Tumor Delineation and Quantitative Assessment of Glucose Metabolic Rate within Histologic Subtypes of Non-Small Cell Lung Cancer by Using Dynamic 18 F Fluorodeoxyglucose PET
Purpose To assess whether dynamic fluorine 18 ( F) fluorodeoxyglucose (FDG) positron emission tomography (PET) has added value over static F-FDG PET for tumor delineation in non-small cell lung cancer (NSCLC) radiation therapy planning by using pathology volumes as the reference standard and to comp...
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Published in | Radiology Vol. 283; no. 2; pp. 547 - 559 |
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Abstract | Purpose To assess whether dynamic fluorine 18 (
F) fluorodeoxyglucose (FDG) positron emission tomography (PET) has added value over static
F-FDG PET for tumor delineation in non-small cell lung cancer (NSCLC) radiation therapy planning by using pathology volumes as the reference standard and to compare pharmacokinetic rate constants of
F-FDG metabolism, including regional variation, between NSCLC histologic subtypes. Materials and Methods The study was approved by the institutional review board. Patients gave written informed consent. In this prospective observational study, 1-hour dynamic
F-FDG PET/computed tomographic examinations were performed in 35 patients (36 resectable NSCLCs) between 2009 and 2014. Static and parametric images of glucose metabolic rate were obtained to determine lesion volumes by using three delineation strategies. Pathology volume was calculated from three orthogonal dimensions (n = 32). Whole tumor and regional rate constants and blood volume fraction (V
) were computed by using compartment modeling. Results Pathology volumes were larger than PET volumes (median difference, 8.7-25.2 cm
; Wilcoxon signed rank test, P < .001). Static fuzzy locally adaptive Bayesian (FLAB) volumes corresponded best with pathology volumes (intraclass correlation coefficient, 0.72; P < .001). Bland-Altman analyses showed the highest precision and accuracy for static FLAB volumes. Glucose metabolic rate and
F-FDG phosphorylation rate were higher in squamous cell carcinoma (SCC) than in adenocarcinoma (AC), whereas V
was lower (Mann-Whitney U test or t test, P = .003, P = .036, and P = .019, respectively). Glucose metabolic rate,
F-FDG phosphorylation rate, and V
were less heterogeneous in AC than in SCC (Friedman analysis of variance). Conclusion Parametric images are not superior to static images for NSCLC delineation. FLAB-based segmentation on static
F-FDG PET images is in best agreement with pathology volume and could be useful for NSCLC autocontouring. Differences in glycolytic rate and V
between SCC and AC are relevant for research in targeting agents and radiation therapy dose escalation.
RSNA, 2016 Online supplemental material is available for this article. |
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AbstractList | Purpose To assess whether dynamic fluorine 18 (
F) fluorodeoxyglucose (FDG) positron emission tomography (PET) has added value over static
F-FDG PET for tumor delineation in non-small cell lung cancer (NSCLC) radiation therapy planning by using pathology volumes as the reference standard and to compare pharmacokinetic rate constants of
F-FDG metabolism, including regional variation, between NSCLC histologic subtypes. Materials and Methods The study was approved by the institutional review board. Patients gave written informed consent. In this prospective observational study, 1-hour dynamic
F-FDG PET/computed tomographic examinations were performed in 35 patients (36 resectable NSCLCs) between 2009 and 2014. Static and parametric images of glucose metabolic rate were obtained to determine lesion volumes by using three delineation strategies. Pathology volume was calculated from three orthogonal dimensions (n = 32). Whole tumor and regional rate constants and blood volume fraction (V
) were computed by using compartment modeling. Results Pathology volumes were larger than PET volumes (median difference, 8.7-25.2 cm
; Wilcoxon signed rank test, P < .001). Static fuzzy locally adaptive Bayesian (FLAB) volumes corresponded best with pathology volumes (intraclass correlation coefficient, 0.72; P < .001). Bland-Altman analyses showed the highest precision and accuracy for static FLAB volumes. Glucose metabolic rate and
F-FDG phosphorylation rate were higher in squamous cell carcinoma (SCC) than in adenocarcinoma (AC), whereas V
was lower (Mann-Whitney U test or t test, P = .003, P = .036, and P = .019, respectively). Glucose metabolic rate,
F-FDG phosphorylation rate, and V
were less heterogeneous in AC than in SCC (Friedman analysis of variance). Conclusion Parametric images are not superior to static images for NSCLC delineation. FLAB-based segmentation on static
F-FDG PET images is in best agreement with pathology volume and could be useful for NSCLC autocontouring. Differences in glycolytic rate and V
between SCC and AC are relevant for research in targeting agents and radiation therapy dose escalation.
