• Title, Summary, Keyword: SUVmax

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FDG PET-CT in Non-small Cell Lung Cancer: Relationship between Primary Tumor FDG Uptake and Extensional or Metastatic Potential

  • Zhu, Shou-Hui;Zhang, Yong;Yu, Yong-Hua;Fu, Zheng;Kong, Lei;Han, Da-Li;Fu, Lei;Yu, Jin-Ming;Li, Jia
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.5
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    • pp.2925-2929
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    • 2013
  • Objective: To explore the relationships between primary tumor $^{18}F$-FDG uptake measured as the SUVmax and local extension, and nodal or distant organ metastasis in patients with NSCLC on pretreatment PET-CT. Methods: 93 patients with NSCLC who underwent $^{18}F$-FDG PET-CT scans before the treatment were included in the study. Primary tumor SUVmax was calculated; clinical stages, presence of local extension, nodal and distant organ metastases were recorded. The patients with SUVmax${\geq}2.5$ were divided into low and high SUVmax groups by using the median SUVmax. The low SUVmax group consisted of 45 patients with SUVmax<10.5, the high SUVmax group consisted of 46 patients with SUVmax${\geq}10.5$. Their data were compared statistically. Results: 91 cases with SUVmax${\geq}2.5$ were included for analysis. The mean SUVmax in patients without any metastasis was $7.42{\pm}2.91$ and this was significantly lower than that ($12.18{\pm}4.94$) in patients with nodal and/or distant organ metastasis (P=0.000). In the low SUV group, 19 patients had local extension, 22 had nodal metastasis, and 9 had distant organ metastasis. In the high SUV group, 31 patients had local extension, 37 had nodal metastasis, and 18 had distant organ metastases. There was a significant difference in local extension (P =0.016), distant organ metastasis (P =0.046), and most significant difference in nodal metastasis rate (P =0.002) between the two groups. In addition, there was a moderate correlation between SUVmax and tumor size (r = 0.642, P<0.001), tumor stage (r = 0.546, P<0.001), node stage (r = 0.388, P<0.001), and overall stage (r = 0.445, P= 0.000). Conclusion: Higher primary tumor SUVmax predicts higher extensional or metastatic potential in patients with NSCLC. Patients with higher SUVmax may need a close follow-up and more reasonable individual treatment because of their higher extensional and metastatic potential.

Maximum standardized uptake value at pre-treatment PET in estimating lung cancer progression after stereotactic body radiotherapy

  • Park, Jisun;Choi, Yunseon;Ahn, Ki Jung;Park, Sung Kwang;Cho, Heunglae;Lee, Ji Young
    • Radiation Oncology Journal
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    • v.37 no.1
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    • pp.30-36
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    • 2019
  • Purpose: This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). Materials and Methods: Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. Results: The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progression-free survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). Conclusion: SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.

Differences in the Prognostic Significance of the SUVmax between Patients with Resected Pulmonary Adenocarcinoma and Squamous Cell Carcinoma

  • Motono, Nozomu;Ueno, Masakatsu;Tanaka, Makoto;Machida, Yuichiro;Usuda, Katsuo;Sakuma, Tsutomu;Sagawa, Motoyasu
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.23
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    • pp.10171-10174
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    • 2015
  • Background: The purpose of this study was to determine the prognostic significance of the maximum standardized uptake value (SUVmax) on F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients undergoing surgical treatment for non-small cell lung cancer. Materials and Methods: Seventy-eight consecutive patients (58 with adenocarcinomas, 20 with squamous cell carcinomas) treated with potentially curative surgery were retrospectively reviewed. Results: The SUVmax was significantly higher in the patients with recurrent than with non-recurrent adenocarcinoma (p<0.01). However, among the patients with squamous cell carcinoma, there were no differences with or without recurrence (p=0.69). Multivariate analysis indicated that the SUVmax of adenocarcinoma lesions was a significant predictor of disease-free survival (p=0.04). In addition, an SUVmax of 6.19, the cut-off point based on ROC curve analysis of the patients with pathological IB or more advanced stage adenocarcinomas, was found to be a significant predictor of disease-free survival (p<0.01). Conclusions: SUVmax is a useful predictor of disease-free survival in patients with resected adenocarcinoma, but not squamous cell carcinoma. Patients with adenocarcinoma exhibiting an SUVmax above 6.19 are candidates for more intensive adjuvant therapy.

