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Yamakawa N, Nakayama Y, Ueda N, Yagyuu T, Tamaki S, Kirita T. Volume-based 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters correlate with delayed neck metastasis in clinical early-stage oral squamous cell carcinoma. Oral Radiol 2023; 39:668-682. [PMID: 37081306 DOI: 10.1007/s11282-023-00686-7] [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: 10/19/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE There is no known preoperative marker that can effectively predict the risk of delayed neck metastasis (DNM), which is an important factor that determines the prognosis of early-stage oral cancer. In this study, we examined whether 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET)/computed tomography (CT) uptake parameters of primary cancer can predict the risk of DNM in early-stage oral squamous cell carcinoma (OSCC). METHODS Data from patients with stage I-II OSCC who underwent surgical resection of the primary tumor without elective neck dissection between January 2009 and December 2016 were retrospectively reviewed. Patient characteristics, histopathological factors, and PET/CT parameters (maximum standardized uptake value [SUVmax], metabolic tumor volume [MTV], and total lesion glycolysis [TLG]) were evaluated for their association with DNM. DNM rates were calculated, and the parameters that were statistically significant in the univariate analysis were used as explanatory variables. Independent factors associated with DNM were identified using multivariate analysis. For all statistical analyses, p-values < 0.05 were considered statistically significant. RESULTS Data from 71 patients were analyzed in the study. The overall DNM rate among all patients was 21.8%. The univariate analysis showed that the T classification, depth of invasion, pattern of invasion, lymphovascular invasion, SUVmax, MTV, and TLG were significant predictors of DNM. However, the multivariate analysis revealed that only the depth of invasion, MTV, and TLG were independent predictors of DNM. CONCLUSION This study suggests that, in addition to conventional predictors, volume-based PET parameters are useful predictors of DNM in those with early-stage OSCC.
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Affiliation(s)
- Nobuhiro Yamakawa
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Yohei Nakayama
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Nobuhiro Ueda
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Takahiro Yagyuu
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Shigehiro Tamaki
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Tadaaki Kirita
- Department of Oral and Maxillofacial Surgery, School of Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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R L, Gupta M, Gupta S, Joseph D, Krishnan AS, Sharma P, Verma S, Mandal S, R S N. Comparison of magnetic resonance imaging and CT scan-based delineation of target volumes and organs at risk in the radiation treatment planning of head and neck malignancies. J Med Imaging Radiat Sci 2023; 54:503-510. [PMID: 37164871 DOI: 10.1016/j.jmir.2023.03.034] [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: 09/27/2022] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION Accuracy of target definition is paramount in radiation treatment planning. The optimal choice of imaging modality to define the tumor volume in head and neck tumors is debatable. The study compared MRI and CT scan-based delineation of target volume and Organs At Risk in head and neck cancers. MATERIALS AND METHODS 54 head and neck carcinoma patients underwent rigid image registration of planning CT images with MRI images. The gross tumor volume of the primary tumor, node, and organs at risk were delineated on both CT and MRI images. A volumetric evaluation was done for gross tumors, nodes, and organs at risk. Dice Similarity coefficient (DSC), Conformity index(CI), Sensitivity index(SI), and Inclusion index(II) were calculated for gross tumor, node, brainstem, and bilateral parotids. RESULTS The mean volume of the tumor in CT and MRI obtained were 41 .94 cc and 34.76 ccs, mean DSC, CI, SI, and II of the tumor were 0.71, 0.56, 67.37, and 79.80. The mean volume of the node in CT and MRI were 12.16 cc and 10.24 cc, mean DSC, CI, SI, and II of the node were 0.61, 0.45, 62.47, and 64. The mean volume of the brainstem in CT and MRI was 24.13 cc and 21.21 cc. The mean volume of the right parotid in CT and MRI was 24.39 cc, 26.04 ccs. The mean volume of left parotid in CT and MRI, respectively, were 23.95 ccs and 25.04 ccs. CONCLUSIONS The study shows that MRI may be used in combination with CT for better delineation of target volume and organs at risk for head and neck malignancies.
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Affiliation(s)
- Lekshmi R
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India.
| | - Manoj Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Deepa Joseph
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Ajay S Krishnan
- Department of Radiation Oncology, Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, India
| | - Pankaj Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Swati Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Shreyosi Mandal
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
| | - Namitha R S
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, India
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Shimizu T, Kim M, Palangka CR, Seki-Soda M, Ogawa M, Takayama Y, Yokoo S. Determination of diagnostic and predictive parameters for vertical mandibular invasion in patients with lower gingival squamous cell carcinoma: A retrospective study. Medicine (Baltimore) 2022; 101:e32206. [PMID: 36626519 PMCID: PMC9750639 DOI: 10.1097/md.0000000000032206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Vertical mandibular invasion of lower gingival squamous cell carcinoma (LGSCC) determines the method of resection, which significantly affects the patient's quality of life. Therefore, in mandibular invasion by LGSCC, it is extremely important to monitor progression, specifically whether invasion is limited to the cortical bone or has progressed to the bone marrow. This retrospective study aimed to identify the diagnostic and predictive parameters for mandibular invasion, particularly vertical invasion, to enable appropriate selection of the method of mandibular resection. Of the patients who underwent surgery for LGSCC between 2009 and 2017, 64 were eligible for participation in the study based on tissue microarrays (TMA) from surgical specimens. This study analyzed morphological features using computed tomography (CT), and metabolic characteristics using maximum standardized uptake value (SUVmax), peak value of SUV (SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis (TLG). Moreover, immunohistochemical analysis of proteins, including parathyroid hormone-related protein (PTHrP), interleukin-6 (IL-6), E-cadherin, and programmed cell death-1 ligand 1 (PD-L1), was performed. Statistical analysis was performed using univariate logistic regression analysis with the forward selection method. The present study showed that MTV (≥2.9 cm3) was an independent diagnostic and predictive factor for positivity of mandibular invasion. Additionally, TLG (≥53.9 bw/cm3) was an independent diagnostic and predictive factor for progression to bone marrow invasion. This study demonstrated that in addition to morphological imaging by CT, the volume-based parameters of MTV and TLG on fluorine-18 fluorodeoxyglucose positron emission tomography were important for predicting pathological mandibular invasion in patients with LGSCC. A more accurate preoperative diagnosis of vertical mandibular invasion would enable the selection of appropriate surgical procedure for mandibular resection.
