18F-FDG PET/CT 代谢参数在鼻型结外NK/T淋巴瘤诊断中价值

目的探讨鼻型结外NK/T淋巴瘤18 F-FDG PET/CT显像代谢参数的相关因素。方法选取47例病理学证实的鼻型结外NK/T淋巴瘤患者,治疗前行^18F-FDG PET/CT检查,根据Ann-Arbor分期系统为参考,早期(Ⅰ~Ⅱ期)32例,进展期(Ⅲ~Ⅳ)期15例,测量两组患者鼻腔病灶最大平均标准值(SUVmax)、平均标准摄取值(SUVmean、)峰值标准摄取值(SUVpeak)、肿瘤代谢体积(MTV)、病灶糖酵解总量(TLG)代谢参数,采用统计学软件SPSS 20.0分析组间关系。结果早期与进展期病灶SUVmax(χ^2=0.027)、SUVmean(χ^2=0.140)、SUVpeak(χ^2=2.108)、MTV(χ^2=1.099)上无统计学差异。而TLG(χ^2=5.240,P=0.022)是独立影响因素,进一步回归分析,与分期呈正相关性,回归系数1.482。结论鼻型结外NK/T淋巴瘤呈18 F-FDG高摄取,代谢参数TLG对淋巴瘤分期有预测价值。     

18F-FLT PET/CT与18F-FDG PET/CT在鼻咽癌诊断和分期中的应用比较

目的 通过与18F-FDG PET/CT显像对比,探讨18 F-FLT PET/CT检测鼻咽癌原发灶和颈部淋巴结转移灶的可行性.方法 12例初治且经病理确诊的鼻咽癌患者(年龄22～62岁)自愿进入该前瞻性临床研究.每位患者先行18F-FDG PET/CT检查,次日行18F-FLF PET/CT检查.至少有2位核医学科和放射科医师阅片,比较18F-FDG PET/CT和18F-FLT PET/CT图像,采用ROI技术计算鼻咽肿瘤、颈部淋巴结转移灶、正常组织对18F-FDG、18F-FLT的SUVmax、SUVmean和MTV.采用非参数Wilcoxon秩和检验比较组间摄取和MTV差异.结果 12例鼻咽癌患者病灶均明显摄取18F-FLT.18F-FLT PET/CT和18F-FDG PET/CT均可准确诊断该组病例,二者对原发灶和淋巴结转移灶的检测结果无明显差别.鼻咽癌病灶的18F-FDG和18F-FLT SUVmax分别为10.7±5.8和6.0±2.4,SUVmean分别为5.8±3.0和3.6±1.5;SUVmax和SUVmean组间差异均有统计学意义(Z=-2.589和-2.353,P均＜0.05),而 MTV在18F-FDG和8F-FLT PET/CT 2种显像方法之问的差异无统计学意义(15.9±9.2和18.1±11.1;Z=-0.786,P＞0.05).6例有颈部淋巴结转移灶患者的SUVmax、SUVmean和MTV在2种显像方法间差异均无统计学意义(8.5±6.2比6.4±2.5、5.3±4.2比3.8±1.4、6.5 ±4.8比6.0±4.4;Z=-0.734、-0.734和-0.674,P均＞0.05).18F-FLT在颞叶摄取(SUVmax 0.7±0.3)明显低于18F-FDG(SUVmax 8.3±2.7;Z=-3.062,P＜0.01),其对于原发灶颅内浸润显示较18F-FDG更清晰.结论 18F-FLT PET/CT在鼻咽癌原发灶和淋巴结转移灶的诊断效能与18F-FDG PET/CT相当,对于显示原发灶的颅底附近侵犯更有利,其临床应用值得进一步研究.     

