SUVmax Group Research Articles

Predictive Value of Maximum Standardized Uptake Value (SUVmax) on 18F-FDG PET/CT in Patients With Locally Advanced or Metastatic Pancreatic Cancer

We investigated the prognostic role of 18F-FDG PET/CT in the prediction of progression-free survival (PFS) and chemotherapeutic response in patients with locally advanced or metastatic pancreatic cancer. We enrolled 21 newly diagnosed patients with locally advanced or metastatic pancreatic cancer who underwent 18F-FDG PET/CT scanning before palliative gemcitabine-based chemotherapy between 2006 and 2012. Maximum standardized uptake value (SUVmax) of the primary tumor was measured by 18F-FDG PET/CT. Chemotherapeutic response was evaluated according to the Response Evaluation Criteria in Solid Tumors. Survival analysis was performed for time to progression using the Kaplan-Meier method. Cox proportional hazard models were used to determine independent prognostic factors. All pancreatic tumors showed detectable FDG uptake (mean SUVmax = 6.8 ± 3.0, range 2-12) The mean SUVmax values among response groups showed no significant difference (P = 0.853) and chemotherapeutic response was not different according to SUVmax level (P = 0.807). PFS was significantly shorter in the high SUVmax (≥6.8) group than in the low SUVmax (<6.8) group (2.9 vs. 6 months, P = 0.012). Multivariate analysis revealed that SUVmax was an independent prognostic factor for predicting PFS (P = 0.046). Higher SUVmax of primary pancreatic tumor is associated with poor PFS and pretreatment SUVmax is an independent prognostic factor for predicting PFS in patients with locally advanced or metastatic pancreatic cancer who received gemcitabine-based palliative chemotherapy. However, pretreatment SUVmax is not associated with chemotherapeutic response.

BTOG-117WHAT IS THE APPROPRIATE OPERATIVE STRATEGY FOR RADIOLOGICALLY SOLID TUMOURS IN SUBCENTIMETRE LUNG CANCER PATIENTS?

OBJECTIVES: Solid lung cancers, even subcentimetre lesions, are considered to be invasive pathologically. However, the clinicopathological features and appropriate operative strategies in patients with these small lesions are still controversial, especially for those with a radiologically solid appearance. METHODS: Between 2004 and 2011, 135 patients underwent pulmonary resection for subcentimetre lung cancer with clinical-N0 (c-N0) status. The findings of preoperative thin-section computed tomography (CT) were reviewed, and subcentimetre lung cancer was divided into three groups: pure ground-glass nodule, part-solid and pure-solid lesions. RESULTS: Among the 135 subcentimetre lung cancer patients with c-N0 status, 71 showed a solid appearance on thin-section CT scan. Furthermore, pathological nodal examinations were performed in 49 patients, and nodal involvement was found pathologically in 6 (12.2%) patients. All of them had pure-solid tumours (P= 0.0010). Among the patients with solid subcentimetre lung cancers, the maximum standardized uptake value (SUVmax) was the only significant predictor of nodal involvement by a multivariate analysis (P= 0.0205). With regard to the surgical outcomes, the overall 5-year survival and disease-free survival rates were 100 and 97.8% for partsolid lesions, and 87.3 and 74.8% for pure-solid lesions, respectively. Moreover, there was a significant difference in disease-free survival between a high SUVmax group (60.0%) and a low SUVmax group (94.9%) (P= 0.0013).

FDG PET-CT in Non-small Cell Lung Cancer: Relationship between Primary Tumor FDG Uptake and Extensional or Metastatic Potential

