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Body Composition to Define Prognosis of Cancers Treated by Anti-Angiogenic Drugs. Diagnostics (Basel) 2023; 13:diagnostics13020205. [PMID: 36673015 PMCID: PMC9858245 DOI: 10.3390/diagnostics13020205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/28/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023] Open
Abstract
Background: Body composition could help to better define the prognosis of cancers treated with anti-angiogenics. The aim of this study is to evaluate the prognostic value of 3D and 2D anthropometric parameters in patients given anti-angiogenic treatments. Methods: 526 patients with different types of cancers were retrospectively included. The software Anthropometer3DNet was used to measure automatically fat body mass (FBM3D), muscle body mass (MBM3D), visceral fat mass (VFM3D) and subcutaneous fat mass (SFM3D) in 3D computed tomography. For comparison, equivalent two-dimensional measurements at the L3 level were also measured. The area under the curve (AUC) of the receiver operator characteristics (ROC) was used to determine the parameters’ predictive power and optimal cut-offs. A univariate analysis was performed using Kaplan−Meier on the overall survival (OS). Results: In ROC analysis, all 3D parameters appeared statistically significant: VFM3D (AUC = 0.554, p = 0.02, cutoff = 0.72 kg/m2), SFM3D (AUC = 0.544, p = 0.047, cutoff = 3.05 kg/m2), FBM3D (AUC = 0.550, p = 0.03, cutoff = 4.32 kg/m2) and MBM3D (AUC = 0.565, p = 0.007, cutoff = 5.47 kg/m2), but only one 2D parameter (visceral fat area VFA2D AUC = 0.548, p = 0.034). In log-rank tests, low VFM3D (p = 0.014), low SFM3D (p < 0.0001), low FBM3D (p = 0.00019) and low VFA2D (p = 0.0063) were found as a significant risk factor. Conclusion: automatic and 3D body composition on pre-therapeutic CT is feasible and can improve prognostication in patients treated with anti-angiogenic drugs. Moreover, the 3D measurements appear to be more effective than their 2D counterparts.
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Riauka TA, Baracos VE, Reif R, Juengling FD, Robinson DM, Wieler M, McEwan AJB. Rapid Standardized CT-Based Method to Determine Lean Body Mass SUV for PET—A Significant Improvement Over Prediction Equations. Front Oncol 2022; 12:812777. [PMID: 35875083 PMCID: PMC9302197 DOI: 10.3389/fonc.2022.812777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 05/26/2022] [Indexed: 01/18/2023] Open
Abstract
In 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) studies, maximum standardized uptake value (SUVmax) is the parameter commonly used to provide a measurement of the metabolic activity of a tumor. SUV normalized by body mass is affected by the proportions of body fat and lean tissue, which present high variability in patients with cancer. SUV corrected by lean body mass (LBM), denoted as SUL, is recommended to provide more accurate, consistent, and reproducible SUV results; however, LBM is frequently estimated rather than measured. Given the increasing importance of a quantitative PET parameter, especially when comparing PET studies over time to evaluate disease response clinically, and its use in oncological clinical trials, we set out to evaluate the commonly used equations originally derived by James (1976) and Janmahasatian et al. (2005) against computerized tomography (CT)-derived measures of LBM.MethodsWhole-body 18F-FDG PET images of 195 adult patients with cancer were analyzed retrospectively. Representative liver SUVmean was normalized by total body mass. SUL was calculated using a quantitative determination of LBM based on the CT component of the PET/CT study (LBMCT) and compared against the equation-estimated SUL. Bland and Altman plots were generated for SUV-SUL differences.ResultsThis consecutive sample of patients undergoing usual care (men, n = 96; women, n = 99) varied in body mass (38–127 kg) and in Body Mass Index (BMI) (14.7–47.2 kg/m2). LBMCT weakly correlated with body mass (men, r2 = 0.32; women, r2 = 0.22), and thus SUV and SULCT were also weakly correlated (men, r2 = 0.24; women, r2 = 0.11). Equations proved inadequate for the assessment of LBM. LBM estimated by James’ equation showed a mean bias (overestimation of LBM compared with LBMCT) in men (+6.13 kg; 95% CI 4.61–7.65) and in women (+6.32 kg; 95% CI 5.26–7.39). Janmahasatian’s equation provided similarly poor performance.ConclusionsCT-based LBM determinations incorporate the patient’s current body composition at the time of a PET/CT study, and the information garnered can provide care teams with information with which to more accurately determine FDG uptake values, allowing comparability over multiple scans and treatment courses and will provide a robust basis for the use of PET Response Criteria in Solid Tumors (PERCIST) in clinical trials.