Standardized Uptake Values Highly Correlate with Tumor Size and Fuhrman Grade in Patients with Clear Cell Renal Cell Carcinoma

  • Polat, Emre Can;Otunctemur, Alper;Ozbek, Emin;Besiroglu, Huseyin;Dursun, Murat;Ozer, Kutan;Horsanali, Mustafa Ozan
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.18
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    • pp.7821-7824
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    • 2014
  • Background: We investigated the correlation between standardized uptake value (SUVmax), tumor size and Fuhrman grade in patients with renal cell carcinoma (RC). Materials and Methods: We retrospectively analyzed the data of 54 patients with clear cell renal cell carcinoma histopathologically diagnosed who underwent fluorine-18 fluoro-2 deoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) between January 2005 and March 2014. Results: Avarage tumor sizes were $5.64{\pm}1.85$, $6.85{\pm}2.24$ and $7.98{\pm}2.45$ in low, medium and high SUVmax groups, respectively. The Spearman's correlation coefficient between the tumor size and SUVmax was 0.385 (p=0.004) and between the Fuhrman grade and SUVmax was 0.578 (p<0.001). Conclusions: SUVmax appears highly correlated with tumor size and Fuhrman grade in patients with histopathologically confirmed clear cell RC. Multicenter studies are needed to provide larger series for more accurate results.

$^{18}F$-FDG PET/CT for the Preoperative Diagnosis of Papillary Thyroid Microcarcinoma: The Value of Dual Time Point Imaging (갑상선미세유두암의 수술 전 진단에서 $^{18}F$-FDG PET/CT: 이중시간 영상의 유용성)

  • Seo, Young-Duk;Kim, Seong-Min;Kim, Kun-Ho;Kim, Je-Ryong
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.6
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    • pp.543-556
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    • 2009
  • Purpose: We studied the patterns of FDG uptake of primary papillary thyroid microcarcinoma (PTMCa) lesions and benign thyroid nodules in dual time point $^{18}F$-FDG PET/CT imaging. Materials and Methods: Consecutive 134 patients (154 lesions) with PTMCa and 49 patients (61 nodules) with benign thyroid nodules equal to or less than 1.0 cm who underwent dual time point $^{18}F$-FDG PET/CT study before surgery were enrolled. We calculated the maximum standardized uptake value of PTMCa and benign nodules in both time points, and percent change of SUVmax (${\Delta}%SUVmax$) and lesion to background ratio of SUVmax (${\Delta}L:B$% ratio) between both time points. The mean time interval between scans was $23.4{\pm}4.4$ minutes (thyroid to thyroid interval: $10.7{\pm}4.4$ minutes). Results: The mean of SUVmax of PTMCa was increased from $4.9{\pm}4.3$ to $5.3{\pm}4.7$ (p<0.001) and ${\Delta}%SUVmax$ was $12.3{\pm}23.6%$. But, the mean of SUVmax of benign nodules was no definite change ($2.1{\pm}1.0$ to $2.1{\pm}1.3$, p=0.686) and ${\Delta}%SUVmax$ was $-0.3{\pm}20.5%$. Of the 154 PTMCa, 100 nodules (64.9%) showed an increase in SUVmax over time, while 19 (31.1%) of the 61 benign thyroid nodules showed an increase (p<0.001). The dual time point $^{18}F$-FDG PET/CT found more PTMCa in visual assessment (62.3% vs. 76.6%, p=0.006), even in smaller than 0.5 cm (38.6% vs. 60.0%, p=0.011). Conclusion: Dual time time $^{18}F$-FDG PET/CT imaging was more useful than single time point $^{18}F$-FDG PET/CT imaging for distinction between PTMCa and benign nodule, especially when nodule showed equivocal or negative findings in single time point $^{18}F$-FDG PET/CT imaging or was smaller than 0.5 cm.

Evaluation of metabolic tumor volume using different image reconstruction on 18F-FDG PET/CT fusion image (18F-FDG PET/CT 융합영상에서 영상 재구성 차이에 의한 MTV (Metabolic tumor volume) 평가)

  • Yoon, Seok Hwan
    • Journal of the Korea Convergence Society
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    • v.9 no.1
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    • pp.433-440
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    • 2018
  • Recently, MTV(metabolic tumor volume) has been used as indices of the whole tumor FDG uptake on FDG PET image but it is influenced by image reconstruction. The purpose of this study was to evaluate the correlation between actual volume and metabolic tumor volume applying different SUVmax threshold for different reconstruction algorithm on phantom study. Measurement were performed on a Siemens Biograph mCT40 using a NEMA IEC body phantom containing different size six spheres filled with F18-FDG applying four SBRs (4:1, 8:1, 10:1, 20:1). Images reconstructed four algorithms (OSEM3D, OSEM3D+PSF, OSEM3D +TOF, OSEM3D+TOF+PSF) and MTV were measured with different SUVmax threshold. Overall, the use of increasing thresholds result in decreasing MTV. and increasing the signal to background ratio decreased MTV by applying same SUVmax threshold. The 40% SUVmax threshold gave the best concordance between measured and actual volume in PSF and PSF+TOF reconstruction image. and the 45% threshold had the best correlation between the volume measured and actual volume in OSEM3D and TOF reconstruction image. we believe that this study will be used when the measurement of MTV applying various reconstruction image.

