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Adnan A, Basu S. PET-based Quantitative Techniques in Assessing Efficacy of Interventional Radiology Procedures in Oncology. PET Clin 2025:S1556-8598(25)00028-8. [PMID: 40340172 DOI: 10.1016/j.cpet.2025.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2025]
Abstract
Interventional radiology (IR) is a super specialised branch where imaging modalities are employed to guide disease specific diagnostic and therapeutic interventions. IR interventions have gained popularity in various oncological and non-oncological indications due to it's ability to effectively diagnose the disease and direct specific targeted treatment. Hybrid imaging using PET CT and PET MRI combines the best of morphological and functional informations and offers improved sensitivity and specificity for detection of lesion; helps in accurate mapping of tumour burden, thereby aiding in planning curative vs palliative intent intervention; more accurate response evaluation to plan redo session in cases of residual / recurrent disease or for follow up evaluation and for prognostication and predicting response. Albeit visual analysis of PET images by specialist is most commonly performed for reading PET scans, PET has a remarkable capability to provide quantitative information. The present review provides a comprehensive assessment of the role of various aspects of quantitative PET parameters in assessing the efficacy of IR interventions. The insights provided will help clinicians, researchers, and medical professionals understand the role of PET imaging in advancing patient care and enhancing the therapeutic outcomes of IR procedures.
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Affiliation(s)
- Aadil Adnan
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Parel, Mumbai, Maharahtra, India; Homi Bhabha National Institute, Mumbai, India; Department of Nuclear Medicine, Medica Cancer Center, Medica Superspeciality Hospital, 127, Eastern Metropolitean Bypass, Mukundapur, Kolkata, West Bengal, India
| | - Sandip Basu
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Centre Annexe, Parel, Mumbai, Maharahtra, India; Homi Bhabha National Institute, Mumbai, India.
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Tamaki N, Manabe O, Hirata K. Cardiovascular imaging in cardio-oncology. Jpn J Radiol 2024; 42:1372-1380. [PMID: 39207643 PMCID: PMC11588866 DOI: 10.1007/s11604-024-01636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
Advances in cancer treatment have improved in patient survival rate. On the other hand, management of cardiovascular complications has been increasingly required in cancer patients. Thus, cardio-oncology has attracted the attention by both oncologists and cardiologists. Cardiovascular imaging has played a key role for non-invasive assessment of cardiovascular alterations complimentary to biomarkers and clinical assessment. Suitable imaging selection and interpretation may allow early diagnosis of cardiovascular injury with potential implications for therapeutic management and improved outcomes after cancer therapy. Echocardiography has been commonly used to evaluate cardiac dysfunction in cardio-oncology area. Cardiac CT is valuable for assessing structural abnormalities of the myocardium, coronary arteries, and aorta. Molecular imaging has an important role in the assessment of the pathophysiology and future treatment strategy of cardiovascular dysfunction. Cardiac MRI is valuable for characterization of myocardial tissue. PET and SPECT molecular imaging has potential roles for quantitative assessment of cardiovascular disorders. Particularly, FDG-PET is considered as an elegant approach for simultaneous assessment of tumor response to cancer therapy and early detection of possible cardiovascular involvement as well. This review describes the promising potential of these non-invasive cardiovascular imaging modalities in cardio-oncology.
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Affiliation(s)
- Nagara Tamaki
- Kyoto College of Medical Science, Sonobe, Kyoto, Japan.
