New Approaches in Characterization of Lesions Dissemination in DLBCL Patients on Baseline PET/CT

Dissemination, expressed recently by the largest Euclidian distance between lymphoma sites (SDmax), appeared a promising risk factor in DLBCL patients. We investigated alternative distance metrics to characterize the robustness of the dissemination information. In 290 patients from the REMARC trial (NCT01122472), the Euclidean (Euc), Manhattan (Man), and Tchebychev (Tch) distances between the furthest lesions, firstly based on the centroid of each lesion and then directly from the two most distant tumor voxels and the Travelling Salesman Problem distance (TSP) were calculated. For PFS, the areas under the ROC curves were between 0.63 and 0.64, and between 0.62 and 0.65 for OS. Patients with high SDmax whatever the method of calculation or high SD_TSP had a significantly poorer outcome than patients with low SDmax or SD_TSP (p < 0.001 for both PFS and OS), with significance maintained in Ann Arbor advanced-stage patients. In multivariate analysis with total metabolic tumor volume and ECOG, each distance feature had an independent prognostic value for PFS. For OS, only SDmax_Tch, SDmax_Euc _Vox, and SDmax_Man _Vox reached significance. The spread of DLBCL lesions measured by the largest distance between lymphoma sites is a strong independent prognostic factor and could be measured directly from tumor voxels, allowing its development in the area of the deep learning segmentation methods.

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Metabolic tumor volume on FDG-PET/CT is a possible prognostic factor for Stage I lung cancer patients treated with stereotactic body radiation therapy: a retrospective clinical study

Journal of Radiation Research ◽

10.1093/jrr/rrw048 ◽

2016 ◽

Vol 57 (6) ◽

pp. 655-661 ◽

Cited By ~ 12

Author(s):

Noriyoshi Takahashi ◽

Takaya Yamamoto ◽

Haruo Matsushita ◽

Toshiyuki Sugawara ◽

Masaki Kubozono ◽

...

Keyword(s):

Single Dose ◽

Tumor Volume ◽

Stereotactic Body Radiation Therapy ◽

Roc Curves ◽

Metabolic Tumor Volume ◽

Tumor Diameter ◽

Lung Cancer Patients ◽

Pet Ct ◽

Stage I Lung Cancer ◽

Fdg Pet Ct

Abstract The aim of this study was to determine whether metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are associated with outcomes in Stage I lung cancer patients treated with stereotactic body radiation therapy (SBRT). Thirty-eight patients underwent [18F] fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) within 60 days before SBRT at our institution between January 2001 and December 2011. The maximum standardized uptake value (SUVmax), MTV2, MTV4, MTV6, TLG40%, TLG50% and TLG60% were calculated. Prognostic factors for overall survival (OS) and local control (LC) were analyzed using Cox's proportional hazards model, and survival curves were calculated using the Kaplan–Meier method. Receiver operating characteristics (ROC) curves of PET parameters for OS and LC were calculated. The median follow-up period for survivors was 37.7 months. Three-year OS and LC rates were 56.4% and 70.5%, respectively, and 5-year OS and LC rates were 36.8% and 70.5%, respectively. In univariate analyses, tumor diameter (P = 0.019), single dose ≥10 Gy (P = 0.017), MTV2 (P = 0.030) and MTV4 (P = 0.048) were significant predictors for OS. Tumor diameter (P < 0.001), single dose ≥10 Gy (P = 0.007), SUVmax (P = 0.035), MTV2 (P < 0.001), MTV4 (P = 0.003), MTV6 (P = 0.017), TLG40% (P < 0.001), TLG50% (P = 0.001) and TLG60% (P = 0.003) were significant predictors for LC. SUVmax was not a significant predictor for OS. We made the ROC curves at PET parameters, and the largest area under the curve value for OS was MTV2 and for LC was TLG40%. Tumor diameter, single dose ≥10 Gy, MTV2 and MTV4 are prognostic factors for OS and LC rates and MTV2 is a better prognostic factor for OS than other PET parameters.

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Metabolic Tumor Volume and Soluble Cytokines Levels in Newly Diagnosed Hodgkin Lymphoma: What It Brings into the Staging Precision?

Blood ◽

10.1182/blood-2018-99-115150 ◽

2018 ◽

Vol 132 (Supplement 1) ◽

pp. 2933-2933 ◽

Cited By ~ 2

Author(s):

VIT K Prochazka ◽

Lenka Henzlova ◽

Marie Lukasova ◽

Veronika Hanackova ◽

Eva Kriegova ◽

...

