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@#The combination of conventional single-photon emission computed tomography (SPECT) and computed tomography (CT) may display the morphological changes of lesions and distribution of imaging agents, which is effective to improve the imaging sensitivity and specificity of tumors and non-tumor diseases. SPECT/CT is feasible to analyze the anatomical structure and metabolic status through displaying multi-site lesions with single imaging, thereby improving differential diagnosis and diagnostic accuracy of diseases. In addition, the novel mixed SPECT/CT device shortens the duration of image acquisition and provides precise attenuation correction and fusion imaging, which provides a scientific basis for rational selection of treatment regimens in clinical practice. This review describes the advances in clinical application of SPECT/CT.
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Objective: To investigate the role of the Deauville five-point scale (5-PS) and maximum standard uptake value variation (△ SUVmax) measures of interim positron emission tomography/computed tomography (PET-CT) in the prognosis evaluation of patients with diffuse large B-cell lymphoma (DLBCL). Methods: A total of 94 patients with histologically confirmed DLBCL at The First Affiliated Hospital of Chongqing Medical University from October 2012 to June 2018 were enrolled in this retrospective study. Clinical characteristics and prognostic factors of patients were analyzed. Survival data were analyzed using the Kaplan-Meier method and Cox proportional hazards model. The prognostic value of △SUVmax and 5-PS in patients with DLBCL was evaluated using the Chi-square test. Results: 5-PS and △SUVmax were grouped by scores of 4 and 86%, respectively. Progression free survival (PFS) and overall survival (OS) were longer in the 5-PS score <4 group than in the 5-PS score ≥4 group. Patients in the △SUVmax ≥86% group had better PFS and OS than those in the △SUVmax <86% group (P<0.05). △SUVmax and 5-PS measures had high negative predictive values (89.4% and 93.6%, respectively; 76.1% and 85.9%, respectively) and low positive predictive values (48.9% and 31.9%, respectively; 47.8% and 34.8%, respectively) for PFS and OS. △SUVmax was more sensitive than 5-PS for the corresponding parameters (82.1% vs. 39.3% and 83.3% vs. 44.4%, respectively). Univariate analysis showed that international prognostic index (IPI) (P=0.007), △SUVmax (P<0.001), 5-PS (P=0.014) and baseline total metabolic tumor volume (TMTV) (P=0.001) were associated with PFS. △SUVmax (P=0.014), 5-PS (P= 0.033), and TMTV (P=0.004) were related to OS. Multivariate analysis showed that TMTV was an independent predictor of OS (P= 0.005). △SUVmax and TMTV were independent predictors of PFS (P=0.002, P=0.020). The PFS of patients with △SUVmax < 86% and high TMTV was significantly shorter than that of those with △SUVmax <86% with low TMTV (P=0.001). Conclusions: 5-PS and △SUVmax can be used to evaluate the prognosis of DLBCL patients. However, the predictive value of △SUVmax was higher than that of 5-PS, and combining △SUVmax with baseline TMTV could further stratify the risk of DLBCL patients.