11C-胆碱对18F-FDG PET/CT显像诊断鼻咽癌和肝细胞肝癌的补充价值

目的 探讨11C-胆碱(CHO) PET/CT对18F-FDG PET/CT显像诊断鼻咽癌(NPC)和HCC的补充价值.方法 将明确诊断的NPC和HCC患者纳入该研究.该研究经医院伦理委员会通过,患者均签署知情同意书.2007年12月至2010年1月,15例局部进展型NPC和76例HCC患者均行18 F-FDG PET/CT显像,其中43例(15例NPC和28例HCC)同时行局部11C-CHO PET/CT显像.病灶处出现18 F-FDG或11C-CHO高摄取者为阳性.半定量分析采用SUVmax、肿瘤/脑(T/B)比值和肿瘤/肝(T/L)比值等指标.统计学分析采用两样本t检验、x2检验、Fisher确切概率法和直线相关分析.结果 (1)在15例局部进展型NPC患者中,病灶处18F-FDG SUVmax明显高于11 C-CHO SUVmax (12.81 ±5.00与6.84±2.76;t =6.416,P＜0.01),但11C-CHO PET/CT显像T/B比值明显高于18F-FDG PET/CT显像(18.62±7.95与1.38±0.59;t=8.801,P＜0.01).2种显像剂在病灶处的摄取结果明显相关(r =0.712,P＜0.01).与18F-FDG PET/CT显像比较,11C-CHO显像改进了50.0％(12/12与6/12;x2=8.000,P＜0.05)患者颅内侵犯病灶、4/14患者颅底侵犯病灶和3/3患者眼眶侵犯病灶的显示.(2)在76例HCC患者中,63.1％ (48/76)的患者18F-FDG PET/CT显像阳性.在28例18 F-FDG PET/CT显像阴性者中,71.4％ (20/28)的患者11C-CHO PET/CT显像阳性.18F-FDG联合11C-CHO使PET/CT诊断HCC的灵敏度从63.1％(48/76)提高到89.5％ (68/76;x2=14.559,P＜0.01).与18F-FDG PET/CT显像比较,11C-CHO PET/CT显像倾向易于检出高分化HCC[6/9与35.7％(5/14);P =0.214];在检测中分化HCC方面,两者差异无统计学意义[6/7与72.0％(18/25),P=0.648].11C-CHO PET/CT显像在检测直径＜5.0 cm的HCC方面较18 F-FDG PET/CT显像灵敏[72.7％ (16/22)与42.1％ (16/38);x2=5.249,P＜0.05],特别是＜2.0 cm病灶[5/7与0/7;P=0.021].结论 11C-CHO与18F-FDG相结合可提高PET/CT对局部进展型NPC T分期诊断的准确性.11C-CHO可弥补18F-FDG显像在高中分化HCC诊断中的不足,从而提高PET/CT的诊断灵敏度.     

非小细胞肺癌原发灶代谢参数与区域淋巴结转移的关系研究

目的探讨非小细胞肺癌(NSCLC)18F-FDG PET/CT显像中原发病灶的各项代谢参数SUVmax、SUVmean、MTV、TLG和病灶T分期与区域淋巴结有无转移及N分期的关系及其临床价值。方法回顾性分析93例18 F-FDG PET/CT检查后行肺癌切除+区域淋巴结清扫术患者的资料,与病理对照,统计分析有无淋巴结转移、N分期与肺癌原发灶SUVmax、SUVmean、MTV、TLG、T分期之间是否有差异及相关性;通过ROC曲线方法评价SUVmax、SUVmean、MTV、TLG、T分期对肺癌患者区域淋巴结有无转移判断的价值。结果93例患者中N0 48例,N1 15例,N2 30例。Mann-Whitney U非参检验分析显示:肺癌原发灶SUVmax、SUVmean、MTV、TLG、T分期在区域淋巴结有无转移两组间均有统计学差异(P均0.05)。Spearman相关分析显示:肺癌原发灶SUVmax、SUVmean、MTV、TLG、T分期与区域淋巴结转移均有相关性(P均0.05)。非参数假设检验独立样本Kruskal-Wallis检验分析显示:除MTV外,肺癌原发灶SUVmax、SUVmean、TLG、T分期与N分期均有统计学差异(P均0.05)。Spearman相关分析,肺癌原发灶SUVmax、SUVmean、TLG、T分期与N分期均有相关性(P均0.05),MTV与N分期无明显相关性(P0.05)。利用ROC曲线分析,SUVmax、SUVmean、MTV、TLG、T分期诊断是否有区域淋巴结转移的曲线下面积分别为0.699、0.695、0.640、0.728、0.626(P均0.05)。TLG在这些参数中曲线下面积最大,具有较高诊断效能,以TLG13.765(g)作为诊断界值,诊断的敏感性83.7%,特异性45.5%,阳性预测值65.1%,阴性预测值71.4%,准确性67.7%。结论 SUVmax、SUVmean、MTV、TLG和病灶T分期与非小细胞肺癌区域淋巴结转移及N分期有一定的相关性,TLG诊断区域淋巴结是否转移效能较高,可作为判断非小细胞肺癌区域淋巴结转移的辅助手段。     

