Standardized Uptake Value Max Research Articles

140 FDG positron emission tomography maximum standardised uptake value (SUVmax) has prognostic value in non-small cell lung cancer treated with radical radiotherapy

Introduction: FDG-PET (positron emission tomography) scanning gives essential anatomical/staging information for decision making prior to radical treatment in non-small cell lung cancer (NSCLC). The standardised uptake value (SUV) gives physiological data based on glucose uptake/metabolism of tumour which may be of prognostic value in addition to the known anatomical/staging information. Method: Retrospective single centre study of biopsy confirmed NSCLC treated with radical RT (+/ chemotherapy). Survival assessed in two groups: PET SUVmax 4 vs PET SUV max >4. Standard 3D PET scans were obtained either in Cheltenham or Cardiff, SUV max as per radiologist report was used. Relationship between PET SUVmax and stage were also investigated: PET SUVmax vs primary tumour size and by LN status/stage group (I/II/III). Results: 103 patients included (6 had SUV max 4; 97 had SUV max >4). 7 had no value for primary tumour size but did have all other information available. There were significant differences in both progression free and overall survival (p = 0.01 and p = 0.02 respectively) between these two groups, although the very small numbers in the SUVmax 4 mean this result should be interpreted with caution. SUVmax was correlated with primary tumour size (Spearman rank correlation coefficient = 0.41) but was independent of TNM stage group (p = 0.95) and LN involvement (p = 0.59). Conclusions: In this study, biopsy confirmed, very low SUV tumours (PET SUVmax 4) had better survival after radical radiotherapy than those with higher SUVmax, supporting the hypothesis that this is of prognostic significance. A major drawback in this study was the very low number of patients with low SUVmax tumours. Further work is warranted to assess the prognostic value of PET SUVmax and any predictive value of PET SUVmax (eg radiotherapy dose/fractionation and the use of chemotherapy).

Post Chemoradiation PET SUV is highly Predictive of Overall Survival in Esophageal Cancer

Purpose: Positron Emission Tomography (PET) scan is a vital tool in the staging, prognosis and response evaluation of gastrointestinal malignancies. The purpose of this study is to determine the prognostic significance of PET standardized uptake values (SUV) in esophageal cancer treated with chemoradiotherapy (CRT). Methods: An IRB approved esophageal cancer database was queried for patients who completed treatment for esophageal cancer with CRT between 2006 and 2010. Patients were included in the analysis if they had nonmetastatic esophageal cancer that completed definitive or preoperative CRT and had pre- and post-CRT PET scans. Patients treated with induction chemotherapy were excluded. The pre-and post-CRT SUV maximum values were obtained. Univariate analysis for overall survival (OS) was performed with Kaplan-Meier and log-rank analysis or hazard ratio model. Multivariate analysis (MVA) for OS was performed with a Cox proportional hazard ratio model. Results: We identified 77 patients who met inclusion criteria with a median followup of 16 months (range 4 - 43 months). Univariate analysis demonstrated that post-CRT SUV max and percent change SUV max were prognostic for OS, while pre-CRT SUV was not prognostic. In addition, there were no deaths in patients with a post-CRT SUV max of ≤3. MVA demonstrated that only post-CRT SUV max (HR 1.401; 95% CI: 1.061-1.850) was prognostic for OS, while age, gender, surgery, histology, tumor length and stage, were not. Conclusions: Our series demonstrates that post-CRT maximum SUV was the strongest predictor of survival in esophageal cancer while pre-CRT SUV was not. Percent change SUV max was prognostic on univariate analysis but not on multivariate analysis. Prospective studies to evaluate the role of post-CRT SUV in the management of esophageal cancer are needed.

Comparison of standardized uptake values obtained from 18f fluorodeoxyglucose positron emission tomography/computed tomography imaging performed with 2d and 3D modes in oncological cases

We investigated the usability of standardized uptake values (SUV) obtained from both two- and three-dimensional (2D and 3D) positron-emission tomography and computed tomography (PET-CT) imaging, and compared the images obtained from these techniques in terms of image quality, lesion detectability, and the presence of artifacts. Image data from 100 patients, who had undergone two PET imagings obtained in 2D and 3D mode after a low dose CT, were evaluated prospectively. Subjective analysis of 2D and 3D images was performed by two readers evaluating the following criteria: overall image quality, detectability of each identified lesion, and the presence of artifacts. The lesions recognized by the readers were also analyzed quantitatively by measuring SUV values. There was a significant difference between the SUVs obtained in 2D and 3D modes. Regardless if the first scan was performed in 2D or 3D mode, the values obtained from 3D imaging were significantly lower than those obtained from 2D imaging (mean SUV(max) was 10.48±7.57 for 2D, and 9.66±6.93 for 3D, P < 0.001). Visual analysis did not reveal significant differences regarding lesion detectability between two modes. In oncological PET-CT applications, SUV values are significantly lower in 3D compared with 2D mode. Thus when serial scanning is needed to evaluate response to therapy in the same patient, the imaging modality should be taken into account and performed with the same method to avoid misinterpretation. Additionally, 3D PET-CT imaging can be used instead of 2D PET-CT due to its shorter scanning time without loss of lesion detectability.