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Affiliation(s)
- Takahiro Shimizu
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- * Correspondence: Takahiro Shimizu, Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, 3-39-22, Showa-machi, Maebashi, Gunma, 371-8511, Japan (e-mail: )
| | - Mai Kim
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Citra R.A.P. Palangka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Mai Seki-Soda
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
- Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masaru Ogawa
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yu Takayama
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Satoshi Yokoo
- Department of Oral and Maxillofacial Surgery, and Plastic Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Fu S, Li Y, Han Y, Wang H, Chen Y, Yan O, He Q, Ma H, Liu L, Liu F. Diffusion-weighted MRI-guided dose painting in patients with locoregionally advanced nasopharyngeal carcinoma treated with induction chemotherapy plus concurrent chemoradiotherapy: a randomized, controlled clinical trial. Int J Radiat Oncol Biol Phys 2022; 113:101-113. [PMID: 35074433 DOI: 10.1016/j.ijrobp.2021.12.175] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
PURPOSES We hypothesized that diffusion-weighted MRI (DWI)-guided dose-painting intensity modulated radiation therapy (DP-IMRT) is associated with improved local tumor control and survival in locoregionally advanced nasopharyngeal carcinoma (NPC). The purpose of this randomized study was to compare the efficacy and toxicity of DWI-guided DP-IMRT to conventional MRI-based IMRT in locoregional advanced NPC. METHODS A total of 260 NPC patients with stage III-IVa disease were randomly assigned in a 1:1 ratio to receive induction chemotherapy followed by chemoradiotherapy by DWI-guided DP-IMRT (group A, n = 130) or conventional MRI-based IMRT (group B, n = 130) in this prospective clinical trial. In group A, subvolume GTVnx-DWI (gross tumor volume of nasopharynx in DWI) was defined as the areas within the GTVnx (gross tumor volume of nasopharynx) with an apparent diffusion coefficient (ADC) below the mean ADC (ADC < mean) according to MRI before induction chemotherapy. The dose to GTVnx-DWI was escalated to 75.2 Gy/32 Fx in patients with T1-2 disease and to 77.55 Gy/33 Fx in those with T3-4 disease in 2.35 Gy per fraction. In group B, PGTVnx was irradiated at 70.4-72.6 Gy/32-33 Fx in 2.2 Gy per fraction. This trial is registered with chictr.org.cn (number). RESULTS A total of 260 patients were included in the trial (130 patients in group A and 130 in group B). Complete response rates after chemoradiotherapy were 99.2% (129/130) and 93.8% (122/130) in groups A and B, respectively (P=0.042). At a median follow-up of 25 months, DWI-guided DP-IMRT was associated with improved 2-year disease-free survival (DFS, 93.6% [95% CI, 88.1% to 99.1%] vs. 87.5% [95% CI, 81.4% to 93.6%], P = 0.015), local recurrence-free survival (LRFS, 100% [95% CI, not applicable (NA)] vs. 91.3% [95% CI, 85.4% to 97.2%]), locoregional recurrence-free survival (LRRFS, 95.8% [95% CI, NA] vs. 91.3% [95% CI, 85.4% to 97.2%]), distant metastasis-free survival (DMFS, 97.8% [95% CI, NA] vs. 90.9% [95% CI, 85.8% to 96.0%]), and overall survival (OS, 100% [95% CI, NA] vs. 94.5% [95% CI, 89.2% to 99.8%]). There were 0 and 3 patients had local-only recurrences in group A and B, respectively. The most common site of first failure in each arm was distant organ failure. No statistically significant differences in acute and late toxic effects were observed. Multivariate analyses showed that dose painting (DWI-guided DP-IMRT vs conventional MRI-based IMRT without DP) was associated with DFS, LRFS, LRRFS and DMFS. EBV DNA level was associated with DFS and LRRFS. CONCLUSIONS DWI-guided DP-IMRT plus chemotherapy is associated with a disease-free survival benefit compared with conventional MRI-based IMRT among patients with locoregionally advanced NPC without increasing acute toxicity.
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Affiliation(s)
- Shengnan Fu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yanxian Li
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yaqian Han
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hui Wang
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China; Key Laboratory of Translational Radiation Oncology, Hunan Province, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Yanzhu Chen
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ouying Yan
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Qian He
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Hongzhi Ma
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Lin Liu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Feng Liu
- Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, China.
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Yang L, Liu F, Wu Y, Fang Q, Zhang X, Du W, Zhang X, Chen D, Luo R. Predictive Value of Occult Metastasis and Survival Significance of Metabolic Tumor Volume Determined by PET-CT in cT1-2N0 Squamous Cell Carcinoma of the Tongue. Front Oncol 2020; 10:542530. [PMID: 33425715 PMCID: PMC7793868 DOI: 10.3389/fonc.2020.542530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/26/2020] [Indexed: 12/17/2022] Open
Abstract
Objectives Our goal was to analyze the possibility of using metabolic tumor volume (MTV) to predict occult cervical metastasis and survival in cT1-2N0 squamous cell carcinoma (SCC) of the tongue. Methods Data on the primary tumor MTV and cervical node status as determined by the maximum standardized uptake value were retrieved. The sensitivity and specificity in predicting occult metastasis were calculated with a fourfold table. Associations between occult metastasis and clinicopathological variables were evaluated by univariate and multivariate analyses. The main study endpoints were locoregional control (LRC) and disease-specific survival (DSS). Results A total of 24 (20.3%) of 118 patients had occult metastasis. An MTV cutoff value of 4.3 cm3 showed a sensitivity of 50.0% and a specificity of 76.6% in predicting occult metastasis. The sensitivity and specificity of PET-CT in predicting occult metastasis in cT1 tumors were 66.6 and 89.8%, respectively, with values of 83.3 and 67.3%, respectively, when combined with the MTV. The sensitivity and specificity of PET-CT in predicting occult metastasis in cT2 tumors were 72.2 and 82.2%, respectively, with values of 88.9 and 57.8%, respectively, when combined with the MTV. Patients with MTV ≥4.3 cm3 had a higher occult metastasis rate than patients with MTV <4.3 cm3. The 5-year LRC and DSS rates were 86 and 94%, respectively, in patients with MTV <4.3 cm3 and 54 and 72%, respectively, in patients with MTV ≥4.3 cm3. Both differences were found to be significant in univariate and multivariate analyses. Conclusions MTV ≥4.3 cm3 was associated with an increased probability of occult metastasis and lower LRC and DSS rates in early-stage SCC of the tongue.
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Affiliation(s)
- Lijie Yang
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fei Liu
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yao Wu
- Department of Stomatology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qigen Fang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xiaojun Zhang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Wei Du
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Xu Zhang
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Defeng Chen
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Ruihua Luo
- Department of Head Neck and Thyroid, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
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Watanabe M, Nakamoto Y, Nakamoto R, Ishimori T, Saga T, Togashi K. Performance Evaluation of a Newly Developed MR-Compatible Mobile PET Scanner with Two Detector Layouts. Mol Imaging Biol 2019; 22:407-415. [PMID: 31222564 DOI: 10.1007/s11307-019-01384-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE A mobile positron emission tomography (PET) scanner called flexible PET (fxPET), designed to fit existing magnetic resonance imaging (MRI) or computed tomography (CT) system, has been developed. The purpose of this study was to evaluate the image quality, lesion detection rate, and quantitative values of fxPET compared with conventional bismuth germanium oxide (BGO)-based PET/CT without time-of-flight capability. PROCEDURES Fifty-nine patients underwent whole-body (WB) PET/CT scans approximately 1 h after injection of 2-deoxy-2-[18F]fluoro-D-glucose, followed by the fxPET scans with detectors located above and below the patients (layout A) and with detectors closer to the patients (layout B). Two readers assessed the image quality using a 4-point grade for each layout and reached a consensus. We evaluated the differences and/or correlations between fxPET and WB PET/CT, including the lesion detection rates, the standardized uptake value (SUV), the metabolic tumor volume (MTV), the total lesion glycolysis (TLG), the tumor-to-normal liver ratio (TLR), and the background liver signal-to-noise ratio (SNR). RESULTS The image quality of layout B was better than layout A (p < 0.0001). Of 184 lesions, the detection rate of layout B was significantly higher than WB PET/CT (p = 0.041), while the detection rate of layout A was comparable to WB PET/CT. The SUVmax/mean/peak were larger, and the MTVs were smaller in fxPET than WB PET/CT, especially in the lesions smaller than 2 cm (p < 0.01). The SUVmax/mean/peak, the MTVs and the TLGs of fxPET had significant positive correlations with WB PET/CT (p < 0.0001). The TLRs were significantly larger (p < 0.0001), but the background SNRs were significantly lower in fxPET than WB PET/CT (p < 0.05). CONCLUSIONS The fxPET system yielded reasonable image quality and quantitative accuracy. Bringing the detectors closer to the patient yielded improved results.
