G, Yang X, Su Y, Wang L, Bai X, Hu M, Yin Y. Tumor Blood Flow Is a Predictor of Radiotherapy Response in Patients With Nasopharyngeal Carcinoma. Front Oncol 2021; 11:567954. [PMID: 34422622 PMCID: PMC8377414 DOI: 10.3389/fonc.2021.567954] [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: 05/31/2020] [Accepted: 06/10/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose The aim of this study was to evaluate tumor blood flow (TBF) as a predictor of radiotherapy response for nasopharyngeal carcinoma (NPC). Materials and Method A total of 134 patients were divided into two groups, the complete response (CR) group and the partial response (PR) group based on RECIST 1.1 recommendations. The statistical difference was evaluated for pre- and mid- or post-treatment TBF and changes of TBF for tumors and metastatic lymph nodes between CR and PR, respectively. The receiver operation characteristic (ROC) curve was utilized to evaluate the accuracy of TBF in predicting the response of radiation therapy. The association between TBF and SUVmax was also investigated. Results The reduction of TBF in CR was significantly lower than that in PR for primary tumors (P <0.001) and metastatic lymph nodes (P <0.001). The multivariate logistic regression analysis indicated that the reduction of TBF is an independent predictor of the response of radiation therapy for primary tumors (P <0.001) and metastatic lymph nodes (P <0.001). The accuracy of TBF reduction in predicting the response of radiation therapy was 0.817 in primary tumors and 0.924 in metastatic lymph nodes, respectively. No significant correlation was observed between the TBF values and SUVmax of primary tumors (r = -0.008, P = 0.954) and metastasis lymph nodes (r = -0.061, P = 0.652). Conclusion This study suggests that the reduction of TBF is a promising parameter for evaluating the response of radiation therapy.
Collapse
Affiliation(s)
- Xiujuan Cao
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jian Song
- Medical Imageology, Shandong Medical College, Jinan, China
| | - Juan Xu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Guanzhong Gong
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xinhua Yang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ya Su
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Lizhen Wang
- Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Xiaodong Bai
- Department of Plastic Surgery, Southern University of Science and Technology Hospital, Shenzhen, China
| | - Man Hu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yong Yin
- Department of Radiation Oncology, Shandong Cancer Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology Physics and Technology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| |
Collapse
|
3
|
Lv W, Ashrafinia S, Ma J, Lu L, Rahmim A. Multi-Level Multi-Modality Fusion Radiomics: Application to PET and CT Imaging for Prognostication of Head and Neck Cancer. IEEE J Biomed Health Inform 2019; 24:2268-2277. [PMID: 31804945 DOI: 10.1109/jbhi.2019.2956354] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To characterize intra-tumor heterogeneity comprehensively, we propose a multi-level fusion strategy to combine PET and CT information at the image-, matrix-and feature-levels towards improved prognosis. Specifically, we developed fusion radiomics in the context of 3 prognostic outcomes in a multi-center setting (4 centers) involving 296 head & neck cancer patients. Eight clinical parameters were first utilized to build a (1) clinical model. We also built models by extracting 127 radiomics features from (2) PET images alone; (3-8) PET and CT images fused via wavelet-based fusion (WF) using CT-weights of 0.2, 0.4, 0.6 and 0.8, gradient transfer fusion (GTF), and guided filtering-based fusion (GFF); (9) fused matrices (sumMat); (10-11) fused features constructed via feature averaging (avgFea) and feature concatenation (conFea); and finally, (12) CT images alone; above models were also expanded to include both clinical and radiomics features. Seven variations of training and testing partitions were investigated. Highest performance in 5, 6 and 5 partitions was achieved by image-level fusion strategies for RFS, MFS and OS prediction, respectively. Among all partitions, WF0.6 and WF0.8 showed significantly higher performance than CT model for RFS (C-index: 0.60 ± 0.04 vs. 0.56 ± 0.03, p-value: 0.015) and MFS (C-index: 0.71 ± 0.13 vs. 0.62 ± 0.08, p-value: 0.020) predictions, respectively. In partition CER 23 vs. 14, WF0.6 significantly outperformed Clinical model for RFS prediction (C-index: 0.67 vs. 0.53, p-value: 0.003); both avgFea and WF0.6 showed C-index of 0.64 and significantly higher than that of PET only (C-index: 0.51, p-value: 0.018 and 0.031, respectively) for OS prediction. Fusion radiomics modeling showed varying improvements compared to single modality models for different outcome predictions in different partitions, highlighting the importance of generalizing radiomics models. Image-level fusion holds potential to capture more useful characteristics.
Collapse
|
4
|
Dual-energy computed tomography for prediction of loco-regional recurrence after radiotherapy in larynx and hypopharynx squamous cell carcinoma. Eur J Radiol 2018; 110:1-6. [PMID: 30599844 DOI: 10.1016/j.ejrad.2018.11.005] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 10/28/2018] [Accepted: 11/04/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate the role of quantitative pre-treatment dual-energy computed tomography (DECT) for prediction of loco-regional recurrence (LRR) in patients with larynx/hypopharynx squamous cell cancer (L/H SCC). METHODS Patients with L/H SCC treated with curative intent loco-regional radiotherapy and that underwent treatment planning with contrast-enhanced DECT of the neck were included. Primary and nodal gross tumor volumes (GTVp and GTVn) were contoured and transferred into a Matlab® workspace. Using a two-material decomposition, GTV iodine concentration (IC) maps were obtained. Quantitative histogram statistics (maximum, mean, standard deviation, kurtosis and skewness) were retrieved from the IC maps. Cox regression analysis was conducted to determine potential predictive factors of LRR. RESULTS Twenty-five patients, including 20 supraglottic and 5 pyriform sinus tumors were analysed. Stage I, II, III, IVa and IVb constituted 4% (1 patient), 24%, 36%, 28% and 8% of patients, respectively; 44% had concurrent chemo-radiotherapy and 28% had neodjuvant chemotherapy. Median follow-up was 21 months. Locoregional control at 1 and 2 years were 75% and 69%, respectively. For the entire cohort, GTVn volume (HR 1.177 [1.001-1.392], p = 0.05), voxel-based maximum IC of GTVp (HR 1.099 [95% CI: 1.001-1.209], p = 0.05) and IC standard deviation of GTVn (HR 9.300 [95% CI: 1.113-77.725] p = 0.04) were predictive of LRR. On subgroup analysis of patients treated with upfront radiotherapy +/- chemotherapy, both voxel-based maximum IC of GTVp (HR 1.127 [95% CI: 1.010-1.258], p = 0.05) and IC kurtosis of GTVp (HR 1.088 [95% CI: 1.014-1.166], p = 0.02) were predictive of LRR. CONCLUSION This exploratory study suggests that pre-radiotherapy DECT-derived IC quantitative analysis of tumoral volume may help predict LRR in L/H SCC.
Collapse
|
5
|
Banks TI, von Eyben R, Hristov D, Kidd EA. Pilot study of combined FDG-PET and dynamic contrast-enhanced CT of locally advanced cervical carcinoma before and during concurrent chemoradiotherapy suggests association between changes in tumor blood volume and treatment response. Cancer Med 2018; 7:3642-3651. [PMID: 29963760 PMCID: PMC6089147 DOI: 10.1002/cam4.1632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 12/26/2022] Open
Abstract
Modern PET/CT radiotherapy simulators offer FDG-PET and dynamic contrast-enhanced (DCE) CT imaging for combined volumetric assessment of tumor metabolism and perfusion. However, the clinical utility of such assessment has not been clearly defined. Thus, in a prospective longitudinal study of primary cervical tumors treated with concurrent chemoradiotherapy (CCRT) we evaluated: (1) whether PET and perfusion parameters correlate or provide complementary information; (2) what imaging changes occur during CCRT; and (3) whether any parameters are predictive of treatment response as assessed by PET/CT 3 months posttherapy. FDG-PET/CT and DCE-CT scans were performed on 21 patients prior to and during CCRT. Coregistered volumetric parametric maps of standardized uptake value (SUV) measures and perfusion parameters blood flow (BF), blood volume (BV), and permeability were generated. Summary statistics for these parameters and their changes were calculated within the metabolic tumor volume (MTV). Correlations between SUV and BF/BV/permeability on local and global bases were assessed with Pearson's coefficient r. MTV, maximum SUV, and mean SUV decreased significantly between the pre- and during-treatment time points, while mean BV and permeability increased significantly. Global correlations between mean BF/BV/permeability and mean SUV values (-.15 < r < .29) were at most moderate. An increase in mean tumor BV during treatment was significantly correlated with complete metabolic response on 3-month posttreatment PET/CT. Weak correlations of SUV and perfusion parameters suggest a complementary role of FDG-PET and DCE-CT for tumor characterization. The association between relative change in mean BV and outcome suggests a potential role for DCE-CT in early evaluation of cervical tumor response to chemoradiotherapy.
