Prognostic Value of FDG PET/CT–Derived Parameters in Pancreatic Adenocarcinoma at Initial PET/CT Staging

Chirindel, Alin; Alluri, Krishna; Chaudhry, Muhammad; Wahl, Richard L.; Pawlik, Timothy M.; Herman, Joseph M.; Subramaniam, Rathan M.

doi:10.2214/ajr.14.13156

Cited by 49 publications

(36 citation statements)

References 21 publications

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“…An unenhanced CT was acquired for attenuation correction and anatomical co-registration. CT parameters were 50 cm axial dynamic FOV, weight-based amperage 20–200 mA, 120–140 kVp, 3.75-mm slice thickness, pitch of 0.984, 0.5-second gantry rotation speed and 512 × 512 matrix 19 .…”

Section: Methodsmentioning

confidence: 99%

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Value of Intratumoral Metabolic Heterogeneity and Quantitative 18F-FDG PET/CT Parameters to Predict Prognosis in Patients With HPV-Positive Primary Oropharyngeal Squamous Cell Carcinoma

Mena

Taghipour

Sheikhbahaei

et al. 2017

Clinical Nuclear Medicine

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Objective To evaluate the impact of intra-tumoral metabolic heterogeneity and quantitative FDG-PET/CT imaging parameters for predicting patient outcomes in primary oropharyngeal squamous cell cancer (OPSCC). METHOD AND MATERIALS We retrospective investigated 105 patients with HPV-positive OPSCC. Maximum standardized uptake value (SUVmax,), and metabolic tumor volume (MTV)were measured for the primary tumors and when available for the metastatic sites. Primary tumor intra-tumoral metabolic heterogeneity was calculated as the area under a cumulative SUV-volume Histograms curve (AUC-CSH). The median follow-up time was 35.4 months (range 3-92 months). Outcome endpoint was event free survival (EFS). Kaplan–Meier survival plots and Cox regression analyses were performed. RESULTS Of the 105 patients included, 19 patients relapsed and 11 deceased during the study period. AUC-CSH indexes were associated with EFS using PET gradient-based (p=0.034) and 50%-Threshold (p=0.02) segmentation methods, on multivariate analysis. Kaplan–Meier survival analysis using optimum cutoff of 16.7 SUVmax and 12.7 ml total MTV were significant predictors of EFS. Combining SUVmax and AUC-CSH index in three subgroups, patients with higher intra-tumoral heterogeneity and higher SUVmax were associated with worse outcome (log-rank p=0.026). Similarly, patients with higher intra-tumoral heterogeneity tumors and higher MTV had worse prognosis (log-rank, p= 0.022). CONCLUSION Intra-tumoral metabolic heterogeneity using FDG-PET was a prognostic factor for EFS in patients with primary HPV (+) OPSCC. The combined predictive effect of FDG avidity, metabolic tumor burden and intra-tumoral heterogeneity provided prognostic survival information in these patients.

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Section: Methodsmentioning

confidence: 99%

“…The gradient-based segmentation consisted of an edge-detection tool, generating an automated volume of interest (VOI), outlined based on the boundaries of the FDG-avid lesion, avoiding adjacent structures. For the threshold segmentation technique, a 50% SUV max -threshold was applied using a spherical VOI, predefined by MIM software tool 19 .…”

Section: Methodsmentioning

confidence: 99%

Value of Intratumoral Metabolic Heterogeneity and Quantitative 18F-FDG PET/CT Parameters to Predict Prognosis in Patients With HPV-Positive Primary Oropharyngeal Squamous Cell Carcinoma

Mena

Taghipour

Sheikhbahaei

et al. 2017

Clinical Nuclear Medicine

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“…PET data were reconstructed with and without CT-based attenuation using an unenhanced CT for attenuation correction and anatomical co-registration. CT parameters were 50 cm axial dynamic FOV, weight-based, 20–200 mA, 120–140 kVp, 3.75-mm slice thickness, pitch of 0.984, 0.5-second gantry rotation speed and 512 × 512 matrix 24 .…”

Section: Methodsmentioning

confidence: 99%

“…For the threshold segmentation technique, a 50% SUV max -threshold was applied using a spherical VOI, predefined by MIM software tool, which was placed over the lesion, adjusting to include the entire FDG-avid tumor, avoiding normal adjacent structures. Once the reader verified drawn boundaries in all three orthogonal planes, segmentation of the obtained volume was performed 24 .…”