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Affiliation(s)
- Masao Watanabe
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Ryusuke Nakamoto
- Department of Radiology, Shiga General Hospital, 5-4-30 Moriyama, Moriyama, Shiga, 524-8524, Japan
| | - Takayoshi Ishimori
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Tsuneo Saga
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
| | - Kaori Togashi
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, 54 Shogoinkawahara-cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Prediction of Lymph Node Maximum Standardized Uptake Value in Patients With Cancer Using a 3D Convolutional Neural Network: A Proof-of-Concept Study. AJR Am J Roentgenol 2019; 212:238-244. [DOI: 10.2214/ajr.18.20094] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Gensheimer MF, Le QT. Adaptive radiotherapy for head and neck cancer: Are we ready to put it into routine clinical practice? Oral Oncol 2018; 86:19-24. [DOI: 10.1016/j.oraloncology.2018.08.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 08/17/2018] [Indexed: 12/27/2022]
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Jun S, Park JG, Seo Y. Accurate FDG PET tumor segmentation using the peritumoral halo layer method: a study in patients with esophageal squamous cell carcinoma. Cancer Imaging 2018; 18:35. [PMID: 30257714 PMCID: PMC6158888 DOI: 10.1186/s40644-018-0169-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 09/20/2018] [Indexed: 02/06/2023] Open
Abstract
Background In a previous study, FDG PET tumor segmentation (SegPHL) using the peritumoral halo layer (PHL) was more reliable than fixed threshold methods in patients with thyroid cancer. We performed this study to validate the reliability and accuracy of the PHL method in patients with esophageal squamous cell carcinomas (ESCCs), which can be larger and more heterogeneous than thyroid cancers. Methods A total of 121 ESCC patients (FDG avid = 85 (70.2%); FDG non-avid = 36 (29.8%)) were enrolled in this study. In FDG avid ESCCs, metabolic tumor length (ML) using SegPHL (MLPHL), fixed SUV 2.5 threshold (ML2.5), and fixed 40% of maximum SUV (SUVmax) (ML40%) were measured. Regression and Bland-Altman analyses were performed to evaluate associations between ML, endoscopic tumor length (EL), and pathologic tumor length (PL). A comparison test was performed to evaluate the absolute difference between ML and PL. Correlation with tumor threshold determined by the PHL method (PHL tumor threshold) and SUVmax was evaluated. Results MLPHL, ML2.5, and ML40% correlated well with EL (R2 = 0.6464, 0.5789, 0.3321, respectively; p < 0.001) and PL (R2 = 0.8778, 0.8365, 0.6266, respectively; p < 0.001). However, ML2.5 and ML40% showed significant proportional error with regard to PL; there was no significant error between MLPHL and PL. MLPHL showed the smallest standard deviation on Bland-Altman analyses. The absolute differences between ML and PL were significantly smaller for MLPHL and ML40% than for ML2.5 (p < 0.0001). The PHL tumor threshold showed an inverse correlation with SUVmax (σ = − 0.923, p < 0.0001). Conclusions SegPHL was more accurate than fixed threshold methods in ESCC. The PHL tumor threshold was adjusted according to SUVmax of ESCC.
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Affiliation(s)
- Sungmin Jun
- Department of Nuclear Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, 49297, South Korea
| | - Jung Gu Park
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, 49297, South Korea
| | - Youngduk Seo
- Department of Nuclear Medicine, Busan Seongso Hospital, Suyeong-ro, Nam-gu, Busan, 48453, Republic of Korea.
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Floberg JM, DeWees TA, Chin RI, Garsa AA, Dehdashti F, Nussenbaum B, Oppelt PJ, Adkins DR, Gay HA, Thorstad WL. Pretreatment metabolic tumor volume as a prognostic factor in HPV-associated oropharyngeal cancer in the context of AJCC 8th edition staging. Head Neck 2018; 40:2280-2287. [DOI: 10.1002/hed.25337] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 01/30/2018] [Accepted: 05/03/2018] [Indexed: 12/31/2022] Open
Affiliation(s)
- John M. Floberg
- Washington University School of Medicine, Department of Radiation Oncology; St Louis MO
| | - Todd A. DeWees
- Mayo Clinic, Department of Biomedical Statistics and Informatics Scottsdale; AZ
| | - Re-I Chin
- St Louis University School of Medicine; St Louis MO
| | - Adam A. Garsa
- Keck School of Medicine of University of Southern California, Department of Radiation Oncology; Los Angeles CA
| | - Farrokh Dehdashti
- Washington University School of Medicine, Mallinckrodt Institute of Radiology Division of Nuclear Medicine; St Louis MO
| | | | - Peter J. Oppelt
- Washington University School of Medicine, Department of Internal Medicine, Division of Oncology; St Louis MO
| | - Douglas R. Adkins
- Washington University School of Medicine, Department of Internal Medicine, Division of Oncology; St Louis MO
| | - Hiram A. Gay
- Washington University School of Medicine, Department of Radiation Oncology; St Louis MO
| | - Wade L. Thorstad
- Washington University School of Medicine, Department of Radiation Oncology; St Louis MO
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Mukoyama N, Suzuki H, Hanai N, Sone M, Hasegawa Y. Pathological tumor volume predicts survival outcomes in oral squamous cell carcinoma. Oncol Lett 2018; 16:2471-2477. [PMID: 30013639 PMCID: PMC6036551 DOI: 10.3892/ol.2018.8951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 05/24/2018] [Indexed: 01/13/2023] Open
Abstract
The present study examined whether the pathological tumor volume (PTV) was correlated with the survival outcomes in patients with oral squamous cell carcinoma (SCC) and clinical lymph node metastasis. Forty-seven patients who underwent radical surgery without preoperative treatment were enrolled. The PTV of the primary tumor, which was surgically resected without preoperative treatment, was calculated based on the diameters in three dimensions. A survival analysis was performed using a Cox proportional hazards model. A PTV of ≥18 cm3 was significantly correlated with shorter overall survival (P<0.01) and local recurrence-free survival (P<0.01) in a univariate analysis. A multivariate analysis with adjustment for the pathological stage (stage I–II/III–IV), primary site (tongue/others) and positive surgical margin and/or extracapsular extension (absent/present) showed that a PTV of ≥18 cm3 was significantly correlated with shorter overall survival (P<0.01) and local recurrence-free survival (P<0.01). The present findings suggested that PTV in oral SCC provides a prognostic parameter that may predict shorter or longer overall and local recurrence-free survival.
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Affiliation(s)
- Nobuaki Mukoyama
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8560, Japan.,Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Michihiko Sone
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8560, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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Effect of different segmentation algorithms on metabolic tumor volume measured on 18F-FDG PET/CT of cervical primary squamous cell carcinoma. Nucl Med Commun 2017; 38:259-265. [PMID: 28118260 PMCID: PMC5318156 DOI: 10.1097/mnm.0000000000000641] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background and purpose It is known that fluorine-18 fluorodeoxyglucose PET/computed tomography (CT) segmentation algorithms have an impact on the metabolic tumor volume (MTV). This leads to some uncertainties in PET/CT guidance of tumor radiotherapy. The aim of this study was to investigate the effect of segmentation algorithms on the PET/CT-based MTV and their correlations with the gross tumor volumes (GTVs) of cervical primary squamous cell carcinoma. Materials and methods Fifty-five patients with International Federation of Gynecology and Obstetrics stage Ia∼IIb and histologically proven cervical squamous cell carcinoma were enrolled. A fluorine-18 fluorodeoxyglucose PET/CT scan was performed before definitive surgery. GTV was measured on surgical specimens. MTVs were estimated on PET/CT scans using different segmentation algorithms, including a fixed percentage of the maximum standardized uptake value (20∼60% SUVmax) threshold and iterative adaptive algorithm. We divided all patients into four different groups according to the SUVmax within target volume. The comparisons of absolute values and percentage differences between MTVs by segmentation and GTV were performed in different SUVmax subgroups. The optimal threshold percentage was determined from MTV20%∼MTV60%, and was correlated with SUVmax. The correlation of MTViterative adaptive with GTV was also investigated. Results MTV50% and MTV60% were similar to GTV in the SUVmax up to 5 (P>0.05). MTV30%∼MTV60% were similar to GTV (P>0.05) in the 5<SUVmax≤10 group. MTV20%∼MTV60% were similar to GTV (P>0.05) in the 10<SUVmax≤15 group. MTV20% and MTV30% were similar to GTV (P>0.05) in the SUVmax of at least 15 group. MTViterative adaptive was similar to GTV in both total and different SUVmax groups (P>0.05). Significant differences were observed among the fixed percentage method and the optimal threshold percentage was inversely correlated with SUVmax. The iterative adaptive segmentation algorithm led to the highest accuracy (6.66±50.83%). A significantly positive correlation was also observed between MTViterative adaptive and GTV (Pearson’s correlation r=0.87, P<0.0001). Conclusion MTViterative adaptive is independent of SUVmax, more accurate, and correlated with GTV. Iterative adaptive algorithm segmentation may be more suitable than the fixed percentage threshold method to estimate the tumor volume of cervical primary squamous cell carcinoma.