18F－FDG PET/CT图像特征与代谢参数对胃肠道间质瘤恶性程度的预测价值

目的探讨18F-FDG PET/CT图像特征及代谢参数对胃肠道间质瘤(GIST)恶性危险度的预测价值。方法回顾性分析2014年3月至2020年6月间在华中科技大学同济医学院附属协和医院与武汉大学中南医院治疗前行18F-FDG PET/CT检查的35例GIST患者(男27例、女8例, 年龄44～84岁)临床及影像资料。将18F-FDG PET/CT中GIST病灶按照图像特征分为环形摄取和非环形摄取, 使用Fisher确切概率法分析图像特征不同分组间肿瘤坏死、美国国立卫生研究院(NIH)危险度分级(简称NIH分级)之间的差异。采用Mann-WhitneyU检验分析SUVmax、基于SUVmax不同阈值(2.5、40%和50%)下的肿瘤代谢体积(MTV;MTV2.5、MTV40%、MTV50%)和病灶糖酵解总量(TLG;TLG2.5、TLG40%、TLG50%)与临床病理特征(病变部位、肿瘤最大径、核分裂象、细胞增殖核抗原Ki-67、坏死、图像特征、NIH分级)的关系。采用Spearman秩相关分析临床病理特征与代谢参数的相关性。绘制不同代谢参数诊断NIH分级的ROC曲线, 采用Delong...     

~(18)F-FDG PET/CT对不明原因发热病因的诊断价值

目的：探讨^18F-脱氧葡萄糖（FDG）PET/CT显像对不明原因发热（FUO）的影像学表现及病因诊断价值。方法：回顾性分析常规检查未能明确诊断FUO病因的45例患者^18F-FDG PET/CT显像资料,根据病理检查或临床随访结果分析^18F-FDG PET/CT显像结果,测量异常摄取病灶最大标准摄取值（SUVmax）。采用SPSS 11.0软件进行数据处理,SUVmax两样本均数比较采用t检验。结果：45例患者中35例^18F-FDG PET/CT全身显像发现至少有1处异常放射性浓聚灶,随访证实其中9例为恶性肿瘤,26例为感染或炎性病变,二者病变的SUVmax分别为6.09±1.46和2.57±1.33,差异有显著性意义（t=6.67,P〈0.05）;10例^18F-FDG PET/CT显像阴性患者,6例病因不明,4例为风湿性疾病。^18F-FDGPET/CT显像有助于临床FUO病因诊断。结论：全身^18F-FDG PET/CT显像在其它检查方法未能明确诊断FUO病因时,可为临床进一步诊断提供重要的参考价值。     

孤立性肺病变18F-FDG PET/CT显像诊断价值及误诊原因分析

目的 探讨18F-FDG PET/CT显像对孤立性肺病变的诊断价值及误诊原因.方法 回顾分析32例孤立性肺部病变患者18F-FDG PET/CT显像结果.将PET/CT结果与病理检查结果进行对比,评价18F-FDG PET/CT显像在孤立性肺部病变诊断中的价值,并分析其误诊原因.应用SPSS 16.0软件行统计学分析,SUVmax及SUVmax变化率(△SUVmax)与病灶直径大小关系采用Pearson相关分析.结果 32例孤立性肺部病变中,恶性病变22例,良性病变10例.18F-FDG PET/CT对68.75％( 22/32)患者进行了准确定性诊断.18F-FDG PET/CT显像假阴性5例,假阳性5例.22例肺部恶性病变中,6例恶性病变早期SUVmax ＜2.5,5例恶性病变△SUVmax＜15％.10例肺部良性病变中,2例良性病变早期SUVmax≥2.5,4例良性病变△SUVmax≥15％.良恶性病变SUVmax及△SUVmax有交叉.32例肺部病变中,孤立性肺部病变最大直径≤3 cm共26例,最大直径＞3 cm共6例,平均(1.98±1.08) cm.SUV max与病变直径大小呈正相关(r=0.690,P＜0.01),△SUVmax与病灶直径大小无相关性(r=-0.081,P＞0.05).结论 18F-FDG PET/CT在肺部孤立性病变定性诊断中有重要临床价值,但单纯依靠SUV max存在不足,应将PET与CT综合分析.     

