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Objective To investigate the characteristics of primary mediastinal large B-cell lymphoma (PMBL) in 18F-fluorodeoxyglucose (FDG) PET/CT imaging.Methods From July 2010 to April 2019,18F-FDG PET/CT images of 27 patients (10 males,17 females,median age 31 (19-57) years)with pathologically confirmed PMBL from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed.The location,shape,density,presence of necrosis and calcification,and invasion around or beyond the lesions were observed.The maximum standardized uptake value (SUVmax),metabolictumor volume (MTV) and total lesion glycolysis (TLG) were measured by automatic segmentation algorithm method.Spearman correlation analysis was used to evaluate the correlation between SUVmax or MTV or TLG and the maximum diameter or Ann Arbor staging.Results The lesions appeared as anterior mediastinal huge masses in 27 patients,and grew in the anterior mediastinal cross-regionally in 25 patients,lobulated at the edge in 24 patients.Low-density necrosis lesions were found in 18 patients.The lesions were surrounded by large blood vessels in 15 patients and tracheae were compressed in 12 patients.Lung tissues were invaded in 3 patients,abdominal lymph nodes and bone marrow were invaded in 1 patient,and no splenomegaly was found in 27 patients.The maximum diameter,SUVmax,MTV and TLG were (11.6±3.7) cm,21.07(15.78,25.09),190.43 (130.14,350.75) cm3 and 2165.54 (1465.86,4185.21) g,respectively.There was no correlation between SUVmax and the maximum diameter of lesions (rs =-0.305,P =0.122),while MTV and TLG were positively correlated with the maximum diameter (rs values:0.741,0.532,both P＜0.05).The maximum diameter,MTV and TLG were positively correlated with Ann Arbor staging (rs values:0.394,0.413,0.422,all P＜0.05),while SUVmax was not (rs=0.031,P＞0.05).Conclusions PMBL mostly presents as large anterior mediastinal mass with the high 18F-FDG uptake in 18F-FDG PET/CT imaging,and the focal necrosis is common,while abdominal lymph nodes,spleen and bone marrow invasion are rare.MTV and TLG of lesions positively correlate with Ann Arbor staging.
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Objective@#To investigate the characteristics of primary mediastinal large B-cell lymphoma (PMBL) in 18F-fluorodeoxyglucose (FDG) PET/CT imaging.@*Methods@#From July 2010 to April 2019, 18F-FDG PET/CT images of 27 patients (10 males, 17 females, median age 31 (19-57) years) with pathologically confirmed PMBL from the First Affiliated Hospital of Nanjing Medical University were retrospectively analyzed. The location, shape, density, presence of necrosis and calcification, and invasion around or beyond the lesions were observed. The maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were measured by automatic segmentation algorithm method. Spearman correlation analysis was used to evaluate the correlation between SUVmax or MTV or TLG and the maximum diameter or Ann Arbor staging.@*Results@#The lesions appeared as anterior mediastinal huge masses in 27 patients, and grew in the anterior mediastinal cross-regionally in 25 patients, lobulated at the edge in 24 patients. Low-density necrosis lesions were found in 18 patients. The lesions were surrounded by large blood vessels in 15 patients and tracheae were compressed in 12 patients. Lung tissues were invaded in 3 patients, abdominal lymph nodes and bone marrow were invaded in 1 patient, and no splenomegaly was found in 27 patients. The maximum diameter, SUVmax, MTV and TLG were (11.6±3.7) cm, 21.07 (15.78, 25.09), 190.43 (130.14, 350.75) cm3 and 2 165.54 (1 465.86, 4 185.21) g, respectively. There was no correlation between SUVmax and the maximum diameter of lesions (rs=-0.305, P=0.122), while MTV and TLG were positively correlated with the maximum diameter (rs values: 0.741, 0.532, both P<0.05). The maximum diameter, MTV and TLG were positively correlated with Ann Arbor staging (rs values: 0.394, 0.413, 0.422, all P<0.05), while SUVmax was not (rs=0.031, P>0.05).@*Conclusions@#PMBL mostly presents as large anterior mediastinal mass with the high 18F-FDG uptake in 18F-FDG PET/CT imaging, and the focal necrosis is common, while abdominal lymph nodes, spleen and bone marrow invasion are rare. MTV and TLG of lesions positively correlate with Ann Arbor staging.
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Objective@#To investigate the prognostic value of metabolic parameters calculated from pretreatment 18F-fluorodeoxyglucose (FDG) PET/CT images in patients with extranodal natural killer/T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ.@*Methods@#From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment 18F-FDG PET/CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/CT images with the threshold value of 40% of maximum standardized uptake value (SUVmax). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUVmax, MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analysis.@*Results@#SUVmax, MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUVmax, MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lactate dehydrogenase (LDH) level, β2-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUVmax, MTV, TLG and treatment mode (chemotherapy or chemoradiotherapy) were relative factors affecting PFS (χ2: 5.466-27.163, all P<0.05). B symptoms, LDH level, β2-microglobulin, EB virus (EBV)-DNA, extra-cavitary extension, ECOG score, KPI, MTV, TLG and treatment mode were relative factors affecting OS (χ2: 4.022-34.774, all P<0.05). SUVmax was not the influencing factor of OS(χ2=2.766, P>0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107-6.802, all P<0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9.106, all P<0.05).@*Conclusions@#MTV and TLG from pretreatment 18F-FDG PET/CT images are independent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUVmax for prognosis.