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Jha AK, Mena E, Caffo B, Ashrafinia S, Rahmim A, Frey E, Subramaniam RM. Practical no-gold-standard evaluation framework for quantitative imaging methods: application to lesion segmentation in positron emission tomography. J Med Imaging (Bellingham) 2017; 4:011011. [PMID: 28331883 DOI: 10.1117/1.jmi.4.1.011011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 02/09/2017] [Indexed: 11/14/2022] Open
Abstract
Recently, a class of no-gold-standard (NGS) techniques have been proposed to evaluate quantitative imaging methods using patient data. These techniques provide figures of merit (FoMs) quantifying the precision of the estimated quantitative value without requiring repeated measurements and without requiring a gold standard. However, applying these techniques to patient data presents several practical difficulties including assessing the underlying assumptions, accounting for patient-sampling-related uncertainty, and assessing the reliability of the estimated FoMs. To address these issues, we propose statistical tests that provide confidence in the underlying assumptions and in the reliability of the estimated FoMs. Furthermore, the NGS technique is integrated within a bootstrap-based methodology to account for patient-sampling-related uncertainty. The developed NGS framework was applied to evaluate four methods for segmenting lesions from F-Fluoro-2-deoxyglucose positron emission tomography images of patients with head-and-neck cancer on the task of precisely measuring the metabolic tumor volume. The NGS technique consistently predicted the same segmentation method as the most precise method. The proposed framework provided confidence in these results, even when gold-standard data were not available. The bootstrap-based methodology indicated improved performance of the NGS technique with larger numbers of patient studies, as was expected, and yielded consistent results as long as data from more than 80 lesions were available for the analysis.
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Affiliation(s)
- Abhinav K Jha
- Johns Hopkins University , Department of Radiology and Radiological Sciences, Baltimore, Maryland, United States
| | - Esther Mena
- Johns Hopkins University , Department of Radiology and Radiological Sciences, Baltimore, Maryland, United States
| | - Brian Caffo
- Johns Hopkins University , Department of Biostatistics, Baltimore, Maryland, United States
| | - Saeed Ashrafinia
- Johns Hopkins University, Department of Radiology and Radiological Sciences, Baltimore, Maryland, United States; Johns Hopkins University, Department of Electrical & Computer Engineering, Baltimore, Maryland, United States
| | - Arman Rahmim
- Johns Hopkins University, Department of Radiology and Radiological Sciences, Baltimore, Maryland, United States; Johns Hopkins University, Department of Electrical & Computer Engineering, Baltimore, Maryland, United States
| | - Eric Frey
- Johns Hopkins University, Department of Radiology and Radiological Sciences, Baltimore, Maryland, United States; Johns Hopkins University, Department of Electrical & Computer Engineering, Baltimore, Maryland, United States
| | - Rathan M Subramaniam
- University of Texas Southwestern Medical Center , Department of Radiology and Advanced Imaging Research Center, Dallas, Texas, United States
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Appropriate margin thresholds for isocontour metabolic volumetry of fluorine-18 fluorodeoxyglucose PET in sarcoma. Nucl Med Commun 2016; 37:1088-94. [DOI: 10.1097/mnm.0000000000000561] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Suzuki H, Nishio M, Nakanishi H, Hanai N, Hirakawa H, Kodaira T, Tamaki T, Hasegawa Y. Impact of total lesion glycolysis measured by 18F-FDG-PET/CT on overall survival and distant metastasis in hypopharyngeal cancer. Oncol Lett 2016; 12:1493-1500. [PMID: 27446459 DOI: 10.3892/ol.2016.4765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/06/2016] [Indexed: 11/05/2022] Open
Abstract
The present study investigated the possible correlation between 18F-2-fluorodeoxyglucose (18F-FDG)-uptake parameters and clinicopathological parameters in hypopharyngeal squamous cell carcinoma (HPSCC). A total of 53 patients, newly diagnosed with HPSCC, received pretreatment 18F-FDG-positron emission tomography/computed tomography (PET/CT). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUVmax and SUVpeak) were calculated as 18F-FDG-uptake parameters of the primary tumor. Tumor thickness, depth of invasion and pathological tumor volume were pathologically measured. Upon univariate survival analysis, SUVmax ≥28.5, SUVpeak ≥19, MTV ≥12 and TLG ≥42 were significantly associated with a shorter overall survival (OS) time, and MTV ≥12 and TLG ≥42 were significantly associated with a shorter distant metastasis-free survival (DMFS) time. Upon multivariate analysis with adjustment for clinical T category and treatment group, patients with SUVmax ≥28.5 exhibited a significantly shorter OS time, while TLG ≥42 was significantly correlated with shorter OS and DMFS times. Upon simple regression analysis, TLG was found to be significantly associated with tumor thickness and depth of invasion, while MTV was found to be closely associated with pathological tumor volume. In conclusion, pretreatment 18F-FDG-PET/CT is likely to provide valuable prognostic parameters in HPSCC.
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Affiliation(s)
- Hidenori Suzuki
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Masami Nishio
- Department of Radiology, Nagoya Positron Emission Tomography Imaging Center, Nagoya, Aichi 454-0933, Japan
| | - Hayao Nakanishi
- Department of Pathology, Aichi Cancer Center Aichi Hospital, Okazaki, Aichi 444-0011, Japan
| | - Nobuhiro Hanai
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Hitoshi Hirakawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Takeshi Kodaira
- Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
| | - Tsuneo Tamaki
- Department of Radiology, East Nagoya Positron Emission Tomography Imaging Center, Nagoya, Aichi 464-0044, Japan
| | - Yasuhisa Hasegawa
- Department of Head and Neck Surgery, Aichi Cancer Center Hospital, Nagoya, Aichi 464-8681, Japan
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18F-FDG PET/CT quantification in head and neck squamous cell cancer: principles, technical issues and clinical applications. Eur J Nucl Med Mol Imaging 2016; 43:1360-75. [DOI: 10.1007/s00259-015-3294-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/14/2015] [Indexed: 01/28/2023]
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(18)F-FDG PET/CT mean SUV and metabolic tumor volume for mean survival time in non-small cell lung cancer. Clin Nucl Med 2015; 40:459-63. [PMID: 25742234 DOI: 10.1097/rlu.0000000000000740] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The study was designed to determine the relationship between survival time of standardized uptake value (SUVmax and SUVmean) and metabolic tumor volume (MTV) in patients with non-small cell lung cancer (NSCLC), and examine the impact of demographic, clinical, and radiological data of these patients on survival. MATERIALS AND METHODS We performed a retrospective analysis of the records of 79 patients with NSCLC who presented to our hospital between May 2010 and March 2013, received a final diagnosis, and underwent F-FDG PET/CT for staging. Clinical, radiological, and F-FDG PET/CT parameters with an impact on prognosis such as the SUVmax of the primary tumor as calculated by the volumetric region of interest in the F-FDG PET/CT scans during initial diagnosis, mean SUV of the tumor, and MTV obtained with a threshold of SUVmax greater than 2.5 were recorded and statistically analyzed. A statistical analysis was carried out based on the clinical, radiological, and PET/CT findings of the patients who were divided into 2 groups: survivors and nonsurvivors. RESULTS Seventy patients (88.6%) were men, and 9 (11.4%) were women. The mean age was 63.65 ± 11.51 years in the nonsurvivor group (n = 40) versus 62.74 ± 10.60 years in the survivor group (n = 39) (Table 1). The mean survival time from diagnosis was 7.9 ± 6.52 months in the nonsurvivor group versus 14.09 ± 7.41 months in the survivor group. The mean survival time was 12.9 ± 7.9 months for those aged 60 or younger, whereas it was 9.9 ± 7.2 years for those aged 60 or older. According to the Cox regression analysis, higher MTV [relative risk (RR), 1.006; P = 0.03] and mean SUVmax (mSUV) (RR, 1.302; P = 0.03) had a significant impact on shortening of the mean survival time. However, no statistical significance was reached for SUVmax measurements (RR, 0.970; P = 0.39). Furthermore, there was a significant relationship between increased tumor size (<2 cm, 2-4 cm, and ≥4 cm) and shortened mean survival time (P = 0.03). CONCLUSION The present study showed that MTV and mSUV of FDG PET/CT scans of the tumor, but not SUVmax, had a significant impact on survival time of patients with NSCLC. Based on this result, we believe that we might have more accurate information about the survival time of our patients if we also evaluate mSUV and MTV in combination with mSUV, which is frequently used for diagnosis and monitoring of patients with NSCLC during our daily practice.