To explore the relationships between primary tumor 18F-FDG uptake measured as the SUVmax and local extension, and nodal or distant organ metastasis in patients with NSCLC on pretreatment PET-CT. 93 patients with NSCLC who underwent 18F-FDG PET-CT scans before the treatment were included in the study. Primary tumor SUVmax was calculated; clinical stages, presence of local extension, nodal and distant organ metastases were recorded. The patients with SUVmax ≥ 2.5 were divided into low and high SUVmax groups by using the median SUVmax. The low SUVmax group consisted of 45 patients with SUVmax<10.5, the high SUVmax group consisted of 46 patients with SUVmax ≥ 10.5. Their data were compared statistically. 91 cases with SUVmax≥2.5 were included for analysis. The mean SUVmax in patients without any metastasis was 7.42 ± 2.91 and this was significantly lower than that (12.18 ± 4.94) in patients with nodal and/or distant organ metastasis (P=0.000). In the low SUV group, 19 patients had local extension, 22 had nodal metastasis, and 9 had distant organ metastasis. In the high SUV group, 31 patients had local extension, 37 had nodal metastasis, and 18 had distant organ metastases. There was a significant difference in local extension (P =0.016), distant organ metastasis (P =0.046), and most significant difference in nodal metastasis rate (P =0.002) between the two groups. In addition, there was a moderate correlation between SUVmax and tumor size (r = 0.642, P<0.001), tumor stage (r = 0.546, P<0.001), node stage (r = 0.388, P<0.001), and overall stage (r = 0.445, P= 0.000). Higher primary tumor SUVmax predicts higher extensional or metastatic potential in patients with NSCLC. Patients with higher SUVmax may need a close follow-up and more reasonable individual treatment because of their higher extensional and metastatic potential.

Clinical impact of 18F-FDG–PET in breast cancer: Survival analysis and comparison of intrinsic subtypes with standardized uptake value.

e12005 Background: [18F] fluorodeoxyglucose positron emission tomography (18F-FDG–PET) scans are known as an important imaging study with their reflection biological activity in various malignancies. To investigate clinical impact of 18F-FDG–PET in breast cancer, we performed survival analysis with maximum standardized uptake values (SUVmax), and compared SUVmax according to breast cancer subtypes. Methods: We reviewed the medical records of 462 patients with breast cancer who underwent primary surgery between April 2004 and December 2008 at single institute. Patients were classified as 4 subtypes: luminal A, luminal B, HER2 and triple negative. The entire patients were randomly assigned as training set (n=220) and validation set (n=242). Results: High SUVmax vs. low SUVmax group was defined with cut-off points of 4 in a training set.At a median follow-up of 6.03 years, the patients with high SUVmax had a shorter disease-free survival in a validation set (p = 0.018, log-rank test). Using multivariate analysis for disease-free survival in the entire patients, high SUVmax was demonstrated as a poor prognostic factor (hazard ratio 2.34, 95% confidence interval 1.18-4.67). In the comparison among subtypes, mean of SUVmax was higher in triple negative type and HER2 type. Also, high SUVmax was significantly associated with larger tumor size, positive node, high Ki67 (≥14%), ER negative, and high histologic grade, and HER2 positive. Conclusions: In breast cancer, the patients with higher SUVmax showed a shorter disease-free survival. Higher SUVmax found in HER-2 and triple negative type suggests that 18F-FDG PET could reflect molecular signature.

Relation between [18F]-FDG-PET/CT and volume perfusion-CT in primary tumors and mediastinal lymph nodes of non-small cell lung cancer

Ziele: The aim of this study was to investigate relations between glucose metabolism as registered by 2-deoxy-2-[18F]fluoro-D-glucose-PET/CT ([18F]FDG-PET/CT) and tumor perfusion as quantified by volume perfusion-CT (VPCT) in primary tumors and mediastinal lymph nodes of patients with non-small cell lung cancer. Methode: 17 patients with non-small cell lung cancer and 56 lymph nodes were enrolled. SUVmax and SUVavg were used for quantification of [18F]FDG uptake. Blood flow (BF), blood volume (BV) and flow extraction product (Ktrans) were determined as perfusion parameters. Perfusion parameters and [18F]FDG uptake values were subsequently correlated with each other. Ergebnis: No correlations were found between perfusion parameters and [18F]FDG uptake, for the primary tumors. Negative correlations were calculated between BF and SUVavg (r =- 0.383), BV and SUVavg (r =- 0.406), BV and SUVmax (r =- 0.377), but not between BF and SUVmax, Ktrans and SUVavg, Ktrans and SUVmax, respectively. In addition, negative correlations existed in the >2.5 SUVmax group between BF and SUVavg (r =- 0.510), BV and SUVavg (r =- 0.390), BF and SUVmax (r =- 0.536), BV and SUVmax (r =- 0.346), respectively. Schlussfolgerung: Glucose metabolism and perfusion seem to be negatively correlated in mediastinal lymph nodes, but uncoupled in large primary tumors. These results may help to advance tumor staging and therapy monitoring.