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Objective To investigate the prognostic value of metabolic parameters calculated from pretreatment 18 F-fluorodeoxyglucose (FDG) PET/ CT images in patients with extranodal natural killer/ T cell lymphoma (ENKTL) of stage Ⅰ-Ⅱ. Methods From August 2010 to April 2018, 67 patients with ENKTL of stage Ⅰ-Ⅱ disease (47 males, 20 females; median age 57 years) in the First Affiliated Hospital of Nanjing Medical University were enrolled, and the clinic data and pretreatment 18 F-FDG PET/ CT imaging data were retrospectively analyzed. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) of tumor tissue were calculated from PET/ CT images with the threshold value of 40％ of maximum standardized uptake value (SUVmax ). The optimal cut-off values of progression-free survival (PFS) and overall survival (OS) of SUVmax , MTV and TLG were investigated by using receiver operating characteristic (ROC) curve analysis. Kaplan-Meier method, log-rank test and Cox proportional hazards model were used for data analy-sis. Results SUVmax , MTV and TLG of 67 patients were 12.32(8.65, 16.96), 13.13(7.37, 22.74) ml, 92.17(46.54, 198.46), respectively. ROC curve analysis showed that the cut-off values of SUVmax , MTV and TLG were 13.09, 18.05 ml and 152.81, respectively. Univariate analysis showed that B symptoms, lac-tate dehydrogenase (LDH) level, β2-microglobulin, Eastern Cooperative Oncology Group (ECOG) score, Korean prognostic index (KPI), SUVmax , MTV, TLG and treatment mode (chemotherapy or chemoradio-therapy) were relative factors affecting PFS (χ2: 5.466-27.163, all P<0.05). B symptoms, LDH level,β2-microglobulin, EB virus (EBV)-DNA, extra-cavitary extension, ECOG score, KPI, MTV, TLG and treatment mode were relative factors affecting OS (χ2: 4.022-34.774, all P<0.05). SUVmax was not the in-fluencing factor of OS(χ2 = 2.766, P>0.05). Multivariate analysis showed that ECOG score, MTV and TLG were independent prognostic predictors of PFS (relative ratio (RR): 5.107- 6.802, all P< 0.05), and ECOG score, MTV, TLG and treatment mode were independent prognostic predictors of OS (RR: 0.221-9. 106, all P<0.05). Conclusions MTV and TLG from pretreatment 18 F-FDG PET/ CT images are inde-pendent prognostic factors for PFS and OS in patients with ENKTL of stage Ⅰ-Ⅱ. MTV and TLG may be more useful than SUVmax for prognosis.
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Objective@#To explore the imaging presentation of 18F-FDG PET-CT and clinical characteristics of the patients with lymphoblastic lymphoma (LBL).@*Methods@#The clinical and imaging data of 18 patients with newly diagnosed LBL in the First Affiliated Hospital with Nanjing Medical University from July 2009 to June 2017 were retrospectively analyzed. The sensitivity, specificity and accuracy of 18F-FDG PET-CT to diagnose bone marrow involvement (BMI) was calculated respectively.@*Results@#There were 18 LBL patients, including 12 male and 6 female with median age of 24.5 (14-51) years old. Eleven patients were T-LBL, and 7 patients were B-LBL. All lesions were presented with high 18F-FDG uptake on 18F-FDG PET-CT imaging, with a median SUVmax of 14.3 (10.6, 16.8). The most frequent lymph node involvement site was mediastinal lymph nodes, and 7 T-LBL cases had jugular node involvement. The most frequent extranodal involvement site was bone marrow, with multifocal FDG accumulation in bone marrow on 18F-FDG PET-CT imaging in 8 cases. The median SUVmax of node and extranodal involvement were 15.0 (9.0, 18.2), 12.3 (8.4, 15.3), and there was no significant difference (Z=-0.867, P= 0.386). The median SUVmax of T-LBL and B-LBL patients was 14.1 (9.2, 15.9), 14.5 (12.1, 19.5) respectively, and there was no significant difference (Z=-0.679, P= 0.497). According to clinical features, 18F-FDG PET-CT and bone marrow biopsy (BMB), 12 patients were diagnosed as BMI. If multifocal FDG accumulation and diffuse hypermetabolism of FDG in bone marrow were considered as the diagnosis criteria, the sensitivity, specificity and accuracy of PET-CT was 91.7% (11/12), 66.7% (4/6), 83.3% (15/18), respectively. The parameters in BMB were 50.0% (6/12), 100.0% (6/6), 66.7% (12/18), respectively.@*Conclusions@#LBL mostly occurs in young men and its clinical manifestations include lymphadenectasis and invasion of bone marrow. 18F-FDG PET-CT has certain characteristics which are helpful to diagnose and staging.
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Objective To validate the value of 18F-fluorodeoxyglucose (FDG) uptake on PET/CT and thyroid transcription factor-1 (TTF-1) expression to predict the epidermal growth factor receptor (EGFR)mutations in lung adenocarcinoma.Methods From May 2012 to May 2016,a total of 137 lung adenocarcinoma patients (89 males,48 females,age range 33-84 years) pathologically proved were reviewed retrospectively.EGFR mutation testing,TTF-1 expression and PET/CT scan were performed for all patients.x2test was used to assess the differences of EGFR mutation in different groups.Two-sample t test was used to compare the differences of maximum standardized uptake value (SUVmax) between EGFR mutation type and EGFR wild type,TTF-1 positive and negative expression.Multivariate logistic regression analysis was used to test the univariate models that yielded the best predictors of EGFR mutation receiver operating characteristic (ROC) curve analysis was performed to quantify the predictive value of those factors.Results EGFR mutation was identified in 53 patients,including 2 cases in exon 18,19 cases in exon 19,3 cases in exon 20 and 29 cases in exon 21.The high risk factors of EGFR mutation were female (x2=7.465,P=0.006),non-smoking (x2=7.193,P=0.007) and positive expression of TTF-1 (x2=9.104,P＜0.05).The SUVmax of EGFR mutation type was significantly lower than that of EGFR wild type (8.76±4.59 and 11.20±5.09;t =2.832,P =0.005).Multivariate analysis showed that the lower SUVmax (SUVmax ＜8.65) and positive expression of TTF-1 were the independent risk factors for EGFR mutation (P=0.032,P=0.018).The combined use of SUVmax and TrF-1 yielded a higher area under the ROC curve (area under curve=0.697),suggesting a good discrimination.Conclusion The combined evaluation of 18F-FDG uptake and expression of TTF-1 may be helpful in predicting EGFR mutation status in patients with lung adenocarcinoma,especially when the genetic testing is not available,and can provide meaningful clues for clinical treatment.