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Jun S, Kim H, Nam HY. A new method for segmentation of FDG PET metabolic tumour volume using the peritumoural halo layer and a 10-step colour scale. A study in patients with papillary thyroid carcinoma. Nuklearmedizin 2015; 54:272-85. [PMID: 26429587 DOI: 10.3413/nukmed-0749-15-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 09/22/2015] [Indexed: 12/15/2022]
Abstract
AIM We observed a layer between tumour activity and background on FDG PET/CT with the 10-step colour scale and the window level set properly. We named the layer peritumoral halo layer (PHL). We performed this study to establish the reliability of metabolic tumor volume (MTV) segmentation using PHL (MTV(PHL)) in patients with papillary thyroid carcinoma. PATIENTS, METHODS Of a total of 140 papillary thyroid carcinoma (PTC) patients, 70 (50.0%) had FDG-avid PTC. In these patients, MTV(PHL), MTV segmented according to fixed 50% SUVmax (MTV(50%)), and fixed SUV with 2.5 to 4.0 (MTV(2.5) to MTV(4.0)) were compared with pathologic tumour volume (PTV). The absolute percentage difference between MTV(PHL) and PTV was compared in micropapillary carcinoma (MPTC) and non-micropapillary carcinoma (non-MPTC) subgroups. The % SUVmax and SUV thresholds of MTV(PHL) were compared with tumour SUVmax. RESULTS Among the MTVs, MTV(50%) was not correlated with PTV (r = -0.16, p = 0.182) and was not reliable according to the Bland-Altman plot. Although MTV(2.5), MTV(3.0), MTV(3.5), and MTV(4.0) correlated with PTV (r = 0.85, 0.86, 0.87, and 0.87, respectively; p < 0.001), these MTVs were not reliable on Bland-Altman analyses. MTV(PHL) was significantly correlated with PTV (r = 0.80, p < 0.001), and the Bland-Altman plot did not show systemic error. The MTV(PHL) was more accurate in non-MPTC than in MPTC (p < 0.001), and the absolute % difference was smaller as PTV became larger (σ = -0.65, p < 0.001). The MTV(PHL) thresholds had correlations with SUVmax (% SUVmax threshold: σ = -0.87, p < 0.001; SUV threshold: r = 0.88, p < 0.001). CONCLUSIONS MTV(PHL) was more reliable than MTV(%SUVmax) or MTV(SUV). The reliability of MTV(PHL) improved with larger PTVs. The threshold of the MTV(PHL) was naturally altered by PHL according to SUVmax.
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Affiliation(s)
| | | | - H-Y Nam
- Hyun-Yeol Nam, M.D., Samsung Changwon Hospital, 158, Paryong-ro, Masan Hoewon-gu, Changwon-si, Korea, 630-723, Tel. +82/55/290-65 93; Fax -55 98,
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Volumetric comparison of positron emission tomography/computed tomography using 4'-[methyl-¹¹C]-thiothymidine with 2-deoxy-2-¹⁸F-fluoro-D-glucose in patients with advanced head and neck squamous cell carcinoma. Nucl Med Commun 2015; 36:219-25. [PMID: 25369751 DOI: 10.1097/mnm.0000000000000241] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We prospectively compared the diagnostic value of PET/computed tomography (CT) findings using the tracers 4'-[methyl-11C]-thiothymidine (11C-4DST) and 2-deoxy-2-18F-fluoro-D-glucose (18F-FDG) in patients with head and neck squamous cell carcinoma (HNSCC). PATIENTS AND METHODS Thirty-eight patients with advanced HNSCC underwent 11C-4DST PET/CT and 18F-FDG PET/CT before treatment. Maximum standardized uptake values (SUVmax) were measured for both PET/CT studies; in addition, total lesion glycolysis (TLG) of 18F-FDG PET/CT and total lesion proliferation (TLP) of 11C-4DST PET/CT were measured. Absolute TLG and TLP values as well as values with various SUV thresholds were measured. All patients were followed up for 13.5±7.5 months (mean±SD) to monitor recurrence. RESULTS A statistically significant correlation was observed between the primary tumor SUVmax for 11C-4DST PET/CT and 18F-FDG PET/CT (r=0.46, P<0.01). TLP values with SUV thresholds strongly correlated with TLG values relative to the same thresholds (r=0.60-0.92, P<0.001). Nine of the 38 patients with post-treatment recurrence were identified. Receiver operating characteristic curves for TLG3.0 and TLP2.5 showed the highest prognostic ability for recurrence; the sensitivity and specificity of TLG3.0 were 89 and 72%, respectively, and the sensitivity and specificity of TLP2.5 were 89 and 55%, respectively. CONCLUSION In patients with advanced HNSCC, the TLP of 11C-4DST PET/CT strongly correlated with the TLG of 18F-FDG PET/CT. Although there were no large differences between these values, the receiver operating characteristic curves of the absolute TLG had slightly better prognostic ability for recurrence.
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Grégoire V, Langendijk JA, Nuyts S. Advances in Radiotherapy for Head and Neck Cancer. J Clin Oncol 2015; 33:3277-84. [PMID: 26351354 DOI: 10.1200/jco.2015.61.2994] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Over the last few decades, significant improvements have been made in the radiotherapy (RT) treatment of head and neck malignancies. The progressive introduction of intensity-modulated RT and the use of multimodality imaging for target volume and organs at risk delineation, together with the use of altered fractionation regimens and concomitant administration of chemotherapy or targeted agents, have accompanied efficacy improvements in RT. Altogether, such improvements have translated into improvement in locoregional control and overall survival probability, with a decrease in the long-term adverse effects of RT and an improvement in quality of life. Further progress in the treatment of head and neck malignancies may come from a better integration of molecular imaging to identify tumor subvolumes that may require additional radiation doses (ie, dose painting) and from treatment adaptation tracing changes in patient anatomy during treatment. Proton therapy generates even more exquisite dose distribution in some patients, thus potentially further improving patient outcomes. However, the clinical benefit of these approaches, although promising, for patients with head and neck cancer need to be demonstrated in prospective randomized studies. In this context, our article will review some of these advances, with special emphasis on target volume and organ-at-risk delineation, use of molecular imaging for tumor delineation, dose painting for dose escalation, dose adaptation throughout treatment, and potential benefit of proton therapy.