~(18)F-FDG PET/CT SUVmax与淋巴瘤临床分期、病理分级关系的探讨

目的:探讨18F-脱氧葡萄糖(18F-FDG)PET/CTSUVmax与淋巴瘤临床分期、病理分级关系。方法:初治淋巴瘤患者23例(均经病理组织学确定),按Ann Arbor分期法进行临床分期,Ⅰ、Ⅱ、Ⅲ及Ⅳ期患者分别有5、6、7、5例;其中20例NHL患者,以病理结果为依据,低、中、高度恶性患者分别有2、9、9例。所有患者皆行18F-FDG PET/CT显像,获得所有病灶的SUVmax值,采用方差分析进行数据处理。结果:①Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的淋巴结平均SUVmax值分别为6.00±2.69、6.88±4.08、11.10±5.05和10.46±4.48,Ⅱ期与Ⅲ、Ⅳ期之间的差异显著(P=0.000),其余各期之间无统计学差异;②低、中、高度恶性NHL患者病灶的平均SUVmax值分别为5.13±0.15、8.47±5.24、10.53±5.37,后两者之间有差异(P=0.03)。结论:SUVmax值与淋巴瘤临床分期及NHL恶性程度呈正相关趋势。     

18F-FDG与18F-FLT PET/CT延迟显像对肺结节诊断效能的评价

目的 通过对多中心、前瞻性研究中接受了18F-脱氧葡萄糖(FDG)与18F-脱氧胸腺嘧啶核苷(FLT)延迟显像病例的分析,探讨18F-FDG与18F-FLT延迟显像对肺结节诊断的效能.方法 6个PET/CT中心,从2006年1月至2007年6月,按照统一标准,采用同机型、同一扫描条件,开展了肺结节样病变18F-FLT和18F-FDG PET/CT显像的多中心临床研究.在经确诊的55例病例中,25例患者进行了18F-FLT显像和延迟显像,34例患者进行了18F-FDG延迟显像.按常规计算延迟显像时病灶最大标准摄取值(SUVmax)及与早期显像时SUVmax相比的变化率(△SUVmax).对照临床确诊结果分析其诊断效能.采用SPSS11.0软件进行统计学处理.结果 18F-FDG延迟显像患者中,6例肺癌中5例、12例结核中9例、16例炎症或其他良性结节中9例的SUVmax较早期相升高.18F-FLT延迟显像组中,7例肺癌中3例、8例结核中3例和10例其他良性病灶中2例的SUVmax上升.经分组统计分析,不同疾病组间18F-FDG延迟显像SUVmax和△SUVmax差异无统计学意义;18F-FLT延迟显像SUVmax和△SUVmax组间差异也无统计学意义.无论18F-FDG还是18F-FLT,延迟显像的诊断效能均不如早期相.无论早期还是延迟显像,单独18F-FDG或18F-FLT显像的诊断效能均不如二者联合应用.结论 18F-FDG和18F-FLT延迟显像的SUVmax变化规律性不强,不宜单独应用于肺结节的鉴别诊断.     

18F-FDG PET/CT显像在恶性胸膜间皮瘤诊断中的价值

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT显像在恶性胸膜间皮瘤(MPM)诊断中的临床价值及原发肿瘤病灶平均标准摄取值(SUVmax)对患者预后的判断价值.方法 回顾性总结17例2002-2008年临床疑诊MPM患者18F-FDG PET/CT显像资料,测量病灶的SUVmax.将病理检查及临床随访证实的MPM患者按照有无转移分为2组,测定每例患者原发肿瘤病灶的SUVmax,用受试者工作特征(ROC)曲线评价SUVmax对患者转移与否的诊断价值,判断预后.采用SPSS 11.0软件进行t检验.结果 经病理及随访结果证实MPM 12例,良性胸膜病变5例,二者的SUVmax分别为5.78±1.81和2.72±2.51,差异有统计学意义(t=2.8,P<0.05).全身18F-FDG PET/CT显像诊断MPM的灵敏度为100%(12/12),特异性为4/5,准确性为94%(16/17),18F-FDG PET/CT显像有7例MPM伴有骨和(或)淋巴结转移.SUVmaxROC曲线分析表明曲线下面积(AUC)为0.80.结论 全身18F-FDG PET/CT显像对于MPM的诊断有重要价值.原发肿瘤病灶SUVmax越高越易发生转移,预后越差.     

