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Aymard S, Rust E, Kaseb A, Liu D, Hubele F, Romain B, Averous G, Brigand C, Imperiale A. Preoperative 18F-FDG PET/CT in Patients with Presumed Localized Colon Cancer: A Prospective Study with Long-Term Follow-Up. Cancers (Basel) 2024; 16:233. [PMID: 38201660 PMCID: PMC10777901 DOI: 10.3390/cancers16010233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/28/2023] [Accepted: 12/29/2023] [Indexed: 01/12/2024] Open
Abstract
We analyzed whether preoperative 18F-FDG PET/CT adds to conventional primary staging in patients with presumed non-metastatic colonic cancer (CC). The prognostic role of 18F-FDG uptake in the primary tumor was evaluated after a mean follow-up of 15 years. Patients with a new diagnosis of presumed localized CC were prospectively enrolled and underwent presurgical 18F-FDG PET/CT. For each colon lesion, SUVmax, SUVpeak, TLG, and MTV were assessed and tested as prognostic factors. Forty-eight patients were included. Post-surgery pathology identified a total of 103 colon lesions, including 58 invasive adenocarcinomas, 4 in situ adenocarcinomas, 3 adenomas with high-grade dysplasia, and 38 adenomas with low-grade dysplasia. Per lesion sensitivity, specificity, positive (PPVs) and negative predictive values (NPVs) for colonic primary tumor detection were 78%, 97%, 98%, and 73% for conventional workup, and 94%, 87%, 92%, and 89% for 18F-FDG PET/CT. Only sensitivity was significantly different between 18F-FDG PET/CT and conventional workup. PET detected an additional ten pathological colonic lesions in seven patients. SUVmax, SUVpeak, and TLG showed significant differences between invasive adenocarcinomas, in situ adenocarcinomas, and high-grade dysplasia compared to low-grade dysplasia. There was a statistically significant difference between pT1-pT2 and pT3-pT4 adenocarcinomas. On patient-based analysis, sensitivity, specificity, PPV, and NPV for nodal staging were 22%, 84%, 44%, and 65% for CECT, and 33%, 90%, 67%, and 70% for 18F-FDG PET/CT, without a statistically significant difference. PET/CT also identified unknown metastatic spread and one synchronous lung cancer in four patients. Overall, 18F-FDG PETCT had an additional diagnostic value in 11 out of 48 patients (23%). 18F-FDG uptake of the primary tumor did not predict nodal or distant metastases. The difference in disease-free survival categorized by median SUVmax, SUVpeak, TLG, and MTV was not significant. Finally, preoperative 18F-FDG PET/CT is valuable in detecting potential colon lesions not visualized by conventional workups, especially in cases of incomplete colonoscopy. It effectively highlights distant metastases but exhibits limitations for N staging. Mainly due to the relatively small sample size, the quantitative analysis of 18F-FDG uptake in the primary tumor did not reveal any association with recurrence or disease-free survival, adding no significant prognostic information.
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Affiliation(s)
- Samuel Aymard
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67033 Strasbourg, France; (S.A.); or (A.K.); (F.H.)
| | - Edmond Rust
- Nuclear Medicine, Fondation de la Maison du Diaconat, 68200 Mulhouse, France;
| | - Ashjan Kaseb
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67033 Strasbourg, France; (S.A.); or (A.K.); (F.H.)
- Radiology, College of Medicine, University of Jeddah, Jeddah 23890, Saudi Arabia
| | - David Liu
- Digestive and General Surgery, University Hospitals of Strasbourg, 67098 Strasbourg, France; (D.L.); (B.R.); (C.B.)
| | - Fabrice Hubele
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67033 Strasbourg, France; (S.A.); or (A.K.); (F.H.)
- University of Strasbourg, 67000 Strasbourg, France
| | - Benoit Romain
- Digestive and General Surgery, University Hospitals of Strasbourg, 67098 Strasbourg, France; (D.L.); (B.R.); (C.B.)
| | - Gerlinde Averous
- Pathology, Strasbourg University Hospitals, 67098 Strasbourg, France;
| | - Cecile Brigand
- Digestive and General Surgery, University Hospitals of Strasbourg, 67098 Strasbourg, France; (D.L.); (B.R.); (C.B.)
- University of Strasbourg, 67000 Strasbourg, France
| | - Alessio Imperiale
- Nuclear Medicine and Molecular Imaging, Institut de Cancérologie Strasbourg Europe (ICANS), University Hospitals of Strasbourg, 67033 Strasbourg, France; (S.A.); or (A.K.); (F.H.)
- University of Strasbourg, 67000 Strasbourg, France
- Molecular Imaging and Radiobiology, Institut Pluridisciplinaire Hubert Curien (IPHC), UMR 7178, CNRS/Unistra, 67037 Strasbourg, France
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Agüloğlu N, Aksu A. Evaluation of survival of the patients with metastatic rectal cancer by staging 18F-FDG PET/CT radiomic and volumetric parameters. Rev Esp Med Nucl Imagen Mol 2023; 42:122-128. [PMID: 36162744 DOI: 10.1016/j.remnie.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to predict the prognosis in patients with metastatic rectal cancer (mRC) by obtaining a model with machine learning (ML) algorithms through volumetric and radiomic data obtained from baseline 18-Fluorine Fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) images. METHODS Sixty-two patients with mRC who underwent 18F-FDG PET/CT imaging for staging between January 2015 and January 2021 were evaluated using LIFEx software. The volume of interest (VOI) of the primary tumor was generated and volumetric and textural features were obtained from this VOI. In addition, metabolic tumor volume (tMTV) and total lesion glycolysis (tTLG) values of tumor foci in the whole body. Clinical and radiomic data were evaluated with ML algorithms to create a model that predicts survival. Significant associations between these features and 1-year and 2-year survival were investigated. RESULTS Random forest algorithm was the most successful algorithm in predicting 2-year survival (AUC: 0.843, PRC: 0.822, and MCC: 0.583). The model obtained with this algorithm was able to predict 49 patients with 79.03% accuracy. While tMTV and tTLG values were successful in predicting 1-year survival (p: 0.002 and 0.007, respectively), texture characteristics from the primary tumor did not show a significant relationship with 1-year survival. CONCLUSIONS In addition to the important role of 18F-FDG PET/CT in staging patients with mRC, this study shows that it is possible to predict survival with ML methods, with parameters obtained using texture analysis from the primary tumor and whole body volumetric parameters.