Role of $^{18}F$-fluoro-2-deoxyglucose Positron Emission Tomography in Gastric GIST: Predicting Malignant Potential Pre-operatively

  • Park, Jeon-Woo;Cho, Chang-Ho;Jeong, Duck-Su;Chae, Hyun-Dong
    • Journal of Gastric Cancer
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    • v.11 no.3
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    • pp.173-179
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    • 2011
  • Purpose: It is difficult to obtain biopsies from gastrointestinal stromal tumors (GISTs) prior to surgery because GISTs are submucoal tumors, despite being the most common nonepithelial neoplasms of the gastrointestinal tract. Unlike anatomic imaging techniques, PET-CT, which is a molecular imaging tool, can be a useful technique for assessing tumor activity and predicting the malignant potential of certain tumors. Thus, we aimed to evaluate the usefulness of PET-CT as a pre-operative prognostic factor for GISTs by analyzing the correlation between the existing post-operative prognostic factors and the maximum SUV uptake (SUVmax) of pre-operative 18F-fluoro-2-deoxyglucose (FDG) PET-CT. Materials and Methods: The study was conducted on 26 patients who were diagnosed with gastric GISTs and underwent surgery after being examined with pre-operative FDG PET-CT. An analysis of the correlation bewteen (i) NIH risk classification and the Ki-67 proliferation index, which are post-operative prognostic factors, and (ii) the SUVmax of PET-CT, which is a pre-operative prognostic factor, was performed. Results: There were significant correlations between (i) SUVmax and (ii) Ki-67 index, tumor size, mitotic count, and NIH risk group (r=0.854, 0.888, 0.791, and 0.756, respectively). The optimal cut-off value for SUVmax was 3.94 between "low-risk malignancy" and "high-risk malignancy" groups. The sensitivity and specificity of SUVmax for predicting the risk of malignancy were 85.7% and 94.7%, respectively. Conclusions: The SUVmax of PET-CT is associated with Ki-67 index, tumor size, mitotic count, and NIH classification. Therefore, it is believed that PET-CT is a relatively safe, non-invasive diagnostic tool for assessing malignant potential pre-operatively.

FDG-PET/CT as prognostic factor and surveillance tool for postoperative radiation recurrence in locally advanced head and neck cancer

  • Kim, Gi-Won;Kim, Yeon-Sil;Han, Eun-Ji;Yoo, Ie-Ryung;Song, Jin-Ho;Lee, Sang-Nam;Lee, Jong-Hoon;Choi, Byung-Oak;Jang, Hong-Seok;Yoon, Sei-Chul
    • Radiation Oncology Journal
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    • v.29 no.4
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    • pp.243-251
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    • 2011
  • Purpose: To evaluate the prognostic value of metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) on initial positron emission tomography-computed tomography (PET-CT) and investigate the clinical value of SUVmax for early detection of locoregional recurrent disease after postoperative radiotherapy in patients with locally advanced head and neck squamous cell carcinoma (HNSCC). Materials and Methods: A total of 100 patients with locally advanced HNSCC received primary tumor excision and neck dissection followed by adjuvant radiotherapy with or without chemotherapy. The MTV and SUVmax were measured from primary sites and neck nodes. The prognostic value of MTV and SUVmax were assessed using initial staging PET/CT (study A). Follow-up PET/CT scan available after postoperative concurrent chemoradiotherapy or radiotherapy were evaluated for the SUVmax value and correlated with locoregional recurrence (study B). A receiver operating characteristic (ROC) curve analysis was used to define a threshold value of SUVmax with the highest accuracy for recurrent disease assessment. Results: High MTV (>41 mL) is negative prognostic factor for disease free survival (p = 0.041). Postradiation SUVmax was significantly correlated with locoregional recurrence (hazard ratio, 1.812; 95% confidence interval, 1.361 to 2.413; P < 0.001). A cutoff value of 5.38 from follow-up PET/CT was identified as having maximal accuracy for detecting locoregional recurrence by ROC analysis. Conclusion: MTV at staging work-up was significantly associated with disease free survival. The SUVmax value from follow-up PET/CT showed high diagnostic accuracy for the detection of locoregional recurrence in postoperatively irradiated HNSCC.