The Feasibility of 18F-fluorodeoxyglucose-positron Emission Tomography Uptake as a Prognostic Factor for Paranasal Sinus Malignancy

There is a correlation between (18)F-fluorodeoxyglucose (FDG) uptake and the level of intracellular metabolic tumor activity, which in turn may be associated with active proliferation, invasion, and prognosis as well as distant metastases in head and neck cancer. This study was designed to assess whether tumor uptake of FDG positron emission tomography (PET) expressed as the maximum standardized uptake value (SUVmax) can be used to predict survival in subjects with paranasal sinus malignancy. We enrolled 42 consecutive subjects with a histological diagnosis of squamous cell carcinoma in paranasal sinus malignancy, into a retrospective institutional imaging trial. Thirty-eight subjects (90.5%) underwent a baseline FDG-PET scan before curative treatment and were eligible for analysis. A total of 38 subjects with paranasal sinus malignancy undergoing PET/computed tomography imaging in the initial stages were assessed separately for a potential correlation between SUVmax and T staging, histological grading, and overall survival. Log-rank testing revealed a significant correlation between overall survival and histological grading (p = 0.046); and there was some correlation between SUVmax and histological grading, but not significantly different. The receiver operation characteristic curve was identified for cutoff value of SUVmax as a prognostic factor. We compared the low tumor of the SUVmax group with the high tumor of the SUVmax group divided by the cutoff value of SUVmax. We did find a significant correlation between SUVmax and disease control and mortality (p = 0.003, p < 0.001). In our study, we concluded that subjects with higher tumor FDG uptakes should be considered for a more aggressive disease.

Prognostic Value of18F-Fluorodeoxyglucose Positron Emission Tomography in Patients with Resectable Pancreatic Cancer

PurposeWe evaluated the prognostic value of 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) in patients with resectable pancreatic cancer.Materials and MethodsWe retrospectively reviewed the medical records of pancreatic cancer patients who underwent curative resection, which included 64 consecutive patients who had preoperative FDG PET scans. For statistical analysis, the maximal standardized uptake value (SUVmax) of primary pancreatic cancer was measured. Survival time was estimated by the Kaplan-Meier method, and Cox's proportional hazard model was used to determine whether SUVmax added new predictive information concerning survival together with known prognostic factors. p<0.05 indicated statistical significance.ResultsOverall survival (OS) and disease-free survival (DFS) were respectively 42.9 months (27.6-58.2; 95% CI) and 14.9 months (10.1-19.7; 95% CI). When subjects were divided into two groups according to SUVmax with a cutoff value of 3.5, the high SUVmax group (n=32; SUVmax >3.5) showed significantly shorter OS and DFS than the low SUVmax group. Multivariate analysis of OS and DFS showed that both high SUVmax and poor tumor differentiation were independent poor prognostic factors.ConclusionOur study showed that degree of FDG uptake was an independent prognostic factor in pancreatic cancer patients who underwent curative resection.

NON-INVASIVE SERIAL MONITORING OF ATHEROSCLEROTIC PLAQUE PROGRESSION AND THROMBOSIS WITH PET-CT IN A RABBIT MODEL

Objectivesto investigate the characteristics of atherosclerotic plaque progression at different stages with PET-CT imaging as well as the feasibility and accuracy of detecting vulnerable plague using this fused imaging techniques.MethodsEighteen...