Collapse
Affiliation(s)
- Thomas I Banks
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Rie von Eyben
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Dimitre Hristov
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| | - Elizabeth A Kidd
- Department of Radiation Oncology, School of Medicine, Stanford University, Stanford, CA, USA
| |
Collapse
|
6
|
Xu P, Li Y, Yang S, Li M, Li C. Positron Emission Tomographic Imaging Elucidates the Complex Relationship Between Glucose Uptake and Tissue Blood Flow Mechanism in Squamous Cell Oral Cancer Patients. Med Sci Monit 2017; 23:4533-4540. [PMID: 28934176 PMCID: PMC5621790 DOI: 10.12659/msm.903974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Through the clinical use of positron emission tomography, we aimed to elucidate the complex relationship between glucose uptake and squamous cell oral cancer (ScOC) growth, along with its mechanism with respect to tissue blood flow (tBF). MATERIAL AND METHODS We retrospectively reviewed a total of 69 newly diagnosed ScOC patients by Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET). Maximum and mean standard uptake values (SUV↑ and SUV) were recorded to assess glucose uptake. Multi-shot spin-echo echo-planar imaging-based pseudo-continuous arterial spin labeling (pcASL) technique at 3.0 T MRI was used to obtain tBF values in ScOC (tBF-ScOC). Patients were divided according to T-stage and location. Pearson's correlation coefficients were calculated between both SUV and tBF-ScOC for significant correlations. RESULTS Forty-one (59.4%) patients had oropharynx and the other 28 (40.6%) patients had laryngopharynx. Significant positive correlations were detected between SUV↑, SUV, tBF-ScOC and non-advanced T-stage (T1a, T1b, T2 and T3), while a negative correlation was observed in the advanced T-stage (T4a and T4b). CONCLUSIONS Using PET imaging, we established the relationship between glucose uptake and ScOC growth on the basis of the division of T-stage and tumor location of ScOC, thereby elucidating the underlying mechanism. Our findings provide insights important to the diagnosis, treatment, and care of ScOC patients.
Collapse
Affiliation(s)
- Ping Xu
- Department of Stomatology, Chengdu Military General Hospital, Chengdu, Sichuan, China (mainland)
| | - Yan Li
- Department of Stomatology, Chengdu Military General Hospital, Chengdu, Sichuan, China (mainland)
| | - Shuyong Yang
- Department of Stomatology, Chengdu Military General Hospital, Chengdu, Sichuan, China (mainland)
| | - Mingzhe Li
- Department of Stomatology, Chengdu Military General Hospital, Chengdu, Sichuan, China (mainland)
| | - Chenjun Li
- Department of Stomatology, Chengdu Military General Hospital, Chengdu, Sichuan, China (mainland)
| |
Collapse
|
7
|
Jena A, Taneja S, Singh A, Negi P, Mehta SB, Ahuja A, Singhal M, Sarin R. Association of pharmacokinetic and metabolic parameters derived using simultaneous PET/MRI: Initial findings and impact on response evaluation in breast cancer. Eur J Radiol 2017. [PMID: 28624017 DOI: 10.1016/j.ejrad.2017.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE To study relationships among pharmacokinetic and 18F-fluorodeoxyglucose (18F-FDG) PET parameters obtained through simultaneous PET/MRI in breast cancer patients and evaluate their combined potential for response evaluation. METHODS The study included 41 breast cancer patients for correlation study and 9 patients (pre and post therapy) for response evaluation. All patients underwent simultaneous PET/MRI with dedicated breast imaging. Pharmacokinetic parameters and PET parameters for tumor were derived using an in- house developed and vendor provided softwares respectively. Relationships between SUV and pharmacokinetic parameters and clinical as well as histopathologic parameters were evaluated using Spearman correlation analysis. Response to chemotherapy was derived as percentage reduction in size and in parameters post therapy. RESULTS Significant correlations were observed between SUVmean, max, peak, TLG with Ktrans (ρ=0.446, 0.417, 0.491, 0.430; p≤0.01); with Kep(ρ=0.303, ρ=0.315, ρ=0.319; p≤0.05); and with iAUC(ρ=0.401, ρ=0.410, ρ=0.379; p≤0.05, p≤0.01). The ratio of ve/iAUC showed significant negative correlation to SUVmean, max, peak and TLG (ρ=0.420, 0.446, 0.443, 0.426; p≤0.01). Ability of SUV as well as pharmacokinetic parameters to predict response to therapy matched the RECIST criteria in 9 out of 11 lesions in 9 patients. Maximum post therapy quantitative reduction was observed in SUVpeak, TLG and Ktrans. CONCLUSION Simultaneous PET/MRI enables illustration of close interactions between glucose metabolism and pharmacokinetic parameters in breast cancer patients and potential of their simultaneity in response assessment to therapy.
Collapse
Affiliation(s)
- Amarnath Jena
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India.
| | - Sangeeta Taneja
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Aru Singh
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Pradeep Negi
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Shashi Bhushan Mehta
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Aashim Ahuja
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Manish Singhal
- Department of Medical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Ramesh Sarin
- Department of Surgical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India
| |
Collapse
|
8
|
Fujima N, Sakashita T, Homma A, Hirata K, Shiga T, Kudo K, Shirato H. Glucose Metabolism and Its Complicated Relationship with Tumor Growth and Perfusion in Head and Neck Squamous Cell Carcinoma. PLoS One 2016; 11:e0166236. [PMID: 27824931 PMCID: PMC5100940 DOI: 10.1371/journal.pone.0166236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 10/25/2016] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To determine the relationship between tumor glucose metabolism and tumor blood flow (TBF) in head and neck squamous cell carcinoma (HNSCC). METHODS We retrospectively analyzed 57 HNSCC patients. Tumor glucose metabolism was assessed by maximum and mean standardized uptake values (SUVmax and SUVmean) obtained by 18F-fluorodeoxyglucose positron-emission tomography. TBF values were obtained by arterial spin labeling with 3-tesla MRI. The correlations between both SUVs and TBF were assessed in the total series and among patients divided by T-stage (T1-T3 and T4 groups) and tumor location (pharynx/oral cavity and sinonasal cavity groups). Pearson's correlation coefficients were calculated for significant correlations. RESULTS Significant correlations were detected: a negative correlation in the advanced T-stage group (TBF and SUV max: r, -0.61, SUVmean: r, -0.62), a positive correlation in the non-advanced T-stage pharynx/oral cavity group (TBF and SUVmax: r, 0.70, SUVmean: r, 0.73), a negative correlation in the advanced T-stage pharynx/oral cavity group (TBF and SUVmax: r, -0.62, SUVmean: r, -0.65), and a negative correlation in the advanced T-stage sinonasal cavity group (TBF and SUVmax: r, -0.61, SUVmean: r, -0.65). CONCLUSION Significant correlations between glucose uptake and TBF in HNSCC were revealed by the division of T-stage and tumor location.
Collapse
Affiliation(s)
- Noriyuki Fujima
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Tomohiro Sakashita
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Akihiro Homma
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kenji Hirata
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tohru Shiga
- Department of Nuclear Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kohsuke Kudo
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroki Shirato
- Department of Radiation Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
- The Global Station for Quantum Medical Science and Engineering, Global Institution for collaborative research and education, Sapporo, Japan
| |
Collapse
|
9
|
Increased 18F-FDG Uptake on PET/CT is Associated With Poor Arterial and Portal Perfusion on Multiphase CT. Clin Nucl Med 2016; 41:296-301. [PMID: 26756099 DOI: 10.1097/rlu.0000000000001105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To correlate 18F-FDG uptake on PET/CT with patterns of arterial and portal perfusion on multi-detector CT (MDCT) in patients with hepatocellular carcinoma (HCC) and to assess the value of variables from PET/CT and MDCT in predicting histological grades and overall survival. METHODS We retrospectively analyzed MDCT and PET/CT of 66 patients with HCC who underwent surgical treatment. Tumor peak standard uptake value (SUV) was divided by the mean liver SUV (T/LSUV). The mean tumor Hounsfield unit (HU) to mean liver HU was calculated for arterial (T/LHU-A) and portal phases (T/LHU-P). All patients were divided into three groups: I, T/LHU-A ≤l and T/LHU-P <1; II, T/LHU-A >1 and T/LHU-P <1; and III, T/LHU-A >1 and T/LHU-P ≥1. The relationships between the CT perfusion groups and T/LSUV were assessed. Multivariate logistic regression analyses were performed using clinical and imaging parameters for predicting histological grade. Overall survival curves stratified by T/LSUV and CT perfusion groups were estimated using the Kaplan-Meier method. RESULTS Statistically significant differences in T/LSUV were noted between groups I and II (2.29 [range 1.74-3.60] vs. 1.20 [range 1.07-1.58], P < 0.001) and groups I and III (2.29 [range 1.74-3.60] vs. 1.30 [range 1.07-1.43], P < 0.001). In multivariate analysis, a T/LSUV cutoff of >1.46 was the only independent predictor of tumor grade, with an odds ratio of 8.462 (95% confidence interval 1.799-39.803). Kaplan-Meier curves showed significant differences in OS according to T/LSUV >1.62, group I perfusion pattern, and T/LSUV >1.62 plus group I perfusion pattern (P = 0.04, P = 0.021, and P = 0.002, respectively). CONCLUSION 18F-FDG PET/CT is not commonly used for detecting HCC due to its limited sensitivity. We found that increased 18F-FDG uptake is associated with decreased arterial and portal perfusion on MDCT. This can be used to preselect patients who would benefit the most from PET/CT. Meanwhile, 18F-FDG uptake remained as the only independent predictor of histological grade, and higher 18F-FDG uptake and lower perfusion pattern on MDCT were significantly related to shorter OS.
