PET/MRI in Cervical Cancer: Associations Between Imaging Biomarkers and Tumor Stage, Disease Progression, and Overall Survival

Background Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression‐free survival (PFS) and overall survival (OS) merit further investigation. Purpose To evaluate the association between PE...

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Published inJournal of magnetic resonance imaging Vol. 53; no. 1; pp. 305 - 318
Main Authors Shih, I‐Lun, Yen, Rouh‐Fang, Chen, Chi‐An, Cheng, Wen‐Fang, Chen, Bang‐Bin, Chang, Yu‐Hsuan, Cheng, Mei‐Fang, Shih, Tiffany Ting‐Fang
Format Journal Article
LanguageEnglish
Published Hoboken, USA John Wiley & Sons, Inc 01.01.2021
Wiley Subscription Services, Inc
Subjects
Biomarkers
Cancer
Cervical cancer
Cervix
Diffusion coefficient
Disease Progression
Evaluation
Female
Field strength
Fluorodeoxyglucose F18
Glycolysis
Hazard assessment
Health hazards
Humans
Image analysis
Image processing
imaging biomarker
Magnetic Resonance Imaging
Medical imaging
overall survival
PET/MRI
Population studies
Positron emission
Positron emission tomography
Prognosis
progression‐free survival
Prospective Studies
Radiopharmaceuticals
Retrospective Studies
Statistical analysis
Statistical models
Statistical tests
Subgroups
Survival
Survival analysis
Tomography
Tumor Burden
Tumors
Uterine Cervical Neoplasms - diagnostic imaging
overall survival
PET/MRI
imaging biomarker
cervical cancer
progression-free survival
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Abstract Background Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression‐free survival (PFS) and overall survival (OS) merit further investigation. Purpose To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer. Study Type Prospective cohort study. Population In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis. Field Strength/Sequence 3.0T integrated PET/MRI including diffusion‐weighted echo‐planar imaging (b = 50 and 1000 s/mm2) and [18F]fluorodeoxyglucose PET. Assessment Two radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors. Statistical Tests A Mann–Whitney U‐test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival. Results In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin, and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008). Data Conclusion PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively. Level of Evidence 1 Technical Efficacy 3
AbstractList Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression-free survival (PFS) and overall survival (OS) merit further investigation. To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer. Prospective cohort study. In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis. 3.0T integrated PET/MRI including diffusion-weighted echo-planar imaging (b = 50 and 1000 s/mm ) and [18F]fluorodeoxyglucose PET. Two radiologists measured the minimum and mean apparent diffusion coefficient (ADC and ADC ), maximum standardized uptake value (SUV ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors. A Mann-Whitney U-test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival. In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADC was significantly lower and MTV, TLG, MTV/ADC , and TLG/ADC were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADC was significantly lower and MTV and MTV/ADC were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUV was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADC was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADC was a predictor of PFS in stage I disease (P = 0.003), ADC (P = 0.038), and MTV (P = 0.020) in stage II, SUV (P = 0.006), and TLG (P = 0.006) in stage IV; and ADC was a predictor of OS in stage III disease (P = 0.008). PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUV and ADC are independent predictors of PFS and OS, respectively. 1 TECHNICAL EFFICACY: 3.