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Affiliation(s)
- Terence A Riauka
- Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Vickie E Baracos
- Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Switzerland
| | - Rebecca Reif
- Division of Oncologic Imaging, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Freimut D Juengling
- Division of Oncologic Imaging, Department of Oncology, University of Alberta, Edmonton, AB, Canada
- Medical Faculty, University Bern, Bern, Switzerland
| | - Don M Robinson
- Division of Medical Physics, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Marguerite Wieler
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Alexander J B McEwan
- Division of Oncologic Imaging, Department of Oncology, University of Alberta, Edmonton, AB, Canada
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Artificial intelligence-aided CT segmentation for body composition analysis: a validation study. Eur Radiol Exp 2021; 5:11. [PMID: 33694046 PMCID: PMC7947128 DOI: 10.1186/s41747-021-00210-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022] Open
Abstract
Background Body composition is associated with survival outcome in oncological patients, but it is not routinely calculated. Manual segmentation of subcutaneous adipose tissue (SAT) and muscle is time-consuming and therefore limited to a single CT slice. Our goal was to develop an artificial-intelligence (AI)-based method for automated quantification of three-dimensional SAT and muscle volumes from CT images. Methods Ethical approvals from Gothenburg and Lund Universities were obtained. Convolutional neural networks were trained to segment SAT and muscle using manual segmentations on CT images from a training group of 50 patients. The method was applied to a separate test group of 74 cancer patients, who had two CT studies each with a median interval between the studies of 3 days. Manual segmentations in a single CT slice were used for comparison. The accuracy was measured as overlap between the automated and manual segmentations. Results The accuracy of the AI method was 0.96 for SAT and 0.94 for muscle. The average differences in volumes were significantly lower than the corresponding differences in areas in a single CT slice: 1.8% versus 5.0% (p < 0.001) for SAT and 1.9% versus 3.9% (p < 0.001) for muscle. The 95% confidence intervals for predicted volumes in an individual subject from the corresponding single CT slice areas were in the order of ± 20%. Conclusions The AI-based tool for quantification of SAT and muscle volumes showed high accuracy and reproducibility and provided a body composition analysis that is more relevant than manual analysis of a single CT slice.
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Zhao J, Xue Q, Chen X, You Z, Wang Z, Yuan J, Liu H, Hu L. Evaluation of SUVlean consistency in FDG and PSMA PET/MR with Dixon-, James-, and Janma-based lean body mass correction. EJNMMI Phys 2021; 8:17. [PMID: 33598849 PMCID: PMC7889776 DOI: 10.1186/s40658-021-00363-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/04/2021] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To systematically evaluate the consistency of various standardized uptake value (SUV) lean body mass (LBM) normalization methods in a clinical positron emission tomography/magnetic resonance imaging (PET/MR) setting. METHODS SUV of brain, liver, prostate, parotid, blood, and muscle were measured in 90 18F-FDG and 28 18F-PSMA PET/MR scans and corrected for LBM using the James, Janma (short for Janmahasatian), and Dixon approaches. The prospective study was performed from December 2018 to August 2020 at Shanghai East Hospital. Forty dual energy X-ray absorptiometry (DXA) measurements of non-fat mass were used as the reference standard. Agreement between different LBM methods was assessed by linear regression and Bland-Altman statistics. SUV's dependency on BMI was evaluated by means of linear regression and Pearson correlation. RESULTS Compared to DXA, the Dixon approach presented the least bias in LBM/weight% than James and Janma models (bias 0.4±7.3%, - 8.0±9.4%, and - 3.3±8.3% respectively). SUV normalized by body weight (SUVbw) was positively correlated with body mass index (BMI) for both FDG (e.g., liver: r = 0.45, p < 0.001) and PSMA scans (r = 0.20, p = 0.31), while SUV normalized by lean body mass (SUVlean) revealed a decreased dependency on BMI (r = 0.22, 0.08, 0.14, p = 0.04, 0.46, 0.18 for Dixon, James, and Janma models, respectively). The liver SUVbw of obese/overweight patients was significantly larger (p < 0.001) than that of normal patients, whereas the bias was mostly eliminated in SUVlean. One-way ANOVA showed significant difference (p < 0.001) between SUVlean in major organs measured using Dixon method vs James and Janma models. CONCLUSION Significant systematic variation was found using different approaches to calculate SUVlean. A consistent correction method should be applied for serial PET/MR scans. The Dixon method provides the most accurate measure of LBM, yielding the least bias of all approaches when compared to DXA.