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Affiliation(s)
- Nurşin Agüloğlu
- The University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Training and Research Hospital, Department of Nuclear Medicine, İzmir, Turkey.
| | - Ayşegül Aksu
- İzmir Katip Çelebi University, Atatürk Training and Research Hospital, Department of Nuclear Medicine, İzmir, Turkey
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Horvat N, El Homsi M, Miranda J, Mazaheri Y, Gollub MJ, Paroder V. Rectal MRI Interpretation After Neoadjuvant Therapy. J Magn Reson Imaging 2023; 57:353-369. [PMID: 36073323 PMCID: PMC9851947 DOI: 10.1002/jmri.28426] [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] [Received: 05/20/2022] [Revised: 08/23/2022] [Accepted: 08/25/2022] [Indexed: 02/01/2023] Open
Abstract
In recent years, several key advances in the management of locally advanced rectal cancer have been made, including the implementation of total mesorectal excision as the standard surgical approach; use of neoadjuvant chemoradiotherapy in selected patients with a high risk of local recurrence, and finally, adoption of organ preservation strategies, through either local excision or nonoperative management in selected patients with clinical complete response following neoadjuvant chemoradiotherapy. This review aims to shed light on the role of rectal MRI in the assessment of treatment response after neoadjuvant therapy, which is especially important given the growing feasibility of nonoperative management. First, an overview of current neoadjuvant therapies and response assessment based on digital rectal examination, endoscopy, and MRI will be provided. Second, the use of a high-quality restaging rectal MRI protocol will be presented. Third, a step-by-step approach to assessing treatment response on restaging rectal MRI following neoadjuvant treatment will be outlined, acknowledging challenges faced by radiologists during MRI interpretation. Finally, research related to response assessment will be discussed. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Natally Horvat
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria El Homsi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joao Miranda
- Department of Radiology, University of Sao Paulo, Sao Paulo, Brazil
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Marc J. Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Viktoriya Paroder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Agüloğlu N, Aksu A. Evaluación de la supervivencia de los pacientes con cáncer de recto metastásico mediante parámetros radiómicos y volumétricos de la PET/TC con [18F]FDG de estadificación. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Lee SW, Park HL, Yoon N, Kim JH, Oh JK, Buyn JH, Choi EK, Hong JH. Prognostic Impact of Total Lesion Glycolysis (TLG) from Preoperative 18F-FDG PET/CT in Stage II/III Colorectal Adenocarcinoma: Extending the Value of PET/CT for Resectable Disease. Cancers (Basel) 2022; 14:cancers14030582. [PMID: 35158851 PMCID: PMC8833504 DOI: 10.3390/cancers14030582] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 01/27/2023] Open
Abstract
We investigated the prognostic role of metabolic parameters from preoperative 18F-FDG PET/CT in stage II/III colorectal adenocarcinoma. A total of 327 stage II/III colorectal adenocarcinoma patients who underwent curative resection were included. The maximal standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were analyzed for optimal cut-offs and their effect on DFS. Differences in DFS rates and hazard ratios for DFS between cut-offs were statistically significant in SUVmax, MTV2.5, MTV3, TLG 2.5, TLG3, and TLG30%. Factors significantly related to DFS in univariate Cox regression were age, sex, stage, preoperative CEA, SUVmax, MTV2.5, MTV3, TLG2.5, TLG3, and TLG30%. Age, sex, preoperative CEA, and TLG2.5 (p = 0.009) sustained statistically significant difference in multivariate analysis. The 1-, 3-, and 5-year DFS rates for TLG2.5 ≤ 448.5 were 98.1%, 79.6%, and 74.8%, significantly higher than 78.4%, 68.5%, and 61.1% of TLG2.5 > 448.5, respectively (p = 0.012). TLG, a parameter indicating both the metabolic activity and metabolic volume, was the strongest predictor independently associated with DFS, among several PET parameters with statistical significance. These results suggest the potential prognostic value of preoperative 18F-FDG PET/CT in stage II/III resectable colorectal cancer.
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Affiliation(s)
- Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea;
| | - Hye Lim Park
- Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea;
| | - Nara Yoon
- Department of Pathology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
| | - Ji Hoon Kim
- Department of General Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
| | - Jin Kyoung Oh
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
| | - Jae Ho Buyn
- Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
| | - Eun Kyoung Choi
- Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon 21431, Korea;
- Correspondence: (E.K.C.); (J.H.H.); Tel.: +82-32-280-5242 (E.K.C.); +82-2-2030-4361 (J.H.H.)
| | - Ji Hyung Hong
- Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul 03312, Korea
- Correspondence: (E.K.C.); (J.H.H.); Tel.: +82-32-280-5242 (E.K.C.); +82-2-2030-4361 (J.H.H.)
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Yin YX, Xie MZ, Liang XQ, Ye ML, Li JL, Hu BL. Clinical Significance and Prognostic Value of the Maximum Standardized Uptake Value of 18F-Flurodeoxyglucose Positron Emission Tomography-Computed Tomography in Colorectal Cancer. Front Oncol 2021; 11:741612. [PMID: 34956868 PMCID: PMC8695495 DOI: 10.3389/fonc.2021.741612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023] Open
Abstract
Background The role of 18F-flurodeoxyglucose (18F-FDG) positron emission tomography–computed tomography (PET/CT) in colorectal cancer (CRC) remains unclear. This study aimed to explore the association of the maximum standardized uptake value (SUVmax), a parameter of 18F-FDG PET/CT, with KRAS mutation, the Ki-67 index, and survival in patients with CRC. Methods Data of 66 patients with CRC who underwent 18F-FDG PET/CT was retrospectively collected in our center. The clinical significance of the SUVmax in CRC and the association of the SUVmax with KRAS mutation and the Ki-67 index were determined. A meta-analysis was conducted by a systematic search of PubMed, Web of Science, and CNKI databases, and the data from published articles were combined with that of our study. The association of the SUVmax with KRAS mutation and the Ki-67 index was determined using the odds ratio to estimate the pooled results. The hazard ratio was used to quantitatively evaluate the prognosis of the SUVmax in CRC. Results By analyzing the data of 66 patients with CRC, the SUVmax was found not to be related to the tumor-node-metastasis stage, clinical stage, sex, and KRAS mutation but was related to the tumor location and nerve invasion. The SUVmax had no significant correlation with the tumor biomarkers and the Ki-67 index. Data of 17 studies indicated that the SUVmax was significantly increased in the mutated type compared with the wild type of KRAS in CRC; four studies showed that there was no remarkable difference between patients with a high and low Ki-67 index score regarding the SUVmax. Twelve studies revealed that the SUVmax had no significant association with overall survival and disease-free survival in CRC patients. Conclusions Based on the combined data, this study demonstrated that the SUVmax of 18F-FDG PET/CT was different between colon and rectal cancers and associated with KRAS mutation but not the Ki-67 index; there was no significant association between the SUVmax and survival of patients with CRC.