Collapse
|
10
|
Tumor stage, tumor site and HPV dependent correlation of perfusion CT parameters and [18F]-FDG uptake in head and neck squamous cell carcinoma. Radiother Oncol 2015; 117:125-31. [DOI: 10.1016/j.radonc.2015.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/24/2015] [Accepted: 09/17/2015] [Indexed: 12/31/2022]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Oosterbroek J, Bennink E, Philippens MEP, Raaijmakers CPJ, Viergever MA, de Jong HWAM. Comparison of DCE-CT models for quantitative evaluation ofKtransin larynx tumors. Phys Med Biol 2015; 60:3759-73. [DOI: 10.1088/0031-9155/60/9/3759] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
13
|
Rana L, Sharma S, Sood S, Singh B, Gupta MK, Minhas RS, Jhobta A, Bhatia V, Venkat B. Volumetric CT perfusion assessment of treatment response in head and neck squamous cell carcinoma: Comparison of CT perfusion parameters before and after chemoradiation therapy. Eur J Radiol Open 2015; 2:46-54. [PMID: 26937435 PMCID: PMC4750578 DOI: 10.1016/j.ejro.2015.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 02/18/2015] [Accepted: 02/23/2015] [Indexed: 11/30/2022] Open
Abstract
Background and purpose World Health Organization estimated that there were 600,000 new cases of head and neck cancers and 300,000 deaths each year worldwide. Scientific modalities to predict the treatment outcomes are not available yet. We conducted this study to (1) compare CT perfusion parameters before and after chemoradiation among patients with head and neck squamous cell carcinoma and (2) to evaluate the prognostic value of each perfusion parameter in predicting the response to chemoradiation. Materials and methods We conducted a prospective study among all patients with head and neck squamous cell carcinoma registered for chemoradiotherapy (CRT) at Regional Cancer Research Center, Shimla, Himachal Pradesh, India during the period June 2012 through June 2013. CTp data were acquired on a 64-slice CT scanner (Light speed VCT Xte; GE Healthcare) with 14 cm z-axis coverage using Volume Helical Shuttle (VHS) feature at baseline, on completion of 40 Gy and 66 Gy of chemoradiation. We dichotomised the treatment outcome as complete response and non-response (partial responders/stable disease/progressive disease) using RECIST 1.1 criteria. We compared all perfusion parameters at baseline, 40 Gy and 66 Gy of CRT between responders and non-responders. We dichotomised the perfusion parameters as high (>median value) and low (≤median value) to analyze association between perfusion parameters and treatment outcome. We calculated the sensitivity, specificity, predictive values, and likelihood ratios for each dichotomized perfusion parameter using Wilson Score method. Results We followed 24 patients (23 of them men) from start of the treatment till completion of it. All had Stage III or Stage IV of the disease. Blood flow (BF) and blood volume (BV) decreased and Mean Transit Time (MTT) increased significantly (p < 0.05) at 66 Gy among responders to CRT as compared to non-responders. Patients with high BF (>106 ml/100 g/min) at baseline were five times more likely (p = 0.004) to respond to treatment as compared to those with low BF. BF was found to be 83.3% predictive of complete response. Other perfusion parameters were not significantly predictive of outcome (p > 0.05) Combination of high BF (>106 ml/100 g/min) and low (≤47 ml/100 g/min) permeability surface (PS) was 100% predictive of response to CRT irrespective of the stage of tumor. Conclusions High BF at baseline is the single best predictor of response to chemoradiaton. A combination of high BF and low PS was found to be 100% predictive of complete response irrespective of the stage of the tumor.
Collapse
Key Words
- BF, blood flow
- BV, blood volume
- CECT, contrast enhanced computed tomography
- CR, complete responder
- CRT, chemotherapy and radiation therapy
- CT perfusion
- CT, computed tomography
- CTP, perfusion computed tomography
- Chemoradiation
- HNSCC, head and neck squamous cell carcinoma
- Head and neck squamous cell carcinoma
- MVD, microvascular density
- PD, progressive disease
- PR, partial responder
- PS, permeability surface area product
- Perfusion parameters
- RECIST 1.1
- RECIST, response evaluation criteria in solid tumors
- ROI, region of interest
- SCC, squamous cell carcinoma
- SCCA, squamous cell carcinoma of aerodigestive tract
Collapse
Affiliation(s)
- Lokesh Rana
- Department of Radio Diagnosis, IGMC Shimla, Himachal Pradesh 171001, India
| | - Sanjiv Sharma
- Department of Radio Diagnosis, IGMC Shimla, Himachal Pradesh 171001, India
| | - Shikha Sood
- Department of Radio Diagnosis, IGMC Shimla, Himachal Pradesh 171001, India
| | - Balraj Singh
- Department of Community Medicine, IGMC Shimla, Himachal Pradesh 171001, India
| | - Manoj K Gupta
- Department of Radiotherapy, Regional Cancer Research Centre, IGMC Shimla, Himachal Pradesh 171001, India
| | - R S Minhas
- Department of E.N.T., IGMC Shimla, Himachal Pradesh 171001, India
| | - Anupam Jhobta
- Department of Radio Diagnosis, IGMC Shimla, Himachal Pradesh 171001, India
| | - Vikas Bhatia
- Department of Radio Diagnosis, IGMC Shimla, Himachal Pradesh 171001, India
| | - Bargavee Venkat
- Department of Radio Diagnosis, IGMC Shimla, Himachal Pradesh 171001, India
| |
Collapse
|
14
|
Luczynska E, Blecharz P, Dyczek S, Stelmach A, Petralia G, Bellomi M, Jereczek-Fossa BA, Jakubowicz J. Perfusion CT is a valuable diagnostic method for prostate cancer: a prospective study of 94 patients. Ecancermedicalscience 2014; 8:476. [PMID: 25435904 PMCID: PMC4239130 DOI: 10.3332/ecancer.2014.476] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Indexed: 12/04/2022] Open
Abstract
Purpose The aim of this study is to assess the usefulness of perfusion computer tomography (pCT) in prostate cancer (PCa) diagnostics. Materials and Methods 94 patients with biopsy-proven PCa were enrolled in the study. Dynamic pCT of the prostate gland was performed for 50 seconds after an intravenous injection of contrast medium. Blood flow (BF), blood volume (BV), mean transit time (MTT) and permeability surface area product (PS) were computed in the suspected PCa area and in normal prostatic tissue. Results PCa was visible in pCT in 90 of the 94 examined patients as a focal peripheral CT enhancement. When PCa was located in the peripheral zone (PZ), it was visible on perfusion maps, mostly showing an early peak followed by wash-out. The average values of all perfusion parameters were higher for tumour than for normal prostate tissue (p < 0.000). BV and BF were dependent on tumour grade expressed by the Gleason score (GS). All PCa cases were divided into groups, according to histological grade, as low (GS ≤ 6), medium (GS = 7), and high (GS > 7). In high-grade PCa, the mean BF value was significantly higher (p = 0.001) than the mean value of BF low- and medium-grade PCa (p = 0.011). Similar results were obtained regarding the mean values of BV; the more aggressive the cancer grade, the higher the mean BV value (p = 0.04). Conclusion CT quantitative perfusion imaging allows PCa to be distinguished from normal prostate tissue. The highest values for BF and BV were observed in the most aggressive PCa grade.