Conventionally-Defined and PET/CT-Defined Complete Response (CR) to Novel Agent-Based Induction Therapy and Autologous Stem-Cell Transplantation (ASCT) In Multiple Myeloma (MM): A Prospective Study of Clinical and Prognostic Implications

Abstract 826Incorporation of novel agents into ASCT allowed the achievement of unprecedented high rates of CR in young MM patients, a gain which translated into extended PFS and OS. As a consequence, interest in the evaluation of the depth of CR has progressively grown. More sensitive tools, such as multiparametric flow cytometry or molecular biology, led to the demonstration of a correlation between the depth of CR and prognosis, but failed to identify the persistence of residual disease outside of the bone marrow level. 18 F-FDG PET/CT is a careful technique to detect with high sensitivity and specificity the presence of active bone lesions and/or bone marrow involvement in newly diagnosed and previously treated MM.We prospectively analysed the prognostic significance of FDG-PET/CT at diagnosis, after induction therapy and ASCT in an homogeneous population of 192 patients with newly diagnosed MM, followed for a median of 43 months. By study design, all patients were studied with FDG-PET/CT at baseline, after induction treatment, after 3 months from ASCT (single or double), once a year during the maintenance/follow-up phase and at time of relapse. Bone marrow involvement was described as negative, diffuse or focal. The number of focal lesions (FLs), as well as size and associated standardized uptake values (SUV) were recorded. Extra-medullary disease (EMD), if present, was described by location, size, number and SUV.Twenty four percent of the patients had a negative PET/CT scan at diagnosis. Among PET/CT-positive patients, 44% showed ≥3 FLs, 46% had SUV values >4.2 and in 6% EMD could be detected. These 3 variables adversely affected 4-year estimates of PFS and OS. In particular, both EMD and severe FDG uptake were significantly associated with shorter PFS and OS.Thirty seven percent of the patients were PET/CT-negative after induction. A strong correlation between conventional response and SUV max reduction was evident, the mean SUV value of patients achieving CR being significantly lower in comparison with that of patients reaching very good partial response (VGPR) or partial response (mean: 1.4 vs 3, respectively) (Cuzick’s trend test, P= 0.016). Persistence of severe FDG uptake (SUV max still >4.2) after induction predicted for shorter PFS at 4 years (P= 0.004).PET/CT negativity (PET-CR) was observed in 65% of patients after 3 months from ASCT(s). A close relationship between PET/CT negativity and response to ASCT was evident, since 95% of patients with a negative PET/CT had achieved at least a VGPR (P= 0.003). Moreover, a correlation between conventional response and SUV max reduction was evident after ASCT as well (mean: 0.8 vs 1.8, respectively) (Cuzick's trend test, P= 0.001). PET-CR after ASCT conferred superior PFS and OS in comparison with persistence of FDG uptake. In particular, the 4-year estimates of PFS and OS for PET-CR patients were 66% and 89%, respectively, as compared with 45% and 65% for positive patients (P=0.02 both for PFS and OS). Notably, 23% of patients achieving CR according to conventional criteria still had positive PET/CT scans and their 4-year estimate of PFS was 30%, as compared with 61% for negative patients (P=0.02).After ASCT, patients were followed with evaluation of M protein every 3 months and of PET/CT once a year. In 44% of those who had a conventionally-defined relapse or progression, the mean time to relapse/progression was 27.6 months for PET-negative patients as compared with 18 months for positive patients (P=0.05). In PET-positive patients, the SUV max was inversely correlated to the time to relapse (correlation coefficient −0.7, P= 0.003).In multivariate analysis, both severe PET/CT involvement at diagnosis (SUV >4.2 and/or EMD) and persistence of FDG uptake after ASCT were independent predictors of worst PFS (SUV >4.2= HR: 2.0, 95%CI: 1.13–3.72; EMD= HR: 15.0, 4.0–55.8; FDG uptake after ASCT= HR: 2.12, 1.19–3.77) and OS (EMD= HR: 6.99, 2.28–21.46; FDG uptake after ASCT= HR: 3.57, 1.03–12.39).In conclusion, PET-defined CR was linked to conventionally-defined CR and was an independent prognostic factor in MM patients receiving up-front novel agent-based induction therapy and ASCT. PET/CT contributed to a more careful definition of CR, in particular after ASCT, and could be usefully incorporated into the algorithm to evaluate the depth of response in young MM patients. Disclosures:No relevant conflicts of interest to declare.

Quantitative Analysis of Response to Treatment with Erlotinib in Advanced Non–Small Cell Lung Cancer Using 18F-FDG and 3′-Deoxy-3′-18F-Fluorothymidine PET