Keyword(s):

High Risk ◽

Tumor Volume ◽

Metabolic Tumor Volume ◽

Tumor Burden ◽

Pet Ct ◽

Staging Systems ◽

Ann Arbor ◽

Frontline Treatment ◽

Systemic Symptoms ◽

Metabolic Tumor Burden

Abstract Background: Frontline therapy of Hodgkin lymphoma (HL) is strictly stage-adapted. Staging systems used are based on historical variables which only indirectly reflects tumor load (Ann Arbor stage) or lymphoma cytokine activity (systemic symptoms, erytrocyte sedimentation rate). With new, abbreviated interim PET-tailored chemotherapy schemes (2+2) and reduced radiotherapy protocols, there is a clinical need for precise staging tools. Last years have brought new insight into the prognostic role of metabolic quantitative PET parameters and HL-associated biomarkers. Total metabolic tumor volume (TMTV) measured using fluoro-deoxyglucose PET (FDG-PET) was found to be a predictor of therapy failure after frontline treatment (Kanoun 2014). Interestingly, TMTV was found capable of identifying poor responders within one (intermediate) staging group (Akhtari, 2018; Cottereau 2018). Serum concentrations of thymus and activation-regulated chemokine (TARC) and other cytokines have been proved to have prognostic significance in the patients treated both in the frontline and relapse setting (Moskowitz, 2015; Guidetti 2017). A relationship between pretreatment TMTV, baseline cytokines levels, and current staging systems has not been analyzed yet. Aim: To analyzed quantitative metabolic PET parameters and selected soluble biomarkers in the context of the staging systems used in the U.S. and Europe Methods: We have analyzed a prospectively enrolled cohort of forty-eight patients with HL who were diagnosed in two large university medical centers from 5/2015 to 2/2018. All pts have undergone pretreatment FDG-PET/CT with quantitative analysis of TMTV, Total Lesion Glycolysis (TLG), Maximum Standardized Uptake Volume (SUVmax.) and the Largest Tumor Diameter (LD) and were sampled for cytokine analysis within 16 (median) days from the PET/CT. We have analyzed a set of four serum biomarkers: CD30 (sCD30), CD163 (sCD163), TARC, and interleukin 6 (sIL6), which were measured using ELISA assays. Results: A cohort consisted of 22 males and 26 females with median age of 42 years (range 21-75). Histology subtype was known in all but one case: nodular sclerosis in 23, mixed cellularity 15, lymphocyte-rich in 5 and nodular-lymphocyte predominant (NLPHL) in four. Ann Arbor stages were as follows: I in 5, II in 20, III in 13 and IV in 10 of the pts with systemic symptoms in 20 (42%) of them. All pts were classified according to the German Hodgkin Study Group (GHSG) and NCCN staging systems. GHSG stages - limited, intermediate and advanced were seen in 8 (17%), 10 (21%) and 30 (62%) pts, respectively. NCCN stages were distributed into early favorable in 8 (17%), early unfavorable in 17 (35%) and advanced in 23 (48%) of the pts. Chemotherapy was applied in all but four pts using: BEACOPPesc, combined BEACOPP+ABVD, ABVD and ABV/COPP protocols in 7, 15, 16 and six pts respectively. Of four pts without chemo one case was treated with local radiotherapy and three with WaW (all of them with NLPHL). Treatment response was known in 41 (85%) of the cases with CR, PR, and PD in 33 (80.5%), 6 (14.6%) and two (4.9%) pts, respectively. Relationships between disease stages and PET-parameters are summarized in Table 1. Briefly, metabolic tumor burden (TMTV, TLG) identified two markedly different groups: low and intermediate/high risk. Similarly, cytokines levels were significantly lower in low-risk patients compared to those with intermediate-high risk (Table 2). Treatment outcome did not correlate either with GHSG nor NCCN stage. We found correlation of sIL-6 (p=0.03) but not sCD30 (p=0.09), sCD163 (p=0.14) and TARC (p=0.57) with CR achievement. In terms of PET-parameters the high TMTV>104 cm3 (P=0.046) and TLG>798 (P=0.003) were associated with not achieving of CR with NPV, PPV and test accuracy of 94.4, 22.0, 58.5 for TMTV and 100%, 36,4%, 66% for TLG, respectively. Conclusion: Adequate frontline treatment policy is vital for achieving an optimal balance between efficacy and toxicity. Current staging systems have a weak correlation with metabolic tumor burden: one-third of those recognized as advanced stage have the low burden, and vice versa about a half of intermediate-risk pts have high tumor burden. Combination of TMTV/TLG and cytokines can be currently used for decision making in borderline stage cases and probably could serve as a backbone for a new staging system in the future. Acknowledgment: IGA_LF_2018_004, MH CZ-DRO (FNOL, 00098892) Disclosures No relevant conflicts of interest to declare.