Collapse
Affiliation(s)
- Elzbieta Luczynska
- Radiology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Pawel Blecharz
- Gynecologic Oncology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Sonia Dyczek
- Radiology Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | - Andrzej Stelmach
- Radiotherapy Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| | | | - Massimo Bellomi
- Radiology Department, European Institute of Oncology, Milan, Italy ; Radiology Department, European Institute of Oncology, Milan, Italy
| | | | - Jerzy Jakubowicz
- Surgery Department, Centre of Oncology, M Sklodowska-Curie Memorial Institute, Cracow Branch, Cracow, Poland
| |
Collapse
|
15
|
The diagnostic value of cervical lymph node metastasis in head and neck squamous carcinoma by using diffusion-weighted magnetic resonance imaging and computed tomography perfusion. BIOMED RESEARCH INTERNATIONAL 2014; 2014:260859. [PMID: 25050333 PMCID: PMC4094719 DOI: 10.1155/2014/260859] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 05/30/2014] [Accepted: 06/01/2014] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to compare diffusion-weighted magnetic resonance imaging (DWI) with computed tomography perfusion (CTP) for preoperative detection of metastases to lymph nodes (LNs) in head and neck squamous cell carcinoma (SCC). METHODS Between May 2010 and April 2012, 30 patients with head and neck SCC underwent preoperative DWI and CTP. Two radiologists measured apparent diffusion coefficient (ADC) values and CTP parameters independently. Surgery and histopathologic examinations were performed on all patients. RESULTS On DWI, 65 LNs were detected in 30 patients. The mean ADC value of metastatic nodes was lower than benign nodes and the difference was statistically significant (P < 0.05). On CTP images, the mean value in metastatic nodes of blood flow (BF) and blood volume (BV) was higher than that in benign nodes, and mean transit time (MTT) in metastatic nodes was lower than that in benign nodes. There were significant differences in BF and MTT values between metastatic and benign LNs (P < 0.05). There were significant differences between the AUCs of DWI and CTP (Z=4.612, P < 0.001). CONCLUSION DWI with ADC value measurements may be more accurate than CTP for the preoperative diagnosis of cervical LN metastases.
Collapse
|
16
|
Tixier F, Groves AM, Goh V, Hatt M, Ingrand P, Le Rest CC, Visvikis D. Correlation of intra-tumor 18F-FDG uptake heterogeneity indices with perfusion CT derived parameters in colorectal cancer. PLoS One 2014; 9:e99567. [PMID: 24926986 PMCID: PMC4057188 DOI: 10.1371/journal.pone.0099567] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/15/2014] [Indexed: 01/12/2023] Open
Abstract
METHODS Thirty patients with proven colorectal cancer prospectively underwent integrated 18F-FDG PET/DCE-CT to assess the metabolic-flow phenotype. Both CT blood flow parametric maps and PET images were analyzed. Correlations between PET heterogeneity and perfusion CT were assessed by Spearman's rank correlation analysis. RESULTS Blood flow visualization provided by DCE-CT images was significantly correlated with 18F-FDG PET metabolically active tumor volume as well as with uptake heterogeneity for patients with stage III/IV tumors (|ρ|:0.66 to 0.78; p-value<0.02). CONCLUSION The positive correlation found with tumor blood flow indicates that intra-tumor heterogeneity of 18F-FDG PET accumulation reflects to some extent tracer distribution and consequently indicates that 18F-FDG PET intra-tumor heterogeneity may be associated with physiological processes such as tumor vascularization.
Collapse
Affiliation(s)
- Florent Tixier
- INSERM, UMR1101, LaTIM, CHRU Morvan, Brest, France
- * E-mail: :
| | - Ashley M. Groves
- Institute of Nuclear Medicine, UCL, Euston Road, London, United Kingdom
| | - Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, Kings College London, St Thomas Hospital, London, United Kingdom
| | - Mathieu Hatt
- INSERM, UMR1101, LaTIM, CHRU Morvan, Brest, France
| | - Pierre Ingrand
- Epidemiology & Biostatistics, CIC Inserm 1402, CHU Milétrie, Poitiers, France
| | | | | |
Collapse
|
17
|
Fischer MA, Vrugt B, Alkadhi H, Hahnloser D, Hany TF, Veit-Haibach P. Integrated ¹⁸F-FDG PET/perfusion CT for the monitoring of neoadjuvant chemoradiotherapy in rectal carcinoma: correlation with histopathology. Eur J Nucl Med Mol Imaging 2014; 41:1563-73. [PMID: 24760269 DOI: 10.1007/s00259-014-2752-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 03/04/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to prospectively monitor changes in the flow-metabolic phenotype (ΔFMP) of rectal carcinoma (RC) after neoadjuvant chemoradiotherapy (CRT) and to evaluate whether ΔFMP of RC correlate with histopathological prognostic factors including response to CRT. METHODS Sixteen patients with RC (12 men, mean age 60.7 ± 12.8 years) underwent integrated (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/perfusion CT (PET/PCT), followed by neoadjuvant CRT and surgery. In 13 patients, PET/PCT was repeated after CRT. Perfusion [blood flow (BF), blood volume (BV), mean transit time (MTT)] and metabolic [maximum and mean standardized uptake values (SUVmax, SUVmean)] parameters as well as the FMP (BF × SUVmax) were determined before and after CRT by two independent readers and correlated to histopathological prognostic factors of RC (microvessel density, necrosis index, regression index, vascular invasion) derived from resected specimens. The diagnostic performance of ΔFMP for prediction of treatment response was determined. RESULTS FMP significantly decreased after CRT (p < 0.001), exploiting higher changes after CRT as compared to changes of perfusion and metabolic parameters alone. Before CRT, no significant correlations were found between integrated PET/PCT and any of the histopathological parameters (all p > 0.05). After CRT, BV and SUVmax correlated positively with the necrosis index (r = 0.67/0.70), SUVmax with the invasion of blood vessels (r = 0.62) and ΔFMP with the regression index (r = 0.88; all p < 0.05). ΔFMP showed high accuracy for prediction of histopathological response to CRT (AUC 0.955, 95 % confidence interval 0.833-1.000, p < 0.01) using a cut-off value of -75%. CONCLUSION In RC, ΔFMP derived from integrated (18)F-FDG PET/PCT is useful for monitoring the effects of neoadjuvant CRT and allows prediction of histopathological response to CRT.
Collapse
Affiliation(s)
- Michael A Fischer
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland,
| | | | | | | | | | | |
Collapse
|
18
|
Driscoll B, Keller H, Jaffray D, Coolens C. Development of a dynamic quality assurance testing protocol for multisite clinical trial DCE-CT accreditation. Med Phys 2014; 40:081906. [PMID: 23927320 DOI: 10.1118/1.4812429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Credentialing can have an impact on whether or not a clinical trial produces useful quality data that is comparable between various institutions and scanners. With the recent increase of dynamic contrast enhanced-computed tomography (DCE-CT) usage as a companion biomarker in clinical trials, effective quality assurance, and control methods are required to ensure there is minimal deviation in the results between different scanners and protocols at various institutions. This paper attempts to address this problem by utilizing a dynamic flow imaging phantom to develop and evaluate a DCE-CT quality assurance (QA) protocol. METHODS A previously designed flow phantom, capable of producing predictable and reproducible time concentration curves from contrast injection was fully validated and then utilized to design a DCE-CT QA protocol. The QA protocol involved a set of quantitative metrics including injected and total mass error, as well as goodness of fit comparison to the known truth concentration curves. An additional region of interest (ROI) sensitivity analysis was also developed to provide additional details on intrascanner variability and determine appropriate ROI sizes for quantitative analysis. Both the QA protocol and ROI sensitivity analysis were utilized to test variations in DCE-CT results using different imaging parameters (tube voltage and current) as well as alternate reconstruction methods and imaging techniques. The developed QA protocol and ROI sensitivity analysis was then applied at three institutions that were part of clinical trial involving DCE-CT and results were compared. RESULTS The inherent specificity of robustness of the phantom was determined through calculation of the total intraday variability and determined to be less than 2.2±1.1% (total calculated output contrast mass error) with a goodness of fit (R2) of greater than 0.99±0.0035 (n=10). The DCE-CT QA protocol was capable of detecting significant deviations from the expected phantom result when scanning at low mAs and low kVp in terms of quantitative metrics (Injected Mass Error 15.4%), goodness of fit (R2) of 0.91, and ROI sensitivity (increase in minimum input function ROI radius by 146±86%). These tests also confirmed that the ASIR reconstruction process was beneficial in reducing noise without substantially increasing partial volume effects and that vendor specific modes (e.g., axial shuttle) did not significantly affect the phantom results. The phantom and QA protocol were finally able to quickly (<90 min) and successfully validate the DCE-CT imaging protocol utilized at the three separate institutions of a multicenter clinical trial; thereby enhancing the confidence in the patient data collected. CONCLUSIONS A DCE QA protocol was developed that, in combination with a dynamic multimodality flow phantom, allows the intrascanner variability to be separated from other sources of variability such as the impact of injection protocol and ROI selection. This provides a valuable resource that can be utilized at various clinical trial institutions to test conformance with imaging protocols and accuracy requirements as well as ensure that the scanners are performing as expected for dynamic scans.