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Affiliation(s)
- Jun Zhao
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Qiaoyi Xue
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Xing Chen
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhiwen You
- Department of Nuclear Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhe Wang
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Jianmin Yuan
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Hui Liu
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
| | - Lingzhi Hu
- Central Research Institute, United Imaging Healthcare Group, Shanghai, China
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Shang J, Tan Z, Cheng Y, Tang Y, Guo B, Gong J, Ling X, Wang L, Xu H. A method for evaluation of patient-specific lean body mass from limited-coverage CT images and its application in PERCIST: comparison with predictive equation. EJNMMI Phys 2021; 8:12. [PMID: 33555478 PMCID: PMC7870732 DOI: 10.1186/s40658-021-00358-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 01/28/2021] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Standardized uptake value (SUV) normalized by lean body mass ([LBM] SUL) is recommended as metric by PERCIST 1.0. The James predictive equation (PE) is a frequently used formula for LBM estimation, but may cause substantial error for an individual. The purpose of this study was to introduce a novel and reliable method for estimating LBM by limited-coverage (LC) CT images from PET/CT examinations and test its validity, then to analyse whether SUV normalised by LC-based LBM could change the PERCIST 1.0 response classifications, based on LBM estimated by the James PE. METHODS First, 199 patients who received whole-body PET/CT examinations were retrospectively retrieved. A patient-specific LBM equation was developed based on the relationship between LC fat volumes (FVLC) and whole-body fat mass (FMWB). This equation was cross-validated with an independent sample of 97 patients who also received whole-body PET/CT examinations. Its results were compared with the measurement of LBM from whole-body CT (reference standard) and the results of the James PE. Then, 241 patients with solid tumours who underwent PET/CT examinations before and after treatment were retrospectively retrieved. The treatment responses were evaluated according to the PE-based and LC-based PERCIST 1.0. Concordance between them was assessed using Cohen's κ coefficient and Wilcoxon's signed-ranks test. The impact of differing LBM algorithms on PERCIST 1.0 classification was evaluated. RESULTS The FVLC were significantly correlated with the FMWB (r=0.977). Furthermore, the results of LBM measurement evaluated with LC images were much closer to the reference standard than those obtained by the James PE. The PE-based and LC-based PERCIST 1.0 classifications were discordant in 27 patients (11.2%; κ = 0.823, P=0.837). These discordant patients' percentage changes of peak SUL (SULpeak) were all in the interval above or below 10% from the threshold (±30%), accounting for 43.5% (27/62) of total patients in this region. The degree of variability is related to changes in LBM before and after treatment. CONCLUSIONS LBM algorithm-dependent variability in PERCIST 1.0 classification is a notable issue. SUV normalised by LC-based LBM could change PERCIST 1.0 response classifications based on LBM estimated by the James PE, especially for patients with a percentage variation of SULpeak close to the threshold.
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Affiliation(s)
- Jingjie Shang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Zhiqiang Tan
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Yong Cheng
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Yongjin Tang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Bin Guo
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Jian Gong
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Xueying Ling
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Lu Wang
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China
| | - Hao Xu
- Department of Nuclear Medicine and PET/CT-MRI Center, The First Affiliated Hospital of Jinan University, No. 613 West Huangpu Road, Guangzhou, 510630, China.