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Objective To assess the role of 68Ga-N,N′-bis(2-hydroxy-5-(carboxyethyl)benzyl) ethylenediamine-N,N′-diacetic acid(HBED-CC)-(Ahx)Lys-CO-Glu(PSMA-11) PET/CT on the detection of metastatic lesions from castration-resistant prostate cancer (CRPC).Methods Sixteen patients with CRPC who underwent 68Ga-PSMA-11 PET/CT between January 2015 and November 2015 were recruited in this study.Mean age of patients was (72±9) years.The PSA levels were 4-12 356 μg/L, Gleason score was 7-10.PET/CT was performed at 1 h postinjection of 68Ga-PSMA-11.Patient-based analysis and lesion-based analysis were performed.ROI analysis was used to calculate the tumor uptake (SUVmax).Final diagnosis was based on histopathology and results of other imaging examinations(99Tcm-MDP imaging, MRI).χ2 test was used to compare the diagnostic efficiencies of PET and CT.Results No adverse effects were observed in patients.68Ga-PSMA-11 PET/CT showed moderate physiologic uptake in salivary glands and proximal small intestine, with predominant tracer clearance by the kidneys.All patients were positive on 68Ga-PSMA-11 PET/CT.Bone metastasis was found in 16 patients, liver metastasis in 2 patients (5 lesions), and lymph node metastasis in 4 patients (26 lesions).The SUVmax of liver, lymph node and bone metastases were 15.06±2.77, 7.54±5.20, 19.01±16.96, respectively.The diagnostic sensitivity, specificity and accuracy on bone metastasis with 68Ga-PSMA-11 PET and CT were 96.30%(52/54) vs 61.11%(33/54), 3/3 vs 1/3, 96.49%(55/57) vs 59.65%(34/57).The sensitivities and accuracies of the two modalities were significantly different(χ2=19.943, 22.593, both P<0.01).Conclusions 68Ga-PSMA-11 PET/CT could precisely detect both primary and metastatic lesions of CRPC, suggesting that it is of great value for the clinical management and treatment.
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Objective To assess the role of 68Ga-N,N'-bis (2-hydroxy-5-(carboxyethyl) benzyl) ethylenediamine-N,N'-diacetic acid(HBED-CC)-(Ahx) Lys-CO-Glu(PSMA-11) PET/CT on the detection of metastatic lesions from castration-resistant prostate cancer (CRPC).Methods Sixteen patients with CRPC who underwent 68Ga-PSMA-11 PET/CT between January 2015 and November 2015 were recruited in this study.Mean age of patients was (72±9) years.The PSA levels were 4-12 356 μg/L,Gleason score was 7-10.PET/CT was performed at 1 h postinjection of 68Ga-PSMA-11.Patient-based analysis and lesionbased analysis were performed.ROI analysis was used to calculate the tumor uptake (SUVmax).Final diagnosis was based on histopathology and results of other imaging examinations(99Tcm-MDP imaging,MRI).x2 test was used to compare the diagnostic efficiencies of PET and CT.Results No adverse effects were observed in patients.68Ga-PSMA-11 PET/CT showed moderate physiologic uptake in salivary glands and proximal small intestine,with predominant tracer clearance by the kidneys.All patients were positive on 68Ga-PSMA-11 PET/CT.Bone metastasis was found in 16 patients,liver metastasis in 2 patients (5 lesions),and lymph node metastasis in 4 patients (26 lesions).The SUVmax of liver,lymph node and bone metastases were 15.06±2.77,7.54±5.20,19.01± 16.96,respectively.The diagnostic sensitivity,specificity and accuracy on bone metastasis with 68Ga-PSMA-11 PET and CT were 96.30％(52/54) vs 61.11％(33/54),3/3 vs 1/3,96.49％ (55/57) vs 59.65％ (34/57).The sensitivities and accuracies of the two modalities were significantly different(x2=19.943,22.593,both P＜0.01).Conclusions 68Ga-PSMA-11 PET/CT could precisely detect both primary and metastatic lesions of CRPC,suggesting that it is of great value for the clinical management and treatment.
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Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients with pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathologic data of 104 patients with pancreatic cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between February 2009 and November 2015 were collected.All the patients underwent preoperative 18F-FDG PET/CT examination.The maximum standardized uptake value (SUVmax),metabolism of volume (MTV) and total lesion of glycolysis (TLG) in primary lesion were calculated.According to the patient's condition,chemotherapy,operation and comprehensive therapy were performed.Observation indicators included:(1) results of imaging examination before treatment;(2) treatment and follow-up;(3) analysis of prognosis factors of patients with pancreatic cancer.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to June 2016.Measurement data with skewed distribution were represented as median (range).The survival curve was drawn by the KaplanMeier method and the Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were respectively done by the Log-rank test and COX proportional hazards model.Results (1) Results of imaging examination before treatment:the 18 F-FDG PET/CT imaging of 104 patients with pancreatic cancer showed the slightly hypodense shadow with inordinately uptake of 18F-FDG,with an unclear boundary.The contrast-enhanced CT showed slight enhancement and hypodense,and partial lesions surrounding adjacent vessels can merge with peripheral enlarged lymph nodes.There were high 18F-FDG uptakes of lymph node metastases,hepatic metastases,adrenal metastases and bone metastases.Of 75 lesions of pulmonary metastases,23 showed high 18F-FDG uptakes and 52 showed no high 18F-FDG uptakes.The SUVmax,MTV and TLG in primary lesion of 104 patients were 7.41 (range,2.00-31.65),14.86 cm3(range,2.17-79.65 cm3) and 66.34 (range,5.31-598.22),respectively.