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Kenji Hirata
- Department of Diagnostic Imaging, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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Manabe O, Takahashi K, Kawakami H, Ohtsuka A, Aikawa T, Maki H, Ibe T, Fujita H, Oyama-Manabe N. Diagnostic values of delayed additional FDG PET/CT scan in the evaluation of cardiac sarcoidosis. Ann Nucl Med 2023; 37:535-540. [PMID: 37418117 DOI: 10.1007/s12149-023-01855-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/16/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE This study aimed to compare the contribution of 18F-fluorodepxyglucose (FDG) positron (PET)/ computed tomography (CT) acquisition of early and delayed scans in patients with cardiac sarcoidosis (CS). METHODS Twenty-three patients with CS (median age: 69 years; 11 women) were retrospectively evaluated using dual-phase FDG PET/CT. All patients were instructed to consume a low-carbohydrate diet followed by fasting for 18 h before FDG injection to reduce physiological myocardial uptake. PET/CT was acquired at 60 min (early) and 100 min (delayed) after FDG administration. Focal and focal on diffuse uptake on visual analysis was considered positive for CS. A semi-quantitative analysis was performed using the maximum standardized uptake value (SUVmax) of the cardiac lesion and the mean SUV (SUVmean) of the blood pool. RESULTS Significant myocardial FDG uptake was observed in 21 patients (91.3%) in the early acquisition group and in 23 patients in the delayed scan group (100%). Compared to the early scan, the delayed scan showed a significantly higher SUVmax of the cardiac lesion [median, 4.0; IQR (interquartile range, 2.9 to 7.0) vs. 5.8 (IQR 3.7 to 10.1); P = 0.0030] and a significantly lower SUVmean of blood pool [median, 1.3 (IQR, 1.2 to 1.4) vs. 1.1 (IQR, 0.9 to 1.2); P < 0.0001]. CONCLUSION Delayed FDG PET/CT acquisition improves detection accuracy in patients with CS compared to early scans with washout of the blood pool activity. Therefore, it can contribute to a more accurate assessment of CS.
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Affiliation(s)
- Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Keiko Takahashi
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
| | - Hiroki Kawakami
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Akira Ohtsuka
- Central Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan
- Department of Cardiology, Juntendo University Urayasu Hospital, Urayasu, Japan
| | - Hisataka Maki
- Department of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tatsuro Ibe
- Department of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideo Fujita
- Department of Cardiovascular Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
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Einama T, Yamagishi Y, Takihata Y, Konno F, Kobayashi K, Yonamine N, Fujinuma I, Tsunenari T, Kouzu K, Nakazawa A, Iwasaki T, Shinto E, Ishida J, Ueno H, Kishi Y. Clinical Impact of Dual Time Point 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Fusion Imaging in Pancreatic Cancer. Cancers (Basel) 2022; 14:cancers14153688. [PMID: 35954351 PMCID: PMC9367454 DOI: 10.3390/cancers14153688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 01/27/2023] Open
Abstract
We examined the value of preoperative dual time point (DTP) 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (FDG PET/CT) as a predictor of early recurrence or the outcomes in patients with pancreatic cancer. Standardized uptake values (SUVs) in DTP FDG PET/CT were performed as preoperative staging. SUVmax1 and SUVmax2 were obtained in 60 min and 120 min, respectively. ΔSUVmax% was defined as (SUVmax2 − SUVmax1)/SUVmax1 × 100. The optimal cut-off values for SUVmax parameters were selected based on tumor relapse within 1 year of surgery. Optimal cut-off values for SUVmax1 and ΔSUVmax% were 7.18 and 24.25, respectively. The combination of SUVmax1 and ΔSUVmax% showed higher specificity and sensitivity, and higher positive and negative predictive values for tumor relapse within 1 year than SUVmax1 alone. Relapse-free survival (RFS) was significantly worse in the subgroups of high SUVmax1 and high ΔSUVmax% (median 7.0 months) than in the other subgroups (p < 0.0001). The multivariate Cox analysis of RFS identified high SUVmax1 and high ΔSUVmax% as independent prognostic factors (p = 0.0060). DTP FDG PET/CT may effectively predict relapse in patients with pancreatic cancer. The combination of SUVmax1 and ΔSUVmax% identified early recurrent patient groups more precisely than SUVmax1 alone.
