Value of ¹⁸F-FDG heterogeneity for discerning metastatic from benign lymph nodes in nasopharyngeal carcinoma patients with suspected recurrence

Abstract

Objective: This study investigated the value of fluorine-18 fludeoxyglucose ( 18 F-FDG) heterogeneity as an indicator of metastatic lymph nodes (LNs) in patients with nasopharyngeal carcinoma (NPC). We further assessed whether addition of this parameter improves diagnostic performance beyond that provided by maximum standardized uptake value (SUV max ). Methods: We analyzed 74 LNs that were suspicious for metastasis. These LNs were measured for coefficient of variation (CV) of 18 F-FDG uptake, which was used as a parameter for 18 F-FDG heterogeneity. Results: Multivariate logistic regression analyses revealed that a high CV (hazard ratio, 20.97; 95% confidence interval, 2.26-194.62; p 5 0.007) was an independent predictor of metastatic LNs. However, receiveroperating characteristic curve analysis (p 5 0.278) and net reclassification (p 5 0.539) were unable to show improved diagnostic performance by addition of CV to SUV max . Conclusion: High CV of 18 F-FDG uptake is an independent risk factor for metastatic LNs in patients with NPC displaying suspicious LNs following treatment. Advances in knowledge: Heterogeneity of 18 F-FDG uptake has a potential as a biomarker of metastatic LNs.

Heterogeneous parameters based on 18F-FET PET imaging can non-invasively predict tumor grade and isocitrate dehydrogenase gene 1 mutation in untreated gliomas

“…Different cell groups in malignant tumors could have different behaviors and treatment responses, and the heterogeneity of malignant tumors is related to oxygen consumption and glucose metabolism (28). Previous studies have demonstrated that heterogeneous parameters, such as HI and COV in 18 F-FDG PET imaging, could benefit treatment response evaluation and patient outcomes in nonsmall cell lung cancer, rectal carcinoma, and nasopharyngeal carcinoma (29)(30)(31). The findings of the present study confirm the potential of these intratumoral heterogeneous semi-quantitative parameters after lesion delineation procedures based on static 18 F-FET PET/CT imaging, which could also contribute to the further understanding of glioma heterogeneity mechanisms in amino acid tracer imaging.…”

Nasopharyngeal Carcinoma Radiomic Evaluation with Serial PET/CT: Exploring Features Predictive of Survival in Patients with Long-Term Follow-Up

“…Many studies are using pretreatment MRI features, which have been used to predict progression-free survival in stage III-IVb patients [63][64][65] and in a smaller sample including low grade tumors [66]. A few earlier studies tried to measure FDG uptake heterogeneity by using different quantitative measures, including SUVmax/SUVmean [67], SUV standard deviation/SUVmean [68] and the derivative of the volume-threshold function [69]; however, a more recent study [13] using the radiomics approach found skewness (a first-order feature) to be a predictor of relapse-free survival and uniformity (a texture feature) to be a predictor of overall survival, which improved the prognostic stratification of other risk factors found by using multivariate analysis, namely age and serum EBV DNA load. A large multicenter study recently showed that treatment decision and prognosis for specific stages could reliably based on a radiomic based nomogram [70].…”