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PURPOSE: The purpose of this study was to investigate the prognostic significance of total metabolic tumor volume (TMTV) and total lesion glycolysis (TLG) in patients with follicular lymphoma (FL) at baseline and mid-treatment with ¹⁸F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) scans. MATERIALS AND METHODS: The study analyzed data from 48 patients with FL who were treated in Jiangsu Province Hospital and reviewed their baseline PET-CT scans. TMTV and TLG were computed by using the absolute value of 2.0, 2.5, and 3.0 thresholding method, respectively. RESULTS: Median age was 53 years, 75.0% of patients had stage III to IV disease, 43.8% had a Follicular Lymphoma International Prognostic Index 1 (FLIPI1) score of 3 to 5 and 20.8% had a FLIPI2 score of 3 to 5. Receiver operating characteristic (ROC) curve analysis showed the optimal cut-off values for TMTV3.0 and TLG3.0 were 476.4 (sensitivity, 85.7%; specificity, 78.0%; area under the curve [AUC], 0.760; p=0.003) and 2,676.9 (sensitivity, 71.4%; specificity, 78.0%; AUC, 0.760; p=0.003). On multivariable analysis, TMTV3.0 and TLG3.0 were independent predictors of both progression-free survival (PFS) (hazard ratio [HR], 5.406; 95% confidence interval [CI], 1.326 to 22.040; p=0.019 and HR, 6.502; 95% CI, 1.079 to 39.182; p=0.042) and overall survival (OS) (HR, 4.111; 95% CI, 1.125 to 15.027; p=0.033 and HR, 5.885; 95% CI, 1.014 to 34.148; p=0.049). ROC curve analysis showed the optimal cut-off values for ΔTMTV3.0 and ΔTLG3.0 were 66.3% (sensitivity, 85.7%; specificity, 63.4%; AUC, 0.774; p 66.3%) and TLG (ΔTLG > 64.5%) reduction are valuable tools for early treatment response assessment in FL patients.
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Humans , Area Under Curve , Disease-Free Survival , Electrons , Glycolysis , Lymphoma, Follicular , Methods , Prognosis , ROC Curve , Sensitivity and Specificity , Tumor BurdenABSTRACT
Objective: To evaluate the application value of fluorine-18-fludeoxyglucose (18F-FDG) PET/CT maximal standard uptake (SUVmax) in the diagnosis of lymphoma. Methods: A total of 103 patients with lymphoma which confirmed by pathological diagnosis in Gansu Provincial Hospital from January 2011 to December 2016 were collected. All patients underwent a whole body simultaneous18F-FDG PET/CT and had complete clinical data. The possible relationships of SUVmax with the different pathological subtypes, clinical stages and risk grades of lymphoma were analyzed. The correlations of SUVmax value with Ki-67 index, lactate dehydrogenase (LDH) and erythrocyte sedimentation rate (ESR) were analyzed. Results: There was no significant difference in SUVmax between Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) (P > 0.05). The SUVmax in patients with strongly invasive diffuse large B-cell lymphoma (DLBCL), T-lymphoblastic lymphoma (T-LBL), anaplastic large cell lymphoma (ALCL) and natural killer (NK)/T cell lymphoma was higher than that in patients with relatively weakly invasive mantle cell lymphoma (MCL), peripheral T-cell lymphoma (PTCL), small lymphocytic lymphoma (SLL), follicular lymphoma (FL) (grade 1-2) and marginal zone lymphoma (MZL) (P 0.05). The SUVmax had no significant difference between stage -Ⅱ and III- in the patients with lymphoma (P > 0.05). The SUVmax in the patients with high-risk NHL was higher than that in the patients with intermediate- and low-risk NHL (both P 0.05). Conclusion:18F-FDG PET/CT SUVmax can be used as a reference indicator for evaluating the invasive degree of lymphoma, predicting Ki-67 index, and judging the risk classification of NHL.
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Objective To explore the impact factors of liver uptake of 18F-FDG in PET/CT imaging,and to preliminary analyze the application of maximum standardized uptake values corrected by conventional body mass,lean body mass and body surface area (SUVmax-B,SUVmax-L,SUVmax-S).Methods A retrospective analysis was performed on 67 healthy subjects who underwent 18F-FDG PET/CT.SUVmax-B,SUVmax-L and SUVmax-S were measured,and the impact of age,levels of fasting blood glucose,body mass index (BMI),CT value of liver,gender and the fatty liver on SUVmax-B,SUVmax-L and SUVmax-S were analyzed.Results The liver SUVmax-B,SUVmax-L,SUVmax-S were positively correlated with the levels of fasting blood glucose (r=0.329,0.336,0.353,P =0.012,0.010,0.007).There was a positive correlation between BMI and SUVmax-B (r=0.543,P＜0.01),SUV-L (r=0.328,P=0.007),while BMI value had no correlation with SUVmax-S (r=0.026,P=0.833).There was no correlation between age,CT value of the liver nor SUVmax-B,SUVmax-L and SUVmax-S (all P＞0.05).The liver SUVmax-B (t=2.608,P=0.011) and SUVmax-L (t=5.272,P=0.001) of male were significantly higher than those of female,while there was no difference between male's and female's liver SUVmax-S and liver SUVmax-S (t=0.759,P=0.450).There was no difference in SUVmax-B,SUVmax-L nor SUVmax-S between fatty liver subjects and non-fatty liver subjects (P=0.646,0.775,0.068).Conclusion The fasting blood glucose level,BMI and sex are the impact factors of liver uptake of 18F-FDG in PET/CT imaging.SUVmax-B can be replaced by SUVmax-L or SUVmax-S for larger BMI subjects,while SUVmax-S can make up differences between different genders.However,correction techniques can not weaken the impact of blood glucose level on SUVmax value of liver.
