Fluorodeoxyglucose-PET for Ablation Treatment Planning, Intraprocedural Monitoring, and Response

Kishore, Sirish; Drabkin, Michael J.; Sofocleous, Constantinos T.

doi:10.1016/j.cpet.2019.06.006

Cited by 9 publications

(4 citation statements)

References 39 publications

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“…With MRI, a concurrent magnetic resonance cholangiopancreatography (MRCP) may be beneficial when detailed evaluation of the relationship of central bile ducts to the target metastasis is necessary. Depending on the primary tumour type, baseline FDG PET/CT can provide valuable information about hepatic and extrahepatic disease and can alter management in a significant percentage of patients 27,28 . MRI and PET/CT are particularly important for patients with CLM undergoing assessment for ablation after prior therapies including resections, ablations (percutaneous or intra‐operative) and systemic or hepatic arterial infusion pump chemotherapy; in these patients, hypoattenuating lesions on contrast‐enhanced CT may represent active metastases or treated, non‐viable tumours.…”

Section: Patient Selection and Pre‐procedures Workupmentioning

confidence: 99%

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Percutaneous image‐guided ablation for hepatic metastases

Sotirchos,

Petre,

Sofocleous

2023

J Med Imag Rad Onc

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SummaryThe presence of hepatic metastases indicates advanced disease and is associated with significant morbidity and mortality, especially when the hepatic disease is not amenable to locoregional treatments. The primary tumour of origin, the distribution and extent of metastatic disease, the underlying liver reserve, the patient performance status and the presence of comorbidities are factors that determine whether a patient will benefit from hepatectomy or local curative‐intent treatments. For patients with metastatic colorectal cancer, the most common primary cancer that spreads to the liver, several studies have demonstrated a survival benefit for patients who can be treated with hepatectomy and/or percutaneous ablation, compared to those treated with chemotherapy alone. Despite advances in surgical techniques increasing the percentage of patients eligible for surgery, most patients have unresectable disease or are poor surgical candidates. Percutaneous ablation can be used to provide local disease control and prolong survival for both surgical and non‐surgical candidates. This is typically offered to patients with small hepatic metastases that can be ablated with optimal (≥10 mm) or at least adequate minimum ablation margins (≥5 mm), as high local tumour control rates can be achieved for these patients which are comparable to surgical resection. This review summarizes available evidence and outcomes following percutaneous ablation of the most frequently encountered types of hepatic metastases in the clinical practice of interventional oncology. Patient selection, technical considerations, follow‐up protocols and oncologic outcomes are presented and discussed.

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Section: Patient Selection and Pre‐procedures Workupmentioning

confidence: 99%

“…Areas of focal hypermetabolic uptake within or at the rim of the ablation zone are suspicious of local tumour progression and when feasible should be reablated. When in question, PET/CT‐guided biopsy should be considered 17,27 …”

Section: Post‐ablation Follow‐upmentioning

confidence: 99%

Percutaneous image‐guided ablation for hepatic metastases

Sotirchos,

Petre,

Sofocleous

2023

J Med Imag Rad Onc

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“…The value of functional images for personalized therapy is limited by cancer histological and genomic heterogeneity [1,2]. Gathering information from medical images regarding proliferation rate, differentiation and heterogeneity, or genomic profile of malignant tumors [3,4], potentially improve selection of the appropriate treatment pathways for targeted therapies while minimizing the need and risks of interventional procedures and maximizing patient comfort [5].…”

Section: Introductionmentioning

confidence: 99%

KRAS mutation effects on the 2-[18F]FDG PET uptake of colorectal adenocarcinoma metastases in the liver