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Affiliation(s)
- Yi-Xin Yin
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Ming-Zhi Xie
- Department of Chemotherapy, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Xin-Qiang Liang
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Meng-Ling Ye
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Ji-Lin Li
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Bang-Li Hu
- Department of Research, Guangxi Medical University Cancer Hospital, Nanning, China
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Ahmed IS, El Gaafary SM, Elia RZ, Hussein RS. FDG-PET/CT in predicting aggressiveness of rectal cancer. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00656-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Background
Treatment response varies significantly among rectal cancer patients. Tumor can show complete regression, stationary appearance, or even tumour progression during the treatment. It is also widely known that the rate of local recurrence is variable. Precise risk stratification of tumor aggressiveness is required for better per patient tailored treatment plan and predicting the overall prognosis of rectal cancer patients The aim of this study was to assess different parameters of baseline [18F] fluorodeoxyglucose positron emission tomography/computed tomography [(18F) FDG-PET/CT] as a non-invasive tool in predicting aggressiveness of the rectal cancer.
Results
Overall, 33 patients were included [19 moderately differentiated adenocarcinoma, 10 poorly differentiated adenocarcinoma and 4 mucinous adenocarcinomas (MAC)]. SUV estimates (SUV max, SUV mean) were greater in the moderately adenocarcinoma group (p = 0.003 and p = 0.019, respectively). MTV and TLG values were similar between the three histopathological groups (p = 0.763 and p = 0.701, respectively). There was no correlation between SUVmax of primary tumor and MTV (r = 0.034; p = 0.849). However, SUVmax and TLG were significantly correlated (r = 0.517; p = 0.002). Strong correlation between tumor size and MTV (r = 0.489; p = 0.003), and TLG (r = 0.506; p = 0.003) were observed. No significant association was found between MTV and TLG and the clinical stage of rectal cancer.
Conclusion
Baseline 18F-FDG PET/CT parameters cannot be used alone as a non-invasive diagnostic technique in assessing aggressiveness and prognosis in patients with primary rectal cancer, and further clinical studies are needed before considering the prognostic role of FDG-PET/CT in rectal cancer.
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Ahn H, Won Lee J, Jang SH, Ju Lee H, Lee JH, Oh MH, Mi Lee S. Prognostic significance of imaging features of peritumoral adipose tissue in FDG PET/CT of patients with colorectal cancer. Eur J Radiol 2021; 145:110047. [PMID: 34801879 DOI: 10.1016/j.ejrad.2021.110047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 08/22/2021] [Accepted: 11/15/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE This study investigated the relationship of imaging features of primary tumor and peritumoral VAT on PET/CT with histopathological findings of peritumoral VAT and recurrence-free survival (RFS) in patients with colorectal cancer. METHODS We retrospectively reviewed 133 patients diagnosed with colorectal cancer who underwent staging FDG PET/CT and received curative surgery. Histogram-based imaging features of primary tumor and peritumoral VAT were extracted from PET/CT images. Based on histopathological analysis of peritumoral VAT, the degree of CD4, CD8, and CD163 cell infiltration and the expression of matrix metalloproteinase-11 and interleukin 6 (IL-6) were graded. Differences in imaging parameters based on the histopathological results and the relationships between imaging features and RFS were assessed. RESULTS Mean CT-attenuation and SUV of peritumoral VAT showed significant positive correlation with CD163 cell infiltration and IL-6 expression of peritumoral VAT. Univariable survival analysis revealed significant correlation between RFS and the mean CT-attenuation, mean SUV, and first-order SUV entropy of peritumoral VAT (p < 0.05). Multivariable analysis indicated that mean SUV and SUV entropy of peritumoral VAT remained significant predictors of RFS after adjustment for age, sex, and T stage (p < 0.05). CONCLUSION FDG uptake of peritumoral VAT was significantly associated with inflammatory response in peritumoral VAT and was an independent predictor of RFS in colorectal cancer patients.
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Affiliation(s)
- Hyein Ahn
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Jeong Won Lee
- Department of Nuclear Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, 25 Simgok-ro 100-gil, Seo-gu, Incheon 22711, Republic of Korea
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Ji-Hye Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Mee-Hye Oh
- Department of Pathology, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea
| | - Sang Mi Lee
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, 31 Suncheonhyang 6-gil, Dongnam-gu, Cheonan, Chungcheongnam-do 31151, Republic of Korea.
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Prognostic value of metabolic parameters on 18F-fluorodeoxyglucose positron tomography/computed tomography in classical rectal adenocarcinoma. Sci Rep 2021; 11:12947. [PMID: 34155222 PMCID: PMC8217562 DOI: 10.1038/s41598-021-92118-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/03/2021] [Indexed: 02/07/2023] Open
Abstract
We aimed to investigate the prognostic value of the metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in classical rectal adenocarcinoma (CRAC). We retrospectively reviewed 149 patients with CRAC who underwent preoperative 18F-FDG PET/CT at initial diagnosis followed by curative surgical resection. 18F-FDG PET/CT metabolic parameters including maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) for disease-free survival (DFS) and overall survival (OS) were evaluated for prognostic significance by univariate and multivariate analyses, along with conventional risk factors including pathologic T (pT) stage, lymph node (LN) metastasis, lymphovascular invasion (LVI), perineural invasion (PNI), and preoperative carcinoembryonic antigen (CEA) level. On univariate analysis, high pT stage, positive LN metastasis, LVI, PNI, MTV, and TLG were significant prognostic factors affecting DFS (all P < 0.05), while CEA level, high pT stage, positive LN metastasis, LVI, PNI, MTV, and TLG affected OS (all P < 0.05). On multivariate analysis, positive LN metastasis, LVI, MTV, and TLG were independent prognostic factors affecting DFS (all P < 0.05), while CEA level, positive LN metastasis, and MTV affected OS (all P < 0.05). Thus, the volume-based metabolic parameters from preoperative 18F-FDG PET/CT scans are independent prognostic factors in patients with CRAC.