18F-FDG PET/CT代谢参数判断Ⅱ～Ⅲ期弥漫大B细胞淋巴瘤的预后价值

目的 探讨Ⅱ~Ⅲ期弥漫大B细胞淋巴瘤（DLBCL）治疗前18F-FDG PET/CT显像中最大标准化摄取值（SUV_max）、代谢体积（MTV）和病灶糖酵解总量（TLG）的预后价值。 方法 回顾性分析2009年6月至2015年12月诊治的85例初诊Ⅱ~Ⅲ期DLBCL患者的临床资料及治疗前18F-FDG PET/CT显像资料。以SUV_max的41%作为阈值,得出病灶的SUV_max、MTV和TLG。由受试者工作特征（ROC）曲线判断SUV_max、MTV及TLG预测无进展生存期（PFS）的最佳界值点。采用Kaplan-Meier法进行生存分析,单因素分析采用Log-rank 检验,多因素生存分析采用Cox比例风险模型。 结果 85例DLBCL患者的SUV_max、MTV及TLG的中位数分别为23.9（16.3）、25.1（95.3）cm3、424.4（1404.6）。ROC曲线分析结果显示:SUV_max的曲线下面积（AUC）=0.610（95%CI=0.483~0.736,P=0.109）,MTV的AUC=0.729（95%CI=0.621~0.838,P=0.001）,TLG的AUC=0.726（95%CI=0.621~0.831,P=0.001）。由于SUV_max的AUC较小,不能通过ROC曲线分析获得界值点,因此以SUV_max的中位数23.9作为界值点进行分组。MTV的界值点为39.1 cm3（灵敏度为73.1%,特异度为69.5%）;TLG的界值点为404.5（灵敏度为80.8%,特异度为61.0%）。单因素分析结果显示:Ann Arbor分期、β-2微球蛋白、乳酸脱氢酶、大肿块、国际预后指数（IPI）、SUV_max、MTV、TLG是Ⅱ~Ⅲ期DLBCL患者PFS的影响因素（χ2=19.118,P=0.000;χ2=12.310,P=0.000;χ2=4.861,P=0.027;χ2=7.731, P=0.013;χ2=19.693, P=0.000;χ2=6.414, P=0.011;χ2=14.538,P=0.000;χ2=13.089, P=0.000）。Ann Arbor分期、β-2微球蛋白、大肿块、IPI、MTV、TLG是患者总体生存期（OS）的影响因素（χ2=14.550, P=0.000;χ2=5.473, P=0.019;χ2=5.643, P=0.018;χ2=15.943, P=0.000;χ2=13.877, P=0.000;χ2=12.677, P=0.000）。由于MTV与TLG呈高度相关,多因素分析时,二者中仅纳入了TLG,结果显示乳酸脱氢酶、TLG是影响患者PFS的独立危险因素（RR=4.891, 95%CI=1.332~11.955,P=0.017;RR=0.195, 95%CI=0.058~0.660,P=0.009）,IPI、TLG是影响患者OS的独立危险因素（RR=0.508, 95%CI=0.270~0.956,P=0.036;RR=0.433, 95%CI=0.227~0.826,P=0.011）。 结论 18F-FDG PET/CT所测得的TLG是影响Ⅱ~Ⅲ期DLBCL患者PFS及OS的独立预后因素,TLG比SUV_max具有更好的预测价值,对DLBCL患者预后判断具有一定的参考价值。     

Usefulness of Combined Metabolic–Volumetric Indices of 18F-FDG PET/CT for the Early Prediction of Neoadjuvant Chemotherapy Outcomes in Breast Cancer

Purpose

The purpose of this study was to investigate the usefulness of metabolic-volumetric indices of ¹⁸F- fluorodeoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) for the evaluation of neoadjuvant chemotherapy outcomes in breast cancer.