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Anthropometer3D: Automatic Multi-Slice Segmentation Software for the Measurement of Anthropometric Parameters from CT of PET/CT. J Digit Imaging 2020; 32:241-250. [PMID: 30756268 DOI: 10.1007/s10278-019-00178-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Anthropometric parameters like muscle body mass (MBM), fat body mass (FBM), lean body mass (LBM), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT) are used in oncology. Our aim was to develop and evaluate the software Anthropometer3D measuring these anthropometric parameters on the CT of PET/CT. This software performs a multi-atlas segmentation of CT of PET/CT with extrapolation coefficients for the body parts beyond the usual acquisition range (from the ischia to the eyes). The multi-atlas database is composed of 30 truncated CTs manually segmented to isolate three types of voxels (muscle, fat, and visceral fat). To evaluate Anthropomer3D, a leave-one-out cross-validation was performed to measure MBM, FBM, LBM, VAT, and SAT. The reference standard was based on the manual segmentation of the corresponding whole-body CT. A manual segmentation of one CT slice at level L3 was also used. Correlations were analyzed using Dice coefficient, intra-class coefficient correlation (ICC), and Bland-Altman plot. The population was heterogeneous (sex ratio 1:1; mean age 57 years old [min 23; max 74]; mean BMI 27 kg/m2 [min 18; max 40]). Dice coefficients between reference standard and Anthropometer3D were excellent (mean+/-SD): muscle 0.95 ± 0.02, fat 1.00 ± 0.01, and visceral fat 0.97 ± 0.02. The ICC was almost perfect (minimal value of 95% CI of 0.97). All Bland-Altman plot values (mean difference, 95% CI and slopes) were better for Anthropometer3D compared to L3 level segmentation. Anthropometer3D allows multiple anthropometric measurements based on an automatic multi-slice segmentation. It is more precise than estimates using L3 level segmentation.
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Blanc-Durand P, Campedel L, Mule S, Jegou S, Luciani A, Pigneur F, Itti E. Prognostic value of anthropometric measures extracted from whole-body CT using deep learning in patients with non-small-cell lung cancer. Eur Radiol 2020; 30:3528-3537. [PMID: 32055950 DOI: 10.1007/s00330-019-06630-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The aim of the study was to extract anthropometric measures from CT by deep learning and to evaluate their prognostic value in patients with non-small-cell lung cancer (NSCLC). METHODS A convolutional neural network was trained to perform automatic segmentation of subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and muscular body mass (MBM) from low-dose CT images in 189 patients with NSCLC who underwent pretherapy PET/CT. After a fivefold cross-validation in a subset of 35 patients, anthropometric measures extracted by deep learning were normalized to the body surface area (BSA) to control the various patient morphologies. VAT/SAT ratio and clinical parameters were included in a Cox proportional-hazards model for progression-free survival (PFS) and overall survival (OS). RESULTS Inference time for a whole volume was about 3 s. Mean Dice similarity coefficients in the validation set were 0.95, 0.93, and 0.91 for SAT, VAT, and MBM, respectively. For PFS prediction, T-stage, N-stage, chemotherapy, radiation therapy, and VAT/SAT ratio were associated with disease progression on univariate analysis. On multivariate analysis, only N-stage (HR = 1.7 [1.2-2.4]; p = 0.006), radiation therapy (HR = 2.4 [1.0-5.4]; p = 0.04), and VAT/SAT ratio (HR = 10.0 [2.7-37.9]; p < 0.001) remained significant prognosticators. For OS, male gender, smoking status, N-stage, a lower SAT/BSA ratio, and a higher VAT/SAT ratio were associated with mortality on univariate analysis. On multivariate analysis, male gender (HR = 2.8 [1.2-6.7]; p = 0.02), N-stage (HR = 2.1 [1.5-2.9]; p < 0.001), and the VAT/SAT ratio (HR = 7.9 [1.7-37.1]; p < 0.001) remained significant prognosticators. CONCLUSION The BSA-normalized VAT/SAT ratio is an independent predictor of both PFS and OS in NSCLC patients. KEY POINTS • Deep learning will make CT-derived anthropometric measures clinically usable as they are currently too time-consuming to calculate in routine practice. • Whole-body CT-derived anthropometrics in non-small-cell lung cancer are associated with progression-free survival and overall survival. • A priori medical knowledge can be implemented in the neural network loss function calculation.