Collapse
Affiliation(s)
- B Driscoll
- Department of Radiation Physics, Princess Margaret Cancer Center, 610 University Avenue, Toronto, Ontario M5G 2M9, Canada.
| | | | | | | |
Collapse
|
19
|
Tong AN, Han SR, Yan P, Gong H, Zhao H, Yao H, Wang YM. Prognostic value of FDG uptake in primary inoperable non-small cell lung cancer. Med Oncol 2013; 31:780. [DOI: 10.1007/s12032-013-0780-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Accepted: 11/20/2013] [Indexed: 12/22/2022]
|
20
|
Bhatnagar P, Subesinghe M, Patel C, Prestwich R, Scarsbrook AF. Functional Imaging for Radiation Treatment Planning, Response Assessment, and Adaptive Therapy in Head and Neck Cancer. Radiographics 2013; 33:1909-29. [DOI: 10.1148/rg.337125163] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
21
|
Integrated (18)F-FDG PET/CT and perfusion CT of primary colorectal cancer: effect of inter- and intraobserver agreement on metabolic-vascular parameters. AJR Am J Roentgenol 2013; 199:1003-9. [PMID: 23096172 DOI: 10.2214/ajr.11.7823] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The purpose of this article is to assess the effect of observers on combined metabolic-vascular parameters in colorectal cancer. SUBJECTS AND METHODS Twenty-five prospective patients (12 men and 13 women; mean age, 66.9 years) with proven primary colorectal adenocarcinoma underwent integrated (18)F-FDG PET/perfusion CT to assess tumor metabolism (mean and maximum standardized uptake value [SUV(mean) and SUV(max), respectively]) and vascularization (blood flow [BF], blood volume [BV], permeability surface-area product, and standardized perfusion value). Intra- and interobserver agreement for PET, perfusion CT, and combined metabolic-flow parameters were determined by Bland-Altman statistics and intraclass correlation coefficients (ICCs). RESULTS The mean tumor size was 3.8 ± 1.6 cm; there were five stage IA/B, six stage IIA/B, eight stage IIIA/B, and six stage IV tumors. Intra- and interobserver agreement for individual parameters was fair to good, with mean differences between observers of -0.74 for SUV(max), -0.16 for SUV(mean), 9.72 for BF, 0.15 for BV, -0.76 for permeability surface-area product, and 0.09 for standardized perfusion value. ICCs were 0.44-0.99 and 0.38-0.89 for intra- and interobserver agreement, respectively. Interobserver agreement was variable for combined metabolic-flow parameters but better for metabolic-flow difference than for metabolic-flow ratio: ICCs were 0.69-0.88 for the metabolic-flow difference and 0.44-0.94 for the metabolic-flow ratio. CONCLUSION Combined parameters to assess the metabolic-flow relationship are influenced by observer variation. Intra- and interobserver agreement are better for the metabolic-flow differences than for the ratios, suggesting that metabolic-flow differences may be a more robust parameter for clinical practice.
Collapse
|
22
|
Ippolito D, Capraro C, Guerra L, De Ponti E, Messa C, Sironi S. Feasibility of perfusion CT technique integrated into conventional 18FDG/PET-CT studies in lung cancer patients: clinical staging and functional information in a single study. Eur J Nucl Med Mol Imaging 2013; 40:156-65. [PMID: 23143661 DOI: 10.1007/s00259-012-2273-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Accepted: 10/04/2012] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the additional functional vascular information and the relationship between perfusion measurements and glucose metabolism (SUVmax) obtained by including a perfusion CT study in a whole-body contrast-enhanced PET/CT protocol in primary lung cancer lesions. METHODS Enrolled in this prospective study were 34 consecutive patients with a biopsy-proven diagnosis of lung cancer who were referred for contrast-enhanced PET/CT staging. This prospective study was approved by our institutional review board, and informed consent was obtained from all patients. Perfusion CT was performed with the following parameters: 80 kV, 200 mAs, 30 scans during intravenous injection of 50 ml contrast agent, flow rate 5 ml/s. Another bolus of contrast medium (3.5 ml/s, 80 ml, 60-s delay) was administered to ensure a full diagnostic contrast-enhanced CT scan for clinical staging. The perfusion CT data were used to calculate a range of tumour vascularity parameters (blood flow, blood volume and mean transit time), and tumour FDG uptake (SUVmax) was used as a metabolic indicator. Quantitative and functional parameters were compared and in relation to location, histology and tumour size. The nonparametric Kruskal-Wallis rank sum test was used for statistical analysis. RESULTS A cut-off value of 3 cm was used according to the TNM classification to discriminate between T1 and T2 tumours (i.e. T1b vs. T2a). There were significant perfusion differences (lower blood volumes and higher mean transit time) between tumours with diameter >30 mm and tumours with diameter <30 mm (p < 0.05; blood volume 5.6 vs. 7.1 ml/100 g, mean transit time 8.6 vs. 3.9 s, respectively). Also there was a trend for blood flow to be lower in larger lesions (p < 0.053; blood flow 153.1 vs. 98.3 ml/100 g tissue/min). Significant inverse correlations (linear regression) were found between blood volume and SUVmax in tumours with diameter >30 mm in diameter. CONCLUSION Perfusion CT combined with PET/CT is feasible technique that may provide additional functional information about vascularity and tumour aggressiveness as a result of lower perfusion and higher metabolism shown by larger lesions.
Collapse
Affiliation(s)
- Davide Ippolito
- School of Medicine, University of Milano-Bicocca, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
23
|
Veit-Haibach P, Kuhn FP, Wiesinger F, Delso G, von Schulthess G. PET-MR imaging using a tri-modality PET/CT-MR system with a dedicated shuttle in clinical routine. MAGMA (NEW YORK, N.Y.) 2012. [PMID: 23053712 DOI: 10.1007/s10334‐012‐0344‐5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Tri-modality PET/CT-MRI includes the transfer of the patient on a dedicated shuttle from one system into the other. Advantages of this system include a true CT-based attenuation correction, reliable PET-quantification and higher flexibility in patient throughput on both systems. Comparative studies of PET/MRI versus PET/CT are readily accomplished without repeated PET with a different PET scanner at a different time point. Additionally, there is a higher imaging flexibility based on the availability of three imaging modalities, which can be combined for the characterization of the disease. The downside is a somewhat higher radiation dose of up to 3 mSv with a low dose CT based on the CT-component, longer acquisition times and potential misalignment between the imaging components. Overall, the tri-modality PET/CT-MR system offers comparative studies using the three different imaging modalities in the same patient virtually at the same time, and may help to develop reliable attenuation algorithms at the same time.
Collapse
Affiliation(s)
- Patrick Veit-Haibach
- Department of Medical Imaging, University Hospital, Rämistrasse 100, 8091 Zurich, Switzerland.
| | | | | | | | | |
Collapse
|
24
|
Veit-Haibach P, Kuhn FP, Wiesinger F, Delso G, von Schulthess G. PET–MR imaging using a tri-modality PET/CT–MR system with a dedicated shuttle in clinical routine. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2012; 26:25-35. [DOI: 10.1007/s10334-012-0344-5] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 09/05/2012] [Accepted: 09/05/2012] [Indexed: 12/14/2022]
|
25
|
Abstract
The standardized uptake value (SUV) and other measurements of tumour uptake of fluorodeoxyglucose (FDG) on positron emission tomography (PET) can potentially be supplemented by additional imaging parameters derived either from the PET images or from the computed tomography (CT) component of integrated PET/CT examinations including tumour size, CT attenuation, texture (reflecting tumour heterogeneity) and blood flow. This article illustrates the emerging benefits of such a multiparametric approach. Example benefits include greater diagnostic accuracy in characterization of adrenal masses achieved by using both the SUV and measured CT attenuation. Tumour size combined with the SUV can potentially improve the prognostic information available from PET/CT in oesophageal and lung cancer. However, greater improvements may be realized through using CT measurements of texture instead of size. Studies in breast and lung cancer suggest that combined PET/CT measurements of glucose metabolism and blood flow provide correlates for tumour proliferation and angiogenesis, respectively. These combined measurements can be utilized to determine vascular-metabolic phenotypes, which vary with tumour type. Uncoupling of blood flow and metabolism suggests a poor prognosis for larger more advanced tumours, high-grade lesions and tumours responding poorly to treatment. Vascular-metabolic imaging also has the potential to subclassify tumour response to treatment. The additional biomarkers described can be readily incorporated in existing FDG-PET examinations thereby improving the ability of PET/CT to depict tumour biology, characterize potentially malignant lesions, and assess prognosis and therapeutic response.