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Affiliation(s)
- Vincent Grégoire
- Vincent Grégoire, Institut de Recherche Clinique, Université Catholique de Louvain, St-Luc University Hospital, Brussels; Sandra Nuyts, Katholieke Universiteit Leuven-University of Leuven, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; and Johannes A. Langendijk, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
| | - Johannes A Langendijk
- Vincent Grégoire, Institut de Recherche Clinique, Université Catholique de Louvain, St-Luc University Hospital, Brussels; Sandra Nuyts, Katholieke Universiteit Leuven-University of Leuven, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; and Johannes A. Langendijk, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Sandra Nuyts
- Vincent Grégoire, Institut de Recherche Clinique, Université Catholique de Louvain, St-Luc University Hospital, Brussels; Sandra Nuyts, Katholieke Universiteit Leuven-University of Leuven, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium; and Johannes A. Langendijk, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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Abstract
PET imaging has contributed substantially in oncology by allowing improved clinical staging and guiding appropriate cancer management. Integration with radiotherapy planning via PET/computed tomography (CT) simulation enables improved target delineation, which is paramount for conformal radiotherapy techniques. This article reviews the present literature regarding implications of PET/CT for radiotherapy planning and management.
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Affiliation(s)
- Beant S Gill
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Sarah S Pai
- Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA
| | - Stacey McKenzie
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232, USA
| | - Sushil Beriwal
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, 5230 Centre Avenue, Pittsburgh, PA 15232, USA.
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Piccinini F, Tesei A, Arienti C, Bevilacqua A. Cancer multicellular spheroids: volume assessment from a single 2D projection. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 118:95-106. [PMID: 25561413 DOI: 10.1016/j.cmpb.2014.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Revised: 12/03/2014] [Accepted: 12/15/2014] [Indexed: 06/04/2023]
Abstract
Volume is one of the most important features for the characterization of a tumour on a macroscopic scale. It is often used to assess the effectiveness of care treatments, thus making its correct evaluation a crucial issue for patient care. Similarly, volume is a key feature on a microscopic scale. Multicellular cancer spheroids are 3D tumour models widely employed in pre-clinical studies to test the effects of drugs and radiotherapy treatments. Very few methods have been proposed to estimate the tumour volume arising from a 2D projection of multicellular spheroids, and even fewer have been designed to provide a 3D reconstruction of the tumour shape. In this work, we propose Reconstruction and Visualization from a Single Projection (ReViSP), an automatic method conceived to reconstruct the 3D surface and estimate the volume of single cancer multicellular spheroids, or even of spheroid cultures. As the input parameter ReViSP requires only one 2D projection, which could be a widefield microscope image. We assessed the effectiveness of our method by comparing it with other approaches. To this purpose, we used a new strategy that allowed us to achieve accurate volume measurements based on the analysis of home-made 3D objects, built by mimicking the spheroid morphology. The results confirmed the effectiveness of our method for both 3D reconstruction and volume assessment. ReViSP software is distributed as an open source tool.
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Affiliation(s)
- Filippo Piccinini
- Advanced Research Center on Electronic Systems (ARCES) for Information and Communication Technologies "E. De Castro", University of Bologna, Italy.
| | - Anna Tesei
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) s.r.l., IRCCS, Biosciences Laboratory, Meldola, FC, Italy.
| | - Chiara Arienti
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) s.r.l., IRCCS, Biosciences Laboratory, Meldola, FC, Italy.
| | - Alessandro Bevilacqua
- Advanced Research Center on Electronic Systems (ARCES) for Information and Communication Technologies "E. De Castro", University of Bologna, Italy; Department of Computer Science and Engineering (DISI), University of Bologna, Italy.
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Kim M, Achmad A, Higuchi T, Arisaka Y, Yokoo H, Yokoo S, Tsushima Y. Effects of intratumoral inflammatory process on 18F-FDG uptake: pathologic and comparative study with 18F-fluoro-α-methyltyrosine PET/CT in oral squamous cell carcinoma. J Nucl Med 2014; 56:16-21. [PMID: 25476535 DOI: 10.2967/jnumed.114.144014] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED The accurate depiction of both biologic and anatomic profiles of tumors has long been a challenge in PET imaging. An inflammation, which is innate in the carcinogenesis of oral squamous cell carcinoma (OSCC), frequently complicates the image analysis because of the limitations of (18)F-FDG and maximum standardized uptake values (SUV(max)). New PET parameters, metabolic tumor volume (MTV) and total lesion glycolysis (TLG), as well as (18)F-fluoro-α-methyltyrosine ((18)F-FAMT), a malignancy-specific amino acid-based PET radiotracer, are considered more comprehensive in tumor image analysis. Here, we showed the substantial effects of the intratumoral inflammatory process on (18)F-FDG uptake and further study the possibility of MTV and TLG to predict both tumor biology (proliferation activity) and anatomy (pathologic tumor volume). METHODS (18)F-FDG and (18)F-FAMT PET images from 25 OSCC patients were analyzed. SUV(max) on the tumor site was obtained. PET volume computerized-assisted reporting was used to generate a volume of interest to obtain MTV and TLG for (18)F-FDG and total lesion retention (TLR) for (18)F-FAMT. The whole tumor dissected from surgery was measured and sectioned for pathologic analysis of tumor inflammation grade and Ki-67 labeling index. RESULTS The high SUV(max) of (18)F-FDG was related to the high inflammation grade. The SUV(max )ratio of (18)F-FDG to (18)F-FAMT was higher in inflammatory tumors (P < 0.05) whereas the corresponding value in tumors with a low inflammation grade was kept low. All (18)F-FAMT parameters were correlated with Ki-67 labeling index (P < 0.01). Pathologic tumor volume predicted from MTV of (18)F-FAMT was more accurate (R = 0.90, bias = 3.4 ± 6.42 cm(3), 95% confidence interval = 0.77-6.09 cm(3)) than that of (18)F-FDG (R = 0.77, bias = 8.1 ± 11.17 cm(3), 95% confidence interval = 3.45-12.67 cm(3)). CONCLUSION (18)F-FDG uptake was overestimated by additional uptake related to the intratumoral inflammatory process, whereas (18)F-FAMT simply accumulated in tumors according to tumor activity as evaluated by Ki-67 labeling index in OSCC.
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Affiliation(s)
- Mai Kim
- Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Arifudin Achmad
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan Human Resource Cultivation Center, Gunma University, Kiryu, Gunma, Japan Department of Radiology, Faculty of Medicine, Gadjah Mada University, Yogyakarta, Indonesia; and
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yukiko Arisaka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hideaki Yokoo
- Department of Human Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Satoshi Yokoo
- Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Abstract
In this review, we review the literature on the use of PET in radiation treatment planning, with an emphasis on describing our institutional methodology (where applicable). This discussion is intended to provide other radiation oncologists with methodological details on the use of PET imaging for treatment planning in radiation oncology, or other oncologists with an introduction to the use of PET in planning radiation therapy.
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FDG PET Metabolic Tumor Volume Segmentation and Pathologic Volume of Primary Human Solid Tumors. AJR Am J Roentgenol 2014; 202:1114-9. [DOI: 10.2214/ajr.13.11456] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Tumor Volumes Measured From Static and Dynamic 18F-fluoro-2-deoxy-D-glucose Positron Emission Tomography-Computed Tomography Scan. J Comput Assist Tomogr 2014; 38:209-15. [DOI: 10.1097/rct.0000000000000017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pérez Romasanta LA, García Velloso MJ, López Medina A. Functional imaging in radiation therapy planning for head and neck cancer. Rep Pract Oncol Radiother 2013; 18:376-82. [PMID: 24416582 PMCID: PMC3863200 DOI: 10.1016/j.rpor.2013.10.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/22/2022] Open
Abstract
Functional imaging and its application to radiotherapy (RT) is a rapidly expanding field with new modalities and techniques constantly developing and evolving. As technologies improve, it will be important to pay attention to their implementation. This review describes the main achievements in the field of head and neck cancer (HNC) with particular remarks on the unsolved problems.