(2) Treatment and follow-up:of 104 patients,12 underwent single operation,13 underwent operation + chemotherapy,53 underwent single chemotherapy and 26 underwent chemoradiotherapy.All the 104 patients were followed up for 7.0-88.0 months,with a median time of 26.0 months.The median survival time,6-months and 1-year survival rates of 104 patients with pancreatic cancer were respectively 7.1 months (range,1.0-42.7 months),52％ and 26％.Results of further analysis showed that the median survival time,6-months and 1-year survival rates were respectively 6.5 months (range,1.4-39.6 months),49％,27％ in 51 patients with carcinoma of head of pancreas and 7.2 months (range,1.0-42.7 months),54％,30％ in 53 patients with carcinoma of pancreatic body and tail.(3) Prognosis factors of patients with pancreatic cancer:results of univariate analysis showed that sex,CA19-9,maximum diameter of tumor,lymph node metastases,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with pancreatic cancer [HR =1.603,1.657,2.017,1.873,2.668,1.822,2.157,2.054,2.154,3.208,1.596,2.096,3.411,95％ confidence interval (CI):1.029-2.499,1.045-2.626,1.305-3.115,1.181-2.971,1.735-4.101,1.453-2.285,1.257-3.703,1.245-3.387,1.399-3.317,2.047-5.028,1.052-2.421,1.372-3.201,2.181-5.335,P＜0.05].Results of multivariate analysis showed that distant metastases,chemotherapy,comprehensive treatment and TLG ≥ 66.34 were independent risk factors affecting poor prognosis of patients with pancreatic cancer (HR=1.906,2.966,2.946,2.053,95％CI:1.201-3.022,1.775-4.956,1.753-4.951,1.104-3.820,P＜0.05).(4) Prognostic factors of patients with carcinoma of head of pancreas:results of univariate analysis showed that maximum diameter of tumor,tumor invading major vessels,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with carcinoma of head of pancreas (HR=2.282,2.320,4.125,5.753,6.155,2.841,4.144,3.131,2.229,2.064,5.380,95％ CI:1.231-4.230,1.098-4.903,1.993-8.539,2.682-12.341,1.850-20.483,1.362-5.926,2.106-8.154,1.545-6.345,1.202-4.132,1.121-3.803,2.630-11.004,P＜0.05).Results of multivariate analysis showed that chemotherapy and TLG ≥ 66.66 were independent risk factors affecting poor prognosis of patients with carcinoma of head of pancreas (HR=7.953,2.824,95％CI:3.110-20.338,1.005-7.932,P＜0.05).(5) Prognostic factors of patients with carcinoma of pancreatic body and tail:results of univariate analysis showed that hepatic metastases,distant metastases,surgery,comprehensive treatment,MTV and TLG were related factors affecting prognosis of patients with carcinoma of pancreatic body and tail (HR =2.083,2.501,3.464,2.295,2.231,3.572,95％CI:1.157-3.784,1.363-4.590,1.441-8.329,1.158-4.546,1.166-4.268,1.901-6.711,P＜0.05).Results of multivariate analysis showed that distant metastases,MTV≥ 15.70 em3 and TLG ≥ 62.75 were independent risk factors affecting poor prognosis of patients with carcinoma of pancreatic body and tail (HR =1.700,2.096,4.047,95％CI:1.080-2.675,1.065-4.126,2.072-7.906,P＜0.05).Conclusion TLG≥66.34,≥66.66,≥62.75 in 18F-FDG PET/CT examination are independent risk factors affecting poor prognosis of patients with pancreatic cancer or pancreatic head cancer or pancreatic body and tail cancer respectively,and MTV ≥ 15.70 cm3 is also an independent risk factor affecting poor prognosis of patient with pancreatic body and tail cancer.18 F-FDG PET/CT examination has certainly reference value for prognosis of patients with pancreatic cancer.
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Objective To investigate the prognostic value of SUVmax , SUVmean , MTV and TLG cal-culated from 18 F-FDG PET/CT in patients with postoperative esophageal cancer. Methods Sixty-one pa-tients ( 51 males, 10 females;age ranged 50-81 ( median:64) years) with esophageal cancer who under-went preoperative 18 F-FDG PET/CT from October 2007 to November 2015 were retrospectively analyzed. The relation of SUVmax , SUVmean , MTV and TLG in primary lesions with clinic pathological factors was ana-lyzed. Differences of metabolic parameters were compared with two-sample t test, one-way analysis of vari-ance, Mann-Whitney u test or Kruskal-Wallis H test. The optimal cutoff points of SUVmax , SUVmean , MTV and TLG for predicting overall survival ( OS) were investigated by ROC curve analysis. The Kaplan-Meier method and log-rank test were used to perform univariate survival analysis, and Cox proportional hazards model was used for multivariate analysis. Results MTV and TLG were associated with tumor length, N stage and clinical stage, while SUVmax and SUVmean were only associated with tumor length ( t=-2.396, F=4.206, 4. 471;z=-3.051,χ2=8.908, 9.796;t=-2.417,-2.423;all P<0. 05) . The optimal cutoff points of SUVmax, SUVmean, MTV and TLG were 11.76, 7.06, 24.35 cm3 and 166. 84 g, respectively. Univariate analysis of OS showed that the lymphatic metastasis, clinical stage and TLG were all significantly associated with the patient outcome (χ2=14.683, 7.139, 11.669, all P<0.05) . Multivariate analysis showed that lym-phatic metastasis and TLG were the independent predictors for OS (β=-1. 472, -1. 223; Wald=5. 224, 4. 668;both P<0.05) . Conclusion For predicting the prognosis of esophageal cancer after operation, TLG of the primary tumor may be more valuable than SUVmax , SUVmean and MTV.