Metabolic Tumor Volume Has Potential Clinical Impact Compared with SUVmax in Primary Gastrointestinal Diffuse Large B Cell lymphoma

Abstract 4983 Background:Primary gastrointestinal (GI) lymphoma is the most commonly involved extranodal site and represents 10–15% of all Non-Hodgkin’s Lymphoma cases. Recent studies showed that the prognostic value of early 18F-FDG PET using maximum standardized uptake volume (SUVmax) on pretreatment was important prognostic factor in primary GI diffuse large B cell lymphoma (DLBCL). However, initial tumor burden is still an important subject associated with prognosis even extranodal DLBCL. The purpose of this study was to assess the prognostic impact of metabolic tumor volume (MTV) as tumor burden using by PET scan technique compared with initial SUVmax in primary GI DLBCL. Patients and methods:From April, 2006 to July, 2009, 125 stage IE (58 patients) or IIE (67 patients) primary GI DLBCL patients with localized lymph node involvement were enrolled and assigned to 6 or 8 cycles of R-CHOP therapy. Median follow-up was 36 months. Median age was 62 years (range, 20–79 years). Seventy-four patients were male and remainders were female. Numbers of patients above 60 years were 71. Twenty-five patients had an Eastern Cooperative Oncology Group performance status of more than two. Calculatory system by computer automatically delineated a extranodal target lesions above SUV, 2.5 and MTV of GI lesion was 3-dimensional reconstructed by fusion software. The SUVmax was collected from predominant GI lesion and calculated based on the attenuation-corrected images, the amount of injected 18F-FDG and body weight. Results:The extranodal sites of GI tract were included stomach and duodenum (64 patients, 51.2%), jejunum (10 patients, 8%), terminal ileum (30 patients, 24%), cecum (7 patients, 5.6%), ascending colon (8 patients, 6.4%), transverse colon (3 patients, 2.4%) and decending colon (3 patients, 2.4%). We used ROC curve analysis. 158.3cm3 was decided as best ideal cut-off value of MTV and 15.5 was decided as the cut-off value of SUVmax. Several factors (age, sex, disease status and IPI score) between high MTV (≥158.3cm3) and low MTV group (<158.3cm3) were not significantly different. However, SUVmax higher in high MTV group than low MTV group (p<0.001). In response by revised International Workshop Criteria, low MTV group had excellent response rates than high MTV group (CR, p<0.001; PR, p=0.014; SD & PD, p<0.001). Moreover, 3-year PFS was higher in low MTV group than high MTV group (low MTV group, 96.7%; high MTV group, 37.1%; p<0.001) and 3-year OS was also higher in low MTV group than high MTV group (low MTV group, 97.8%; high MTV group, 42.9%; p<0.001). The PFS and OS were higher in low SUVmax group (<15.5) than high SUVmax group (≥15.5) (p<0.001, p<0.001, respectively). In univariate analysis, high IPI score is still important prognostic factor for PFS and OS (PFS: HR, 4.181 [1.844-9.478] p=0.001 & OS: HR, 4.300 [1.801-10.263] p=0.001). High MTV and high SUVmax were also poor prognostic factors for PFS and OS (high MTV; PFS: HR, 26.543 [7.923-88.231] p<0.001 & OS: HR, 32.458 [7.579-139.018] p<0.001) (high SUVmax; PFS: HR, 6.998 [2.399-20.418] p<0.001 & OS: HR, 13.976 [3.257-59.979] p<0.001). In multivariate analysis, high MTV group (PFS: HR, 19.850 [5.193-75.870] p<0.001 & OS: HR, 17.918 [3.694-86.904] p<0.001) and high IPI score (PFS: HR, 2.659 [1.136-6.223] p=0.024 & OS: HR, 2.866 [1.175-6.989] p=0.021) were independent prognostic factors for PFS and OS. However, SUVmax had not significant value for survival. Conclusion:In primary GI DLBCL, high MTV is very important and potential prognostic factor compared with SUVmax for predicting the survival. Therefore, more aggressive treatment strategy would be performed in primary GI DLBCL patients having initial high tumor burden. Disclosures:No relevant conflicts of interest to declare.