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Background@#After the first examination of patients with lymphoma diagnosis, important laboratory tests such as complete blood count; albumin, kidney and liver function tests; uric acid; β2-microglobulin; C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); and lactate dehydrogenase (LDH) examinations are recommended. In this study, our aim was to find the relationship between laboratory parameters and the maximum standard uptake value (SUV) of positron emission tomography/computed tomography (PET/CT) in patients with lymphoma at the diagnosis and after treatment.@*Methods@#Thirty-four lymphoma patients treated at Mustafa Kemal University Internal Medicine Clinic between 2014 and 2017 were included in this retrospective study. Results of CRP, ESR, LDH, albumin, and white blood cell (WBC) count were recorded before each PET scan test, and each parameter was analyzed for correlation with SUVmeasurements.@*Results@#Spearman's correlation test showed that the after-treatment SUVvalues were significantly correlated with the after-treatment LDH, ESR, and CRP values (for LDH, ESR, and CRP, R: 0.453, 0.426, and 0.351; P = 0.007, 0.012, and 0.042, respectively). On the other hand, albumin and WBC count did not show a significant correlation with the after-treatment SUVvalues (all P > 0.05).@*Conclusions@#CRP, ESR, and LDH values may also be good predictors in patients for whom PET/CT imaging cannot be performed.
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Humans , Blood Sedimentation , C-Reactive Protein , Fluorodeoxyglucose F18 , L-Lactate Dehydrogenase , Lymphoma , Diagnostic Imaging , Multimodal Imaging , Positron Emission Tomography Computed Tomography , Positron-Emission Tomography , Retrospective StudiesABSTRACT
Whole-body PET-CT scanning has been used in the diagnosis and treatment of tumor to providing functional and morphological imaging. As the most widely used semi-quantitative analysis index, the cutoff value of SUV would affect the final diagnosis, therapeutic regimen and prognosis estimation. Therefore, the article reviews the influential factors of SUV, its correction methods, its cutoff values of differential various tumors and the progress of SUV. Although there is no acknowledged cutoff value of SUV in tumor diagnosis, SUV is still an important semi-quantitative index, and its rational and prudent use would increase both of the sensitivity and specificity in tumor diagnosis.
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Objective The objective of this study was to evaluate the correlation between maximum standard uptake values( SUVmax ) of 18 F-FDG PET/CT and BRAF mutation in patients with papillary thyroid car-cinoma(PTC).Methods Atotalof51patients(meanageof49.3±12.9years)whounderwent18F-FDGPET/CT imaging and biopsy before thyroidectomy were retrospectively analyzed. Based on the pathological results, there were 48 patients with PTC and 3 patients with follicular thyroid carcinoma(FTC). The SUVmax of thyroid nodule was measured by semi-quantitative analysis. The correlation between clinical data( gender,age,tumor size and thyroglobulin concentration) and SUVmax was also analyzed. The difference of SUVmax between the two groups was analyzed by comparing the BRAF V600E mutation group and the non-mutation group. Results In patients with PTC,27 patients had BRAF V600E mutations and 11 patients had no tumor mutation. The SUVmax of BRAF V600E mutation group was significantly higher than that in the non-mutated group(5. 5 ± 3. 9 vs. 2. 2 ± 1. 2,P=0. 002). The SUVmax of patients with tumor diameter≥1 cm was significantly higher than that in patients with tumor <1 cm(P<0. 05). The SUVmax of patients with elevated thyroglobulin concentration was higher than that in normal patients(P<0. 05). No BRAF V600E mutation was observed in the FTC group. Conclusion The BRAF V600E mutant gene has a high SUVmax value in patients with PTC. There were significant difference in SUVmax among different tumor size and serum thyroglobulin concentration.
