Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer
- 21 April 2014
- journal article
- Published by Society of Nuclear Medicine in Journal of Nuclear Medicine
- Vol. 55 (6), 891-897
- https://doi.org/10.2967/jnumed.113.127340
Abstract
18F-FDG PET/CT is effective in the assessment of therapy response. Changes in glucose uptake or tumor size are used as a measure. Tumor heterogeneity was found to be a promising predictive and prognostic factor. We investigated textural parameters for their predictive and prognostic capability in patients with rectal cancer using histopathology as the gold standard. In addition, a comparison to clinical outcome was performed. Methods: Twenty-seven patients with rectal cancer underwent 18F-FDG PET/CT before, 2 wk after the start, and 4 wk after the completion of neoadjuvant chemoradiotherapy. In all PET/CT scans, conventional parameters (tumor volume, diameter, maximum and mean standardized uptake values, and total lesion glycolysis [TLG]) and textural parameters (coefficient of variation [COV], skewness, and kurtosis) were determined to assess tumor heterogeneity. Values on pretherapeutic PET/CT as well as changes early in the course of therapy and after therapy were compared with histopathologic response. In addition, the prognostic value was assessed by correlation with time to progression and survival time. Results: The COV showed a statistically significant capability to assess histopathologic response early in therapy (sensitivity, 68%; specificity, 88%) and after therapy (79% and 88%, respectively). Thereby, the COV had a higher area under the curve in receiver-operating-characteristic analysis than did any analyzed conventional parameter for early and late response assessment. The COV showed a statistically significant capability to evaluate disease progression and to predict survival, although the latter was not statistically significant. Conclusion: Tumor heterogeneity assessed by the COV, being superior to the investigated conventional parameters, is an important predictive factor in patients with rectal cancer. Furthermore, it can provide prognostic information. Therefore, its application is an important step for personalized treatment of rectal cancer.Keywords
This publication has 22 references indexed in Scilit:
- Assessment of tumor heterogeneity: an emerging imaging tool for clinical practice?Insights into Imaging, 2012
- Quantifying tumour heterogeneity in 18F-FDG PET/CT imaging by texture analysisEuropean Journal of Nuclear Medicine and Molecular Imaging, 2012
- Intratumor Heterogeneity and Branched Evolution Revealed by Multiregion SequencingNew England Journal of Medicine, 2012
- Tumour heterogeneity in non-small cell lung carcinoma assessed by CT texture analysis: a potential marker of survivalEuropean Radiology, 2011
- Assessment of Response to Tyrosine Kinase Inhibitors in Metastatic Renal Cell Cancer: CT Texture as a Predictive BiomarkerRadiology, 2011
- DCE-MRI biomarkers of tumour heterogeneity predict CRC liver metastasis shrinkage following bevacizumab and FOLFOX-6British Journal of Cancer, 2011
- Effect of Tumor Heterogeneity on the Assessment of Ki67 Labeling Index in Well-differentiated Neuroendocrine Tumors Metastatic to the LiverThe American Journal of Surgical Pathology, 2011
- Physical and clinical performance of the mCT time-of-flight PET/CT scannerPhysics in Medicine & Biology, 2011
- Prostate cancer characterization on MR images using fractal featuresMedical Physics, 2010
- Spatial Heterogeneity in Sarcoma 18F-FDG Uptake as a Predictor of Patient OutcomeJournal of Nuclear Medicine, 2008