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The Quarterly Journal of Nuclear Medicine and Molecular Imaging 2018 May 10

DOI: 10.23736/S1824-4785.18.03067-4

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Evaluation of multifunctional imaging parameters in gastro-oesophageal cancer using F-18-FDG-PET/CT with integrated perfusion CT

Bert-Ram SAH 1, 2, 3, 4 , Christian A. LEISSING 1, 4, Gaspar DELSO 1, 5, Edwin E. ter VOERT 1, Stefan KRIEG 4, Sebastian LEIBL 6, Paul M. SCHNEIDER 7, Cäcilia S. REINER 2, 4, Martin W. HÜLLNER 1, 4, Patrick VEIT-HAIBACH 1, 2, 8

1 Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Suisse; 2 Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Suisse; 3 Department of Cancer Imaging, King's College London, London, UK; 4 University of Zurich, Zurich, Suisse; 5 GE Healthcare, Waukesha, WI, USA; 6 Department of Pathology, University Hospital of Zurich, Zurich, Suisse; 7 Department of Surgery, University Hospital of Zurich, Center for Visceral, Thoracic and Specialized Tumor Surgery, Hirslanden Medical Center, Zurich, Suisse; 8 Joint Department of Medical Imaging, University of Toronto, Toronto, ON, Canada


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BACKGROUND: Positron emission tomography (PET) / computed tomography (CT) is among the most frequently used imaging modalities for initial staging of gastro-oesophageal (GE) cancer, whereas CT-perfusion (CTP) provides different multiparametric information. This proof of concept study compares CTP- and PET-parameters in patients with GE cancer to evaluate correlations and a possible prognostic value of a combined PET/CTP imaging procedure.
METHODS: A total of 31 patients with F-18-FDG-PET/CT and CTP studies were prospectively analysed. Patients had adenocarcinoma (n = 22) and oesophageal squamous cell carcinoma (SCC, n = 9). Imaging was performed before start of treatment. CTP parameters [blood flow (BF), blood volume (BV), mean transit time (MTT)] and metabolic parameters [(maximum and mean standardised uptake values and standard deviation (SUVmax, SUVmean, SUVsd), metabolic tumour volume (MTV) and tumour lesion glycolysis (TLG)], as well as flow metabolic product [FMP (BF × SUVmax)] were determined and their relationship was compared. Additionally their association to clinical parameters (differentiation grading, staging, HER2-status, follow-up status) and to histopathological regression (post-neoadjuvant regression grading) was evaluated.
RESULTS: Correlation between parameters of both modalities was significant between MTT and MTV (r = 0.375, p = 0.038); no other significant correlation was found. Patients with complete histopathological regression showed significantly lower BF and BV than patients with nearly complete or partial response. TLG and regression grading showed significant correlation with staging. All other quantitative parameters for CTP and PET data did not correlate significantly with histopathological regression grading, differentiation or staging.
CONCLUSIONS: The combination of PET and CTP parameters (FMP) showed no significant prognostic value. Significant correlations were only found between MTT and MTV, which indicates a possible perfusional/metabolic coupling. Therefore, pre-therapeutic CTP and PET- parameters provide complementary information about the pre-therapeutic tumour status and are not interchangeable. Only CTP parameters might be able to predict complete histopathological regression. On the other hand, only PET parameters are correlated with staging.


KEY WORDS: Positron emission tomography - FDG - CT-perfusion - Gastric cancer - Oesophageal cancer

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