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Affiliation(s)
- Paul Blanc-Durand
- Department of Nuclear Medicine, Henri Mondor Hospital/AP-HP, Créteil, F-94010, France. .,INSERM IMRB, Team 8, U-PEC, Créteil, F-94000, France. .,Université Paris-Est Créteil (U-PEC), F-94000, Créteil, France.
| | - Luca Campedel
- Department of Oncology, Groupe Hospitalier Pitié Salpêtrière C. Foix/AP-HP, Paris, F-75013, France
| | - Sébastien Mule
- Université Paris-Est Créteil (U-PEC), F-94000, Créteil, France.,Department of Radiology, Henri Mondor Hospital/AP-HP, Créteil, F-94010, France
| | | | - Alain Luciani
- Université Paris-Est Créteil (U-PEC), F-94000, Créteil, France.,Department of Radiology, Henri Mondor Hospital/AP-HP, Créteil, F-94010, France
| | - Frédéric Pigneur
- Department of Radiology, Henri Mondor Hospital/AP-HP, Créteil, F-94010, France
| | - Emmanuel Itti
- Department of Nuclear Medicine, Henri Mondor Hospital/AP-HP, Créteil, F-94010, France.,INSERM IMRB, Team 8, U-PEC, Créteil, F-94000, France.,Université Paris-Est Créteil (U-PEC), F-94000, Créteil, France
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Popinat G, Cousse S, Goldfarb L, Becker S, Gardin I, Salaün M, Thureau S, Vera P, Guisier F, Decazes P. Sub-cutaneous Fat Mass measured on multislice computed tomography of pretreatment PET/CT is a prognostic factor of stage IV non-small cell lung cancer treated by nivolumab. Oncoimmunology 2019; 8:e1580128. [PMID: 31069139 DOI: 10.1080/2162402x.2019.1580128] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/11/2018] [Accepted: 01/07/2019] [Indexed: 12/26/2022] Open
Abstract
Introduction: Our aim was to explore the prognostic value of anthropometric parameters in patients treated with nivolumab for stage IV non-small cell lung cancer (NSCLC). Methods: We retrospectively included 55 patients with NSCLC treated by nivolumab with a pretreatment 18FDG positron emission tomography coupled with computed tomography (PET/CT). Anthropometric parameters were measured on the CT of PET/CT by in-house software (Anthropometer3D) allowing an automatic multi-slice measurement of Lean Body Mass (LBM), Fat Body Mass (FBM), Muscle Body Mass (MBM), Visceral Fat Mass (VFM) and Sub-cutaneous Fat Mass (SCFM). Clinical and tumor parameters were also retrieved. Receiver operator characteristics (ROC) analysis was performed and overall survival at 1 year was studied using Kaplan-Meier and Cox analysis. Results: FBM and SCFM were highly correlated (ρ = 0.99). In ROC analysis, only FBM, SCFM, VFM, body mass index (BMI) and metabolic tumor volume (MTV) had an area under the curve (AUC) significantly higher than 0.5. In Kaplan-Meier analysis using medians as cut-offs, prognosis was worse for patients with low SCFM (<5.69 kg/m2; p = 0.04, survivors 41% vs 75%). In Cox univariate analysis using continuous values, BMI (HR = 0.84, p= 0.007), SCFM (HR = 0.75, p = 0.003) and FBM (HR = 0.80, p= 0.004) were significant prognostic factors. In multivariate analysis using clinical parameters (age, gender, WHO performance status, number prior regimens) and SCFM, only SCFM was significantly associated with poor survival (HR = 0.75, p = 0.006). Conclusions: SCFM is a significant prognosis factor of stage IV NSCLC treated by nivolumab.