Popović

Talarico

Hoff

et al. 2020

Preprint

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Background: Deriving individual tumor genomic characteristics from patient imaging analysis is desirable. We explore the predictive value of 2-[18F]FDG uptake with regards to the KRAS mutational status of colorectal adenocarcinoma liver metastases (CLM). Methods : 2-[18F]FDG PET/CT images, surgical pathology and molecular diagnostic reports of 37 patients who underwent PET/CT-guided biopsy of CLM were reviewed under an IRB-approved retrospective research protocol. Sixty CLM in 39 interventional PET scans of the 37 patients were segmented using two different auto-segmentation tools implemented in different commercially available software packages. PET standard uptake values (SUV) were corrected for: 1) partial volume effect (PVE) using cold wall-corrected contrast recovery coefficients derived from phantom spheres with variable diameter; and 2) variability of arterial tracer supply and variability of uptake time after injection until start of PET scan derived from the tumor-to-blood standard uptake ratio (SUR) approach. The correlations between the KRAS mutational status and the mean, peak, and maximum SUV were investigated using Student ’ s t-test, Wilcoxon rank sum test with continuity correction, logistic regression and receiver operation characteristic (ROC) analysis. These correlation analyses were also performed for the ratios of the mean, peak and maximum tumor uptake to the mean blood activity concentration at the time of scan: SUR_mean, SUR_peak, and SUR_max , respectively. Results: Fifteen patients harbored KRAS missense mutations ( KRAS+ ) while another 3 harbored KRAS gene amplification. For 31 lesions the mutational status was derived from the PET/CT-guided biopsy. The Student ’ s-t p-values for separating KRAS mutant cases decreased after applying PVE correction to all uptake metrics of each lesion and when applying correction for uptake time variability to the SUR metrics. The observed correlations were strongest when both corrections were applied to SUR MAX and when the patients harboring gene amplification were grouped with the wild type: p ≤ 0.001; ROC area under the curve (AUC) = 0.77 and 0.75 for the two different segmentations respectively with a mean specificity of 0.69 and sensitivity of 0.85. Conclusions: The correlations observed after applying the described corrections show potential for assigning probabilities for the KRAS missense mutation status in CLM using 2-[18F]FDG PET images.

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“…regarding proliferation rate, differentiation and heterogeneity, or genomic profile of malignant tumors [3,4] potentially improves selection of the appropriate treatment pathways for targeted therapies while minimizing the need and risks of interventional procedures and maximizing patient comfort [5].…”

mentioning

confidence: 99%

KRAS mutation effects on the 2-[18F]FDG PET uptake of colorectal adenocarcinoma metastases in the liver

et al. 2020

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Background Deriving individual tumor genomic characteristics from patient imaging analysis is desirable. We explore the predictive value of 2-[18F]FDG uptake with regard to the KRAS mutational status of colorectal adenocarcinoma liver metastases (CLM). Methods 2-[18F]FDG PET/CT images, surgical pathology and molecular diagnostic reports of 37 patients who underwent PET/CT-guided biopsy of CLM were reviewed under an IRB-approved retrospective research protocol. Sixty CLM in 39 interventional PET scans of the 37 patients were segmented using two different auto-segmentation tools implemented in different commercially available software packages. PET standard uptake values (SUV) were corrected for: (1) partial volume effect (PVE) using cold wall-corrected contrast recovery coefficients derived from phantom spheres with variable diameter and (2) variability of arterial tracer supply and variability of uptake time after injection until start of PET scan derived from the tumor-to-blood standard uptake ratio (SUR) approach. The correlations between the KRAS mutational status and the mean, peak and maximum SUV were investigated using Student’s t test, Wilcoxon rank sum test with continuity correction, logistic regression and receiver operation characteristic (ROC) analysis. These correlation analyses were also performed for the ratios of the mean, peak and maximum tumor uptake to the mean blood activity concentration at the time of scan: SURMEAN, SURPEAK and SURMAX, respectively. Results Fifteen patients harbored KRAS missense mutations (KRAS+), while another 3 harbored KRAS gene amplification. For 31 lesions, the mutational status was derived from the PET/CT-guided biopsy. The Student’s t test p values for separating KRAS mutant cases decreased after applying PVE correction to all uptake metrics of each lesion and when applying correction for uptake time variability to the SUR metrics. The observed correlations were strongest when both corrections were applied to SURMAX and when the patients harboring gene amplification were grouped with the wild type: p ≤ 0.001; ROC area under the curve = 0.77 and 0.75 for the two different segmentations, respectively, with a mean specificity of 0.69 and sensitivity of 0.85. Conclusion The correlations observed after applying the described corrections show potential for assigning probabilities for the KRAS missense mutation status in CLM using 2-[18F]FDG PET images.

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Fluorodeoxyglucose-PET for Ablation Treatment Planning, Intraprocedural Monitoring, and Response

Cited by 9 publications

References 39 publications

Percutaneous image‐guided ablation for hepatic metastases

Percutaneous image‐guided ablation for hepatic metastases

KRAS mutation effects on the 2-[18F]FDG PET uptake of colorectal adenocarcinoma metastases in the liver

KRAS mutation effects on the 2-[18F]FDG PET uptake of colorectal adenocarcinoma metastases in the liver

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