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Affiliation(s)
- Luis A. Pérez Romasanta
- Radiation Oncology, Hospital Universitario de Salamanca, Ps. San Vicente 58, 37007 Salamanca, Spain
| | | | - Antonio López Medina
- Medical Physics Department and Radiological Protection, Galaria – Hospital do Meixoeiro – Complexo Hospitalario Universitario de Vigo, Vigo, Spain
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Schakel T, Hoogduin JM, Terhaard CHJ, Philippens MEP. Diffusion weighted MRI in head-and-neck cancer: geometrical accuracy. Radiother Oncol 2013; 109:394-7. [PMID: 24183864 DOI: 10.1016/j.radonc.2013.10.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Revised: 10/02/2013] [Accepted: 10/07/2013] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The aim of this study is to assess the geometric accuracy of diffusion weighted (DW)-MRI by quantification of geometric distortions in the gross tumor volume (GTV) in head and neck (HN) cancer. MATERIALS & METHODS A retrospective analysis was performed on the data of 23 patients (with 24 lesions). For these patients, magnetic field maps and DW-MRI were acquired. The magnetic field maps were converted to voxel displacement maps. GTV delineations were transferred onto these voxel displacement maps and the voxel shifts in the GTV were analyzed. RESULTS The median shift was 3.2mm and the maximal posterior and anterior shifts were up to 15.0 and 26.0mm respectively. The range of shifts varied from 11.8 to 25.6mm. The percentage of GTV voxels that showed a shift of at least 6mm was found to be 23.2%. CONCLUSIONS Current DW-MRI images of HN tumors show severe distortions up to centimeters, which restrict the use of DW-MRI scans for GTV definition in RT treatment planning.
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Affiliation(s)
- Tim Schakel
- Department of Radiotherapy, University Medical Center Utrecht, The Netherlands.
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PET-based primary tumor volumetric parameters and survival of patients with non-small cell lung carcinoma. AJR Am J Roentgenol 2013; 200:635-40. [PMID: 23436855 DOI: 10.2214/ajr.12.9138] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The purpose of the study was to assess metabolic tumor volume and total glycolytic activity of the primary tumor as prognostic parameters for outcome in patients with non-small cell lung carcinoma (NSCLC). MATERIALS AND METHODS Thirty-nine patients who had undergone a baseline staging PET/CT examination at our institution for the diagnosis of NSCLC were retrospectively identified. The maximum standardized uptake value (SUV(max)), metabolic tumor volume, and total glycolytic activity were segmented from PET using the gradient method; 12-month survival and overall survival at the end of follow-up were used as outcome measures. Multivariate logistic regression, receiver operating characteristic curve analysis, and Kaplan-Meier curves for survival analysis were generated and compared using the Mantel-Cox log-rank test. RESULTS The mean gradient-based metabolic tumor volume and gradient-based total glycolytic activity were significantly greater in the patients who died (93.3 mL and 597.5 g) than in those who survived (19.3 mL and 193.9 g, respectively) (p < 0.003 and p < 0.031). There was no statistically significant difference in the mean SUV(max) between the patients who survived (12.7) at 12 months and those who had died (13.1) (p = 0.85). On multivariate analysis, gradient-based metabolic tumor volume was the only variable associated with 12-month mortality when adjusted for all other factors.(.) The area under the curve (AUC) for gradient-based metabolic tumor volume was 0.77 (p < 0.006). A significant difference in the time to survival was observed between high and low gradient-based metabolic tumor volume (log-rank p < 0.05) cohorts using the median gradient-based metabolic tumor volume (9.7 mL) as the cut point. CONCLUSION PET-based volumetric imaging parameters are potential prognostic markers of outcome in patients with NSCLC.
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Powell C, Schmidt M, Borri M, Koh DM, Partridge M, Riddell A, Cook G, Bhide SA, Nutting CM, Harrington KJ, Newbold KL. Changes in functional imaging parameters following induction chemotherapy have important implications for individualised patient-based treatment regimens for advanced head and neck cancer. Radiother Oncol 2013; 106:112-7. [PMID: 23089306 DOI: 10.1016/j.radonc.2012.09.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Revised: 07/09/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND When induction chemotherapy (IC) is used prior to chemoradiotherapy (CRT) in head and neck cancer (HNC), functional imaging (FI) may inform adaptation of treatment plans with the aim of optimising outcomes. Understanding the impact of IC on FI parameters is, therefore, essential. PURPOSE To prospectively evaluate the feasibility of acquiring serial FI ((18)F-FDG-PET, diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) MRI) and its role in defining individualised treatment regimens following IC in HNC. METHODS AND MATERIALS Ten patients with stage III and IV HNC underwent conventional (CT and MRI) and functional (DW, DCE-MRI and (18)F-FDG-PET/CT) imaging at baseline and following two cycles of IC prior to definitive CRT. RESULTS One patient withdrew due to claustrophobia. Seven out of nine patients had a complete metabolic response to IC on (18)F-FDG-PET imaging. DCE-MRI showed a significant fall in transfer constant (K(trans)) (0.209 vs 0.129 min(-1)P<0.01) and integrated area under gadolinium curve at 60s (IAUGC6O) (18.4 vs 11.9 mmol/min, P<0.01) and DW-MRI a rise in ADC (0.89 vs 1.06 × 10(-3) mm(2)/s, P<0.01) following IC. CONCLUSIONS Acquiring FI sequences is feasible in HNC. There are marked changes in FI parameters following IC which may guide adaptation of individualised treatment regimens.
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Affiliation(s)
- Ceri Powell
- The Royal Marsden NHS Trust, Surrey, United Kingdom
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Van de Wiele C, Kruse V, Smeets P, Sathekge M, Maes A. Predictive and prognostic value of metabolic tumour volume and total lesion glycolysis in solid tumours. Eur J Nucl Med Mol Imaging 2012; 40:290-301. [PMID: 23151913 DOI: 10.1007/s00259-012-2280-z] [Citation(s) in RCA: 127] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/10/2012] [Indexed: 12/13/2022]
Abstract
Data available in patients suffering from squamous cell carcinoma of the head and neck, lung carcinoma, oesophageal carcinoma and gynaecological malignancies suggest that metabolic tumour volume and to a lesser extent total lesion glycolysis have the potential to become valuable in the imaging of human solid tumours as prognostic biomarkers for short- to intermediate-term survival outcomes, adding value to clinical staging, for assessment of response to treatment with neoadjuvant and concurrent chemotherapy, and for treatment optimization; for example, based on early treatment response assessment using changes in metabolic tumour volume over time, it might be possible to select patients who require a more aggressive treatment to improve their outcome. Prospective studies enrolling consecutive patients, adopting standardized protocols for FDG PET acquisition and processing, adjusting for potential confounders in the analysis (tumour size and origin) and determining the optimal methodology for determination of these novel markers are mandatory.
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Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, P7, University Hospital Ghent, De Pintelaan 185-B, 9000 Ghent, Belgium.
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Haigentz M, Cohen EEW, Wolf GT, Strojan P, Eisbruch A, Ferlito A. The future of induction chemotherapy for head and neck squamous cell carcinoma. Oral Oncol 2012; 48:1065-7. [PMID: 22981388 DOI: 10.1016/j.oraloncology.2012.08.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 08/17/2012] [Indexed: 11/15/2022]
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Perez-Romasanta LA, Bellon-Guardia M, Torres-Donaire J, Lozano-Martin E, Sanz-Martin M, Velasco-Jimenez J. Tumor volume delineation in head and neck cancer with 18-fluor-fluorodeoxiglucose positron emission tomography: adaptive thresholding method applied to primary tumors and metastatic lymph nodes. Clin Transl Oncol 2012; 15:283-93. [PMID: 22865325 DOI: 10.1007/s12094-012-0914-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 07/04/2012] [Indexed: 01/05/2023]
Abstract
PURPOSE There are several potential advantages of using 18-fluor-fluorodeoxiglucose (18F-FDG) PET for target volume contouring, but before PET-based gross tumor volumes (GTVs) can reliably and reproducibly be incorporated into high-precision radiotherapy planning, operator-independent segmentation tools have to be developed and validated. The purpose of the present work was to apply the adaptive to the signal/background ratio (R(S/B)) thresholding method for head and neck tumor delineation, and compare these GTV(PET) to reference GTV(CT) volumes in order to assess discrepancies. MATERIALS AND METHODS A cohort of 19 patients (39 lesions) with a histological diagnosis of head and neck cancer who would undergo definitive concurrent radiochemotherapy or radical radiotherapy with intensity-modulated radiotherapy technique (IMRT), were enrolled in this prospective study. Contouring on PET images was accomplished through standardized uptake value (SUV)-threshold definition. The threshold value was adapted to R(S/B). To determine the relationship between the threshold and the R(S/B), we performed a phantom study. A discrepancy index (DI) between both imaging modalities, overlap fraction (OF) and mismatch fraction (MF) were calculated for each lesion and imaging modality. RESULTS The median DI value for lymph nodes was 2.67 and 1.76 for primary lesions. The OF values were larger for CT volumes than for PET volumes (p < 0.001), for both types of lesions. The MF values were smaller for CT volumes than for PET volumes (p < 0.001), for both types of lesions. The GTV(PET) coverage (OF(PET)) was strongly correlated with the lesion volume (GTV(CT)) for metastatic lymph nodes (Pearson correlation = 0.665; p < 0.01). For smaller lesions, despite the GTV volumes were relatively larger on PET than in CT contours, the coverage was poorer. Accordingly, the MF(PET/CT) was negatively correlated with the lesion volume for metastatic lymph nodes. CONCLUSIONS The present study highlights the considerable challenges involved in using FDG PET imaging for the delineation of GTV in head and neck neoplasms. The methods that rely mainly on SUV(max) for thresholding, as the RS/B method, are very sensitive to partial volume effects and may provide unreliable results when applied on small lesions.