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Usefulness of FDG-PET/CT-Based Radiomics for the Characterization and Genetic Orientation of Pheochromocytomas Before Surgery

Cancers ◽

10.3390/cancers12092424 ◽

2020 ◽

Vol 12 (9) ◽

pp. 2424

Author(s):

Catherine Ansquer ◽

Delphine Drui ◽

Eric Mirallié ◽

Karine Renaudin-Autain ◽

Antoine Denis ◽

...

Keyword(s):

Genetic Testing ◽

Fdg Pet ◽

Metabolic Tumor Volume ◽

Total Lesion Glycolysis ◽

Added Value ◽

Textural Features ◽

Pet Ct ◽

Fdg Pet Ct ◽

Cluster 2

Purpose: To assess the potential added value of FDG-PET/CT radiomics for the characterization of pheochromocytomas (PHEO) and their genetic orientation prior to surgery and genetic testing. Methods: This retrospective monocentric study, included 49 patients (52 tumors) that underwent both FDG-PET/CT and MIBG scan before surgery. A germline mutation was secondarily identified in 13 patients in one of the genes related to Cluster 1 (n = 4) or Cluster 2 (n = 9). No mutation was identified in 32 patients and 4 did not have genetic testing. Correlation between several PET-based biomarkers, including SUVmax, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and textural features, and biochemical and genetic features were analyzed. Results: Sensitivity of FDG-PET/CT alone was 92%, and 98% when combined to MIBG. The SUVmax was significantly higher for mutated tumors classified in Cluster 1 than in Cluster 2 (p = 0.002) or for tumors with no identified mutations (p = 0.04). MTV and TLG of the tumors with the most intense uptake discriminated mutated Cluster 2 from sporadic tumors, but not from Cluster 1 tumors. Textural features combined with MTV led to better differentiation between sporadic and mutated tumors (p < 0.05). Conclusion: FDG-PET/CT is useful for preoperative characterization of PHEO, and when combined with radiomics biomarkers, provides evidences for a genetic predisposition.

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Diagnostic value of metabolic tumor volume assessed by 18F-FDG PET/CT added to SUVmax for characterization of thyroid 18F-FDG incidentaloma

Nuclear Medicine Communications ◽

10.1097/mnm.0b013e328362d2d7 ◽

2013 ◽

Vol 34 (9) ◽

pp. 868-876 ◽

Cited By ~ 9

Author(s):

Bo Hyun Kim ◽

Seong-Jang Kim ◽

Heeyoung Kim ◽

Yun Kyung Jeon ◽

Sang Soo Kim ◽

...

Keyword(s):

Fdg Pet ◽

Tumor Volume ◽

Metabolic Tumor Volume ◽

Diagnostic Value ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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Baseline Metabolic Tumor Volume in 18FDG-PET-CT Scans in Classical Hodgkin Lymphoma Using Semi-Automatic Segmentation

Blood ◽

10.1182/blood-2019-125495 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4049-4049

Author(s):

Julia Driessen ◽

Gerben J.C. Zwezerijnen ◽

Jakoba J Eertink ◽

Marie José Kersten ◽

Anton Hagenbeek ◽

...