Collapse
|
26
|
Shastry M, Miles KA, Win T, Janes SM, Endozo R, Meagher M, Ell PJ, Groves AM. Integrated 18F-fluorodeoxyglucose-positron emission tomography/dynamic contrast-enhanced computed tomography to phenotype non-small cell lung carcinoma. Mol Imaging 2012; 11:353-360. [PMID: 22954179 PMCID: PMC4210517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
We applied modern molecular and functional imaging to the pretreatment assessment of lung cancer using combined dynamic contrast-enhanced computed tomography (DCE-CT) and (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) to phenotype tumors. Seventy-four lung cancer patients were prospectively recruited for (18)F-FDG-PET/DCE-CT using PET/64-detector CT. After technical failures, there were 64 patients (35 males, 29 females; mean age [± SD] 67.5 ± 7.9 years). DCE-CT yielded tumor peak enhancement (PE) and standardized perfusion value (SPV). The uptake of (18)F-FDG quantified on PET as the standardized uptake value (SUV(max)) assessed tumor metabolism. The median values for SUV(max) and SPV were used to define four vascular-metabolic phenotypes. There were associations (Spearman rank correlation [rs]) between tumor size and vascular-metabolic parameters: SUV(max) versus size (rs = .40, p = .001) and SUV/PE versus size (r = .43, p < .001). Patients with earlier-stage (I-IIA, n = 30) disease had mean (± SD) SUV/PE 0.36 ± 0.28 versus 0.56 ± 0.32 in later-stage (stage IIB-IV, n = 34) disease (p = .007). The low metabolism with high vascularity phenotype was significantly more common among adenocarcinomas (p = .018), whereas the high metabolism with high vascularity phenotype was more common among squamous cell carcinomas (p = .024). Other non-small cell lung carcinoma tumor types demonstrated a high prevalence of the high metabolism with low vascularity phenotype (p = .028). We show that tumor subtypes have different vascular-metabolic associations, which can be helpful clinically in managing lung cancer patients to hone targeted therapy.
Collapse
Affiliation(s)
- Manu Shastry
- Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Shastry M, Miles KA, Win T, Janes SM, Endozo R, Meagher M, Ell PJ, Groves AM. Integrated
18
F-Fluorodeoxyglucose–Positron Emission Tomography/Dynamic Contrast-Enhanced Computed Tomography to Phenotype Non–Small Cell Lung Carcinoma. Mol Imaging 2012. [DOI: 10.2310/7290.2011.00052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Manu Shastry
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Kenneth A. Miles
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Thida Win
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Sam M. Janes
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Raymond Endozo
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Marie Meagher
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Peter J. Ell
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| | - Ashley M. Groves
- From the Institute of Nuclear Medicine and Centre for Respiratory Research, University College London, London, UK; Brighton and Sussex University Hospitals, Brighton, UK; and Chest Medicine, Lister Hospital, Stevenage, Herts, UK
| |
Collapse
|
28
|
Veit-Haibach P, Schmid D, Strobel K, Soyka JD, Schaefer NG, Haerle SK, Huber G, Studer G, Seifert B, Hany TF. Combined PET/CT-perfusion in patients with head and neck cancers. Eur Radiol 2012; 23:163-73. [DOI: 10.1007/s00330-012-2564-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 12/23/2022]
|
29
|
Brain perfusion CT compared with ¹⁵O-H₂O PET in patients with primary brain tumours. Eur J Nucl Med Mol Imaging 2012; 39:1691-701. [PMID: 22736199 PMCID: PMC3464373 DOI: 10.1007/s00259-012-2173-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 06/04/2012] [Indexed: 02/05/2023]
Abstract
Purpose Perfusion CT (PCT) measurements of regional cerebral blood flow (rCBF) have been proposed as a fast and easy method for identifying angiogenically active tumours. In this study, quantitative PCT rCBF measurements in patients with brain tumours were compared to the gold standard PET rCBF with 15O-labelled water (15O-H2O). Methods On the same day within a few hours, rCBF was measured in ten adult patients with treatment-naïve primary brain tumours, twice using 15O-H2O PET and once with PCT performed over the central part of the tumour. Matching rCBF values in tumour and contralateral healthy regions of interest were compared. Results PCT overestimated intratumoural blood flow in all patients with volume-weighted mean rCBF values of 28.2 ± 18.8 ml min−1 100 ml−1 for PET and 78.9 ± 41.8 ml min−1 100 ml−1 for PCT. There was a significant method by tumour grade interaction with a significant tumour grade rCBF difference for PCT of 32.9 ± 15.8 ml min−1 100 ml−1 for low-grade (WHO I + II) and 81.5 ± 15.4 ml min−1 100 ml−1 for high-grade (WHO III + IV) tumours, but not for PET. The rCBF PCT and PET correlation was only significant within tumours in two patients. Conclusion Although intratumoural blood flow measured by PCT may add valuable information on tumour grade, the method cannot substitute quantitative measurements of blood flow by PET and 15O-H2O PET in brain tumours.
Collapse
|
30
|
Goh V, Engledow A, Rodriguez-Justo M, Shastry M, Peck J, Blackman G, Endozo R, Taylor S, Halligan S, Ell P, Groves AM. The flow-metabolic phenotype of primary colorectal cancer: assessment by integrated 18F-FDG PET/perfusion CT with histopathologic correlation. J Nucl Med 2012; 53:687-92. [PMID: 22454485 DOI: 10.2967/jnumed.111.098525] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
UNLABELLED The aim of this study was to assess the in vivo flow-metabolic phenotype in primary colorectal cancer with integrated (18)F-FDG PET/perfusion CT and its relationship to gold standard histopathologic assessment of angiogenesis and hypoxia. METHODS 45 patients (26 male and 19 female; mean age, 67.6 y) with primary colorectal cancer underwent integrated (18)F-FDG PET/perfusion CT, deriving tumor glucose metabolism (maximum standardized uptake value) and regional blood flow. From this cohort, 35 underwent surgery subsequently, without intervening neoadjuvant treatment, allowing histopathologic correlation with tumor stage, CD105 microvessel density, vascular endothelial growth factor (VEGF), glucose transporter protein 1 (Glut-1), and hypoxia-inducible factor 1 expression. RESULTS The flow-metabolic ratio was significantly lower for tumors with higher VEGF (3.65 vs. 5.98; P = 0.01) or hypoxia-inducible factor 1 expression (3.63 vs. 5.48; P = 0.04) versus tumors with lower expression. There were significant negative correlations between the tumor flow-metabolic ratio and VEGF expression (r = -0.55, P = 0.0008), indicating that tumors with low blood flow but higher metabolism were associated with higher VEGF expression. Flow and metabolism were coupled in higher-stage (stage III/IV) tumors but not lower-stage tumors (stage I/II) (r = 0.47, P = 0.03, vs. r = 0.09, P = 0.65, respectively. CONCLUSION Tumors with a low-flow-high-metabolism phenotype demonstrated higher VEGF expression and may reflect a more angiogenic phenotype.