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Affiliation(s)
- Takahiro Einama
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Yoji Yamagishi
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Yasuhiro Takihata
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Fukumi Konno
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Kazuki Kobayashi
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Naoto Yonamine
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Ibuki Fujinuma
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Takazumi Tsunenari
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Akiko Nakazawa
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Toshimitsu Iwasaki
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Jiro Ishida
- Tokorozawa PET Diagnostic Imaging Clinic, Saitama 359-1124, Japan;
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Saitama 359-8513, Japan; (T.E.); (Y.Y.); (Y.T.); (F.K.); (K.K.); (N.Y.); (I.F.); (T.T.); (K.K.); (A.N.); (T.I.); (E.S.); (H.U.)
- Correspondence: ; Tel.: +81-4-2995-1211
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Manabe O, Oyama-Manabe N, Aikawa T, Tsuneta S, Tamaki N. Advances in Diagnostic Imaging for Cardiac Sarcoidosis. J Clin Med 2021; 10:jcm10245808. [PMID: 34945105 PMCID: PMC8704832 DOI: 10.3390/jcm10245808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/05/2021] [Accepted: 12/09/2021] [Indexed: 11/16/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease of unknown etiology, and its clinical presentation depends on the affected organ. Cardiac sarcoidosis (CS) is one of the leading causes of death among patients with sarcoidosis. The clinical manifestations of CS are heterogeneous, and range from asymptomatic to life-threatening arrhythmias and progressive heart failure due to the extent and location of granulomatous inflammation in the myocardium. Advances in imaging techniques have played a pivotal role in the evaluation of CS because histological diagnoses obtained by myocardial biopsy tend to have lower sensitivity. The diagnosis of CS is challenging, and several approaches, notably those using positron emission tomography and cardiac magnetic resonance imaging (MRI), have been reported. Delayed-enhanced computed tomography (CT) may also be used for diagnosing CS in patients with MRI-incompatible devices and allows acceptable evaluation of myocardial hyperenhancement in such patients. This article reviews the advances in imaging techniques for the evaluation of CS.
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Affiliation(s)
- Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan; (O.M.); (T.A.)
| | - Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan; (O.M.); (T.A.)
- Correspondence: ; Tel.: +81-48-647-2111
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama 330-8503, Japan; (O.M.); (T.A.)
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo 060-8648, Japan;
| | - Nagara Tamaki
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
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Oyama-Manabe N, Manabe O, Aikawa T, Tsuneta S. The Role of Multimodality Imaging in Cardiac Sarcoidosis. Korean Circ J 2021; 51:561-578. [PMID: 34085435 PMCID: PMC8263295 DOI: 10.4070/kcj.2021.0104] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 04/21/2021] [Indexed: 12/19/2022] Open
Abstract
The etiology and the progression of sarcoidosis remain unknown. However, cardiac sarcoidosis (CS) is significantly associated with a poor prognosis due to the associated congestive heart failure, arrhythmias (such as an advanced atrioventricular block), and ventricular tachyarrhythmia. Novel imaging modalities are now available to detect CS lesions secondary to active inflammation, granuloma formation, and fibrotic changes. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) and cardiac magnetic resonance imaging (CMR) play essential roles in diagnosing and monitoring patients with confirmed or suspected CS. The following focused review will highlight the emerging role of non-invasive cardiac imaging techniques, including FDG PET/CT and CMR.