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Lee JH, Lee HS, Kim S, Park EJ, Baik SH, Jeon TJ, Lee KY, Ryu YH, Kang J. Prognostic significance of bone marrow and spleen 18F-FDG uptake in patients with colorectal cancer. Sci Rep 2021; 11:12137. [PMID: 34108552 PMCID: PMC8190120 DOI: 10.1038/s41598-021-91608-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 05/28/2021] [Indexed: 11/12/2022] Open
Abstract
Serum inflammatory markers are used in the prognostication of colorectal cancer (CRC); however, the corresponding role of positron emission tomography (PET)-derived inflammatory markers remains unclear. This study aimed to investigate the prognostic value of 18F-fluorodeoxyglucose (FDG) uptake in the bone marrow and spleen of patients with CRC and evaluate the relationship between FDG uptake estimates in these organs and serum inflammatory markers. In total, 411 patients who underwent preoperative FDG PET/computed tomography (CT) within 1 month of surgery were enrolled. The mean standardized uptake values of the bone marrow and spleen were normalized to the value of the liver, thereby generating bone marrow-to-liver uptake ratio (BLR) and spleen-to-liver uptake ratio (SLR) estimates. The value of BLR and SLR in predicting overall survival (OS) was assessed using the Cox proportional hazards model. The correlation between BLR or SLR and neutrophil-to-lymphocyte ratio (NLR) was evaluated. The predictive accuracy of BLR alone and in combination with SLR was compared using the integrated area under the receiver operating characteristic curves (iAUC). In the univariate analysis, BLR (> 1.06) and SLR (> 0.93) were significant predictors of OS. In the multivariate analysis, BLR was an independent predictor of OS (hazard ratio = 5.279; p < 0.001). Both BLR and SLR were correlated with NLR (p < 0.001). A combination of BLR and SLR was better than BLR alone at CRC prognostication (iAUC, 0.561 vs. 0.542). FDG uptake estimates in the bone marrow and spleen may be useful imaging-derived biomarkers of systemic inflammation, supporting CRC prognostication.
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Affiliation(s)
- Jae-Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Soyoung Kim
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Eun Jung Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Seung Hyuk Baik
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea
| | - Tae Joo Jeon
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Hoon Ryu
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea.
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Kang J, Lee JH, Lee HS, Cho ES, Park EJ, Baik SH, Lee KY, Park C, Yeu Y, Clemenceau JR, Park S, Xu H, Hong C, Hwang TH. Radiomics Features of 18F-Fluorodeoxyglucose Positron-Emission Tomography as a Novel Prognostic Signature in Colorectal Cancer. Cancers (Basel) 2021; 13:cancers13030392. [PMID: 33494345 PMCID: PMC7866240 DOI: 10.3390/cancers13030392] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/16/2021] [Accepted: 01/18/2021] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to investigate the prognostic value of radiomics signatures derived from 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomography (PET) in patients with colorectal cancer (CRC). From April 2008 to Jan 2014, we identified CRC patients who underwent 18F-FDG-PET before starting any neoadjuvant treatments and surgery. Radiomics features were extracted from the primary lesions identified on 18F-FDG-PET. Patients were divided into a training and validation set by random sampling. A least absolute shrinkage and selection operator Cox regression model was applied for prognostic signature building with progression-free survival (PFS) using the training set. Using the calculated radiomics score, a nomogram was developed, and its clinical utility was assessed in the validation set. A total of 381 patients with surgically resected CRC patients (training set: 228 vs. validation set: 153) were included. In the training set, a radiomics signature labeled as a rad_score was generated using two PET-derived features, such as gray-level run length matrix long-run emphasis (GLRLM_LRE) and gray-level zone length matrix short-zone low-gray-level emphasis (GLZLM_SZLGE). Patients with a high rad_score in the training and validation set had a shorter PFS. Multivariable analysis revealed that the rad_score was an independent prognostic factor in both training and validation sets. A radiomics nomogram, developed using rad_score, nodal stage, and lymphovascular invasion, showed good performance in the calibration curve and comparable predictive power with the staging system in the validation set. Textural features derived from 18F-FDG-PET images may enable detailed stratification of prognosis in patients with CRC.
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Affiliation(s)
- Jeonghyun Kang
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (E.J.P.); (S.H.B.)
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
- Correspondence: (J.K.); (T.H.H.); Tel.: +82-2-2019-3372 (J.K.); +1-216-442-5565 (T.H.H.)
| | - Jae-Hoon Lee
- Department of Nuclear Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Eun-Suk Cho
- Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea;
| | - Eun Jung Park
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (E.J.P.); (S.H.B.)
| | - Seung Hyuk Baik
- Department of Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (E.J.P.); (S.H.B.)
| | - Kang Young Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul 03722, Korea;
| | - Chihyun Park
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
- Department of Computer Science and Engineering, Kangwon National University, Chuncheon-si, Gangwon-do 24341, Korea
- Interdisciplinary Graduate Program in Medical Bigdata Convergence, Kangwon National University, Chuncheon-si, Gangwon-do 24341, Korea
| | - Yunku Yeu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
| | - Jean R. Clemenceau
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
| | - Sunho Park
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
| | - Hongming Xu
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
| | - Changjin Hong
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
| | - Tae Hyun Hwang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA; (C.P.); (Y.Y.); (J.R.C.); (S.P.); (H.X.); (C.H.)
- Correspondence: (J.K.); (T.H.H.); Tel.: +82-2-2019-3372 (J.K.); +1-216-442-5565 (T.H.H.)
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Cai-Xia W, Rong-Fu W. Clinical application and research advancement of positron emission tomography/computed tomography in colorectal cancer. Shijie Huaren Xiaohua Zazhi 2020; 28:925-932. [DOI: 10.11569/wcjd.v28.i18.925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer is one of the most common malignant tumors of the digestive system. Early diagnosis and accurate staging and restaging of tumors are the preconditions for standardized treatment of colorectal cancer, which is conducive to the selection of treatment options and the evaluation of prognosis, as well as the improvement of patients' quality of life. With the popularization of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT), its value in the diagnosis, staging and restaging, treatment decision-making, and efficacy and prognosis assessment of colorectal cancer is becoming increasingly important. This review briefly introduces the application and advancement of PET/CT in the diagnosis and treatment of colorectal cancer, in the hope that clinicians can have a more comprehensive understanding of the significance of PET/CT in the diagnosis and treatment of colorectal cancer.