Methods

Twenty-four patients with locally advanced breast cancer were enrolled in the study. They underwent baseline ¹⁸F-FDG PET/CT scan and received four or six cycles of neoadjuvant chemotherapy, interim ¹⁸F-FDG PET/CT was done after second cycle of chemotherapy. Maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary lesions were calculated. Reduction rates of these parameters were obtained between baseline and interim ¹⁸F-FDG PET/CT. Chemotherapy outcomes were assessed using tumor size reduction rate and histological grading system (Miller and Payne system). Reduction rates of SUVmax, MTV, and TLG correlated with chemotherapy outcomes.

Results

MTV and TLG reduction rates showed significant correlation with tumor size reduction rate (R = 0.68, P = 0.0004; R = 0.62, P = 0.002, respectively). However, SUVmax reduction rate showed no significant correlation. MTV and TLG reduction rates were significantly higher in responders than nonresponders, as determined by Miller and Payne system (P < 0.0007, P < 0.002). However, SUVmax reduction rate showed no significant difference. On ROC analysis, the area under the MTV and TLG curves was 0.886, and that of SUVmax was 0.743. Sensitivity, specificity, positive predictive value, and negative predictive value to predict histopathologic response were the same for MTV and TLG, and the values were 100 %, 85.7 %, 83.3 %, and 100 %, respectively (at the reduction rate of 93.2 % for MTV, and 95.8 % for TLG).

Conclusion

Changes of metabolic–volumetric indices successfully reflected the neoadjuvant chemotherapy outcomes. MTV and TLG could be robust indices in discriminating pathologic responder as SUVmax, after neoadjuvant chemotherapy.     

Volume-based assessment by 18F-FDG PET/CT predicts survival in patients with stage III non-small-cell lung cancer

Purpose

We evaluated the prognostic impact of volume-based assessment by ¹⁸F-FDG PET/CT in patients with stage III non-small-cell lung cancer (NSCLC).

Methods

We reviewed 194 consecutive patients with stage IIIA NSCLC treated with surgical resection (surgical group) and 115 patients treated with nonsurgical therapy (nonsurgical group: 50 stage IIIA, 65 stage IIIB). Metabolic tumour volume (MTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax) of primary tumours were measured using pretreatment ¹⁸F-FDG PET/CT. Overall survival was assessed using the Kaplan-Meier method. The prognostic significance of PET parameters and other clinical variables was assessed using Cox proportional hazards regression analyses. To evaluate and compare the predictive performance of PET parameters, time-dependent receiver operating characteristic (ROC) curve analysis was used.

Results

In the Cox proportional hazards models, MTV (HR?=?1.27 for a doubling of MTV, P?=?0.008) and TLG (HR?=?1.22 for a doubling of TLG, P?=?0.035) were significantly associated with an increased risk of death after adjusting for age, gender, histological cell type, T stage, N stage, and treatment variables in the surgical group. SUVmax was not a significant prognostic factor in either the surgical or nonsurgical group. In the time-dependent ROC curve analysis, volume-based PET parameters predicted survival better than SUVmax.

Conclusion

The volume-based PET parameters (MTV and TLG) are significant prognostic factors for survival independent of tumour stage and better prognostic imaging biomarkers than SUVmax in patients with stage IIIA NSCLC after surgical resection.     

Metabolic tumour burden assessed by 18F-FDG PET/CT associated with serum CA19-9 predicts pancreatic cancer outcome after resection

Purpose

Tumour burden is one of the most important prognosticators for pancreatic ductal adenocarcinoma (PDAC). The aim of this study was to investigate the predictive significance of metabolic tumour burden measured by ¹⁸F-FDG PET/CT in patients with resectable PDAC.

Methods

Included in the study were 122 PDAC patients who received preoperative ¹⁸F-FDG PET/CT examination and radical pancreatectomy. Metabolic tumour burden in terms of metabolic tumour volume (MTV) and total lesion glycolysis (TLG), pathological tumour burden (tumour size), serum tumour burden (baseline serum CA19-9 level), and metabolic activity (maximum standard uptake value, SUVmax) were determined, and compared for their performance in predicting overall survival (OS) and recurrence-free survival (RFS).