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Affiliation(s)
- Geoffrey Popinat
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France
| | - Stéphanie Cousse
- Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care, Rouen University Hospital, Rouen, France
| | - Lucas Goldfarb
- Department of Nuclear Medicine, Hôpital Avicenne, Bobigny, France
| | - Stéphanie Becker
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,Faculty of Medicine, University of Rouen, Rouen, France
| | - Isabelle Gardin
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,Faculty of Medicine, University of Rouen, Rouen, France
| | - Mathieu Salaün
- Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care, Rouen University Hospital, Rouen, France.,Faculty of Medicine, University of Rouen, Rouen, France
| | - Sébastien Thureau
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,Faculty of Medicine, University of Rouen, Rouen, France.,Department of Radiotherapy and Oncology, Henri Becquerel Cancer Center, Rouen, France
| | - Pierre Vera
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,Faculty of Medicine, University of Rouen, Rouen, France
| | - Florian Guisier
- Department of Pulmonology, Thoracic Oncology, and Respiratory Intensive Care, Rouen University Hospital, Rouen, France
| | - Pierre Decazes
- Department of Nuclear Medicine, Henri Becquerel Cancer Center, Rouen, France.,Faculty of Medicine, University of Rouen, Rouen, France
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Prognostic value of pretreatment PET/CT lean body mass-corrected parameters in patients with hepatocellular carcinoma. Nucl Med Commun 2018; 39:564-571. [PMID: 29634658 DOI: 10.1097/mnm.0000000000000842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was designed to investigate whether pretreatment fluorine-18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) lean body mass-corrected parameters could predict the overall survival (OS) better than the established predictors in patients with hepatocellular carcinoma (HCC). PATIENTS AND METHODS We retrospectively analyzed 61 patients with HCC with pretreatment F-FDG-PET/CT. Besides obtaining clinical factors, we measured both lean body mass-corrected and body weight-corrected PET/CT parameters, including metabolic tumor volume, maximal standardized uptake value of the tumor, total lesion glycolysis, tumor-to-normal liver uptake ratio, and so on. The prognostic value of those factors for OS was assessed by statistical software. RESULTS In the univariate analysis, PET/CT parameters, ascites, serum α-fetoprotein, alkaline phosphatase, aspartate transaminase (AST), tumor number, tumor size of the maximal one, vascular invasion, TNM stage, Child-Pugh class, Barcelona Clinic Liver Cancer (BCLC) staging, and Okuda staging were significant predictors of OS. In multivariate and Kaplan-Meier analyses, lean body mass-corrected maximum standardized uptake value (lbmSUVmax) more than 3.35 g/ml, AST more than 42.00 U/l, and BCLC staging B-C were significant independent predictors of poor OS. When BCLC staging variable was stratified by four categories instead of two in the multivariate analysis, it was not the statistically significant independent predictor anymore, but lbmSUVmax and AST still were. CONCLUSION Pretreatment F-FDG-PET/CT lean body mass-corrected parameters can predict the OS in patients with HCC. Moreover, lbmSUVmax and AST, as the independent predictors of OS, could supplement the prognostic value of the BCLC staging system.
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Gomes Marin JF, Duarte PS, Willegaignon de Amorim de Carvalho J, Sado HN, Sapienza MT, Buchpiguel CA. Comparison of the Variability of SUV Normalized by Skeletal Volume with the Variability of SUV Normalized by Body Weight in 18F-Fluoride PET/CT. J Nucl Med Technol 2018; 47:60-63. [PMID: 30139886 DOI: 10.2967/jnmt.118.215111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/06/2018] [Indexed: 01/05/2023] Open
Abstract
Our objective was to test the hypothesis that variability in SUV normalized by skeletal volume (SV) in 18F-fluoride (18F-NaF) PET/CT studies is lower than variability in SUV normalized by body weight (BW). Methods: The mean SUV (SUVmean) was obtained for whole skeletal volume of interest (wsVOI) in 163 selected 18F-NaF PET/CT studies. These studies were performed to investigate bone metastases and were considered to have normal results. SUVmean was calculated with normalization by BW (BW SUVmean), with normalization by SV (SV SUVmean), and without normalization (WN SUVmean). The total SV for each patient was also estimated on the basis of the wsVOI defined on the CT component of the PET/CT study. SUVmean variability for each patient was estimated as the absolute value of the difference between the SUVmean for the patient and the mean of the SUVmean for the whole group of patients, divided by the mean of the SUVmean for the whole group of patients. The variabilities of SUVmean calculated by the 3 methods were compared using a paired 1-tailed Wilcoxon test. Results: The mean variability for the BW, SV, and WN SUVmean was 0.16, 0.13, and 0.16, respectively. There were statistically significant differences between SV and BW SUVmean variability (P = 0.03) and between SV and WN SUVmean variability (P < 0.01). There was no statistically significant difference between BW and WN SUVmean variability (P = 0.4). Conclusion: In patients with normal 18F-NaF PET/CT results, SV SUVmean presents lower variability than BW SUVmean.