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Affiliation(s)
- Wu Cai-Xia
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Wang Rong-Fu
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China,Department of Nuclear Medicine, Peking University International Hospital, Beijing 102206, China
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13
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Alçın G, Şanlı Y, Yeğen G, Kaytan Sağlam E, Çermik TF. The Impact of Primary Tumor and Locoregional Metastatic Lymph Node SUV max on Predicting Survival in Patients with Rectal Cancer. Mol Imaging Radionucl Ther 2020; 29:65-71. [PMID: 32368877 PMCID: PMC7201433 DOI: 10.4274/mirt.galenos.2020.40316] [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] [Indexed: 12/21/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the impact of maximum standard uptake value (SUVmax) of the primary tumor and locoregional metastatic lymph node in predicting survival in patients with the preoperative rectal adenocarcinoma. Methods: One hundred and fifteen patients [mean age ± standard deviation (SD): 58.7±11.4 years] with biopsy-proven rectal adenocarcinoma underwent 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) imaging for the staging were included in this study. All patients were followed-up for a minimum of 12 months (mean ± SD: 29.7±13.5 months). Tumor-node-metastasis 2017 clinical staging, SUVmax of the primary rectal tumor and locoregional lymph nodes on the PET/CT studies were evaluated. Results: All patients had increased FDG activity of the primary tumor. The mean ± SD SUVmax of the primary tumor and locoregional metastatic lymph node were 21.0±9.1 and 4.6±2.8, respectively. Primary tumor SUVmax did not have an effect on predicting survival (p=0.525) however locoregional metastatic lymph node SUVmax had an effect (p<0.05) on predicting survival. Clinical stage of the disease was a factor predicting survival (p<0.001). Conclusion: 18F-FDG PET/CT is an effective imaging modality for detecting primary tumors and metastases in rectal adenocarcinoma and clinical stage assessment with PET/CT had an effect on predicting survival. Furthermore, in our study locoregional lymph node SUVmaks was defined as a factor in predicting survival.
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Affiliation(s)
- Göksel Alçın
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Yasemin Şanlı
- İstanbul University, İstanbul Faculty of Medicine, Department of Nuclear Medicine, İstanbul, Turkey
| | - Gülçin Yeğen
- İstanbul University, İstanbul Faculty of Medicine, Department of Pathology, İstanbul, Turkey
| | - Esra Kaytan Sağlam
- İstanbul University, İstanbul Faculty of Medicine, Department of Radiation Oncology, İstanbul, Turkey
| | - Tevfik Fikret Çermik
- University of Health and Sciences, İstanbul Training and Research Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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14
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Belge G, Bilgin C, Ozkaya G, Kandemirli SG, Alper E. Prognostic value of pretreatment tumor-to-blood standardized uptake ratio (SUR) in rectal cancer. Ann Nucl Med 2020; 34:432-440. [PMID: 32297136 DOI: 10.1007/s12149-020-01465-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 04/02/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The prognostic value of SUV on pretreatment F-18 FDG PET/CT imaging in patients with rectal cancer is a matter of debate. SUR is of prognostic value for survival in different cancers. In this study, we aimed to examine the potential prognostic value of SUR and other parameters in pretreatment F-18 FDG PET/CT for non-metastatic rectal cancer. METHODS One hundred four non-metastatic rectal cancer patients who underwent pretreatment PET/CT between March 2012 and January 2018 were included in the study. Firstly, SUVmax, SUVmean, MTV, and TLG were calculated semi-automatically at the workstation. SUR was calculated as the ratio of tumor SUVmax to thoracic aorta blood SUVmean. Univariate Cox regression and Kaplan-Meier analysis were used to evaluate overall survival (OS), progression free survival (PFS), and local recurrence (LR). Then, multivariate Cox regression analysis, which included the parameters that were significant in the univariate analysis, was performed. RESULTS Multivariate Cox regression analysis revealed that SUR was a prognostic factor for PFS. Age and T stage were prognostic factors for both OS and PFS. MTV was found to be independent risk factors for OS. CONCLUSIONS In our study, SUR was the only F-18 FDG PET/CT parameter found to be significant for PFS. The development of new parameters can increase the prognostic value of F-18 FDG PET/CT.
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Affiliation(s)
- Gokce Belge
- Department of Nuclear Medicine, Uludag University School of Medicine, 16059, Bursa, Turkey.
| | - Cem Bilgin
- Department of Radiology, Uludag University School of Medicine, Bursa, Turkey
| | - Guven Ozkaya
- Department of Statistics, Uludag University School of Medicine, Bursa, Turkey
| | | | - Eray Alper
- Department of Nuclear Medicine, Uludag University School of Medicine, 16059, Bursa, Turkey
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15
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PET in Gastrointestinal, Pancreatic, and Liver Cancers. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Usefulness of metabolic activity of adipose tissue in FDG PET/CT of colorectal cancer. Abdom Radiol (NY) 2018; 43:2052-2059. [PMID: 29198007 DOI: 10.1007/s00261-017-1418-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine the relationship between metabolic activity of adipose tissue on FDG PET/CT and prognosis in colorectal cancer. METHODS A total of 176 colorectal cancer patients with curative surgical resection were retrospectively enrolled. Volume and metabolic activity of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) on FDG PET/CT images were measured. The maximum standardized uptake value (SUV) of primary tumor (SUVtumor) was also obtained. Univariate analysis with log-rank test and multivariate Cox regression analyses were used to evaluate prognostic values of volume and metabolic activity of SAT and VAT as well as SUVtumor and clinicopathologic factors. RESULTS Of 176 patients, 26 experienced recurrence during follow-up. SUVtumor showed significant correlation with serum C-reactive protein level (r = 0.242, p = 0.001), SUV of VAT (r = 0.167, p = 0.026), and size of primary tumor (r = 0.341, p < 0.001). In univariate analysis with log-rank test, SUV of VAT (p = 0.009) and SAT (p = 0.006), volume of VAT (p = 0.015), N stage (p < 0.001), M stage (p < 0.001), tumor involvement of resection margin (p = 0.001), and lymphatic invasion (p = 0.024) were significantly associated with recurrence-free survival (RFS). However, SUVtumor showed no significant association with RFS. In multivariate Cox regression analysis, SUV of VAT (p = 0.016), presence of lymph node metastasis (p < 0.001), and tumor involvement of resection margin (p = 0.011) were independent prognostic factors for RFS. CONCLUSIONS The SUV of VAT in patients with colorectal cancer is significantly associated with FDG uptake of primary tumor. It is an independent predictor for RFS.