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Objective:To investigate the prognostic value of18F-FDG PET/CT by calculating maximal standard uptake values(SUVmax) in patients with pancreatic carcinoma of TOMO knife radiotherapy.Methods:Sixty five cases of pancreatic carcinoma who underwent18F-FDG PET/CT scan before TOMO radiotherapy were reviewed retrospectively, the18F-FDG uptake of primary tumors was measured with the SUVmax. SUVmax<3.0 was divided into group A(32 cases), SUVmax≥3.0 was divided into group B(33 cases), the relationship of SUVmax and other clinical factors with the survival of the 65 patients were analyzed.Results:By Log-rank univariate analysis showed that the differences in group A(SUVmax<3.0) and group B(SUVmax≥3.0) in patiengts with middle survival time was statistically significant(15.5:7 months)atP=0.001. TNM stages(x2=6.625,P<0.010), CA19-9(x2=10.298,P<0.001) and GTV dose(x2=8.054, P<0.005) were also statistically different at (P<0.05). Multivariate analysis showed that the SUVmax and preoperative serum CA19-9 level were independent risk factors that prevent the long-term survival of the prognosis of patients in this group.Conclusion: SUVmax has a certain clinical value in predicting the prognosis of patients with pancreatic cancer, and can guide clinical diagnosis and treatment planning, and extend the lifespan of patients with pancreatic carcinoma.
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Objective:To explore the effects of body mass index (BMI) and gender on primary lung cancer 18F-FDG uptake param-eters, standardized uptake value (SUV), and standard uptake value of lean body mass (SUL). Methods:Data of 50 patients with prima-ry lung cancer confirmed by 18F-FDG positron emission tomography (PET)/computed tomography (CT) were retrospectively analyzed. AW4.6 workstation was employed to measure the SUVmean and SUVmax. Meanwhile, PETVCAR (PET Volume Computed Assisted Reading, GE Healthcare) software was used to automatically measure the SULmean, SULmax, and SULpeak. The SUVmean, SUV-max, SULmean, and SULmax of the liver (central region of the right lobe) were also measured automatically by PETVCAR. Afterward, T/N ratios (lesion SUVmax/liver SUVmean, lesion SULmax/liver SULmean, and lesion SULpeak/liver SULmean) of the lung cancer lesions were calculated. Correlations of the 18F-FDG metabolic parameters with BMI and gender of the patients were analyzed. Results:Liver SUVmean and SUVmax demonstrated significant positive correlations with BMI in all the patients (γ=0.38 and 0.36, P0.05). No significant correlation was not-ed between the SUVmean, SUVmax, SULmean, SULmax, and SULpeak of the lung cancer lesions and BMI (P>0.05). The correlation trend is the same as that in different gender groups. Only the SUVmax T/N ratio of the lung cancer lesions showed a significant nega-tive correlation with BMI (γ=?0.29, P0.05). Con-clusion:Patient BMI and gender mainly affect SUV values, particularly SUVmax, by contrast, patient BMI and gender did not signifi-cantly influence SUL and T/N ratio (SUL). Hence, SUL can be more suitable to quantitatively analyze and assess treatment response ob-jectively. This result will be helpful to the clinical application and promotion of PERCIST, which evaluates treatment response mainly by SUL.