The purpose of this study was to evaluate the relevance for the prediction of clinical benefit of first-line treatment with erlotinib using different quantitative parameters for PET with both (18)F-FDG and 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) in patients with advanced non-small cell lung cancer. Data were used from a prospective trial involving patients with untreated stage IV non-small cell lung cancer. (18)F-FDG PET and (18)F-FLT PET were performed before and 1 (early) and 6 (late) weeks after erlotinib treatment. Several quantitative standardized uptake values (SUVs) using different definitions of volumes of interest with varying isocontours (maximum SUV [SUV(max)], 2-dimensional peak SUV [SUV(2Dpeak)], 3-dimensional [3D] peak SUV [SUV(3Dpeak)], 3D isocontour at 50% of the maximum pixel value [SUV(50)], 3D isocontour at 50% adapted for background [SUV(A50)], 3D isocontour at 41% of the maximum pixel value adapted for background [SUV(A41)], 3D isocontour at 70% of the maximum pixel value [SUV(70)], 3D isocontour at 70% adapted for background [SUV(A70)], and relative SUV threshold level [SUV(RTL)]) and metabolically active volume measurements were obtained in the hottest single tumor lesion and in the sum of up to 5 lesions per scan in 30 patients. Metabolic response was defined as a minimum reduction of 30% in each of the different SUVs and as a minimum reduction of 45% in metabolically active volume. Progression-free survival (PFS) was compared between patients with and without metabolic response measured with each of the different parameters, using Kaplan-Meier statistics and a log-rank test. Patients with a metabolic response on early (18)F-FDG PET and (18)F-FLT PET in the hottest single tumor lesion as well as in the sum of up to 5 lesions per scan had a significantly longer PFS, regardless of the method used to calculate SUV. However, the highest significance was obtained for SUV(max), SUV(50), SUV(A50), and SUV(A41.) Patients with a metabolic response measured by SUV(max) and SUV(3Dpeak) on late (18)F-FDG PET in the hottest single tumor lesion had a significantly longer PFS. Furthermore, Kaplan-Meier analyses showed a strong association between PFS and response seen by metabolically active volume, measured either in early (18)F-FLT or in late (18)F-FDG. Early (18)F-FDG PET and (18)F-FLT PET can predict PFS regardless of the method used for SUV calculation. However, SUV(max), SUV(50), SUV(A50), and SUV(A41) measured with (18)F-FDG might be the best robust SUV to use for early response prediction. Metabolically active volume measurement in early (18)F-FLT PET and late (18)F-FDG PET may have an additional predictive value in monitoring response in patients with advanced non-small cell lung cancer treated with erlotinib.

Thyroid Incidentaloma Detected by Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: Practical Management Algorithm

Our aim was to design a practical algorithm for management of an increasing number of incidental findings of thyroid lesions identified by (18)F-fluorodeoxyglucose positron emission tomography with computed tomography (FDG-PET/CT). The reports of 3641 patients examined by FDG-PET/CT for evaluation of nonthyroid cancer were reviewed. The anatomic locations and standardized uptake values (SUV) of any focally increased thyroid FDG uptake were reanalyzed and related to surrounding normal thyroid ((T)SUV(max)/(thy)SUV(mean) ratio) and liver ((T)SUV(max)/(liver)SUV(mean)). Focal FDG uptakes in the thyroid were reported in 37 cases (1%; 26 women). Neoplastic thyroid lesions were diagnosed in 16 patients: papillary thyroid cancer in 9, follicular neoplasia in 5, and metastatic lesions (lung cancer and squamous cell carcinoma) in 2. Benign lesions were diagnosed in 11 patients. Ten patients with malignancy elsewhere did not undergo thyroid examination. In all, 11 patients underwent thyroid surgery (8 with papillary cancer, 3 with follicular adenoma); the median tumor size was 12 mm (8-40 mm). The (T)SUV(max)/(thy)SUV(mean) ratio was higher for the malignant lesions [median 5.53 (2.75-30.81) vs. 3.70 (1.82-31.70); P < 0.05], albeit with a considerable overlap between individual patients. The (T)SUV(max) and (T)SUV(max)/(liver)SUV(mean) did not differ between groups. The (T)SUV(max)/(thy)SUV(mean) and / (thy)SUV(mean) ratios correlated with the tumor size (r = 0.64 and r = 0.66; P < 0.05). An incidental finding of focal uptake of FDG in the thyroid is associated with a significant risk of thyroid cancer. If the patient would benefit from thyroidectomy if a malignancy were identified, further diagnostic workup with ultrasonography-guided fine-needle aspiration and cytology is recommended.

Prognostic value of metabolic tumor burden on 18F-FDG PET in nonsurgical patients with non-small cell lung cancer