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17
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Lee JW, Baek MJ, Ahn TS, Lee SM. Fluorine-18-fluorodeoxyglucose uptake of bone marrow on PET/CT can predict prognosis in patients with colorectal cancer after curative surgical resection. Eur J Gastroenterol Hepatol 2018; 30:187-194. [PMID: 29120905 DOI: 10.1097/meg.0000000000001018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE This study investigated the relationship of fluorine-18-fluorodeoxyglucose (F-FDG) uptake of bone marrow (BM) on PET/computed tomography (PET/CT) with clinicopathologic factors and survival in patients with colorectal cancer. PATIENTS AND METHODS The study retrospectively included 226 patients with colorectal cancer who underwent F-FDG PET/CT for staging workup and treated with curative surgical resection. The maximum F-FDG uptake of primary cancer (Tmax) and mean F-FDG uptake of BM [BM standardized uptake value (SUV)] were derived from PET/CT images. The relationships between BM SUV and clinicopathologic factors and prognostic value of BM SUV for predicting recurrence-free survival (RFS) were assessed. RESULTS Patients with T3-T4 stage and hepatic metastases had significantly higher values of BM SUV than those with T1-T2 stage and no distant metastases (P<0.05). BM SUV showed significant positive correlation with Tmax, tumor size, serum C-reactive protein level, white blood cell count, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio (P<0.05). Univariate survival analysis revealed that N stage, M stage, tumor involvement of resection margin, lymphatic invasion, and BM SUV were significant predictors for RFS (P<0.05), whereas Tmax failed to show significance. In multivariate analysis, N stage (P=0.012 for N1 stage and P=0.020 for N2 stage), tumor involvement of resection margin (P=0.009), and BM SUV (P=0.005) were significantly associated with RFS. CONCLUSION Increased BM SUV was observed in patients with advanced stage and increased serum inflammatory markers. BM SUV was an independent predictor for RFS in colorectal cancer.
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Affiliation(s)
- Jeong Won Lee
- Department of Nuclear Medicine.,Institue for Integrative Medicine, Catholic Kwandong University College of Medicine, International St. Mary's Hospital, Incheon
| | | | | | - Sang Mi Lee
- Department of Nuclear Medicine, Cheonan Hospital, Soonchunhyang University, Cheonan, Korea
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18
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Elevated tumor-to-liver uptake ratio (TLR) from 18F-FDG-PET/CT predicts poor prognosis in stage IIA colorectal cancer following curative resection. Eur J Nucl Med Mol Imaging 2017; 44:1958-1968. [PMID: 28812134 PMCID: PMC5656694 DOI: 10.1007/s00259-017-3779-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/11/2017] [Indexed: 02/06/2023]
Abstract
Purpose The prognostic value of the tumor-to-liver uptake ratio (TLR) from 18-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F–FDG-PET/CT) in the early stage of colorectal cancer (CRC) is unclear. Notably, some stage IIA CRC patients experience early recurrence even after curative resection and might benefit from neoadjuvant or adjuvant chemotherapy. This study aims to evaluate whether elevated TLR from 18F–FDG-PET/CT can predict poor prognosis in stage IIA CRC patients undergoing curative resection. Methods From April 2010 to December 2013, 504 consecutive CRC patients with different TNM stages (I-IV) underwent 18F–FDG-PET/CT scans at the 6th Affiliated Hospital of Sun Yat-Sen University. Among the patients, 118 with stage IIA CRC who accepted preoperative 18F–FDG-PET/CT scanning and were treated with curative surgery alone were reviewed retrospectively. The maximum standardized uptake value (SUVmax) in the primary tumor, TLR, and demographic, clinical, histopathological, and laboratory data were analyzed. Receiver operating characteristic (ROC) curve, univariate and multivariate analyses were performed to identify prognostic factors associated with patient disease-free survival (DFS) and overall survival (OS). Results ROC curve analysis demonstrated that TLR was superior to primary tumor SUVmax in predicting the risk of recurrence in stage IIA CRC. The optimal TLR cutoff was 6.2. Univariate analysis indicated that elevated TLR, tumor size, and lymphovascular/neural invasion correlated with DFS (P = 0.001, P = 0.002, and P = 0.001, respectively) and OS (P = 0.001, P = 0.003, and P < 0.001, respectively). The 1-, 3-, and 5-year DFS rates were 98.4%, 96.9%, and 96.9% for stage IIA CRC patients with lower TLR (≤6.2) versus 77.8%, 60.6%, and 60.6% for those with elevated TLR (>6.2), respectively. The 1-, 3-, and 5-year OS rates were 100.0%, 100.0%, and 98.3% for the patients with lower TLR versus 98.1%, 83.3%, and 74.3% for those with elevated TLR. Cox regression analysis showed that elevated TLR [>6.2; hazard ratio (HR): 3.109–57.463; P < 0.001] and tumor size (>4.4 cm; HR: 1.636–19.155; P = 0.006) were independent risk factors for DFS. Meanwhile, elevated TLR (>6.2; HR: 1.398–84.945; P = 0.023) and lymphovascular/neural invasion (positive; HR: 1.278–12.777; P = 0.017) were independent risk factors for OS. Conclusion Elevated TLR predicted worse DFS and OS for stage IIA CRC patients and might serve as a potential radiological index to identify candidates for neoadjuvant or adjuvant chemotherapy. Stage IIA CRC patients with elevated TLR should be monitored carefully for early detection of possible recurrence.