Results

MTV and TLG were significantly associated with baseline serum CA19-9 level (P?=?0.001 for MTV, P?<?0.001 for TLG) and tumour size (P?<?0.001 for MTV, P?=?0.001 for TLG). Multivariate analysis showed that MTV, TLG and baseline serum CA19-9 level as either categorical or continuous variables, but not tumour size or SUVmax, were independent risk predictors for both OS and RFS. Time-dependent receiving operating characteristics analysis further indicated that better predictive performances for OS and RFS were achieved by MTV and TLG compared to baseline serum CA19-9 level, SUVmax and tumour size (P?<?0.001 for all).

Conclusion

MTV and TLG showed strong consistency with baseline serum CA19-9 level in better predicting OS and RFS, and might serve as surrogate markers for prediction of outcome in patients with resectable PDAC.     

F-18 FDG PET/CT metabolic tumor volume predicts overall survival in patients with disseminated epithelial ovarian cancer

ObjectiveWe evaluated the prognostic impact of quantitative assessment by maximum standardized uptake value (SUVmax), metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG) on [F-18] FDG PET/CT for patients with peritoneal carcinomatosis from epithelial ovarian cancer (EOC).MethodsThirty-one patients with EOC underwent PET/CT for an early restaging after cytoreductive surgery, having been diagnosed with carcinomatosis (before chemotherapy). The SUVmax, MTV (cm³; 42% threshold) and TLG (g) were registered on residual peritoneal lesions. The patients were followed up 20 ± 12 months thereafter. The PET/CT results were compared to overall survival (OS).ResultsThe Kaplan-Meier survival analysis for the SUVmax did not reveal significant differences in OS (p = 0.48). The MTV survival analysis showed a significant higher OS in patients presenting with a higher tumour burden than those with less tumour burden (p = 0.01; 26 vs. 14 months), whereas TLG exhibited a similar trend though not significant (p = 0.06). Apart from chemo-resistance, the higher the MTV, the better will be the response to chemotherapy.ConclusionsQuantitative assessment by MTV rather than by SUVmax and TLG on PET/CT may be helpful for stratifying patients who present with peritoneal carcinomatosis from EOC, in order to implement the appropriate therapeutic regimen.     

The role of F-18 FDG PET/CT in evaluating the impact of HIV infection on tumor burden and therapy outcome in patients with Hodgkin lymphoma

Background

To evaluate the impact of HIV infection on tumor burden and therapy outcome following treatment with chemotherapy in patients with Hodgkin lymphoma.

Methods

A total of 136 patients with classical Hodgkin lymphoma were studied (mean age ± SD = 32.31 ± 1.39 years, male = 86, female = 50). Advanced disease (stage III and IV) was present in 64% of patients. HIV infection was present in 57 patients while 79 patients were HIV-negative. Baseline F-18 FDG PET/CT was obtained in all patients. SUVmax, MTV and TLG were determined on the baseline scan to evaluate for tumor burden. All patients completed a standard regimen of adriamycin, bleomycin, vinblastine and dacarbazine (ABVD). After a median period of 8 weeks (range = 6 to 17 weeks), a repeat F-18 FDG PET/CT scan was obtained to evaluate response to therapy using Deauville 5-point scoring system.

Results

The HIV-positive and HIV-negative groups were similar with regards to age and disease stage. The groups were heterogeneous with respect to gender (p = 0.029). The SUVmax, MTV and TLG of lesions were not significant different between the two groups. Complete response was seen in 72.8% of the study population. Presence of HIV infection was associated with higher rate of treatment failure with 40.4% of the HIV-positive patients having treatment failure while only 17.7% of the HIV-negative patients had treatment failure (p = 0.0034). HIV infection was a significant predictor of response to chemotherapy. Effects of SUVmax, MTV, TLG and Ann Arbor stage of the disease were not statistically significant as predictors of therapy outcome. In a multiple logistic regression, presence of HIV infection still remained an independent predictor of therapy outcome in the presence of other factors such as SUVmax, MTV, TLG and the Ann Arbor stage of the disease.

Conclusions

HIV infection is not associated with a higher tumor burden in patients with Hodgkin lymphoma. HIV infection is, however, a strong predictor of poor therapy outcome in patients treated with standard regimen of ABVD.