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Objective To investigate the prognostic value of 18F-FDG PET-CT in patients with diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 130 DLBCL patients from June 2009 to May 2015 and pretreatment 18F-FDG PET-CT were retrospectively analyzed.Results The 130 DLBCL patients' median of maximal standard uptake value(SUVmax),metabolic tumor volume(MTV)and total lesion glycolysis(TLG)was 19.93,34.45 cm3,459.92 respectively.Univariate analysis showed that the affecting factors of progression-free survival(PFS)and overall survival(OS)rate included Eastern Cooperative Oncology Group(ECOG)grade,Ann Arbor stage,β2-MG,lactate dehydrogenase level,tumor diameter,bone marrow involvement,National Comprehensive Cancer Network International Prognostic Index(NCCN-IPI),MTV and TLG(all P <0.05),while age was related with PFS rate(P<0.05).As MTV and TLG were strongly correlated,only TLG measure was used for multivariate analysis.The result showed that ECOG grade,Ann Arbor stage,NCCN-IPI and TLG were statistically significant predictors of PFS rate,and NCCN-IPI and TLG were independent factors of OS rate(all P<0.05).According to TLG and NCCN-IPI,the patients were divided into three groups: low risk group,mediate risk group and high risk group.The 3-year PFS rates of these groups were 66.0%,36.8% and 26.1% respectively(P< 0.05),and the 3-year OS rates of these groups were 70.0%,49.1% and 39.1% respectively(P < 0.05).Conclusion TLG in 18F-FDG PET-CT is an independent prognostic factor for PFS and OS in patients with DLBCL,which has a reference value for prognosis of DLBCL.
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Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients with pancreatic cancer.Methods The retrospective cross-sectional study was conducted.The clinicopathologic data of 104 patients with pancreatic cancer who were admitted to the First Affiliated Hospital of Nanjing Medical University between February 2009 and November 2015 were collected.All the patients underwent preoperative 18F-FDG PET/CT examination.The maximum standardized uptake value (SUVmax),metabolism of volume (MTV) and total lesion of glycolysis (TLG) in primary lesion were calculated.According to the patient's condition,chemotherapy,operation and comprehensive therapy were performed.Observation indicators included:(1) results of imaging examination before treatment;(2) treatment and follow-up;(3) analysis of prognosis factors of patients with pancreatic cancer.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients up to June 2016.Measurement data with skewed distribution were represented as median (range).The survival curve was drawn by the KaplanMeier method and the Log-rank test was used for survival analysis.The univariate analysis and multivariate analysis were respectively done by the Log-rank test and COX proportional hazards model.Results (1) Results of imaging examination before treatment:the 18 F-FDG PET/CT imaging of 104 patients with pancreatic cancer showed the slightly hypodense shadow with inordinately uptake of 18F-FDG,with an unclear boundary.The contrast-enhanced CT showed slight enhancement and hypodense,and partial lesions surrounding adjacent vessels can merge with peripheral enlarged lymph nodes.There were high 18F-FDG uptakes of lymph node metastases,hepatic metastases,adrenal metastases and bone metastases.Of 75 lesions of pulmonary metastases,23 showed high 18F-FDG uptakes and 52 showed no high 18F-FDG uptakes.The SUVmax,MTV and TLG in primary lesion of 104 patients were 7.41 (range,2.00-31.65),14.86 cm3(range,2.17-79.65 cm3) and 66.34 (range,5.31-598.22),respectively.(2) Treatment and follow-up:of 104 patients,12 underwent single operation,13 underwent operation + chemotherapy,53 underwent single chemotherapy and 26 underwent chemoradiotherapy.All the 104 patients were followed up for 7.0-88.0 months,with a median time of 26.0 months.The median survival time,6-months and 1-year survival rates of 104 patients with pancreatic cancer were respectively 7.1 months (range,1.0-42.7 months),52％ and 26％.Results of further analysis showed that the median survival time,6-months and 1-year survival rates were respectively 6.5 months (range,1.4-39.6 months),49％,27％ in 51 patients with carcinoma of head of pancreas and 7.2 months (range,1.0-42.7 months),54％,30％ in 53 patients with carcinoma of pancreatic body and tail.(3) Prognosis factors of patients with pancreatic cancer:results of univariate analysis showed that sex,CA19-9,maximum diameter of tumor,lymph node metastases,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with pancreatic cancer [HR =1.603,1.657,2.017,1.873,2.668,1.822,2.157,2.054,2.154,3.208,1.596,2.096,3.411,95％ confidence interval (CI):1.029-2.499,1.045-2.626,1.305-3.115,1.181-2.971,1.735-4.101,1.453-2.285,1.257-3.703,1.245-3.387,1.399-3.317,2.047-5.028,1.052-2.421,1.372-3.201,2.181-5.335,P＜0.05].Results of multivariate analysis showed that distant metastases,chemotherapy,comprehensive treatment and TLG ≥ 66.34 were independent risk factors affecting poor prognosis of patients with pancreatic cancer (HR=1.906,2.966,2.946,2.053,95％CI:1.201-3.022,1.775-4.956,1.753-4.951,1.104-3.820,P＜0.05).(4) Prognostic factors of patients with carcinoma of head of pancreas:results of univariate analysis showed that maximum diameter of tumor,tumor invading major vessels,hepatic metastases,distant metastases,clinical staging,surgery,chemotherapy,comprehensive treatment,SUVmax,MTV and TLG were related factors affecting prognosis of patients with carcinoma of head of pancreas (HR=2.282,2.320,4.125,5.753,6.155,2.841,4.144,3.131,2.229,2.064,5.380,95％ CI:1.231-4.230,1.098-4.903,1.993-8.539,2.682-12.341,1.850-20.483,1.362-5.926,2.106-8.154,1.545-6.345,1.202-4.132,1.121-3.803,2.630-11.004,P＜0.05).Results of multivariate analysis showed that chemotherapy and TLG ≥ 66.66 were independent risk factors affecting poor prognosis of patients with carcinoma of head of pancreas (HR=7.953,2.824,95％CI:3.110-20.338,1.005-7.932,P＜0.05).(5) Prognostic factors of patients with carcinoma of pancreatic body and tail:results of univariate analysis showed that hepatic metastases,distant metastases,surgery,comprehensive treatment,MTV and TLG were related factors affecting prognosis of patients with carcinoma of pancreatic body and tail (HR =2.083,2.501,3.464,2.295,2.231,3.572,95％CI:1.157-3.784,1.363-4.590,1.441-8.329,1.158-4.546,1.166-4.268,1.901-6.711,P＜0.05).Results of multivariate analysis showed that distant metastases,MTV≥ 15.70 em3 and TLG ≥ 62.75 were independent risk factors affecting poor prognosis of patients with carcinoma of pancreatic body and tail (HR =1.700,2.096,4.047,95％CI:1.080-2.675,1.065-4.126,2.072-7.906,P＜0.05).Conclusion TLG≥66.34,≥66.66,≥62.75 in 18F-FDG PET/CT examination are independent risk factors affecting poor prognosis of patients with pancreatic cancer or pancreatic head cancer or pancreatic body and tail cancer respectively,and MTV ≥ 15.70 cm3 is also an independent risk factor affecting poor prognosis of patient with pancreatic body and tail cancer.18 F-FDG PET/CT examination has certainly reference value for prognosis of patients with pancreatic cancer.