The objective of this study was to assess the prognostic value of metabolic tumor burden on 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET)/CT measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG), independent of Union Internationale Contra la Cancrum (UICC)/American Joint Committee on Cancer (AJCC) tumor, node, and metastasis (TNM) stage, in comparison with that of standardized uptake value (SUV) in nonsurgical patients with non-small cell lung cancer (NSCLC). This study retrospectively reviewed 169 consecutive nonsurgical patients (78 men, 91 women, median age of 68 years) with newly diagnosed NSCLC who had pretreatment (18)F-FDG PET/CT scans. The (18)F-FDG PET/CT scans were performed in accordance with National Cancer Institute guidelines. The MTV of whole-body tumor (MTV(WB)), of primary tumor (MTV(T)), of nodal metastases (MTV(N)), and of distant metastases (MTV(M)); the TLG of whole-body tumor (TLG(WB)), of primary tumor (TLG(T)), of nodal metastases (TLG(N)), and of distant metastases (TLG(M)); the SUV(max) of whole-body tumor (SUV(maxWB)), of primary tumor (SUV(maxT)), of nodal metastases (SUV(maxN)), and of distant metastases (SUV(maxM)) as well as the SUV(mean) of whole-body tumor (SUV(meanWB)), of primary tumor (SUV(meanT)), of nodal metastases (SUV(meanN)), and of distant metastases (SUV(meanM)) were measured with the PETedge tool on a MIMvista workstation with manual adjustment. The median follow-up among survivors was 35 months from the PET/CT (range 2-82 months). Statistical methods included Kaplan-Meier curves, Cox regression, and C-statistics. There were a total of 139 deaths during follow-up. Median overall survival (OS) was 10.9 months [95% confidence interval (CI) 9.0-13.2 months]. The MTV was statistically associated with OS. The hazard ratios (HR) for 1 unit increase of ln(MTV(WB)), √(MTV(T)), √(MTV(N)), and √(MTV(M)) before/after adjusting for stage were: 1.47/1.43 (p < 0.001/<0.001), 1.06/1.05 (p < 0.001/<0.001), 1.11/1.10 (p < 0.001/<0.001), and 1.04/1.03 (p = 0.007/0.043), respectively. TLG had statistically significant associations with OS with the HRs for 1 unit increase in ln(TLG(WB)), √(TLG(T)), √(TLG(N)), and √(TLG(M)) before/after adjusting for stage being 1.36/1.33 (p < 0.001/<0.001), 1.02/1.02 (p = 0.001/0.002), 1.05/1.04 (p < 0.001/<0.001), and 1.02/1.02 (p = 0.003/0.024), respectively. The ln(SUV(maxWB)) and √(SUV(maxN)) were statistically associated with OS with the corresponding HRs for a 1 unit increase before/after adjusting for stage being 1.46/1.43 (p = 0.013/0.024) and 1.22/1.16 (p = 0.002/0.040). The √(SUV(meanN)) was statistically associated with OS before and after adjusting for stage with HRs for a 1 unit increase of 1.32 (p < 0.001) and 1.24 (p = 0.015), respectively. The √(SUV(meanM)) and √(SUV(maxM)) were statistically associated with OS before adjusting for stage with HRs for a 1 unit increase of 1.26 (p = 0.017) and 1.18 (p = 0.007), respectively, but not after adjusting for stage (p = 0.127 and 0.056). There was no statistically significant association between OS and √(SUV(maxT)), ln(SUV(meanWB)), or √(SUV(meanT)). There was low interobserver variability among three radiologists with intraclass correlation coefficients (ICC) greater than 0.94 for SUV(maxWB), ln(MTV(WB)), and ln(TLG(WB)). Interobserver variability was higher for SUV(meanWB) with an ICC of 0.806. Baseline metabolic tumor burdens at the level of whole-body tumor, primary tumor, nodal metastasis, and distant metastasis as measured with MTV and TLG on FDG PET are prognostic measures independent of clinical stage with low inter-observer variability and may be used to further stratify nonsurgical patients with NSCLC. This study also suggests MTV and TLG are better prognostic measures than SUV(max) and SUV(mean). These results will need to be validated in larger cohorts in a prospective study.

18F-FluoroDeoxyGlucose Uptake of Bone and Soft Tissue Sarcomas in Pediatric Patients

A high 18F-fluorodeoxyglucose (FDG) uptake by positron emission tomography/computed tomography (PET/CT) imaging in sarcomas of adults has been reported. The current study aimed at defining the degree of 18F-FDG uptake of pediatric sarcomas. This retrospective study included 29 patients (23 males, 6 females; mean age 14 ± 5 years) with soft tissue (n = 9) or bone (n = 20) sarcomas. Twenty-two patients (76%) underwent 18F-FDG PET/CT and 7 (24%) had dedicated 18F-FDG PET studies. Tumor 18F-FDG uptake was quantified by standard uptake value (SUV)max and tumor-to-liver ratios (SUV ratios; tumor SUVmax/liver SUVmean). Tumor SUVmax and SUV ratios were correlated with tumor Ki-67 expression. SUVmax ranged from 1.4 to 24 g/mL (median 2.5 g/mL) in soft tissue sarcomas and 1.6 to 20.4 g/mL (median 6.9 g/mL) in bone sarcomas (P = .03), and from 1.6 to 9.2 g/mL (median 3.9 g/mL) and 3.5 to 20.4 g/mL (median 12 g/mL) in Ewing sarcoma and osteosarcoma, respectively (P = .009). Tumor SUV ratios ranged from 0.8 to 8.7 (median 1.9) in soft tissue sarcomas and 1.4 to 8.9 (median 3.8) in bone sarcomas (P = .08). Ewing sarcoma had a significantly lower tumor SUV ratio than osteosarcoma (P = .01). Ki-67 expression correlated significantly with the 18F-FDG uptake in bone but not in soft tissue sarcomas. All sarcomas were visualized by 18F-FDG PET/CT imaging. A higher 18F-FDG uptake was observed in osteosarcoma than in Ewing and soft tissue sarcomas. The results of this study suggest that the degree of tumor 18F-FDG uptake is sufficient to allow for monitoring of therapeutic responses in pediatric sarcomas.

