Tumorous tissue characterization using integrated 18F-FDG PET/dual-energy CT in lung cancer: Combining iodine enhancement and glycolytic activity

Martin, Simon S.; Muscogiuri, Emanuele; Burchett, Philip; Assen, Marly van; Tessarin, Giovanni; Vogl, Thomas J.; Schoepf, U. Joseph; Cecco, Carlo N. De

doi:10.1016/j.ejrad.2021.110116

Cited by 2 publications

(2 citation statements)

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“…Sufficient dose reduction using photon-counting CT with preserved quantification could justify interim scans. On the other hand, there is preliminary work investigating the utility of combining FDG PET and spectral imaging information, and initial results suggest a synergistic effect 27 . Furthermore, we found significant differences in ΔIoD for the individual TRGs, which may allow an even more individualized approach to therapy modification, as a binary classification may neglect relevant prognostic differences 28 …”

Section: Discussionmentioning

confidence: 71%

“…On the other hand, there is preliminary work investigating the utility of combining FDG PET and spectral imaging information, and initial results suggest a synergistic effect. 27 Furthermore, we found significant differences in ΔIoD for the individual TRGs, which may allow an even more individualized approach to therapy modification, as a binary classification may neglect relevant prognostic differences. 28 Similar to ADC, initial studies suggest a correlation between tumor cellularity and IoD.…”

Section: Discussionmentioning

confidence: 71%

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Evaluating Treatment Response in GEJ Adenocarcinoma

Graf,

Gawlitza,

Makowski

et al. 2024

Invest Radiol

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Background Neoadjuvant therapy regimens have significantly improved the prognosis of GEJ (gastroesophageal junction) cancer; however, there are a significant percentage of patients who benefit from earlier resection or adapted therapy regimens, and the true response rate can only be determined histopathologically. Methods that allow preoperative assessment of response are lacking. Purpose The purpose of this retrospective study is to assess the potential of pretherapeutic and posttherapeutic spectral CT iodine density (IoD) in predicting histopathological response to neoadjuvant chemotherapy in patients diagnosed with adenocarcinoma of the GEJ. Methods In this retrospective cohort study, a total of 62 patients with GEJ carcinoma were studied. Patients received a multiphasic CT scan at diagnosis and preoperatively. Iodine-density maps were generated based on spectral CT data. All tumors were histopathologically analyzed, and the tumor regression grade (TRG) according to Becker et al (Cancer. 2003;98:1521–1530) was determined. Two experienced radiologists blindly placed 5 defined ROIs in the tumor region of highest density, and the maximum value was used for further analysis. Iodine density was normalized to the aortic iodine uptake. In addition, tumor response was assessed according to standard RECIST measurement. After assessing interrater reliability, the correlation of IoD values with treatment response and with histopathologic TRG was evaluated. Results The normalized ΔIoD (IoD at diagnosis − IoD after neoadjuvant treatment) and the normalized IoD after neoadjuvant treatment correlated significantly with the TRG. For the detection of responders and nonresponders, the receiver operating characteristic (ROC) curve for normalized ΔIoD yielded the highest area under the curve of 0.95 and achieved a sensitivity and specificity of 92.3% and 92.1%, respectively. Iodine density after neoadjuvant treatment achieved an area under the curve of 0.88 and a sensitivity and specificity of 86.8% and 84.6%, respectively (cutoff, 0.266). Iodine density at diagnosis and RECIST did not provide information to distinguish responders from nonresponders. Using the cutoff value for IoD after neoadjuvant treatment, a reliable classification of responders and nonresponders was achieved for both readers in a test set of 11 patients. Intraclass correlation coefficient revealed excellent interrater reliability (intraclass correlation coefficient, >0.9). Lastly, using the cutoff value for normalized ΔIoD as a definition for treatment response, a significantly longer survival of responders was shown. Conclusions Changes in IoD after neoadjuvant treatment of GEJ cancer may be a potential surrogate for therapy response.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 71%