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Intra-reader reliability of FDG PET volumetric tumor parameters: effects of primary tumor size and segmentation methods. Ann Nucl Med 2012; 26:707-14. [PMID: 22797818 DOI: 10.1007/s12149-012-0630-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2012] [Accepted: 06/25/2012] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To establish the effects of size and segmentation methods on intra-reader reliability of primary tumor metabolic tumor volume (MTV) and total glycolytic activity (TGA) in human solid tumors. METHODS This is a retrospective study of 121 patients who had a baseline FDG PET/CT scan for oncologic staging. Volumetric parameter readings were performed in random order on two separate occasions, 12 weeks apart, by the same reader. The MTV and TGA were segmented using gradient and fixed maximum standardized uptake value (SUVmax) threshold methods. Intra-reader reliability was established by the intraclass correlation coefficient (ICC) and Bland-Altman analysis. RESULTS The biases for MTV were 2.95, 14.76 and 11.13% for gradient segmentation, 38 and 50% SUVmax fixed threshold segmentations, respectively (p < 0.0001). For TGA, the corresponding biases were 0.76, 10.36 and 7.46% (p < 0.0001). There were no statistically significant differences in the biases between the first and second reads for MTV segmented for small and large volume tumors by the gradient method (p < 0.34) or 50% SUVmax threshold segmentation (p < 0.08). However, there were statistically significant differences in the corresponding biases for the 38% SUVmax threshold segmentation (p < 0.04). There were no statistically significant differences in the biases between the first and second reads for TGA segmented for small and large volume tumors (p < 0.98). CONCLUSION Intra-reader reliability for primary tumor FDG MTV and TGA is affected by the tumor size and segmentation methods. The segmentation bias was smaller for gradient method than percentage fixed threshold method for MTV. The segmentation biases were smaller for TGA than MTV.
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Suzuki O, Nishiyama K, Morimoto M, Hashiguchi H, Tanaka K, Nakajima A, Nakamura S, Yoshino K. Defining PET standardized uptake value threshold for tumor delineation with metastatic lymph nodes in head and neck cancer. Jpn J Clin Oncol 2012; 42:491-7. [PMID: 22547728 DOI: 10.1093/jjco/hys049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Hot spots of F-18 fluorodeoxyglucose positron emission tomograms are variable in size according to window settings of standardized uptake values. The purpose of this study was to determine the standardized uptake value threshold that represents the target volume. METHODS Sixty-three patients who underwent fluorodeoxyglucose positron emission tomographic computed tomography and were diagnosed as having head and neck cancer with cervical lymphadenopathy were studied. The horizontal and vertical diameters of metastatic lymph nodes (LN-CT) were measured at the center of computed tomographic images. Of the corresponding nodes, the maximal standardized uptake value (SUVmax) and standardized uptake value profiles along the central horizontal and vertical axes were calculated on positron emission tomographic images (LN-PET). On the standardized uptake value profiles, the standardized uptake value levels (SUVeq) where the size of LN-PET was equivalent to the diameters of LN-CT were obtained. The regression formula between SUVeq and SUVmax was obtained. The regression formula of SUVeq was validated in subsequent 30 positron emission tomographic computed tomography studies. RESULTS The mean horizontal and vertical diameters of LN-CT were 14.9 and 16.4 mm, respectively. SUVmax ranged from 1.88 to 9.07, and SUVeq was between 1.16 and 6.42. The regression formula between SUVeq and SUVmax was as follows: SUVeq = 1.21 + 0.34 × SUVmax (coefficient of correlation: R = 0.69). The validation study resulted in a good correlation between the volume of lymph nodes on computed tomography and positron emission tomographic computed tomography (R(2) = 0.93). CONCLUSIONS The formula with a relatively high coefficient of correlation is considered to indicate that SUVeq is not constant, but is a complex of an absolute standardized uptake value and is proportional to SUVmax.
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Affiliation(s)
- Osamu Suzuki
- Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Disease, 1-3-3 Nakamichi, Higashinari-ku, Osaka City, Osaka Prefecture, Japan.
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Dibble EH, Alvarez ACL, Truong MT, Mercier G, Cook EF, Subramaniam RM. 18F-FDG metabolic tumor volume and total glycolytic activity of oral cavity and oropharyngeal squamous cell cancer: adding value to clinical staging. J Nucl Med 2012; 53:709-15. [PMID: 22492732 DOI: 10.2967/jnumed.111.099531] [Citation(s) in RCA: 187] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED (18)F-FDG metabolic tumor volume (MTV) and total glycolytic activity (TGA) have been proposed as potential prognostic imaging markers for patient outcome in human solid tumors. The purpose of this study was to establish whether MTV and TGA add prognostic information to clinical staging in patients with oral and oropharyngeal squamous cell carcinomas (SCCs). METHODS The Institutional Review Board approved this Health Insurance Portability and Accountability Act-compliant single-institution retrospective study. Forty-five patients with histologically proven oral or oropharyngeal SCC underwent PET/CT for initial cancer staging and were included in the study. MTV was measured using a gradient-based method (PET Edge) and fixed-threshold methods at 38%, 50%, and 60% of maximum standardized uptake value (SUV). The TGA is defined as MTV × mean SUV. Bland-Altman analysis was used to establish the reliability of the methods of segmentation. Outcome endpoints were overall survival (OS) and progression-free survival. Cox proportional hazards univariate and multivariate regression analyses were performed. RESULTS In Cox regression models, MTV and TGA were the only factors significantly associated with survival outcome after adjusting for all other covariates including American Joint Committee on Cancer (AJCC) stage, with hazards ratio of 1.06 (95% confidence interval, 1.01-1.10; P = 0.006) and 1.00 (95% confidence interval, 1.00-1.01; P = 0.02). The model fit was significantly better when MTV was added to AJCC stage in model I (χ(2) value change, 1.16-6.71; P = 0.01) and when TGA was added to AJCC stage in model II (χ(2) value change, 1.16-4.37; P = 0.04). The median cutoff point of 7.7 mL for primary tumor MTV was predictive of time to OS (log rank P = 0.04). The median cutoff point of 55 g for PET Edge primary tumor TGA was predictive of time to OS (log rank P = 0.08), though the result was not statistically significant. CONCLUSION Gradient-based segmentations of primary tumor MTV and TGA are potential (18)F-FDG markers for time to survival in patients with oral and oropharyngeal SCC and may provide prognostic information in addition to AJCC stage. These exploratory imaging markers need validation in larger cohort studies.
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Affiliation(s)
- Elizabeth H Dibble
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
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