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Objective To investigate the prognostic value of SUVmax , SUVmean , MTV and TLG cal-culated from 18 F-FDG PET/CT in patients with postoperative esophageal cancer. Methods Sixty-one pa-tients ( 51 males, 10 females;age ranged 50-81 ( median:64) years) with esophageal cancer who under-went preoperative 18 F-FDG PET/CT from October 2007 to November 2015 were retrospectively analyzed. The relation of SUVmax , SUVmean , MTV and TLG in primary lesions with clinic pathological factors was ana-lyzed. Differences of metabolic parameters were compared with two-sample t test, one-way analysis of vari-ance, Mann-Whitney u test or Kruskal-Wallis H test. The optimal cutoff points of SUVmax , SUVmean , MTV and TLG for predicting overall survival ( OS) were investigated by ROC curve analysis. The Kaplan-Meier method and log-rank test were used to perform univariate survival analysis, and Cox proportional hazards model was used for multivariate analysis. Results MTV and TLG were associated with tumor length, N stage and clinical stage, while SUVmax and SUVmean were only associated with tumor length ( t=-2.396, F=4.206, 4. 471;z=-3.051,χ2=8.908, 9.796;t=-2.417,-2.423;all P<0. 05) . The optimal cutoff points of SUVmax, SUVmean, MTV and TLG were 11.76, 7.06, 24.35 cm3 and 166. 84 g, respectively. Univariate analysis of OS showed that the lymphatic metastasis, clinical stage and TLG were all significantly associated with the patient outcome (χ2=14.683, 7.139, 11.669, all P<0.05) . Multivariate analysis showed that lym-phatic metastasis and TLG were the independent predictors for OS (β=-1. 472, -1. 223; Wald=5. 224, 4. 668;both P<0.05) . Conclusion For predicting the prognosis of esophageal cancer after operation, TLG of the primary tumor may be more valuable than SUVmax , SUVmean and MTV.
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Objective To investigate the prognostic value of 18F-FDG PET-CT in patients with diffuse large B-cell lymphoma(DLBCL).Methods The clinical data of 130 DLBCL patients from June 2009 to May 2015 and pretreatment 18F-FDG PET-CT were retrospectively analyzed.Results The 130 DLBCL patients' median of maximal standard uptake value(SUVmax),metabolic tumor volume(MTV)and total lesion glycolysis(TLG)was 19.93,34.45 cm3,459.92 respectively.Univariate analysis showed that the affecting factors of progression-free survival(PFS)and overall survival(OS)rate included Eastern Cooperative Oncology Group(ECOG)grade,Ann Arbor stage,β2-MG,lactate dehydrogenase level,tumor diameter,bone marrow involvement,National Comprehensive Cancer Network International Prognostic Index(NCCN-IPI),MTV and TLG(all P <0.05),while age was related with PFS rate(P<0.05).As MTV and TLG were strongly correlated,only TLG measure was used for multivariate analysis.The result showed that ECOG grade,Ann Arbor stage,NCCN-IPI and TLG were statistically significant predictors of PFS rate,and NCCN-IPI and TLG were independent factors of OS rate(all P<0.05).According to TLG and NCCN-IPI,the patients were divided into three groups: low risk group,mediate risk group and high risk group.The 3-year PFS rates of these groups were 66.0%,36.8% and 26.1% respectively(P< 0.05),and the 3-year OS rates of these groups were 70.0%,49.1% and 39.1% respectively(P < 0.05).Conclusion TLG in 18F-FDG PET-CT is an independent prognostic factor for PFS and OS in patients with DLBCL,which has a reference value for prognosis of DLBCL.
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Objective To investigated the prognostic value of 18 F-FDG PET/CT in patients with limited-stage small cell lung cancer (LS-SCLC). Methods Sixty-six patients (58 males, 8 females;median age 65 years) with LS-SCLC who underwent pretreatment 18 F-FDG PET/CT from April 2009 to December 2015 were included in this retrospective study. The relations between the SUVmax , the sum of MTV ( MTVsum ) , the sum of TLG ( TLGsum ) and clinical factors were analyzed. ROC curve was plotted to estimate the most discrimination threshold ( cutoff point) for each parameter to maximize the sensitivity and specifici-ty in predicting the progression or recurrence. Kaplan-Meier method and log-rank test were used to perform univariate survival analysis and Cox proportional hazards model for multivariate analysis. Results The SUVmax, MTVsum and TLGsum of 66 patients were 10.57±3.27, 38.71(2.89, 221.68) cm3 and 267.04 (1167, 1684.13), respectively. SUVmax, MTVsum and TLGsum were all associated with hydrothorax, the maximum diameter of tumor, clinical stage and LDH. MTVsum and TLGsum were also associated with tumor type and NSE. During the median 33 months of follow-up, 4 patients were lost to follow-up, 43 patients were progressive or recurrent with the median PFS of 12.30 months, and 38 patients died with the median OS of 15.75 months. The optimal cutoff point of SUVmax, MTVsum and TLGsum were 10.08, 16.18 cm3, 209.14, re-spectively. Univariate analysis showed that hydrothorax, the maximum diameter of tumor, clinical stage, NSE, LDH, surgery, MTVsum and TLGsum were all associated with PFS and OS. SUVmax was associated with PFS, but not with OS. Multivariate analysis demonstrated that NSE, LDH, MTVsum and TLGsum were the in-dependent predictors of PFS ( HR:3.83, 4.46, 9.26, 3.87, all P<0.05) , and LDH, MTVsum were also the independent predictors of OS ( HR:2.77, 6.83, both P<0.05) . However, SUVmax was not the independent predictor of PFS(HR=1.47, P>0.05). Conclusions 18F-FDG PET/CT can predict the prognosis of pa-tients with LS-SCLC. SUVmax is correlated with PFS, MTVsum and TLGsum are independent predictors of PFS, and MTVsum is also an independent predictor of OS.