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Objective To evaluate the use of corrected standard uptake value(SUV)in patient with peripheral solitary pulmonary lesion and the relationship between corrected SUV and the lesion's size.Methods This retrospective study included 69 patients with peripheral solitary pulmonary lesions seen on PET and CT scans whose diagnoses were confirmed by pathology.Each lesion’s FDG uptake was quantified by using two methods:the SUV and the corrected SUV.The lesion’s size was recorded on CT.Results The diagnostic accuracy was 88.7% and 98.5% for PET/CT and combining corrected SUV with CT respectively.There was a positive correlation between SUV,corrected SUV and the size of lesions(r 1 =0.536,P <0.001;r 2 =0.637,P <0.001).Conclusion Measur-ing corrected SUV appears to improve the accuracy of FDG PET/CT for characterization of peripheral solitary pulmonary lesions . The volume of lesion may potentially affect the value of SUV.
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ObjectiveTo explore the prognostic value of pretreated maximum standardized uptake value (SUVmax) using 18-fluorodeoxyglucose positron emission tomography with computed tomography (18FDG PET/CT) in locally-advanced nasopharyngeal carcinoma (NPC) treated by intensity-modulated radiotherapy (IMRT).MethodsOne hundred and forty previously untreated stage Ⅲ - Ⅳb ( UICC/AJCC 6th) patients with biopsy-proven nasopharyngeal carcinoma were examined.All of the enrolled patients accepted whole body/head-neck 18FDG PET/CT before radical IMRT. 18FDG uptakes were recorded as SUVmax of primary tumor (SUVmax-P) and SUVmax of cervical lymph nodes (SUVmax-N).The relationships between SUVmax and long-term clinical outcomes were analyzed.ResultsThe median SUVmax-P was 10.4,and the median SUVmax-N was 6.2.The SUVmax-P was weakly correlated with T-stage ( R =0.279,P =0.001 ).The SUVmax-N was weakly correlated with N stage ( R =0.334,P =0.000 ).There were no difference of the median SUVmax-P (9.2 vs.10.4,U =560.50,P =0.805 ) and the median SUVmax-N (4.0vs.5.0,U =576.00,P =0.908) between patients with and without local recurrence.The median SUVmax-P of patients with distant metastasis was significantly higher than those without metastasis (11.9 vs.9.8,U =987.50,P =0.014).The SUV of 10.2 was taken as a cut-off for high and low uptake tumors.For patients with SUVmax-P ＞ 10.2,the 5-year distant metastasis-free survival (DMFS) and 5-year overall survival (OS)were significantly higher than those with SUVmax-P ≤ 10.2 (69.1％ vs.95.5％,x2 =15.88,P =0.000;68.4％ vs.94.0％,x2 =15.56,P =0.000,respectively).Multivariate analysis showed that SUVmax-P was the only independent risk factor of 5-year DMFS and OS ( HR =7.87,P =0.001 and HR =5.14,P =0.003). Conclusion SUVmax-P is a useful biomarker predicting long-term clinical outcomes in newly diagnosed locally-advanced NPC patients.
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In this study, we evaluated feasibility of applying MTV (Metabolic Target Volume) to respiratory gated radiotherapy for more accurate treatment using various SUV (Standard Uptake Value) from PET images. We compared VOI (Volume of Interest) images from 50%, 30% and 5% SUV (standard uptake volume) from PET scan of an artificial target with GTV (Gross Tumor Volume) images defined by percentage of respiratory phase from 4D-CT scan for respiratory gated radiotherapy. It is found that the difference of VOI of 30% SUV is reduced noticeably comparing with that of 50% SUV in longitudinal direction with respect to total GTV of 4D-CT image. Difference of VOI of 30% SUV from 4D-PET image defined by respiratory phase from 25% inhalation to 25% exhalation, and GTV from 4D-CT with the same phase is shown below 0.6 cm in maximum. Thus, it is better to use 4D-PET images than conventional PET images for applying MTV to gated RT. From the result that VOI of 5% SUV from 4D-PET agrees well with reference image of 4D-CT in all direction, and the recommendation from department of nuclear medicine that 30% SUV be advised for defining tumor range, it is found that using less than 30% SUV will be more accurate and practical to apply MTV for respiratory gated radiotherapy.
