Abstract
PurposeThe purpose of this study was to determine if 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) features are associated with contemporaneous metastases in patients with oesophageal/gastroesophageal cancer.MethodsFollowing IRB approval and informed consent, patients underwent a staging PET/MRI following 18F-FDG injection (326 ± 28 MBq) and 156 ± 23 min uptake time. First-order histogram and second-order grey level co-occurrence matrix features were computed for PET standardized uptake value (SUV) and MRI T1-W, T2-W, diffusion weighted (DWI) and apparent diffusion coefficient (ADC) images for the whole tumour volume. K-means clustering assessed the correlation of feature-pairs with metastases. Multivariate analysis of variance (MANOVA) was performed to assess the statistical separability of the groups identified by feature-pairs. Sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy (ACC) were calculated for these features and compared with SUVmax, ADCmean and maximum diameter alone for predicting contemporaneous metastases.ResultsTwenty patients (18 males, 2 female; median 67 years, range 52–86) comprised the final study cohort; ten patients had metastases. Lower second-order SUV entropy combined with higher second-order ADC entropy were the best feature-pair for discriminating metastatic patients, MANOVA p value <0.001 (SN = 80%, SP = 80%, PPV = 80%, NPV = 80%, ACC = 80%). SUVmax (SN = 30%, SP = 80%, PPV = 60%, NPV = 53%, ACC = 55%), ADCmean (SN = 20%, SP = 70%, PPV = 40%, NPV = 47%, ACC = 45%) and tumour maximum diameter (SN = 10%, SP = 90%, PPV = 50%, NPV = 50%, ACC = 50%) had poorer sensitivity and accuracy.ConclusionHigh ADC entropy combined with low SUV entropy is associated with a higher prevalence of metastases and a promising initial signature for future study.
Highlights
Oesophageal/gastroesophageal (GOJ) cancer is a leading cause of cancer deaths worldwide with 572,034 new cases annually [1]
Better patient stratification for treatment beyond our current staging practice remains a key challenge for GOJ patients given that quality of life remains poor for many patients postsurgery, taking up to 3 years to return to pre-therapy levels [5]. 18F-fluorodeoxyglucose positron emission tomography/ magnetic resonance imaging (18F-FDG-PET/MRI) has shown promise as a one-stop imaging modality for oesophageal cancer [6]
A retrospective study of sequential 18F-FDG-PET/ MRI of 19 patients with non-metastatic oesophageal cancer, comparing the diagnostic efficacy of endoscopic ultrasonography (EUS), computed tomography (CT) and 18F-FDG-PET/ MRI for locoregional staging with a pathological reference standard in 15 patients found similar T-staging accuracy and slightly superior N-staging compared to EUS [6]
Summary
Oesophageal/gastroesophageal (GOJ) cancer is a leading cause of cancer deaths worldwide with 572,034 new cases annually [1]. Data from the OEO2 [2] and MAGIC [3] trials for GOJ cancer have shown a 6 and 13% improvement in 5-year overall survival for neoadjuvant chemotherapy, respectively; while the CROSS trial [4] found a superior overall survival of 49 versus 24 months for neoadjuvant chemoradiotherapy plus surgery versus surgery alone. Overall survival remains poor, namely, the 5-year relative survival rate drops from 43 to 5% for localized and metastatic disease, respectively (https://www.cancer.net/cancer-types/esophageal-cancer/ statistics). A retrospective study of sequential 18F-FDG-PET/ MRI of 19 patients with non-metastatic oesophageal cancer, comparing the diagnostic efficacy of endoscopic ultrasonography (EUS), computed tomography (CT) and 18F-FDG-PET/ MRI for locoregional staging with a pathological reference standard in 15 patients found similar T-staging accuracy and slightly superior N-staging compared to EUS [6]
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