Collapse
Affiliation(s)
- Vicky Goh
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Squamous cell cancer of hypopharynx and larynx – Evaluation of metastatic nodal disease based on computed tomography perfusion studies. Eur J Radiol 2012; 81:1034-9. [DOI: 10.1016/j.ejrad.2011.01.084] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Accepted: 01/20/2011] [Indexed: 11/21/2022]
|
32
|
Current status and guidelines for the assessment of tumour vascular support with dynamic contrast-enhanced computed tomography. Eur Radiol 2012; 22:1430-41. [PMID: 22367468 DOI: 10.1007/s00330-012-2379-4] [Citation(s) in RCA: 136] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 11/23/2011] [Accepted: 11/24/2011] [Indexed: 12/13/2022]
Abstract
Dynamic contrast-enhanced computed tomography (DCE-CT) assesses the vascular support of tumours through analysis of temporal changes in attenuation in blood vessels and tissues during a rapid series of images acquired with intravenous administration of iodinated contrast material. Commercial software for DCE-CT analysis allows pixel-by-pixel calculation of a range of validated physiological parameters and depiction as parametric maps. Clinical studies support the use of DCE-CT parameters as surrogates for physiological and molecular processes underlying tumour angiogenesis. DCE-CT has been used to provide biomarkers of drug action in early phase trials for the treatment of a range of cancers. DCE-CT can be appended to current imaging assessments of tumour response with the benefits of wide availability and low cost. This paper sets out guidelines for the use of DCE-CT in assessing tumour vascular support that were developed using a Delphi process. Recommendations encompass CT system requirements and quality assurance, radiation dosimetry, patient preparation, administration of contrast material, CT acquisition parameters, terminology and units, data processing and reporting. DCE-CT has reached technical maturity for use in therapeutic trials in oncology. The development of these consensus guidelines may promote broader application of DCE-CT for the evaluation of tumour vascularity. Key Points • DCE-CT can robustly assess tumour vascular support • DCE-CT has reached technical maturity for use in therapeutic trials in oncology • This paper presents consensus guidelines for using DCE-CT in assessing tumour vascularity.
Collapse
|
33
|
Truong MT, Saito N, Ozonoff A, Wang J, Lee R, Qureshi MM, Jalisi S, Sakai O. Prediction of locoregional control in head and neck squamous cell carcinoma with serial CT perfusion during radiotherapy. AJNR Am J Neuroradiol 2011; 32:1195-201. [PMID: 21757530 DOI: 10.3174/ajnr.a2501] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tumor hypoxia is a known factor of radioresistance in HNSCC. CTP is a noninvasive method of measuring tumor perfusion in vivo. The purpose of our study was to determine serial changes in tumor perfusion in HNSCC during a course of RT by using CTP and to correlate tumor perfusion measurements to LRC. MATERIALS AND METHODS A prospective study was performed in 15 patients with HNSCC receiving definitive RT who underwent serial CTP before RT; at weeks 2, 4, and 6 of RT; and 6 weeks after RT. The median follow-up was 28 months (range, 6-44 months). Thirteen patients achieved LRC, and 2 patients had LRF. Tumor perfusion parameters, including BF, BV, MTT, and CP, were obtained by using a deconvolution-based analysis. RESULTS Pretreatment tumor BF was significantly higher in patients who achieved LRC, 118.0 mL/100 g/min, compared with those with LRF, 53.4 mL/100 g/min (P = .004). Similarly, pretreatment CP was higher in patients with LRC, 16.6 mL/100 g/min, compared with those with LRF, 7.7 mL/100 g/min (P = .02). At week 2 of RT, tumor BF parameters showed a 27.5% increase versus an 18.1% decrease from pretreatment BF values (P = .046) in patients with LRC and LRF, respectively. A decrease in BF and BV was observed in both groups 6 weeks after RT compared with these values at baseline scanning. CONCLUSIONS An increase in tumor BF and CP by using CTP early during a course of RT predicts LRC in patients with HNSCC treated with RT.
Collapse
Affiliation(s)
- M T Truong
- Departments of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Demonstrating Intertumoural Differences in Vascular-Metabolic Phenotype with Dynamic Contrast-Enhanced CT-PET. INTERNATIONAL JOURNAL OF MOLECULAR IMAGING 2011; 2011:679473. [PMID: 21629862 PMCID: PMC3094879 DOI: 10.1155/2011/679473] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 02/24/2011] [Indexed: 01/10/2023]
Abstract
Purpose. To assess whether the differences in vascular-metabolic relationships between lymphoma masses and colorectal liver metastases predicted from previous histopathological studies can be demonstrated by dynamic contrast-enhanced CT (DCE-CT) combined with fluorodeoxyglucose positron emission tomography (FDG-PET). Methods. DCE-CT and FDG-PET studies were drawn from an imaging archive for patients with either lymphoma masses (n = 11) or hepatic metastases from colorectal cancer (CRM: n = 12). Tumour vascularity was assessed using DCE-CT measurements of perfusion. Tumour glucose metabolism was expressed as the mean FDG Standardised Uptake Value (SUVFDG). The relationship between metabolism and vascularity in each group was assessed from SUVFDG /perfusion ratios and Pearson correlation coefficients. Results. An SUVFDG threshold of 3.0 was used to designate lymphoma masses as active (AL, n = 6) or inactive lymphoma (IL, n = 5). Tumour perfusion was significantly higher in AL (0.65 mL/min/mL) than CRM (0.37 mL/min/mL: P = .031) despite similar SUVFDG (5.05 and 5.33, resp.). AL demonstrated higher perfusion values than IL (0.24 mL/min/mL: P = .006). SUVFDG/perfusion was significantly higher in CRM (15.3 min) than IL (4.2 min, P < .01). There was no correlation between SUVFDG and perfusion for any patient group.
Collapse
|
35
|
Trojanowska A, Grzycka-Kowalczyk L, Trojanowski P, Klatka J, Drop A. Computed tomography perfusion examination is helpful in evaluating the extent of oropharyngeal and oral cavity cancer. Pol J Radiol 2011; 76:14-9. [PMID: 22802811 PMCID: PMC3389912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/06/2011] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Squamous cell cancer (SCC) of the head and neck, like other malignancies, should be reported with regard to TNM classification and treated accordingly. Sole anatomic imaging has its drawbacks, as early lesion detection often remains challenging, non-neoplastic processes can mimic malignancies and there are doubts concerning the extent of tumour. The purpose of this study was to perform assessment of head and neck squamous cell cancer and surrounding tissue, in order to examine the relationship between perfusion measurements derived from CT perfusion imaging (CTP) and histologic evaluation of resected tissue. MATERIAL/METHODS We prospectively evaluated 21 primary SCC of the oral cavity and oropharynx, using contrast enhanced CT of the head and neck followed by CTP examination at the level of tumour. Blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability (PS) values were calculated with use of manually drawn regions of interest (ROIs) over the lesions and on the contralateral side. Results were compared with histologic analysis of resected tissue. RESULTS CTP was possible in all twenty one patients, but one did not undergo surgery. Of the remaining twenty, four had retromolar trigone cancer, nine had tongue cancer and seven had tonsil cancer. We found significant differences between infiltrated and healthy tissue. Differentiation was most reliable by using blood flow (BF), permeability surface (PS) and blood volume (BV). CONCLUSIONS CTP shows promise in distinguishing benign and malignant processes, primarily by means of BF, BV and PS.
Collapse
Affiliation(s)
- Agnieszka Trojanowska
- 1st Department of General Radiology Medical University of Lublin, Lublin, Poland,Author’s address: Agnieszka Trojanowska, 1st Department of General Radiology Medical University of Lublin, Jaczewskiego 8 Str., 20-954 Lublin, Poland, e-mail:
| | | | - Piotr Trojanowski
- Chair and Department of Otolaryngology Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
| | - Janusz Klatka
- Chair and Department of Otolaryngology Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
| | - Andrzej Drop
- 1st Department of General Radiology Medical University of Lublin, Lublin, Poland
| |
Collapse
|
36
|
Trojanowski P, Klatka J, Trojanowska A, Jargiełło T, Drop A. Evaluation of cervical lymph nodes with CT perfusion in patients with hypopharyngeal and laryngeal squamous cell cancer. Pol J Radiol 2011; 76:7-13. [PMID: 22802810 PMCID: PMC3389909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 12/06/2010] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND In patients with head and neck squamous cell cancer, metastases in cervical lymph nodes still remain the single most important negative predicting factor. Their presence reduces overall 5-year survival by 50%. The aim of the study was to evaluate the role of computed tomography perfusion (CTP) for differentiation between metastatic and non-metastatic cervical lymph nodes in patients with squamous cell cancer of hypopharynx and larynx. MATERIAL/METHODS This was a prospective single center study of 18 consecutive patients. Eleven patients with squamous cell cancer of the hypopharynx and seven patients with laryngeal cancer underwent CT examination of the neck followed by CTP. Group II, III, and V of lymph nodes were evaluated. Perfusion maps of basic parameters (blood flow [BF], blood volume [BV], mean transit time [MTT] and permeability surface [PS]) were reconstructed for all patients. In all patients resection of primary tumour along with neck dissection was performed. Lymph nodes underwent histopathological examinations for presence of metastases. CTP parameters were related with histological analysis of resected nodes. RESULTS CTP and histological findings of 65 nodes were correlated. 24 of them were metastatic and 41 were non-metastatic. Metastatic nodes showed significant hyperperfusion, comparing to non-metastatic ones. An average value of BF in metastatic nodes was 136.4 ml/100 g/min, BV was 7.7 ml/100 g, MTT was 4.4 s and PS was 19.4 ml/100 g/min. The average values for non-metastatic nodes were: BF was 80.7 ml/100 g/min, BV was 4.7 ml/100 g, MTT was 5.6 s and PS was 12.8 ml/100 g/min. The differences were significantly higher for BF, BV and PS values (p<0.05). CONCLUSIONS CTP may be useful in differentiation between metastatic and non-metastatic lymph nodes, based on evaluation of the value of BF, BV and PS.