Quantifying the effects of iodine contrast media on standardised uptake values of FDG PET/CT images: an anthropomorphic phantom study

This study aimed to quantify the amount of change in Standardised Uptake Values (SUVs) of PET/CT images by simulating the set-up as closely as possible to the actual patient scanning. The experiments were conducted using an anthropomorphic phantom, which contained an amount of radioactivity in the form of Fluorodeoxyglucose (FDG) in a primary plastic test tube and one litre saline bags, including the insertion of bony structures and another two test tubes containing different concentrations of iodine contrast media. Standard scanning protocols were employed for the PET/CT image acquisition. The highest absolute differences in the SUVmax and SUVmean values of the saline bags were found to be about 0.2 and 0.4, respectively. The primary test tube showed the largest change of 1.5 in both SUVs; SUV max and SUVmean. However, none of these changes were found to be statistically significant. The clinical literature also contains no evidence to suggest that the changes of this magnitude would change the final diagnosis. Based on these preliminary data, we propose that iodine contrast media can be used during the CT scan of PET/CT imaging, without significantly affecting the diagnostic quality of this integrated imaging modality.

Adrenal Masses in Patients With Cancer: PET/CT Characterization With Combined CT Histogram and Standardized Uptake Value PET Analysis

Our purpose was to determine the diagnostic performance of 18F-FDG PET/CT for characterizing adrenal masses in patients with cancer, combining standardized uptake value (SUV) and CT histogram analysis. A total of 117 adrenal masses in 93 patients with cancer (61 men and 32 women; mean [± SD] age, 67.2 ± 10.3 years; range, 38-84 years) were evaluated with FDG PET/CT. Of the 117 lesions, 42 were malignant according to histopathologic analysis or size change, whereas 75 were benign on the basis of stability for 6 months. Size, mean attenuation value, percentage of negative pixels at CT histogram analysis, maximum SUV (SUV(max)), and average SUV were calculated for each adrenal lesion. Moreover, FDG adrenal uptake was compared with radioactivity of the aorta, liver, and spleen by calculating the SUV ratios of adrenal lesion to aorta, adrenal lesion to liver, and adrenal lesion to spleen. PET/CT value was assessed by using independent t tests and receiving operating characteristic (ROC) analysis. There was a statistically significant difference in size, attenuation value, percentage of negative pixels, and SUV between benign and malignant masses. All malignant lesions showed FDG activity higher than that in liver, spleen, and aorta, with SUV(max) greater than 2.8 in all cases, whereas with the CT histogram analysis, all lesions with a percentage of negative pixels higher than 10% were benign. Combined SUV and CT histogram analysis yielded 100% sensitivity, 97.3% specificity, 95.7% positive predictive value, and 100% negative predictive value. At ROC analysis, combined SUV and CT histogram analysis (area under the ROC curve [AUC], 0.996) was more accurate than simple SUV(max) analysis (AUC, 0.961) and the combination of SUV(max) and attenuation value (AUC, 0.987). The combination of SUV and CT histogram analysis allowed us to significantly improve the PET/CT diagnostic accuracy for characterizing adrenal lesions, leading to a significant reduction in the number of false-positive cases.

Standard uptake value and metabolic tumor volume of 18F-FDG PET/CT predict short-term outcome early in the course of chemoradiotherapy in advanced non-small cell lung cancer

The aim of this study is to investigate the role of standard uptake values (SUVs) and metabolic tumor volume (MTV) in [(18)F]fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) to predict the short-term outcome of chemoradiotherapy (CRT) in patients with advanced non-small cell lung cancer (NSCLC). A total of 37 patients were included in the prospective study. All patients were evaluated by FDG PET before and following 40 Gy radiotherapy (RT) with a concurrent cisplatin-based chemotherapy regimen. Semiquantitative assessment was used to determine maximum and mean SUVs (SUV(max)/SUV(mean)) and metabolic tumor volume (MTV). Short-term outcome using the treatment response evaluation was assessed according to the Response Evaluation Criteria in Solid Tumors. The receiver-operating characteristic (ROC) curve analysis was used to determine the diagnostic accuracy of (18)F-FDG PET in identifying responders. Changes in SUV(max), SUV(mean), and MTV were significantly more pronounced in responders than in nonresponders (p = 0.002, 0.002, 0.000). The thresholds of SUV(max), SUV(mean), and MTV changes defined by ROC curve analysis were 37.2, 41.7, and 29.7%, respectively. The sensitivity, specificity, and accuracy of SUV(max) change for predicting tumor response were 83.3, 84.6, and 84.9%, respectively. The sensitivity, specificity, and accuracy of SUV(mean) change for predicting tumor response were 79.2, 100, and 88.8%, respectively. The sensitivity, specificity, and accuracy of MTV change for predicting tumor response were 91.7, 84.6, and 92.3%, respectively. SUV and MTV changes from two serial (18)F-FDG PET/CT scans, before and after initial CRT, allow prediction of the treatment response in advanced NSCLC.

Standardized uptake value (SUV) by positron emission tomography/computed tomography (PET/CT) as a prognostic variable in metastatic breast cancer (MBC).