Section: Methodsmentioning

confidence: 99%

18F-FDG PET/CT Metabolic Tumor Volume and Intratumoral Heterogeneity in Pancreatic Adenocarcinomas

Mena

Sheikhbahaei

Taghipour

et al. 2017

Clinical Nuclear Medicine

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Objectives We aimed to determine the consistency of quantitative PET measurements of metabolic tumor volume (MTV) and intra-tumoral heterogeneity index for primary untreated pancreatic adenocarcinomas, when using dual-time-point 18F-FDG PET/CT imaging. Methods This is an Institutional Review Board approved, retrospective study including 71 patients with pancreatic adenocarcinoma, who underwent dual-time-point 18F-FDG PET/CT imaging, at ~1h (early) and ~2h (delayed), post injection. Automated gradient-based and 50% SUVmax-threshold segmentation methods were used to assess the primary tumor MTV, and metabolic intra-tumoral heterogeneity index, calculated as the area under Cumulative SUV-volume histograms (AUC-CSH), with lower AUC-CHS indexes corresponding to higher degrees of tumor heterogeneity. We defined that more than a ±10% change in MTV or AUC-CSH, compared to baseline, as clinically significant. Results 71 FDG-avid pancreatic tumors were identified, with an average tumor diameter of 3.4±0.9 cm (range, 1.5 to 6.4 cm). MTV values remained consistent between early and delayed imaging when using the gradient PET segmentation method (p=0.086), whereas statistically significant change was seen when using 50% SUVmax-threshold segmentation (p <0.001). A decrease in more than 10% change in MTV (% ΔMTV) was observed in 70.4% (50/71) tumors, and 7.0% (5/71) of the tumors showed an increase more than 10 % ΔMTV, when using the 50% SUVmax-threshold segmentation. AUC-CSH indexes showed statistically significant differences between early and delayed time points (p<0.001), when using the gradient segmentation. AUC-CSH index decreased ≥10% in 40.8% (29/71) of the tumors. AUC-CSH index remained stable between early and delayed when using the 50% SUVmax-threshold segmentation (p=0.148) with % of change of less than 10% for all tumors. Conclusion Metabolic Tumor Volume was relatively stable between early and delayed time points when PET gradient segmentation was used but changed >10% in 77.4% of the tumors at delayed time point when threshold segmentation was used. The tumor heterogeneity index (AUC-CSH) changed >10% in 40.8% of tumors at delayed imaging, when gradient segmentation was used but remained stable when threshold segmentation was used. It is important to standardize uptake time and segmentation methods to use FDG PET metabolic tumor volume and heterogeneity index as imaging biomarkers.

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“…Esto por supuesto disminuye la capacidad de encontrar significación estadística en la valoración de las variables estudiadas. Este hecho puede explicar en parte que algunos factores no resultaron significativos en nuestro estudio, pero sí mostraron utilidad pronóstica en otros, tales como el estadio AJCC 10 , tamaño tumoral 13 , la etapa T patológica 13 , el VTM [12][13][14] , el MTG 12,13,21 , y los niveles sanguíneos de Ca19-9 12 . Además de la utilidad pronóstica del PET/CT sugerida en nuestro estudio, es necesario, antes de recomendar su uso clínico en etapificación de cáncer de páncreas, determinar su valor diagnós-tico, asunto que no ha sido demostrado suficientemente en la literatura, y que no formó parte de los objetivos de este trabajo.…”

Section: Discussionunclassified

Utilidad pronóstica del PET/CT en cáncer de páncreas

et al. 2018

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Prognostic Value of FDG PET/CT–Derived Parameters in Pancreatic Adenocarcinoma at Initial PET/CT Staging

Abstract: Age, SUVmax, peak SUV, and total lesion glycolysis (i.e., tumor glycolytic activity) of the primary tumor are associated with PFS, and tumor glycolytic activity is associated with OS in patients with pancreatic adenocarcinoma.

Cited by 49 publications

References 21 publications

Value of Intratumoral Metabolic Heterogeneity and Quantitative 18F-FDG PET/CT Parameters to Predict Prognosis in Patients With HPV-Positive Primary Oropharyngeal Squamous Cell Carcinoma

Value of Intratumoral Metabolic Heterogeneity and Quantitative 18F-FDG PET/CT Parameters to Predict Prognosis in Patients With HPV-Positive Primary Oropharyngeal Squamous Cell Carcinoma

18F-FDG PET/CT Metabolic Tumor Volume and Intratumoral Heterogeneity in Pancreatic Adenocarcinomas

Utilidad pronóstica del PET/CT en cáncer de páncreas

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