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Objective To investigate the relationship between metabolic parameters of 18F-FDG PET-CT and cilinicopathological features of patients with lung squamous cell carcinoma. Methods The study comprised 118 patients with lung squamous cell carcinoma. All patients undergone 18F-FDG PET-CT before surgery. Maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were measured, and total lesion glycolysis (TLG) was calculated. Relationship between metabolic parameters and clinicopathological factors was analyzed. Results SUVmax, MTV and TLG of 118 primary lesions were 11.93 (3.12-41.46), 27.71 cm3 (0.54-347.10 cm3) and 153.13 (1.65-2219.37), respectively. SUVmax was related to tumor differentiation degree and pleural invasion (χ2= 15.358, P= 0.000; Z= -2.875, P= 0.004); MTV was related to tumor differentiation degree, pleural invasion, vascular invasion and lymphatic metastasis (χ2= 13.341, P= 0.001; Z= -2.855, P= 0.004; Z= -2.683, P= 0.008; Z= -3.951, P= 0.000), TLG was also related to these clinicopathological factors (χ2= 15.609, P= 0.001;Z= -3.901, P= 0.002;Z= -2.311, P=0.021;Z= -3.721, P= 0.000). T stage and TNM stage had positive correlation with all metabolic parameters (r= 0.326, 0.794, 0.732;r= 0.358, 0.718, 0.668; all P< 0.05). And for N stage, SUVmax was no correlative (r=0.125, P=0.107), but MTV and TLG were positively correlative (r=0.399, 0.371, both P< 0.05). According the MTV or TLG and tumor size, patiens were divided into three groups: low-risk group, moderate-risk group and high-risk group. Significant differences were found among the three groups not even in MTV model, but also in TLG model (χ2= 20.800, P= 0.000; χ2= 20.069, P= 0.000). Conclusions Metabolic parameters of lung squamous cell carcinoma primary lesion have good correlation with clinicopathological factors, and can reflect partial characteristics of the tumor pathology in a certain extent. Furthermore, the probability of lymphatic metastasis could be predicted by MTV or TLG combined with tumor size.
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Objective To investigate the clinical value of Fluorine-18-fluorodeoxyglucose (18 F-FDG) PET/CT examination to predict the prognosis of patients after colorectal cancer operation.Methods The retrospective cross-sectional study was adopted.The clinicopathological data of 80 patients with colorectal cancer who were admitted to the First Hospital of Nanjing Medical University from March 2007 to October 2015 were collected.Eighty patients received first preoperative 18 F-FDG PET/CT examination and underwent operations under decisions of patients and their families,and then adjuvant chemotherapy were performed according to the patients' condition.Observation indicators included:(1) preoperative imaging examination,(2) situations of treatment and follow-up,(3) analysis of prognostic factors.The patients were followed up by outpatient examination and telephone interview once every 3 months within postoperative 1 year,once every half a year within postoperative 2 years and then once a year up to May 2016.The follow-up included tumor recurrence or progression and survival of patients.Tumor-free survival time was from postoperative day 1 to tumor recurrence or progression and death or end of follow-up.Overall survival time was from postoperative day 1 to death or end of follow-up.Measurement data with skewed distribution were represented as M (Qn) and M (range).The optimal cutoff point of tumor-free survival of maximum standardized uptake value (SUVmax),mean standardized uptake value (SUV),metabolism of volume (MTV) and total lesion of glycolysis (TLG) were investigated using the ROC curve analysis,and calculating area under the curve (AUC).The median was used as a cutoff point if there was smaller AUC.The Kaplan-Meier method and Log-rank test were respectively used for survival analysis and univariate analysis,and COX proportional hazards model for multivariate analysis.Results (1) Results of preoperative imaging examination:results of PET/CT in patients with colorectal cancer showed there were circumscribed thickening of bowel wall,intestinal cavity strictures,fuzzy fat space around the some lesions,enlarged lymph node and 18 F-FDG uptake increased abnormally.The SUV SUV MTV and TLG of 80 patients were 11.83(4.26,35.42),7.06(2.38,20.92),20.47 cm3 (1.29 cm3,161.50 cm3) and 138.58 (14.17,857.89),respectively.ROC curve showed that the AUC of SUV SUV MTV and TLG were 0.453,0.448,0.815 and 0.749 [95％ confidence interval (CI):0.307-0.600,P ＞0.05;0.303-0.594,P ＞ 0.05;0.717-0.913,P ＜ 0.05;0.635-0.863,P ＜ 0.05],respectively.The median SUVmax (11.83) and SUV (7.06) were used as the cutoff points due to smaller AUC of SUVmax and SUV.The cutoff point of MTV was 18.79 cm3 (sensitivity =86.2％ and specificity =68.3％),and the cutoff point of TLG was 142.05 (sensitivity =75.9％ and specificity =70.7％).(2) Situations of treatment and follow-up:among 80 patients,13 underwent the radical resection of colorectal cancer and resection of liver metastasis and 67 underwent radical resection of colorectal cancer.Sixty-two patients received postoperative chemotherapy,including 45 with chemotherapy regimens of capecitabine and 17 with fluorouracil.Eighty patients were followed up for 41.8 months (range,6.5-109.1 months).During the follow-up,29 patients had tumor recurrence or progression,and 19 patients were dead.The median tumor-free survival time,1-,3-and 5-year tumor-free survival rates in 80 patients were 19.5 months (range,2.0-109.1 months),73.7％,36.3％ and 18.8％,respectively.The median overall survival time,1-,3-and 5-year overall survival rates were 31.8 months (range,3.3-109.1 months),76.3％,37.5％ and 20.0％,respectively.