567 Background: The accurate prediction of outcome from MBC is challenging. PET/CT could be useful as it combines anatomical with functional imaging. This could enable greater individualization of treatment. However, there is substantial SUV variation by site. In this retrospective, single-institution study, we examine baseline SUV on PET/CT as a predictor of outcome from MBC. Methods: Patients (Pts) with ≥1 metastatic lesion on PET/CT performed ≤60 days of diagnosis of MBC from 01/01/2001 to 12/31/2008 were identified through institutional databases. Pts who received chemotherapy < 30 days prior to PET/CT were excluded. Electronic medical record reports were reviewed and maximum SUV (SUV-MAX) by site for lesions in bone, liver, lung, and lymph node (LN) was recorded. In a secondary analysis, PET/CT scans were reviewed and SUV-MAX recalculated. Relationships between SUV-MAX tertiles and OS were assessed using Cox regression by site. Results: We identified 285 pts, median age 57 yrs (range 27-90) who had PET/CT at median of 2.3 yrs (range 0-41) from primary BC (67% ER+ and 21% HER2+). The median time between PET/CT and MBC diagnosis was -9 days (range -58 to 59). At median follow-up of 53 mths, 163 pts have died and median OS is 41 mths (95%CI 34-48). The SUV-MAX by site was; bone (N=159) median 7.0 (range 2.1 - 29.6); liver (N=55) median 8.2 (range 2.9 - 51.2); lung (N=89) median 4.7 (range 1.1 - 24.0); LN (N=180) median 6.9 (range 1.2 - 34.0). On univariate analysis, higher SUV in bone was associated with shorter survival (p<0.001); table. This was maintained in multivariate analyses after adjusting for known prognostic variables (p=0.02). A similar trend for shorter survival for higher SUV was noted in liver (p=0.07). However, no relationship between SUV and OS was noted in lung (p =0.34) and LN (p=0.6). Conclusions: This large retrospective study of pts with chemotherapy-naïve MBC suggests that SUV-MAX in bone strongly correlates with prognosis. SUV in bone: Univariate analysis for OS. Variable N (%) N P value HR Max SUV Tertiles 159 <.001 1 54 (34%) – (ref) 2 53 (33%) – 1.42 3 52 (33%) – 2.76 ER neg 38 (24%) 159 <.001 2.55 HER2 neg 122 (80%) 152 0.56 0.86 Grade 3 103 (75%) 138 0.03 1.95

No correlation between glucose metabolism and apparent diffusion coefficient in diffuse large B-cell lymphoma: A PET/CT and DW-MRI study

Purpose Both positron emission tomography/computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (DW-MRI) are oncologic feasible techniques for evaluating the malignancy of tumors. Standardized uptake value (SUV) is a marker of tumor glucose metabolism detected by PET/CT. Apparent diffusion coefficient (ADC) measured by DWI can provide information about tissue cellularity. The aim of the study was to evaluate the correlation between SUV and ADC in untreated diffuse large B-cell lymphoma (DLBCL). Materials and methods Fifteen pre-therapy patients with histologically proven DLBCL underwent PET/CT and DWI examinations within two days. Tumor glucose metabolism was evaluated by the maximum and mean SUV (SUV max and SUV mean) on the PET/CT images. The mean ADC value was measured directly on the parametric ADC maps. Results In total, 28 lymphoma lesions with best match PET/CT and DWI were identified and evaluated. The mean SUV max and SUV mean were 16.8 and 11.1, respectively; the mean ADC was 0.74 × 10 −3 mm 2/s. There was no correlation between the mean ADC and the SUV max or SUV mean. Conclusion SUV determined from PET/CT and ADC value measured from DWI are different indices for the diagnosis of tumor malignancy, they may provide complimentary functional information of tumor tissue.

Quantitative diffusion weighted MRI: A functional biomarker of nodal disease in Hodgkin lymphoma?

This study explores the relationship between MRI Apparent Diffusion Coefficient (ADC) and PET Standardized Uptake Value (SUV) measurements in pediatric Hodgkin lymphoma. Sixteen patients (mean age 15.4 yrs, 8 male) with proven Hodgkin lymphoma were recruited and staged using PET-CT, anatomical MRI and additional 1.5T diffusion weighted imaging (DWI) prior to and following chemotherapy. Pre-treatment lymph nodes and anatomically paired post-treatment residual tissue located on MRI were matched to the corresponding PET-CT. Region of interest (ROI) analysis was used to extract quantitative measurements. Mean ADC (ADC(mean)) and maximum SUV (SUV(max)) were recorded and correlation assessed using Spearman statistics. Fifty-three ROIs were sampled. Pre- and post-treatment ADC(mean) ranged from 0.77 × 10(−3) to 1.79 × 10(−3) (median 1.15 × 10(−3) mm(2)s(−1)) and 1.08 × 10(−3) to 3.18 ×10(−3) (median 1.88 × 10(−3) mm(2)s(−1)), and SUV(max) from 2.60 to 25.4 (median 8.85 mg/ml) and 1.00 to 3.50 mg/ml (median 1.90 mg/ml). Median post-treatment ADC(mean) was higher, and median SUV(max) lower than pretreatment values (p < 0.0001). There was an inverse correlation between pre-treatment ADC(mean) and SUV(max) (p = 0.005) and between fractional change ([post-treatment – pre-treatment]/pre-treatment)in ADC(mean) and SUV(max) (p =0.002). Our results confirm a strong reciprocal relationship between nodal ADC(mean) and SUV(max) in Hodgkin lymphoma;supporting the potential application of quantitative DWI as a functional biomarker of disease.