The Clinical Value of Dual Time Point F-18 FDG PET/CT Imaging for the Differentiation of Colonic Focal Uptake Lesions (장관 내 국소 섭취증가 병소의 감별에 있어 추가 지연 F-18 FDG PET/CT의 임상적 유용성)

  • Kim, Jin-Suk;Lim, Seok-Tae;Jeong, Young-Jin;Kim, Dong-Wook;Jeong, Hwan-Jeong;Sohn, Myung-Hee
    • Nuclear Medicine and Molecular Imaging
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    • v.43 no.4
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    • pp.309-316
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    • 2009
  • Purpose: F-18 FDG can be accumulated in the liver, bowel, kidney, urinary tract, and muscles physiologically. The aim of this study was to evaluate the clinical value of dual time point 18F-FDG PET /8 imaging for the differentiation of the colonic focal uptake lesions. Materials and Methods: One hundred thirty two patients (M:F = 77:55, Age 62.8$\pm$11.6 years) underwent $^{18}$F-FDG PET/CT at two time points, prospectively: early image at 50-60 min and delayed image at 4-4.5 hours after the intravenous injection of $^{18}$F-FDG. Focally increased uptake lesions on early images but disappeared or shifted on delayed images defined a physiological uptake. For the differential evaluation of persistent focal uptake lesions on delayed images, colonoscopy and histopathologic examination were performed. SUVmax changes between early and delayed images were also compared. Results: Among the 132 patients, 153 lesions of focal colonic uptake were detected on early images of $^{18}$F-FDG PET/CT. Of these, 72 (47.1%) lesions were able to judge with physiological uptake because the focal increased uptake disappeared from delayed image. Among 81 lesions which was showed persistent increased uptake in delayed image, 61 (75.3%) lesions were confirmed as the malignant tumor and 14 (17.3%) lesions were confirmed as the benign lesions including adenoma and inflammatory disease. Remaining 6 (7.4%) lesions were confirmed as the physiological uptake because there was no particular lesion in the colonoscopy. In the malignant lesions, the calculated dual time point change for SUVmax ($\Delta$%SUVmax) was 20.8$\pm$18.7%, indicating a significant increase in SUVmax between the two point (p<0.01). In contrast, the change in SUVmax for the non-malignant lesions including benign lesions and physiological uptake was -13.7%$\pm$24.2%. For the differentiation of the malignant and non-malignant focal colonic uptake lesions, $\Delta$%SUVmax was the most effective parameter, and the cut-off value using -5% provided the best sensitivity, specificity, and accuracy. Conclusion: The dual time point $^{18}$F-FDG PET/CT imaging with SUVmax change evaluation could be an important noninvasive method for the differentiation of malignant and benign focal colonic uptake lesions including physiologic uptake.

Prognostic Significance of 18F-fluorodeoxyglucose Positron Emission Tomography (PET)-based Parameters in Neoadjuvant Chemoradiation Treatment of Esophageal Carcinoma

  • Ma, Jin-Bo;Chen, Er-Cheng;Song, Yi-Peng;Liu, Peng;Jiang, Wei;Li, Ming-Huan;Yu, Jin-Ming
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.4
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    • pp.2477-2481
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    • 2013
  • Aims and Background: The purpose of the research was to study the prognostic value of tumor 18F-FDG PET-based parameters in neoadjuvant chemoradiation for patients with squamous esophageal carcinoma. Methods: Sixty patients received chemoradiation therapy followed by esophagectomy and two 18FDG-PET examinations at pre- and post-radiation therapy. PET-based metabolic-response parameters were calculated based on histopathologic response. Linear regression correlation and Cox proportional hazards models were used to determine prognostic value of all PET-based parameters with reference to overall survival. Results: Sensitivity (88.2%) and specificity (86.5%) of a percentage decrease of SUVmax were better than other PET-based parameters for prediction of histopathologic response. Only percentage decrease of SUVmax and tumor length correlated with overall survival time (linear regression coefficient ${\beta}$: 0.704 and 0.684, P<0.05). The Cox proportional hazards model indicated higher hazard ratio (HR=0.897, P=0.002) with decrease of SUVmax compared with decrease of tumor size (HR=0.813, P=0.009). Conclusion: Decrease of SUVmax and tumor size are significant prognostic factors in chemoradiation of esophageal carcinoma.