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Baik H, Lee SM, Seo SH, An MS, Kim KH, Bae KB, Oh MK, Hong KH. Prognostic value of positron emission tomography/computed tomography for adjuvant chemotherapy of colon cancer. ANZ J Surg 2017; 88:587-591. [PMID: 28687025 DOI: 10.1111/ans.14098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/06/2017] [Accepted: 05/07/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND To assess the prognostic value of preoperative 18 F-fluorodeoxyglucose positron emission tomography/computed tomography in patients with high-risk stage II or stage III colon cancer who underwent FOLFOX chemotherapy. METHODS The study included 166 patients with high-risk stage II or stage III colon cancer who received FOLFOX4 chemotherapy. Retrospective patient data were analysed including pathological stage, histology, disease-free survival (DFS) and the maximum standardized uptake value (SUVmax ) of the primary tumour on 18 F-fluorodeoxyglucose positron emission tomography/computed tomography. The primary end point was DFS. RESULTS There were recurrences in 29 of the 166 patients (17.4%). Measuring the area under the receiver operating characteristic curve, the cut-off value of SUVmax with maximum sensitivity and specificity was 10.95. Using the Kaplan-Meier method, the DFS of the patients categorized by SUVmax tended to differ (P = 0.055). In univariate analyses, the risk factors for DFS were age over 70 years, higher N stage and neural invasion. SUVmax ≤ 10.95 showed a tendency, but was not significant (P = 0.0604). In multivariate analyses, the risk factors for DFS were age over 70 and neural invasion. CONCLUSIONS The results of this study suggest that high fluorodeoxyglucose uptake of the primary mass in high-risk stage II and stage III colon cancer does not significantly correlate with DFS.
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Affiliation(s)
- HyungJoo Baik
- Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Seok Mo Lee
- Department of Nuclear Medicine, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Sang Hyuk Seo
- Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Min Sung An
- Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Kwang Hee Kim
- Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Ki Beom Bae
- Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Min Kyung Oh
- Clinical Trial Center in Pharmacology, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
| | - Kwan Hee Hong
- Department of Surgery, Inje University College of Medicine, Busan Paik Hospital, Busan, Korea
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Güreşci S, Özmen Ö, Uzman M, Şimşek G, Tatci E, Gökçek A, Yeniova AÖ. Correlation of Ki-67 proliferation index and 18-fluorodeoxyglucose uptake in colorectal incidental lesions detected by positron emission tomography-computed tomography. Turk J Med Sci 2016; 46:1182-7. [PMID: 27513423 DOI: 10.3906/sag-1410-24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 09/13/2015] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM To investigate whether focal high maximum standardized uptake value (SUVmax) determined by 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) imaging is correlated with proliferation index in the colorectal region. MATERIALS AND METHODS SUVmax values of 31 colorectal neoplasms that were incidentally detected during PET-CT examination were compared to dysplasia degree, histopathologic diagnosis, and immunohistochemical expression of the Ki-67 proliferation marker. RESULTS Statistically significant correlations were found between SUVmax and Ki-67 proliferation index, dysplasia degree, and histopathologic diagnosis. Median SUVmax value was found to be significantly higher in high-risk lesions than low-risk lesions. CONCLUSION The Ki-67 proliferation index is an indicator of SUVmax in colorectal tract. SUVmax values can predict malignancy and prognosis in this region. Colonoscopy and biopsy should always be performed whenever a focal high FDG uptake is determined incidentally in a patient.
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Affiliation(s)
- Servet Güreşci
- Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Özlem Özmen
- Department of Nuclear Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Metin Uzman
- Department of Gastroenterology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Gülçin Şimşek
- Department of Pathology, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Ebru Tatci
- Department of Nuclear Medicine, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Atila Gökçek
- Department of Radiology, Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, Turkey
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Gauthé M, Richard-Molard M, Cacheux W, Michel P, Jouve JL, Mitry E, Alberini JL, Lièvre A. Role of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography in gastrointestinal cancers. Dig Liver Dis 2015; 47:443-54. [PMID: 25766918 DOI: 10.1016/j.dld.2015.02.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/06/2015] [Indexed: 12/11/2022]
Abstract
Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) has become a routine imaging modality for many malignancies and its use is currently increasing. In the present review article, we will summarize the evidence for FDG-PET/CT use in digestive cancers (excluding neuroendocrine tumours), and review the existing recommendations. While PET/CT is nowadays considered to be an important tool in the initial workup of oesophageal and anal cancers, new data are emerging regarding its use in assessing therapeutic efficacy, radiotherapy treatment planning, and detection of recurrence in case of isolated tumour marker elevation. Moreover, PET/CT may help decision making by detecting distant metastatic sites especially in potentially resectable metastatic colorectal cancer and, to a lesser extent, in localized gastric and pancreatic cancers. Finally, incidental focal colonic FDG uptakes require exploration by colonoscopy, as they are often associated with premalignant or malignant lesions.
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Affiliation(s)
- Mathieu Gauthé
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; Department of Nuclear Medicine, Centre Oscar Lambret, Lille, France.
| | - Marion Richard-Molard
- Institut Curie, René Huguenin Hospital, Department of Radiation Therapy, Saint-Cloud, France
| | - Wulfran Cacheux
- Institut Curie, Department of Medical Oncology, Paris, France
| | - Pierre Michel
- Department of Gastroenterology, Rouen University Hospital, France; University of Rouen, Rouen, France
| | - Jean-Louis Jouve
- Department of Gastroenterology, Dijon University Hospital, University of Burgundy, INSERM U866, Dijon, France
| | - Emmanuel Mitry
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Jean-Louis Alberini
- Institut Curie, René Huguenin Hospital, Department of Nuclear Medicine, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
| | - Astrid Lièvre
- Institut Curie, René Huguenin Hospital, Department of Medical Oncology, Saint-Cloud, France; University of Versailles Saint Quentin, Faculty of Health Sciences, Montigny-Le-Bretonneux, France
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Abstract
OBJECTIVE CT remains the imaging modality of choice in the diagnosis of colorectal cancer (CRC) and anal cancer. However, advances in imaging have expanded the role of MRI and PET/CT. This article focuses on the evolving role of FDG PET/CT in the diagnosis, radiation therapy planning, therapy assessment, and posttherapy monitoring of CRC and anal cancer. CONCLUSION FDG PET/CT is a valuable imaging modality that impacts the clinical management of patients with CRC and those with anal cancer.