What is the relationship between 18F-FDG aortic aneurysm uptake on PET/CT and future growth rate?

In this study we investigate the relationship between (18)F-fluorodeoxyglucose (FDG) metabolism and future aneurysm expansion measured by serial duplex ultrasound. Current screening programmes are increasing the identification of patients with abdominal aortic aneurysm (AAA). The management of these patients remains challenging and methods of risk stratification are sought. Thirty-four consecutive patients [31 men, 3 women, median age 75 years, interquartile range (IQR) 71-78] with aortic aneurysms under routine surveillance with serial ultrasound were prospectively recruited for (18)F-FDG positron emission tomography (PET)/CT. A whole vessel type analysis was performed measuring the highest aortic wall (18)F-FDG uptake (standardized uptake value or SUV(max)), and target to background ratio (TBR) for each axial image and median SUV(max) and TBR value were calculated. Institutional Review Board permission and informed patient consent were obtained. Nine patients failed to undergo 12-month follow-up study (deceased n = 2, withdrew n = 1, failed to attend ultrasound scan n = 5, emergency aneurysm repair n = 1) leaving 25 patients for analysis. The median whole vessel SUV(max) was 1.70 (IQR 1.45-2.08). The median whole vessel TBR was 1.15 (IQR 1.00-1.40). The median aneurysm expansion at 12 months was 2.0 mm (IQR 0.5-5.0). The correlation (r) between (18)F-FDG SUV(max) and ultrasound expansion at 1 year was -0.501 (p = 0.011). The preliminary findings from this observational longitudinal pilot study suggest that there is an inverse trend between (18)F-FDG uptake on PET and future AAA expansion. Aortic aneurysms with lower metabolic activity may therefore be more likely to expand.

1778 FDG PET/CT AS IMAGING BIOMARKER FOR ADVANCED RENAL CELL CARCINOMA

You have accessJournal of UrologyKidney Cancer: Advanced1 Apr 20111778 FDG PET/CT AS IMAGING BIOMARKER FOR ADVANCED RENAL CELL CARCINOMA Noboru Nakaigawa, Masahiro Yao, Kazuhide Makiyama, Ryogo Minamimoto, Tomio Inoue, and Yoshinobu Kubota Noboru NakaigawaNoboru Nakaigawa Yokohama, Japan More articles by this author , Masahiro YaoMasahiro Yao Yokohama, Japan More articles by this author , Kazuhide MakiyamaKazuhide Makiyama Yokohama, Japan More articles by this author , Ryogo MinamimotoRyogo Minamimoto Yokohama, Japan More articles by this author , Tomio InoueTomio Inoue Yokohama, Japan More articles by this author , and Yoshinobu KubotaYoshinobu Kubota Yokohama, Japan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.2106AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The antitumor effect of molecular targeting therapeutics for renal cell carcinoma (RCC) is not cytotoxic. It is thought that the therapeutics suppress the biological activity of cancer cells. Although the strategy based on the biological activity of cancer is necessary, the biomarkers evaluating biological activity of RCC was not established. 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is a useful non-invasive tool to evaluate the metabolic status of tumors and the metabolic status can be evaluated quantitatively using the index called standardized uptake value (SUV). We investigated the usefulness of SUV evaluated by FDG PET/CT for the management of advanced RCC prospectively. METHODS Total 39 patients with advanced RCC were evaluated by FDG PET/CT before systematic therapies. And the 19 patients who were treated (sorafenib 11 cases, sunitinib 8 cases) more than 3 weeks were evaluated again 1 month after treatment started. The impact of maximum SUV (SUV max; highest SUV in an individual patient) and change ratio of SUVmax on the prognosis was analyzed prospectively. RESULTS The SUVmax before treatment of 39 patients ranged between 1.4 and 16.6. The patients with RCC showing high SUVmax demonstrated poor prognosis (P=0.005 hazard ratio 1.326, 95% CI 1.089–1.614). The mean survival time of 7 patients with RCC showing SUVmax less than 7.0 was 716±43 days, that of 13 patiens with RCC showing SUVmax between 7.0 and 12.0 was 550±91 days, and that of 9 patients RCC showing SUVmax higher or 12.0 was 154±56 days (P=0.001). Of 19 patients treated more than 3 weeks, progression free survival of 10 patients whose SUVmax decreased more or 20% after treatment were 458±271 days and that of 9 patients whose SUVmax decreased less than 20% was146±47 days (P=0.004). CONCLUSIONS The SUVmax calculated by FDG PET/CT is an interesting index to predict prognosis and evaluate the response of molecular targeting therapies. The SUVmax has potency as  gImaging Biomarker h evaluating the biological activity of advanced RCC and will provide helpful information for clinical decision-making. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e714 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Noboru Nakaigawa Yokohama, Japan More articles by this author Masahiro Yao Yokohama, Japan More articles by this author Kazuhide Makiyama Yokohama, Japan More articles by this author Ryogo Minamimoto Yokohama, Japan More articles by this author Tomio Inoue Yokohama, Japan More articles by this author Yoshinobu Kubota Yokohama, Japan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prognostic value of 18F-FDG PET image-based parameters in oesophageal cancer and impact of tumour delineation methodology