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Affiliation(s)
| | | | | | - Heitor Naoki Sado
- Division of Nuclear Medicine, São Paulo Cancer Institute, São Paulo, Brazil; and
| | | | - Carlos Alberto Buchpiguel
- Division of Nuclear Medicine, São Paulo Cancer Institute, São Paulo, Brazil; and.,University of São Paulo Medical School, São Paulo, Brazil
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Patient-specific lean body mass can be estimated from limited-coverage computed tomography images. Nucl Med Commun 2018; 39:521-526. [PMID: 29672462 DOI: 10.1097/mnm.0000000000000845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In PET/CT, quantitative evaluation of tumour metabolic activity is possible through standardized uptake values, usually normalized for body weight (BW) or lean body mass (LBM). Patient-specific LBM can be estimated from whole-body (WB) CT images. As most clinical indications only warrant PET/CT examinations covering head to midthigh, the aim of this study was to develop a simple and reliable method to estimate LBM from limited-coverage (LC) CT images and test its validity. PATIENTS AND METHODS Head-to-toe PET/CT examinations were retrospectively retrieved and semiautomatically segmented into tissue types based on thresholding of CT Hounsfield units. LC was obtained by omitting image slices. Image segmentation was validated on the WB CT examinations by comparing CT-estimated BW with actual BW, and LBM estimated from LC images were compared with LBM estimated from WB images. A direct method and an indirect method were developed and validated on an independent data set. RESULTS Comparing LBM estimated from LC examinations with estimates from WB examinations (LBMWB) showed a significant but limited bias of 1.2 kg (direct method) and nonsignificant bias of 0.05 kg (indirect method). CONCLUSION This study demonstrates that LBM can be estimated from LC CT images with no significant difference from LBMWB.
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Halsne T, Müller EG, Spiten AE, Sherwani AG, Gyland Mikalsen LT, Revheim ME, Stokke C. The Effect of New Formulas for Lean Body Mass on Lean-Body-Mass-Normalized SUV in Oncologic 18F-FDG PET/CT. J Nucl Med Technol 2018; 46:253-259. [PMID: 29599401 DOI: 10.2967/jnmt.117.204586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 12/24/2017] [Indexed: 12/11/2022] Open
Abstract
Because of better precision and intercompatibility, the use of lean body mass (LBM) as a mass estimate in the calculation of SUV (SUL) has become more common in research and clinical studies today. Thus, the equations deciding this quantity must be those that best represent the actual body composition. Methods: LBM was calculated for 44 patients examined with 18F-FDG PET/CT scans by means of the sex-specific predictive equations of James and Janmahasatians, and the results were validated using a CT-based method that makes use of the eyes-to-thighs CT component of the PET/CT aquisition and segments the voxels according to Hounsfield units. Intraclass correlation coefficients and Bland-Altman plots were used to assess agreement between the various methods. Results: A mean difference of 6.3 kg (limits of agreement, -15.1 to 2.5 kg) between [Formula: see text] and [Formula: see text] was found. This difference was higher than the 3.8-kg difference observed between [Formula: see text] and [Formula: see text] (limits of agreement, -12.5 to 4.9 kg). In addition, [Formula: see text] had a higher intraclass correlation coefficient with [Formula: see text] (0.87; 95% confidence interval, 0.60-0.94) than with [Formula: see text] (0.77; 95% confidence interval, 0.11-0.91). Thus, we obtained better agreement between [Formula: see text] and [Formula: see text] Although there were exceptions, the overall effect on SUL was that [Formula: see text] was greater than [Formula: see text] Conclusion: We have verified the reliability of the suggested [Formula: see text] formulas with a CT-derived reference standard. Compared with the more traditional and available set of [Formula: see text] equations, the [Formula: see text] formulas tend to yield better agreement.