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Affiliation(s)
- Noriko Oyama-Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tadao Aikawa
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.,Department of Cardiology, Hokkaido Cardiovascular Hospital, Sapporo, Japan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
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Akamatsu G, Tashima H, Takyu S, Kang HG, Iwao Y, Takahashi M, Yoshida E, Yamaya T. Design consideration of compact cardiac TOF-PET systems: a simulation study. Phys Med Biol 2021; 66. [PMID: 33721860 DOI: 10.1088/1361-6560/abeea4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/15/2021] [Indexed: 11/12/2022]
Abstract
Myocardial perfusion imaging (MPI) with PET plays a vital role in the management of coronary artery disease. High sensitivity systems can contribute to maximizing the potential value of PET MPI; therefore, we have proposed two novel detector arrangements, an elliptical geometry and a D-shape geometry, that are more sensitive and more compact than a conventional large-bore cylindrical geometry. Here we investigate two items: the benefits of the proposed geometries for cardiac imaging; and the effects of scatter components on cardiac PET image quality. Using the Geant4 toolkit, we modeled four time-of-flight (TOF) PET systems: an 80-cm-diameter cylinder, a 40-cm-diameter cylinder, a compact ellipse, and a compact D-shape. Spatial resolution and sensitivity were measured using point sources. Noise equivalent count rate (NECR) and image quality were examined using an anthropomorphic digital chest phantom. The proposed geometries showed higher sensitivity and better count rate characteristics with a fewer number of detectors than the conventional large-bore cylindrical geometry. In addition, we found that the increased intensity of the scatter components was a big factor affecting the contrast in defect regions for such a compact geometry. It is important to address the issue of the increased intensity of the scatter components to develop a high-performance compact cardiac TOF PET system.
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Affiliation(s)
- Go Akamatsu
- National Institute of Radiological Sciences, Chiba, 263-8555, JAPAN
| | | | - Sodai Takyu
- National Institute of Radiological Sciences, Chiba, JAPAN
| | - Han Gyu Kang
- National Institute of Radiological Sciences, Chiba, JAPAN
| | - Yuma Iwao
- National Institute of Radiological Sciences, Chiba, JAPAN
| | | | - Eiji Yoshida
- National Institute of Radiological Sciences, Chiba, JAPAN
| | - Taiga Yamaya
- National Institute of Radiological Sciences, Chiba, JAPAN
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Hirata K, Tamaki N. Quantitative FDG PET Assessment for Oncology Therapy. Cancers (Basel) 2021; 13:cancers13040869. [PMID: 33669531 PMCID: PMC7922629 DOI: 10.3390/cancers13040869] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary PET enables quantitative assessment of tumour biology in vivo. Accumulation of F-18 fluorodeoxyglucose (FDG) may reflect tumour metabolic activity. Quantitative assessment of FDG uptake can be applied for treatment monitoring. Numerous studies indicated biochemical change assessed by FDG-PET as a more sensitive marker than morphological change. Those with complete metabolic response after therapy may show better prognosis. Assessment of metabolic change may be performed using absolute FDG uptake or metabolic tumour volume. More recently, radiomics approaches have been applied to FDG PET. Texture analysis quantifies intratumoral heterogeneity in a voxel-by-voxel basis. Combined with various machine learning techniques, these new quantitative parameters hold a promise for assessing tissue characterization and predicting treatment effect, and could also be used for future prognosis of various tumours. Abstract Positron emission tomography (PET) has unique characteristics for quantitative assessment of tumour biology in vivo. Accumulation of F-18 fluorodeoxyglucose (FDG) may reflect tumour characteristics based on its metabolic activity. Quantitative assessment of FDG uptake can often be applied for treatment monitoring after chemotherapy or chemoradiotherapy. Numerous studies indicated biochemical change assessed by FDG PET as a more sensitive marker than morphological change estimated by CT or MRI. In addition, those with complete metabolic response after therapy may show better disease-free survival and overall survival than those with other responses. Assessment of metabolic change may be performed using absolute FDG uptake in the tumour (standardized uptake value: SUV). In addition, volumetric parameters such as metabolic tumour volume (MTV) have been introduced for quantitative assessment of FDG uptake in tumour. More recently, radiomics approaches that focus on image-based precision medicine have been applied to FDG PET, as well as other radiological imaging. Among these, texture analysis extracts intratumoral heterogeneity on a voxel-by-voxel basis. Combined with various machine learning techniques, these new quantitative parameters hold a promise for assessing tissue characterization and predicting treatment effect, and could also be used for future prognosis of various tumours, although multicentre clinical trials are needed before application in clinical settings.
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Affiliation(s)
- Kenji Hirata
- Department of Diagnostic Imaging, Graduate School of Medicine, Hokkaido University, Sapporo 060-8638, Japan;
| | - Nagara Tamaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan
- Correspondence:
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