     

Total lesion glycolysis by 18F-FDG PET/CT is a reliable predictor of prognosis in soft-tissue sarcoma

Purpose

Preoperative identification of aggressiveness is important for the establishment of a treatment strategy in patients with soft-tissue sarcoma (STS). We compared the predictive values of various metabolic parameters derived from PET/CT with ¹⁸F-FDG, including maximal standardized uptake value (SUVmax), total lesion glycolysis (TLG) and metabolic tumour volume (MTV).

Methods

A total of 66 patients with STS who had undergone FDG PET/CT before tumour resection were reviewed retrospectively. We determined SUVmax, TLG and MTV to compare their value in predicting disease progression, which was defined as local recurrence and metastases. Receiver operating characteristic curve (ROC) analysis was used to compare the accuracy. Univariate and multivariate analyses of conventional clinicopathological variables were used to compare the reliability of the metabolic parameters.

Results

TLG exhibited greater accuracy than SUVmax or MTV in ROC analysis (area under curve, AUC, 0.802, 0.726 and 0.681, respectively). The cut-off values for disease progression derived from the AUC data were TLG 250; SUVmax 6.0, and MTV 40 cm³. In univariate analysis, TLG (>250) was a more significant predictive factor than SUVmax and MTV (P?<?0.001, P?=?0.031 and P?=?0.022, respectively). TLG was the only meaningful metabolic parameter in the multivariate analysis (P?=?0.008) other than presence of metastasis at diagnosis (P?=?0.003).

Conclusion

TLG is a more accurate predictor of disease progression than SUVmax or MTV. TLG enables accurate preoperative assessment of aggressiveness comparable with conventional clinicopathological parameters.     

A case of non-Hodgkin’s lymphoma of the ovary: Usefulness of18F-FDG PET for staging and assessment of the therapeutic response

Primary ovarian lymphoma as the initial manifestation is rare. A 27-year-old woman presented to our hospital with the symptoms of lower abdominal fullness and pollakisuria. CT scan and MRI revealed bilateral ovarian tumors, which showed heterogeneous masses. 18F-FDG PET revealed strong uptake by the abdominal masses, and the maximum standardized uptake value (SUVmax) was 12.5. Abnormal uptake was not shown by other regions. An exploratory laparotomy was performed. Histological findings revealed diffuse large B-cell lymphoma. The clinical stage was IV according to the Ann Arbor system. International prognostic index (IPI) was 3 (high-intermediate risk). Chemotherapy was administered consisting of three courses of an R-CHOP regimen, and 18F-FDG PET and CT scan revealed no signs of involvement 3 months after initiation of the chemotherapy. 18F-FDG PET was a useful method for staging and assessment of the therapeutic response in primary ovarian lymphoma.     

The role of metabolic tumor volume and total lesion glycolysis on 18F-FDG PET/CT in the prognosis of epithelial ovarian cancer

Purpose

This study assessed the prognostic value of pre-operative 2-[¹⁸F] fluoro-2-deoxy-D-glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) volumetric parameters, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), in patients with epithelial ovarian cancer.

Methods

A total of 175 patients with epithelial ovarian cancer who underwent ¹⁸?F-FDG PET/CT and subsequent cytoreductive surgery were retrospectively enrolled. Maximum standardized uptake value (SUVmax) on ¹⁸F-FDG PET/CT was measured for all patients. Because nine patients showed low tumor-to-background uptake ratios, MTV and TLG were measured in 166 patients. Univariate and multivariate analyses were performed to evaluate the prognostic significance of SUVmax, MTV, TLG, and clinicopathological factors for disease progression-free survival.

Results

Disease progressed in 78 (44.6 %) of the 175 patients, and the 2-year disease progression-free survival rate was 57.5 %. Univariate analysis showed that tumor stage, histopathological type, presence of regional lymph node metastasis, residual tumor after cytoreductive surgery, pre-operative serum carbohydrate antigen 125 (CA125) level, SUVmax, MTV, and TLG were significant prognostic factors (p?100.0).

Conclusion

Along with tumor stage, TLG is an independent prognostic factor for disease progression after cytoreductive surgery in patients with epithelial ovarian cancer. By combining tumor stage and TLG, one can further stratify the risk of disease progression for patients undergoing cytoreductive surgery.