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Affiliation(s)
- Trygve Halsne
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway
| | | | - Ann-Eli Spiten
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | | | | | - Mona-Elisabeth Revheim
- Department of Nuclear Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway; and
| | - Caroline Stokke
- Department of Diagnostic Physics, Oslo University Hospital, Oslo, Norway.,Department of Life Sciences and Health, Oslo Metropolitan University, Oslo, Norway
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Automatic Measurement of the Total Visceral Adipose Tissue From Computed Tomography Images by Using a Multi-Atlas Segmentation Method. J Comput Assist Tomogr 2018; 42:139-145. [PMID: 28708717 DOI: 10.1097/rct.0000000000000652] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The visceral adipose tissue (VAT) volume is a predictive and/or prognostic factor for many cancers. The objective of our study was to develop an automatic measurement of the whole VAT volume using a multi-atlas segmentation (MAS) method from a computed tomography. METHODS A total of 31 sets of whole-body computed tomography volume data were used. The reference VAT volume was defined on the basis of manual segmentation (VATMANUAL). We developed an algorithm, which measured automatically the VAT volumes using a MAS based on a nonrigid volume registration algorithm coupled with a selective and iterative method for performance level estimation (SIMPLE), called VATMAS_SIMPLE. The results were evaluated using intraclass correlation coefficient and dice similarity coefficients. RESULTS The intraclass correlation coefficient of VATMAS_SIMPLE was excellent, at 0.976 (confidence interval, 0.943-0.989) (P < 0.001). The dice similarity coefficient of VATMAS_SIMPLE was also good, at 0.905 (SD, 0.076). CONCLUSIONS This newly developed algorithm based on a MAS can measure accurately the whole abdominopelvic VAT.
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Aide N, Lasnon C, Veit-Haibach P, Sera T, Sattler B, Boellaard R. EANM/EARL harmonization strategies in PET quantification: from daily practice to multicentre oncological studies. Eur J Nucl Med Mol Imaging 2017; 44:17-31. [PMID: 28623376 PMCID: PMC5541084 DOI: 10.1007/s00259-017-3740-2] [Citation(s) in RCA: 183] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/24/2017] [Indexed: 01/18/2023]
Abstract
Quantitative positron emission tomography/computed tomography (PET/CT) can be used as diagnostic or prognostic tools (i.e. single measurement) or for therapy monitoring (i.e. longitudinal studies) in multicentre studies. Use of quantitative parameters, such as standardized uptake values (SUVs), metabolic active tumor volumes (MATVs) or total lesion glycolysis (TLG), in a multicenter setting requires that these parameters be comparable among patients and sites, regardless of the PET/CT system used. This review describes the motivations and the methodologies for quantitative PET/CT performance harmonization with emphasis on the EANM Research Ltd. (EARL) Fluorodeoxyglucose (FDG) PET/CT accreditation program, one of the international harmonization programs aiming at using FDG PET as a quantitative imaging biomarker. In addition, future accreditation initiatives will be discussed. The validation of the EARL accreditation program to harmonize SUVs and MATVs is described in a wide range of tumor types, with focus on therapy assessment using either the European Organization for Research and Treatment of Cancer (EORTC) criteria or PET Evaluation Response Criteria in Solid Tumors (PERCIST), as well as liver-based scales such as the Deauville score. Finally, also presented in this paper are the results from a survey across 51 EARL-accredited centers reporting how the program was implemented and its impact on daily routine and in clinical trials, harmonization of new metrics such as MATV and heterogeneity features.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France.
- Inserm U1086 ANTICIPE, Caen University, Caen, France.
| | - Charline Lasnon
- Inserm U1086 ANTICIPE, Caen University, Caen, France
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Patrick Veit-Haibach
- Department of Nuclear Medicine and Department of Diagnostic and Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
- Joint Department Medical Imaging, University Health Network, University of Toronto, Toronto, Canada
| | - Terez Sera
- Nuclear Medicine Department, University of Szeged, Szeged, Hungary
| | - Bernhard Sattler
- Department of Nuclear Medicine, University Hospital of Leipzig, 04103, Leipzig, Germany
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
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