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Exhalation , Inhalation , Nuclear Medicine , Positron-Emission TomographyABSTRACT
Objective To analyze the correlation between 18F-FDG SUV and immunohistochemical index including GLUT1, Ki-67, MVD, survivin and cyclinA in non-snall-cell lung cancer. Methods Thirty-three patients with NSCLC underwent preoperative PET/CT examination and surgical operation. All patients were divided into two groups according to the size of tumor (cutoff=3 cm), metastasis of mediastinal or hilar lymph nodes or not, and histological types of the cancer, respectively. The expression of GLUT1, Ki-67, MVD, survivin and cyclinA were estimated with SP immunohistochemical technique, and were analyzed statistically to reveal the correlation to FDG SUV. Results The rate of positive expression of GLUT1, Ki-67 and CD34 were 66.67%, 72.73% and 100%, respectively. The mean value of CD34 in all 33 patients was 12.6±2.9 (12-56). The rate of positive expression of survivin was 84.85%, and the corresponding data of cyclinA was 27.27%. Conclusion There is linear correlation between FDG PET SUV and GLUT1, but not between FDG PET SUV and Ki-67, MVD, survivin and cyclinA. The expressions of GLUT1, Ki-67, MVD, survivin and cyclinA are not related with the size of tumor, nor metastasis of lymph nodes. The expression of GLUT1 and Ki-67 is related with histological types of the cancer, but not with MVD, survivin and cyclinA.
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Objective To determine whether the use of 18F-FDG PET/CT alters staging and management of nasopharyngeal carcinoma (NPC) when compared with MRI staging practice;and to explore the relation of standard uptake value (SUV) of 18F-FDG PET/CT and the pathological classification and T staging of NPC. Methods The study was performed retrospectively on a group of 41 patients with a new diagnosis of NPC. All the patients underwent whole body PET/CT scanning and head & neck MRI scanning within 3 weeks of each other. The AJCC protocol was introduced to stage NPC and the results of the PET/CT were compared with MRI based on pathologic diagnosis. Results ①Primary tumor:the accuracy of T staging of PET/CT was significantly higher than MRI (85.37% vs 60.98%,U=2.49,P
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PURPOSE: The purpose of this study was to assess the diagnostic accuracy of various quantitation methods using F-18-fluorodeoxyglucose (FDG) in patients with malignant or benign lung lesion. MATERIALS AND METHODS: 22 patients (13 malignant including 5 bronchoalverolar cell cancer; 9 benign lesions including 1 hamartoma and 8 active inflammation) were studied after overnight fasting. We performed dynamic PET imaging for 56 min after injection of 370 MBq (10 mCi) of FDG. Standardized uptake values normalized to patients body weight and plasma glucose concentration (SUVglu) were calculated. The uptake rate constant of FDG and glucose metabolic rate were quantified using Patlak graphical analysis (Kpat and Mrpat), three compartment-five parameter model (K5p, MR5p), and six parameter model taking into account heterogeneity of tumor tissue (K6p, MR6p), Areas under receiver operating charac-teristic curves (ROC) were calculated for each method. RESULTS: There was no significant difference of rate constant or glucose metabolic rate measured by various quantitation methods between malignant and benign lesions. The area under ROC curve were 0.73 for SUVglu, 0.66 for Kpat, 0.77 for Mrpat, 0.71 for KSp, 0.73 for MRSp, 0.70 for K6p, and 0.78 for MR6p, No significant difference of area under the ROC curve between these rnethods v;as observed except the area between Kpat vs. Mrpat (p<0.05). CONCLUSION: Quantitative methods did not improve diagnostic accuracy in comparison with nonkinetic methods. However, the clinical utility of these methods needs to be evaluated further in patients with low pretest likelihood of active inflammation or bronchoalveolar cell carcinoma.