Collapse
Affiliation(s)
- Piotr Trojanowski
- Chair and Department of Otolaryngology Head and Neck Surgery, Medical University of Lublin, Lublin, Poland,Author’s address: Piotr Trojanowski, Chair and Department of Otolaryngology Head and Neck Surgery, Medical University of Lublin, Jaczewskiego 8 St., 20-954 Lublin, Poland, e-mail:
| | - Janusz Klatka
- Chair and Department of Otolaryngology Head and Neck Surgery, Medical University of Lublin, Lublin, Poland
| | | | - Tomasz Jargiełło
- Department of Interventional Radiology and Neuroradiology Medical University of Lublin, Lublin, Poland
| | - Andrzej Drop
- 1st Department of General Radiology, Medical University of Lublin, Lublin, Poland
| |
Collapse
|
37
|
Miles KA. Molecular imaging with dynamic contrast-enhanced computed tomography. Clin Radiol 2010; 65:549-56. [PMID: 20541654 DOI: 10.1016/j.crad.2010.04.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 04/15/2010] [Accepted: 04/22/2010] [Indexed: 01/10/2023]
Abstract
Dynamic contrast-enhanced computed tomography (DCE-CT) is a quantitative technique that employs rapid sequences of CT images after bolus administration of intravenous contrast material to measure a range of physiological processes related to the microvasculature of tissues. By combining knowledge of the molecular processes underlying changes in vascular physiology with an understanding of the relationship between vascular physiology and CT contrast enhancement, DCE-CT can be redefined as a molecular imaging technique. Some DCE-CT derived parameters reflect tissue hypoxia and can, therefore, provide information about the cellular microenvironment. DCE-CT can also depict physiological processes, such as vasodilatation, that represent the physiological consequences of molecular responses to tissue hypoxia. To date the main applications have been in stroke and oncology. Unlike some other molecular imaging approaches, DCE-CT benefits from wide availability and ease of application along with the use of contrast materials and software packages that have achieved full regulatory approval. Hence, DCE-CT represents a molecular imaging technique that is applicable in clinical practice today.
Collapse
Affiliation(s)
- K A Miles
- Clinical Imaging Sciences Centre, Brighton & Sussex Medical School, University of Sussex, Falmer, Brighton, UK.
| |
Collapse
|
38
|
64-row MDCT perfusion of head and neck squamous cell carcinoma: technical feasibility and quantitative analysis of perfusion parameters. Eur Radiol 2010; 21:113-21. [DOI: 10.1007/s00330-010-1898-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Revised: 06/06/2010] [Accepted: 07/02/2010] [Indexed: 10/19/2022]
|
39
|
Bisdas S, Seitz O, Middendorp M, Chambron-Pinho N, Bisdas T, Vogl TJ, Hammerstingl R, Ernemann U, Mack MG. An exploratory pilot study into the association between microcirculatory parameters derived by MRI-based pharmacokinetic analysis and glucose utilization estimated by PET-CT imaging in head and neck cancer. Eur Radiol 2010; 20:2358-66. [PMID: 20443116 DOI: 10.1007/s00330-010-1803-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Accepted: 03/17/2010] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To examine the feasibility of deriving quantitative microcirculatory parameters and to investigate the relationship between vascular and metabolic characteristics of head and neck tumours in vivo, using dynamic contrast-enhanced (DCE) MRI and fluorodeoxyglucose (FDG) PET imaging. METHODS Twenty-seven patients with primary squamous cell carcinoma (SCCA) underwent DCE-MRI and combined PET/CT imaging. DCE-MRI data were post-processed by using commercially available software. Transfer constant (K (trans)), extravascular extracellular blood volume (v (e)), transfer constant from the extracellular extravascular space to plasma (k (ep)) and iAUC (initial area under the signal intensity-time curve) were calculated. 3D static PET data were acquired and standardised uptake values (SUV) calculated. RESULTS All microcirculatory parameters in tumours were higher than in normal muscle tissue (P ≤ 0.0019). Significant correlations were shown between k (ep) and K (trans) (ρ = 0.77), v (e) and k (ep) (ρ = -0.7), and iAUC and v (e) (ρ = 0.53). Significant correlations were observed for SUV(mean) and v (e) as well as iAUC (ρ = 0.42 and ρ = 0.66, respectively). SUV(max) was significantly correlated with iAUC (ρ = 0.69). CONCLUSIONS The demonstrated relationships between vascular and metabolic characteristics of primary SCCA imply a complex interaction between vascular delivery characteristics and tumour metabolism. The lack of correlation between SUV and K (trans)/k (ep) suggests that both diagnostic techniques may provide complementary information.
Collapse
Affiliation(s)
- Sotirios Bisdas
- Department of Neuroradiology, Eberhard Karls University Hospital, Hoppe Seyler Str. 3, 72076, Tübingen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
40
|
|
41
|
Feasibility of integrated CT-liver perfusion in routine FDG-PET/CT. ACTA ACUST UNITED AC 2009; 35:528-36. [DOI: 10.1007/s00261-009-9559-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Accepted: 06/23/2009] [Indexed: 10/20/2022]
|
42
|
Abstract
Breast cancer is a complex disease and molecular imaging may contribute to better management through providing new insight for early detection. Fluorodeoxyglucose (FDG)-PET/CT has made great strides as a functional anatomic technique and recently gained attention in the diagnosis, staging, and follow-up of breast cancer. FDG-PET and CT complement each other's strengths in integrated FDGPET/CT. One-stop-shop whole-body FDG-PET/CT coupled with integrated FDG-PET/CT mammography has also been advocated.
Collapse
|
43
|
Miracle AC, Rezaei A, Gandhi D, Mukherji SK. CT perfusion of the neck: internal carotid artery versus external carotid artery as the reference artery. AJNR Am J Neuroradiol 2009; 30:1598-601. [PMID: 19369615 DOI: 10.3174/ajnr.a1531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Arterial selection for reference time-enhancement curve generation in deconvolution-based perfusion CT (PCT) studies of the head and neck is under-evaluated. This study of 11 patients with confirmed head and neck squamous cell carcinoma demonstrates significant correlation (range, r = 0.85-0.95) between perfusion parameter values derived with internal carotid artery (ICA) as compared to an external carotid artery reference, supporting the use of the ICA as arterial reference in PCT studies of the neck.
Collapse
Affiliation(s)
- A C Miracle
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, MI 48190, USA.
| | | | | | | |
Collapse
|
44
|
Kumar R, Das CJ. Hybrid PET-dynamic CECT in the management of breast cancer. Eur J Nucl Med Mol Imaging 2009; 36:413-5. [DOI: 10.1007/s00259-008-1055-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
45
|
Cancer-associated stroma affects FDG uptake in experimental carcinomas. Implications for FDG-PET delineation of radiotherapy target. Eur J Nucl Med Mol Imaging 2008; 36:616-23. [DOI: 10.1007/s00259-008-1012-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Accepted: 11/04/2008] [Indexed: 12/13/2022]
|
46
|
Abstract
Combined positron emission tomography–computed tomography (PET-CT) has made a significant impact on cancer imaging. The use of CT to map tissue attenuation for correction of PET images and the ability to co-register the functional information provided by PET with the anatomical data afforded by CT, has resulted in demonstrable improvements in diagnostic accuracy. However, attenuation correction and anatomical localisation may not represent the full benefits of integrating CT with PET. The use of CT acquisition techniques for patient positioning and the use of contrast media can improve diagnostic performance, and incorporation of CT image processing techniques such as perfusion CT, 3D imaging and computer-assisted diagnosis offers new applications. The interpretation of PET-CT images can be improved by fully integrating the morphological appearances on CT into image analysis. Better utilisation of the CT component of PET-CT could further enhance the benefits of PET-CT in oncology but will have implications for manufacturers and purchasers of PET-CT equipment and analysis software. Furthermore, specialists working in PET-CT will need CT competencies beyond knowledge of cross-sectional anatomy. CT continues to exhibit rapid evolution and these advances will inevitably impact on the practice of PET-CT.
Collapse
Affiliation(s)
- K A Miles
- Brighton and Sussex Medical School, Brighton, UK.
| |
Collapse
|