(18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) image-derived parameters, such as standardized uptake value (SUV), functional tumour length (TL) and tumour volume (TV) or total lesion glycolysis (TLG), may be useful for determining prognosis in patients with oesophageal carcinoma. The objectives of this work were to investigate the prognostic value of these indices in oesophageal cancer patients undergoing combined chemoradiotherapy treatment and the impact of TV delineation strategies. A total of 45 patients were retrospectively analysed. Tumours were delineated on pretreatment (18)F-FDG scans using adaptive threshold and automatic (fuzzy locally adaptive Bayesian, FLAB) methodologies. The maximum standardized uptake value (SUV(max)), SUV(peak), SUV(mean), TL, TV and TLG were computed. The prognostic value of each parameter for overall survival was investigated using Kaplan-Meier and Cox regression models for univariate and multivariate analyses, respectively. Large differences were observed between methodologies (from -140 to +50% for TV). SUV measurements were not significant prognostic factors for overall survival, whereas TV, TL and TLG were, irrespective of the segmentation strategy. After multivariate analysis including standard tumour staging, only TV (p < 0.002) and TL (p = 0.042) determined using FLAB were independent prognostic factors. Whereas no SUV measurement was a significant prognostic factor, TV, TL and TLG were significant prognostic factors for overall survival, irrespective of the delineation methodology. Only functional TV and TL derived using FLAB were independent prognostic factors, highlighting the need for accurate and robust PET tumour delineation tools for oncology applications.

F-18 FDG PET/CT Imaging of Bulky Myxofibrosarcoma in Chest Wall

Myxofibrosarcoma (MFS) has a spectrum of malignant fibroblastic lesions with variably myxoid stroma and pleomorphism. A 67-year-old man with a bulky mass on his chest wall was diagnosed with MFS. He underwent F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography for detection of metastasis. FDG positron emission tomography /computed tomography showed inhomogeneous high FDG uptake (max standardized uptake value, 10.1) in the bulky tumor with no evidence of metastasis, and the tumor was successfully resected. FDG uptake seemed to be reflected by the broad spectrum of pathologic heterogeneity. And MFS should be considered when making a diagnosis of inhomogeneous FDG-avid lesions in the bulky masses of soft tissue.

FOLFOX6 and bevacizumab in non-optimally resectable liver metastases from colorectal cancer

Background:In patients with colorectal liver metastases (CLM) R0 resection significantly improves overall survival (OS).Methods:In this report, we present the results of a phase II trial of FOLFOX6+bevacizumab in patients with non-optimally resectable CLM. Patients received six cycles of FOLFOX6+ five of bevacizumab. Patients not achieving resectability received six additional cycles of each. A PET-CT was performed at baseline and again within 1 month after initiating treatment.Results:From September 2005 to July 2009, 21 patients were enrolled (Male/Female: 15/6; median age: 65 years). An objective response (OR) was documented in 12 cases (57.1% complete responses (CRs): 3, partial response (PR): 9); one patient died from toxicity before surgery. Thirteen patients underwent radical surgery (61.9%). Three (23%) had a pathological CR (pCR). Six patients (46.1%) experienced minor postsurgical complications. After a median 38.8-month follow-up, the median OS was 22.5 months. Patients achieving at least 1 unit reduction in Standard uptake value (SUV)max on PET-CT had longer progression-free survival (PFS) (median PFS: 22 vs 14 months, P=0.001).Conclusions:FOLFOX6+bevacizumab does not increase postsurgical complications, yields high rates of resectability and pCR. Early changes in PET-CT seem to be predictive of longer PFS.

Evaluation of contrast medium enhancement and [18F]-FDG uptake of liver metastasis in PET/CT prior to therapy

To evaluate the contrast medium enhancement and [(18)F]-FDG uptake of liver metastases in patients suffering from colon or breast carcinoma prior to therapy. PET/CT (Philips Gemini) with 200MBq [(18)F]-FDG and contrast medium was performed in 50 patients with colon and 39 patients with breast carcinoma. Lesions were characterized with the presence or the absence of a rim enhancement. The area size, the HU(mean), HU(max), SUV(mean), SUV(max) of the lesion and of the liver were determined. The standard uptake values (SUVs) were correlated with the tumor markers CEA and CA 15-3. The lesions of colon carcinoma had HU(mean)-values of 70.7±19.2 and of breast carcinoma 88.1±21.7 (p<0.0001). In breast cancer the SUV(mean) was 3.9±1.3 versus 4.4±1.9 in colon carcinoma (p=0.0182). Lesion of colon carcinoma with rim enhancement had a significantly higher SUV(mean) (4.4±1.5 versus 3.6±1.2; p=0.001) and SUV(max) (6.7±2.6 versus 5.1±2.1; p=0.000) than lesions without a rim enhancement. A good correlation between tumor markers and SUVs(max) could be found in both tumor groups; r=0.83 (p<0.01) for colon carcinoma and r=0.82 (p<0.01) for breast carcinoma. The rim enhancement of the lesions in colon carcinoma indicate a significantly higher SUV.