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Lee M, Yeum TS, Kim JW, Oh S, Lee SA, Moon HR, Choi YH, Han YM, Choi JM, Jang DK. Recent chemotherapy reduces the maximum-standardized uptake value of 18F-fluoro-deoxyglucose positron emission tomography in colorectal cancer. Gut Liver 2014; 8:254-64. [PMID: 24827621 PMCID: PMC4026642 DOI: 10.5009/gnl.2014.8.3.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the influence of recent chemotherapy on the patterns of the maximum-standardized uptake value (M-SUV) and sensitivity of (18)F-fluoro-deoxyglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in colorectal cancer. METHODS We retrospectively analyzed the FDG-PET/CT of 509 patients who underwent surgery for colorectal cancer. Subgroup analysis was performed according to chemotherapy status; 401 patients were not treated with chemotherapy and 108 patients were treated with chemotherapy within 6 months prior to surgery. Pathologic analysis of the surgical specimen was used as the gold standard. RESULTS The M-SUV was significantly lower in patients treated with chemotherapy than in those not treated with chemotherapy in pathologically confirmed same stages of disease. The difference in the sensitivity of the M-SUV according to chemotherapy status was greatest using a cutoff M-SUV value of 6.4 (p<0.001). The longest diameter of the primary tumor was the most important factor that correlated with M-SUV of the primary tumor irrespective of the chemotherapy effect (p<0.001). The M-SUV of the primary tumor was not an independent predictor of lymph node metastasis in colorectal cancer. CONCLUSIONS The results indicate that the M-SUV of FDG-PET/CT should be interpreted in the context of concurrent chemotherapy.
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Affiliation(s)
- Minjong Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Tae Sung Yeum
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Won Kim
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea, Departments of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sohee Oh
- Departments of Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Shin Ae Lee
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hong Ran Moon
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Hoon Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Yoo Min Han
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Ji Min Choi
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Dong Kee Jang
- Department of Internal Medicine and Liver Research Institute, Seoul National University Hospital, Seoul, Korea
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Su B, Xu B, Wan J. Correlation between long-term aspirin use and F-fluorodeoxyglucose uptake in colorectal cancer measured by PET/CT. PLoS One 2014; 9:e109459. [PMID: 25290692 PMCID: PMC4188583 DOI: 10.1371/journal.pone.0109459] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/09/2014] [Indexed: 12/22/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the relationship between long-term aspirin use with pretreatment 18 Fluorodeoxyglucose (FDG) uptake of primary lesions of Colorectal cancer (CRC) and evaluate their clinical significance. MATERIALS AND METHODS We enrolled 84 patients with CRC who underwent 18F-FDG PET/CT scanning before surgery between 1st July 2008 and 1st March 2013 and followed up until 1st March 2014. Maximum standardized uptake value (SUVmax) of the primary tumor was measured by 18F-FDG PET/CT. The history of aspirin taken and other clinicopathogical factors were also obtained and their relationships were examined by Mann-Whitney or χ2 tests. Progression-free survival (PFS) was determined by standard Kaplan-Meier survival analysis. Cox proportional hazards regression was performed to determine whether history of aspirin taken, pretreatment SUVmax, age, gender, TNM stage, tumor sizes and differentiation influenced outcomes. RESULTS CRC Patients with long-term history of aspirin use had lower SUVmax of primary lesions than control group (9.74±2.62 vs. 13.91±6.18) and showed a trend towards improved PFS after curative surgery. However, pretreatment of SUVmax showed no prognostic value in patients with CRC. CONCLUSIONS Long-term aspirin use is associated with lower pretreatment SUVmax of CRC and is a promising prognostic factor for predicting PFS in patients with CRC.
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Affiliation(s)
- Binbin Su
- Department of Gastroenterology, South Building, Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese PLA General Hospital, Beijing, China
- * E-mail: (JW); (BX)
| | - Jun Wan
- Department of Gastroenterology, South Building, Chinese PLA General Hospital, Beijing, China
- * E-mail: (JW); (BX)
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Bu W, Wei R, Li J, Wang L, Shi C, Song J, Ma S, Chen H, Cong N. Association between carcinoembryonic antigen levels and the applied value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in post-operative recurrent and metastatic colorectal cancer. Oncol Lett 2014; 8:2649-2653. [PMID: 25364443 PMCID: PMC4214442 DOI: 10.3892/ol.2014.2523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 08/15/2014] [Indexed: 01/01/2023] Open
Abstract
Positron emission tomography (PET) using 18F-fluorodeoxyglucose has been widely used for analyzing cellular metabolism. The present study aimed to evaluate the association between the diagnostic value of PET/computed tomography (CT) in patients with post-operative recurrent and metastatic colorectal cancer (CRC), and the different levels of carcinoembryonic antigen (CEA). A total of 105 suspected recurrent and metastatic CRC patients (67 males and 38 females; mean age, 48.5 years) were included in this retrospective study. All the patients underwent PET/CT examination. The differences in the PET/CT diagnostic values of CEA-positive and -negative patients with recurrent CRC following surgery were retrospectively analyzed and compared. Among the 105 CRC patients, 87 exhibited recurrence and metastasis, as confirmed by histopathological diagnosis or clinical follow-up data. By contrast, the PET/CT examination results revealed that 85 cases were true positives (a false positive foci was diagnosed in one of the patients), 18 were true negatives and 2 were false negatives. Correspondingly, the sensitivity and degree of accuracy were 97.7 and 97.1%, respectively. The detection rates of PET/CT for the recurrence and metastases were 85.3% in the CEA-positive group and 75.7% in the CEA-negative group. No significant differences were observed between the two groups. Overall, CEA levels do not help improve the detection rate of PET/CT in the recurrence and metastasis of CRC. PET/CT imaging has a high sensitivity and degree of accuracy in detecting recurrence and metastasis following CRC surgery. Therefore, this method is ideal for monitoring relapsed and metastatic foci of post-operative colon cancer cases.
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Affiliation(s)
- Wenzhe Bu
- Department of Surgical Oncology (Interventional Therapy), Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Ran Wei
- Department of Computed Tomography, Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Jinpeng Li
- Department of Surgical Oncology (Interventional Therapy), Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Lijun Wang
- Department of Computed Tomography, Shandong Medical Imaging Research Institute, Jinan, Shandong 250000, P.R. China
| | - Congcong Shi
- Six Ward of Shandong Mental Health Center, Jinan, Shandong 250014, P.R. China
| | - Jinlong Song
- Department of Surgical Oncology (Interventional Therapy), Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Shuangshuang Ma
- Department of Surgical Oncology (Interventional Therapy), Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Hua Chen
- Department of Surgical Oncology (Interventional Therapy), Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
| | - Ning Cong
- Department of Surgical Oncology (Interventional Therapy), Shandong Cancer Hospital and Institute, Shandong Academy of Medical Sciences, Jinan, Shandong 250117, P.R. China
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Prognostic value of 18 F-FDG uptake by regional lymph nodes on pretreatment PET/CT in patients with resectable colorectal cancer. Eur J Nucl Med Mol Imaging 2014; 41:2203-11. [DOI: 10.1007/s00259-014-2840-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 06/16/2014] [Indexed: 01/13/2023]
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