Clinical implication of FDG–PET in advanced gastric cancer with signet ring cell histology

The purpose of this study was to investigate the role of the standardized uptake values (SUV), a semi-quantitative assessment of tumor FDG uptake, as a prognosticator for advanced signet ring cell carcinoma (SRC). We reviewed the files of 41 patients who underwent curative gastrectomy for advanced SRC and who had an FDG-PET at initial presentation between September 2003 and December 2007. The median follow-up period was 30.9 months (range: 4.0-70.3). We found a correlation between the SUVmax and TNM stage. When the patients were divided into two groups (low vs. high SUVmax) based on a median SUVmax of 3.80, the high-SUVmax group showed more aggressive tumor behavior than did the low SUVmax group. In addition, the high SUVmax group showed more postoperative recurrence (P = 0.028), shorter relapse-free survival (P = 0.004), and lower 30-month cancer-specific survival rates (40.0% vs. 69.3%, P = 0.008). However, in multivariate analysis, SUVmax failed to be an independent predictor of overall survival. Although SUVmax of initial PET scan was not an independent predictor of patient outcomes after curative surgery, higher SUVmax is associated with more advanced stage and indicates more aggressive tumor biology in advanced SRC.

SU-GG-T-490: Estimation of Boost Dose Required to Compensate for High FDG Uptake in Head and Neck Squamous Cell Carcinoma

Purpose: Although high FDG regions are recognized as a possible target for boost dose escalation, there is no clear basis for selecting the boost dose. Based on available published data, we make an estimate of the range of extra dose required to equalize local control between FDG‐avid and non‐avid tumors.Method and Materials: A literature review was performed for radiation therapy (RT) for head and neck squamous cell carcinoma (HNSCC), in which RT‐only outcomes were compared for high and low FDG uptake groups. Among nine relevant trials, only three provided adequate data for analysis. Either local control or disease free survival were used to estimate Tumor Control Probability (TCP). A logistic TCP model was used. Values of TD50 were found for each group with three different γ50 values (γ50=1, 2 or 4), with 2 thought to most likely represent clinical reality. The dose required for the high SUVmax group to achieve the same level of TCP can be directly calculated from the ratio for any TCP level, since the slope was assumed to be the same for both groups. The ratio of TD50's for high SUVmax group and low SUVmax group (TD50,high/TD50,low) was calculated. Results: Estimated TD50,high/TD50,low ratios were found to be in the range of 1.11∼2.06, with decreasing values as the presumed value of γ50 increased up to 4. With γ50=2, the derived ratios of (TD50,high/TD50,low) were 1.22, 1,23, and 1.44. Conclusion: The boost dose mostly likely required to compensate for radioresistant FDG‐avid tumors is estimated to be 84–98 Gy, assuming a non‐boost dose of 70 Gy, although values between 77 Gy and 140 Gy cannot be ruled out. These estimates provide a rational starting point for clinical trials to test the usefulness of IMRT boots FDG‐avid tumors. Supported by a grant from TomoTherapy, Inc.

18F‐FDG uptake and its clinical relevance in primary gastric lymphoma

We studied the clinical relevance of (18)F-fluorodeoxyglucose ((18)F-FDG) uptake in patients with primary gastric lymphoma underwent positron emission tomography (PET)/ computed tomography (CT) scan. Forty-two patients with primary gastric lymphoma were analysed: 32 diffuse large B-cell lymphomas (DLBCL) and 10 extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas). The PET/CT scans were compared with clinical and pathologic features, and the results of CT and endoscopy. Nine patients were up-staged based on the results of their PET/CT scan compared to CT (seven DLBCLs, two MALT lymphomas) while six patients were down-staged by the PET/CT scan. The standard uptake value (SUV) was used as an indicator of a lesion with a high metabolic rate. The high SUVmax group, defined as an SUVmax >or= median value, was significantly associated with an advanced Lugano stage (p < 0.001). Three patients with DLBCL, who showed an initially high SUVmax, died of disease progression. Among 24 patients for whom follow-up PET/CT scan with endoscopy was performed, 11 patients with ulcerative or mucosal lesions showed residual (18)F-FDG uptake. All of these gastric lesions were grossly and pathologically benign lesions without evidence of lymphoma cells. In conclusion, PET/CT scan can be used in staging patients with primary gastric lymphoma; however, the residual (18)F-FDG uptake observed during follow-up should be interpreted cautiously and should be combined with endoscopy and multiple biopsies of the stomach.