BackgroundPositron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression‐free survival (PFS) and overall survival (OS) merit further investigation.PurposeTo evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer.Study TypeProspective cohort study.PopulationIn all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis.Field Strength/Sequence3.0T integrated PET/MRI including diffusion‐weighted echo‐planar imaging (b = 50 and 1000 s/mm2) and [18F]fluorodeoxyglucose PET.AssessmentTwo radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors.Statistical TestsA Mann–Whitney U‐test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival.ResultsIn advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin, and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008).Data ConclusionPET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively.Level of Evidence1Technical Efficacy3
Background Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression‐free survival (PFS) and overall survival (OS) merit further investigation. Purpose To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer. Study Type Prospective cohort study. Population In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis. Field Strength/Sequence 3.0T integrated PET/MRI including diffusion‐weighted echo‐planar imaging (b = 50 and 1000 s/mm2) and [18F]fluorodeoxyglucose PET. Assessment Two radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean), maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors. Statistical Tests A Mann–Whitney U‐test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival. Results In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin, and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008). Data Conclusion PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively. Level of Evidence 1 Technical Efficacy 3
Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression-free survival (PFS) and overall survival (OS) merit further investigation.BACKGROUNDPositron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with progression-free survival (PFS) and overall survival (OS) merit further investigation.To evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer.PURPOSETo evaluate the association between PET/MRI biomarkers and tumor stage, PFS, and OS in patients with cervical cancer.Prospective cohort study.STUDY TYPEProspective cohort study.In all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis.POPULATIONIn all, 54 patients with newly diagnosed cervical cancer and measurable tumors (>1 cm) were included in the image analysis.3.0T integrated PET/MRI including diffusion-weighted echo-planar imaging (b = 50 and 1000 s/mm2 ) and [18F]fluorodeoxyglucose PET.FIELD STRENGTH/SEQUENCE3.0T integrated PET/MRI including diffusion-weighted echo-planar imaging (b = 50 and 1000 s/mm2 ) and [18F]fluorodeoxyglucose PET.Two radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean ), maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors.ASSESSMENTTwo radiologists measured the minimum and mean apparent diffusion coefficient (ADCmin and ADCmean ), maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors.A Mann-Whitney U-test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival.STATISTICAL TESTSA Mann-Whitney U-test was used to evaluate the association between the imaging biomarkers and tumor stage. A Cox proportional hazards model was used to assess the relationships between the imaging biomarkers and survival.In advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin , and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008).RESULTSIn advanced tumors (T ≥ 1b2, M1, stage ≥ IB3), ADCmin was significantly lower and MTV, TLG, MTV/ADCmin , and TLG/ADCmin were significantly higher (P values between <0.001 and 0.036). In N1 tumors, ADCmin was significantly lower and MTV and MTV/ADCmin were significantly higher (P values between 0.005 and 0.016). In survival analysis, SUVmax was an independent predictor of PFS (hazard ratio [HR] = 4.57, P < 0.05), and ADCmin was an independent predictor of OS (HR = 0.02, P < 0.05). In subgroup analysis of patients with different stages, MTV/ADCmin was a predictor of PFS in stage I disease (P = 0.003), ADCmin (P = 0.038), and MTV (P = 0.020) in stage II, SUVmax (P = 0.006), and TLG (P = 0.006) in stage IV; and ADCmin was a predictor of OS in stage III disease (P = 0.008).PET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively.DATA CONCLUSIONPET/MRI biomarkers of cervical cancer are associated with tumor stage and survival. SUVmax and ADCmin are independent predictors of PFS and OS, respectively.1 TECHNICAL EFFICACY: 3.LEVEL OF EVIDENCE1 TECHNICAL EFFICACY: 3.
Author Chen, Chi‐An
Cheng, Wen‐Fang
Shih, I‐Lun
Chen, Bang‐Bin
Shih, Tiffany Ting‐Fang
Yen, Rouh‐Fang
Chang, Yu‐Hsuan
Cheng, Mei‐Fang
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  fullname: Cheng, Wen‐Fang
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  organization: National Taiwan University
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Keywords overall survival
PET/MRI
imaging biomarker
cervical cancer
progression-free survival
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2014; 83
2012; 127
2018; 49
2018; 68
2006; 80
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2013; 14
2018; 2
2017; 90
2020; 30
2015; 42
2007; 110
2019; 117
2012; 22
2009; 15
2012; 8
2016; 23
2011; 120
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Snippet Background Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their...
Positron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their associations with...
BackgroundPositron emission tomography (PET)/MRI biomarkers have been shown to have prognostic significance in patients with cervical cancer. Their...
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StartPage 305
SubjectTerms Biomarkers
Cancer
Cervical cancer
Cervix
Diffusion coefficient
Disease Progression
Evaluation
Female
Field strength
Fluorodeoxyglucose F18
Glycolysis
Hazard assessment
Health hazards
Humans
Image analysis
Image processing
imaging biomarker
Magnetic Resonance Imaging
Medical imaging
overall survival
PET/MRI
Population studies
Positron emission
Positron emission tomography
Prognosis
progression‐free survival
Prospective Studies
Radiopharmaceuticals
Retrospective Studies
Statistical analysis
Statistical models
Statistical tests
Subgroups
Survival
Survival analysis
Tomography
Tumor Burden
Tumors
Uterine Cervical Neoplasms - diagnostic imaging
Title PET/MRI in Cervical Cancer: Associations Between Imaging Biomarkers and Tumor Stage, Disease Progression, and Overall Survival
URI https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fjmri.27311
https://www.ncbi.nlm.nih.gov/pubmed/32798280
https://www.proquest.com/docview/2469500346
https://www.proquest.com/docview/2434477320
Volume 53
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