RSNA, 2016 Online supplemental material is available for this article. |
Author | Visser, Eric P Oyen, Wim J G Visvikis, Dimitris Looijen-Salamon, Monika G Verhagen, Ad F T M Vriens, Dennis Bussink, Johan de Geus-Oei, Lioe-Fee Meijer, Tineke W H |
Author_xml | – sequence: 1 givenname: Tineke W H surname: Meijer fullname: Meijer, Tineke W H organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 2 givenname: Lioe-Fee surname: de Geus-Oei fullname: de Geus-Oei, Lioe-Fee organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 3 givenname: Eric P surname: Visser fullname: Visser, Eric P organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 4 givenname: Wim J G surname: Oyen fullname: Oyen, Wim J G organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 5 givenname: Monika G surname: Looijen-Salamon fullname: Looijen-Salamon, Monika G organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 6 givenname: Dimitris surname: Visvikis fullname: Visvikis, Dimitris organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 7 givenname: Ad F T M surname: Verhagen fullname: Verhagen, Ad F T M organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 8 givenname: Johan surname: Bussink fullname: Bussink, Johan organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) – sequence: 9 givenname: Dennis surname: Vriens fullname: Vriens, Dennis organization: From the Departments of Radiation Oncology (T.W.H.M., J.B.), Radiology and Nuclear Medicine (L.F.d.G.O., E.P.V., W.J.G.O.), Pathology (M.G.L.S.), and Cardiothoracic Surgery (A.F.T.M.V.), Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands (L.F.d.G.O., D. Vriens); Biomedical Photonic Imaging Group, MIRA Institute, University of Twente, Enschede, the Netherlands (L.F.d.G.O.); Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, London, England (W.J.G.O.); and INSERM, UMR 1101, LaTIM, Université de Bretagne Occidentale, Brest, France (D. Visvikis) |
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References | r2 r3 r4 Strauss LG (r32) 2013; 3 r5 r6 r7 r8 r9 r10 r12 r11 r14 r13 r16 r15 de Geus-Oei LF (r30) 2006; 47 r18 r17 r19 r21 r20 r23 r22 r25 r24 r27 r26 r29 O’Rourke N (r1) 2010 r28 Okazumi S (r31) 1992; 33 |
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Snippet | Purpose To assess whether dynamic fluorine 18 (
F) fluorodeoxyglucose (FDG) positron emission tomography (PET) has added value over static
F-FDG PET for tumor... |
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SubjectTerms | Aged Aged, 80 and over Biomarkers, Tumor - metabolism Carcinoma, Non-Small-Cell Lung - diagnostic imaging Carcinoma, Non-Small-Cell Lung - metabolism Carcinoma, Non-Small-Cell Lung - pathology Fluorodeoxyglucose F18 - pharmacokinetics Glucose - metabolism Humans Image Interpretation, Computer-Assisted - methods Lung Neoplasms - diagnostic imaging Lung Neoplasms - metabolism Lung Neoplasms - pathology Male Metabolic Clearance Rate Middle Aged Molecular Imaging - methods Neoplasm Staging Positron-Emission Tomography - methods Radiopharmaceuticals - pharmacokinetics Reproducibility of Results Sensitivity and Specificity |
Title | Tumor Delineation and Quantitative Assessment of Glucose Metabolic Rate within Histologic Subtypes of Non-Small Cell Lung Cancer by Using Dynamic 18 F Fluorodeoxyglucose PET |
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