Clinical usefulness of PET/CT in initial staging and response evaluation of primary gastric lymphoma

e19541 Background: Positron emission tomography (PET)/computed tomography (CT) scan has a well-established role in the management of non-Hodgkin's lymphoma (NHL). However, in case of the primary gastric lymphoma, which is the most frequent extranodal NHL, the role of PET/CT scan is still controversial. Methods: We retrospectively analyzed 42 patients with primary gastric lymphoma who underwent PET/CT scans; 32 patients with diffuse large B-cell lymphoma (DLBCL) and 10 patients with extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) were analyzed. The PET/CT scans were compared with clinicopathologic features and the results of CT and endoscopy. After corresponding treatment, response was evaluated by conventional CT scans or PET/CT scans and endoscopy with biopsy Results: Nine patients were up-staged based on the results of their PET/CT scan compared to CT (7 DLBCL, 2 MALT lymphomas) while six patients were down-staged by the PET/CT scan. The high SUVmax group, defined as SUVmax ≥ median value, was significantly associated with an advanced Lugano stage (P &lt; 0.001). Three patients with DLBCL, who showed an initially high SUVmax, died of disease progression. Although not statistically significant, there was a tendency of inferior outcome in the group with high SUVmax. Among 24 patients for whom follow-up PET/CT scan with endoscopy was performed, 11 patients with ulcerative or mucosal lesions showed residual FDG uptake. All of these gastric lesions were grossly and pathologically benign lesions without evidence of lymphoma cells. Conclusions: PET/CT scan can help staging patients with primary gastric lymphoma, and the maximum SUV has possibility to have prognostic value. However, the residual FDG uptake observed during follow-up should be interpreted cautiously in association with the results of endoscopy and multiple gastric biopsies. No significant financial relationships to disclose.

Usefulness of FDG-PET in predicting the prognosis of advanced pancreatic carcinoma with chemotherapy

14043 Background: 18F-fluorodeoxyglucose (FDG) PET is a new diagnostic imaging technique that takes advantage of increased glucose metabolism by the tumor cells. High uptake of FDG is reportedly associated with poor survival in head and neck cancer (Heikki et al., 1997, Nuclear Oncology). FDG uptake diminishes with elevated levels of plasma glucose. We herein evaluated the usefulness of FDG-PET in predicting the prognosis of advanced pancreatic carcinoma (APC). Methods: FDG-PET was performed on 32 consecutive patients with APC between July 2001 and April 2004. The patients fasted for at least 5 hr before the study. The plasma glucose level was controlled under 150 mg/dl by using oral antidiabetic or insulin therapy in advance. FDG-PET images were acquired 45 min after intravenous injection of FDG. We did not measure the plasma glucose level directly before imaging. The FDG uptake in the primary tumor was quantitated as the standardized uptake value (SUV), and the maximum SUV (SUVmax) was measured in the regions of interest. All of the 32 APC patients received chemotherapy (26: gemcitabine, 1: gemcitabine + UFT, 5: TS-1). We analyzed the correlation between SUVmax and the overall survival. Then, we excluded the diabetics (n = 8) and compared SUV in the non-diabetic patients (n = 24). The overall survival curve was plotted according to the method of Kaplan and Meier. The difference in the overall survival was calculated using the log-rank test, and a multivariate analysis was conducted. Results: 32 patients were examined. All cases showed FDG uptake in the pancreatic tumor (SUVmax ranged from 2.73 to 9.67). The overall survival ranged from 38 to 945 days with a median of 261 days.These patients were classified into two groups at a median SUVmax value of 4.81. There was no significant difference in the overall survival between these two groups (p &gt; 0.05). The non-diabetic patients (n = 24) were classified into two groups at a median SUVmax value of 5.51. The high SUVmax group had shorter overall survival than the low SUVmax group (p = 0.039). The multivariate analysis using Cox hazard model also revealed that SUVmax was a significant, independent factor that influenced the survival (p = 0.043) in the non-diabetic patients. Conclusions: FDG-PET may be a useful modality in determining the prognosis of APC. No significant financial relationships to disclose.