Keyword(s):

Board Of Directors ◽

Research Funding ◽

Automatic Segmentation ◽

Visual Quality ◽

Metabolic Tumor Volume ◽

Advisory Committees ◽

18Fdg Pet ◽

Pet Ct ◽

Segmentation Methods

Introduction Baseline metabolic tumor volume (bMTV) is increasingly studied as a prognostic factor for classical Hodgkin lymphoma (cHL). Before implementation as a clinical prognostic marker, it is important to investigate different methods for deriving bMTV since not all methods are suitable for each type of malignancy. Semi-automatic segmentation is influenced less by observer bias and variability compared to manual segmentation and might therefore be more reliable for assessing bMTV. However, not much is known about the use of different semi-automatic segmentation methods and how this influences the prognostic value of bMTV in cHL. Here we present a comparison of bMTV derived with 6 semi-automatic segmentation methods. In addition, a visual quality scoring of all segmentations is performed to gain insight into which segmentation methods could be used to determine bMTV in cHL. Methods We selected 61 baseline 18FDG-PET-CT scans that met specific quality criteria (http://EARL.EANM.org) from patients treated in the Transplant BRaVE study for relapsed/refractory cHL [Blood 2018 132:2923]. Six semi-automatic segmentation methods were applied using the Accurate tool, an in-house developed software application which has already been validated in other types of cancer, including diffuse large B-cell lymphoma [Eur Radiol 2019 06178:9, J Nucl Med. 2018;59(suppl 1):1753]. We compared two fixed thresholds (SUV4.0 and SUV2.5), two relative thresholds (A50P: a contrast corrected 50% of standard uptake value (SUV) peak, and 41max: 41% of SUVmax), and 2 majority vote methods, MV2 and MV3 selecting delineations of ≥2 and ≥3 of previously mentioned methods, respectively. Quality of the segmentation was scored using visual quality scores (QS) by two reviewers (JD, GZ): QS-1 for complete selections containing all visible tumor localizations; QS-2 when segmentations 'flood' into regions with physiological FDG uptake; QS-3 when segmentations do not select all visible lesions; or QS-4: a combination of QS-2 and QS-3. In addition, the quality of the delineation was rated: QS-A for good visual delineation of lesions; QS-B for too small delineation; and QS-C for too large delineation. All segmentations that had score QS-2 or QS-4 were manually adapted by erasing regions that flooded into areas with high physiological uptake. Figure 1 shows examples of the quality scores. We used Spearman's correlations to compare the bMTV of all semi-automatic methods. Comparison of quality scores was performed using chi-square tests. Results The median bMTV differed substantially among the segmentation methods, ranging from 24 mL for SUV4.0 to 88 mL for 41max (Table 1). However, there was a high significant correlation (p <0.0001) between all methods with spearman coefficients ranging between 0.77 and 0.93 (Table 2). The quality of the segmentation was best using the SUV2.5 threshold with QS-1 in 64% of scans and delineation was best for MV3 with QS-A in 56% (Table 3). The segmentation quality was significantly better when less than 5 lesions were present on a scan. A large difference was observed for SUV2.5 with score QS-1 in 91% of cases for scans with <5 lesions (n=22), compared to QS-1 in 49% for scans containing ≥5 lesions (n=39) (p <0.001; Table 3). The delineation quality did not depend on the number of lesions. However, for SUV2.5, A50P and MV3, the delineation was considered better when the SUVmax of selected volumes of interest (VOI) was <10, while SUV4.0 performed significantly better with a SUVmax ≥10 (Table 3). Conclusions We found a good correlation between all methods, suggesting that the segmentation method used will probably not influence the predictive value of bMTV. Ease of use was highest with a semi-automatic segmentation of bMTV using the SUV2.5 segmentation method. SUV2.5 had the best visual quality and needed least manual adaptation. To investigate possible implementation of bMTV in clinical practice, we will validate the quality of the segmentation methods and the predictive value of bMTV in a larger cohort of patients with other prognostic parameters including quantitative radiomics analysis of baseline PET-scans. Disclosures Kersten: Bristol-Myers Squibb: Honoraria, Research Funding; Gilead: Honoraria; Roche: Honoraria, Research Funding; Celgene: Honoraria, Research Funding; Novartis: Honoraria; Mundipharma: Honoraria, Research Funding; Amgen: Honoraria, Research Funding; Miltenyi: Honoraria; Takeda Oncology: Research Funding; Kite Pharma: Honoraria, Research Funding. Zijlstra:Janssen: Honoraria; Gilead: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Takeda: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees.

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The Role of [18F]Fluciclovine PET/CT in the Characterization of High-Risk Primary Prostate Cancer: Comparison with [11C]Choline PET/CT and Histopathological Analysis

Cancers ◽

10.3390/cancers13071575 ◽

2021 ◽

Vol 13 (7) ◽

pp. 1575

Author(s):

Lucia Zanoni ◽

Riccardo Mei ◽

Lorenzo Bianchi ◽

Francesca Giunchi ◽

Lorenzo Maltoni ◽

...