(3) Analysis of prognostic factors:results of univariate analysis showed that tumor location,N staging,M staging,clinical staging,postoperative chemotherapy,MTV and TLG were relative factors affecting postoperative tumor-free survival rate (HR =3.469,5.325,5.295,8.605,2.630,7.388,5.155,95％ CI:1.522-7.906,2.256-12.568,2.405-11.657,2.969-24.937,1.063-6.504,2.550-21.403,2.178-12.204,P ＜ 0.05).The tumor location,tumor differentiation,N staging,M staging,clinical staging,MTV and TLG were relative factors affecting postoperative overall survival rate (HR =2.697,2.814,3.083,2.916,4.193,5.450,4.876,95％ CI:1.011-7.197,1.121-7.062,1.166-8.149,1.140-7.454,1.386-12.678,1.581-18.786,1.727-13.766,P ＜ 0.05).In multivariate analysis,stage Ⅲ-Ⅳ of clinical staging and TLG≥ 142.05 were independent risk factors affecting postoperative tumor-free survival rate (HR =9.879,3.569,95％ CI:1.854-22.836,1.127-11.306,P＜0.05).The stage M1,stage Ⅲ-Ⅳ of clinical staging and TLG≥ 142.05 were independent risk factors affecting postoperative overall survival rate (HR =4.522,9.315,10.120,95％ CI:1.223-16.717,1.338-24.864,2.385-12.947,P＜0.05).Conclusion TLG through 18 F-FDG PET/CT examination is an independent prognostic factor affecting postoperative tumor-free survival rate and overall survival rate in patients with colorectal cancer after curative resection,and it has certainly reference value for prognosis.
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Objective To evaluate the imaging characteristics of 18 F-FDG PET/CT in patients with Castleman's disease (CD).Methods Twelve patients (male 7,female 5,mean age:(51.2±19.3)years) with pathologically confirmed CD and 18F-FDG PET/CT were retrospectively enrolled.A lesion with SUVmax greater than that of normal liver tissue was defined as positive.Lesion size (short diameter) was measured.Correlation between size and SUVmax was analyzed by Pearson correlation analysis.SUVmax of different clinical and pathological types was compared using Mann-Whitney rank sum test.Results Among 12patients,7 patients had localized CD (LCD) involving a single group of lymph nodes and 5 patients had multicentric CD (MCD) involving more than one group of lymph nodes with some having lung and spleen infiltration.A total of 129 positive lesions were found (7 of LCD,122 of MCD) and the average SUVmax was 4.20±1.84 (range:2.50 to 10.70).There was no significant correlation between SUVmax and lesion size (r =0.189,P＞0.05).There was no significant difference in SUVmax between LCD and MCD (4.23±1.77 vs 4.19±1.86; Z=-0.108,P＞0.05) ; but there was significant difference in SUVmax between the patients with and without clinical manifestations (4.56±2.06 vs 3.41±0.87; Z=-2.443,P＜0.05).No significant difference was found between SUVmax of hyaline vascular CD and plasma cell CD (3.63±0.89 vs 4.26±1.91; Z=-0.519,P＞0.05).Conclusions CD shows primarily lymph node involvement with increased 18F-FDG uptake.However,the degree of FDG uptake does not correlate with clinical presentation or pathological types.
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Objective To evaluate the clinical value of 18F-FDG PET-CT imaging on monitoring recurrence, metastasis and therapeutic decision-making in small intestinal adenocarcinoma patients after radical surgery. Methods Twenty-two patients were enrolled, who underwent surgical operation before received PET-CT scan. PET-CT findings were retrospectively observed to compare with the results of follow-up [postoperative pathology and (or) long-term clinical follow-up]. The roles of PET-CT on therapeutic decision-making were then investigated. Results Among 22 patients, 14 cases were finally diagnosed as recurrence and (or) metastasis, the other 8 cases as disease-free survival after long-term follow-up. According to PET-CT, 13 cases were diagnosed as recurrence and (or) metastasis (including 12 true-positive and 1 false-positive), and 9 cases were negative (including 2 false-negative). The diagnostic sensitivity, specificity, accuracy, positive predictive value and negative predictive value of PET-CT were 85.7 % (12/14), 87.5 % (7/8), 86.4 %(19/22), 92.3%(12/13) and 77.8%(7/9), respectively. The therapeutic decisions were changed in 10 patients (10/22, 45.5 % ) based on PET-CT results. Conclusion 18F-FDG PET-CT has an important clinical value on the detection of recurrence and (or) metastasis of small intestinal adenocarcinoma, which is an ideal method of monitoring.
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Objective To determine the prognostic value of maximum standard uptake (SUVmax) of pretreatment 18F-FDG PET-CT in patients with newly diagnosed soft tissue sarcomas (STS).Methods The clinical data of 34 patients with STS undergoing 18F-FDG PET-CT before treatment were analyzed retrospectively.The relationship between SUVmax of PET-CT and prognostic factors was evaluated by MannWhitney' s non-paraetric test and Spearman' s rank correlation test.The prognostic factors were analyzed by univariate and multivariate analysis.Results Among 34 patients, the median SUVmax was 10.3 (1.5-28.2), and the median maximum diameter was 6.7 cm (1.8-17.2 cm) with positively association between them (r =0.389, P =0.028).SUVmax was also associated with pathological grade, AJCC staging and distant metastasis, respectively (all P ＜ 0.05).In univariate analysis, distant metastasis, pathological grade, AJCC staging, and SUVmax were found to be the prognostic factors (all P ＜ 0.05).Multivariate analysis results indicated that only the SUVmax and distant metastasis were the independent unfavorable prognostic factors (both P ＜ 0.05).Conclusions The SUmax of pretreatment 18F-FDG PET-CT is well correlated with prognostic factors, and it can predict the prognosis of patients with STS.