Keyword(s):

Bone Marrow ◽

High Risk ◽

Malignant Lesion ◽

Lesion Detection ◽

Histopathological Analysis ◽

Choline Pet ◽

Primary Prostate Cancer ◽

Pet Ct

The primary aim of the study was to evaluate the role of [18F]Fluciclovine PET/CT in the characterization of intra-prostatic lesions in high-risk primary PCa patients eligible for radical prostatectomy, in comparison with conventional [11C]Choline PET/CT and validated by prostatectomy pathologic examination. Secondary aims were to determine the performance of PET semi-quantitative parameters (SUVmax; target-to-background ratios [TBRs], using abdominal aorta, bone marrow and liver as backgrounds) for malignant lesion detection (and best cut-off values) and to search predictive factors of malignancy. A six sextants prostate template was created and used by PET readers and pathologists for data comparison and validation. PET visual and semi-quantitative analyses were performed: for instance, patient-based, blinded to histopathology; subsequently lesion-based, un-blinded, according to the pathology reference template. Among 19 patients included (mean age 63 years, 89% high and 11% very-high-risk, mean PSA 9.15 ng/mL), 45 malignant and 31 benign lesions were found and 19 healthy areas were selected (n = 95). For both tracers, the location of the “blinded” prostate SUVmax matched with the lobe of the lesion with the highest pGS in 17/19 cases (89%). There was direct correlation between [18F]Fluciclovine uptake values and pISUP. Overall, lesion-based (n = 95), the performance of PET semiquantitative parameters, with either [18F]Fluciclovine or [11C]Choline, in detecting either malignant/ISUP2-5/ISUP4-5 PCa lesions, was moderate and similar (AUCs ≥ 0.70) but still inadequate (AUCs ≤ 0.81) as a standalone staging procedure. A [18F]Fluciclovine TBR-L3 ≥ 1.5 would depict a clinical significant lesion with a sensitivity and specificity of 85% and 68% respectively; whereas a SUVmax cut-off value of 4 would be able to identify a ISUP 4-5 lesion in all cases (sensitivity 100%), although with low specificity (52%). TBRs (especially with threshold significantly higher than aorta and slightly higher than bone marrow), may be complementary to implement malignancy targeting.

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High Basal Maximal Standardized Uptake Value (SUVmax) in Follicular Lymphoma Identifies Patients with a Low Risk of Long-Term Relapse

Cancers ◽

10.3390/cancers13122876 ◽

2021 ◽

Vol 13 (12) ◽

pp. 2876

Author(s):

Giovanni Manfredi Assanto ◽

Giulia Ciotti ◽

Mattia Brescini ◽

Maria Lucia De Luca ◽

Giorgia Annechini ◽

...

Keyword(s):

Risk Factors ◽

Follicular Lymphoma ◽

Standardized Uptake Value ◽

Metabolic Tumor Volume ◽

Late Relapse ◽

Prognostic Role ◽

Pet Ct ◽

Group A ◽

Group B

Background: Despite that the unfavorable prognostic role of a high Total Metabolic Tumor Volume (TMTV) in Follicular Lymphoma has been demonstrated, the role of SUVmax alone at baseline PET/CT could have a different prognostic role. Patients and Methods: We performed a retrospective observational monocentric cohort study. All patients affected by FL who underwent a basal PET/CT were included. Two subgroups were identified and compared in terms of PFS and OS: (A) Basal SUVmax ≤ 6; and (B) Basal SUVmax > 6. Results: Ninety-four patients were included, 34 in group A (36.2%) and 60 in group B (63.8%). The PFS at two years was comparable in the two groups (97%). The five-year PFS was 73.5% for group A and 95% for group B (p 0.005). The five-year PFS in the whole cohort was 87.5%. A clear advantage was confirmed in group A in the absence of other risk factors. Patients with SUVmax ≤ 6 and no risk factors showed a 5-year PFS of 73% against 83% for patients with SUVmax > 6 and at least two risk factors. Conclusion: A high FDG uptake favorably correlated with PFS. A low basal SUVmax reflected a higher rate of late relapse requiring a prolonged follow-up. The basal SUVmax is an approachable parameter with prognostic implications.

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