OtherCONTINUING EDUCATION

Imaging Surrogates of Tumor Response to Therapy: Anatomic and Functional Biomarkers

Binsheng Zhao, Lawrence H. Schwartz and Steve M. Larson
Journal of Nuclear Medicine February 2009, 50 (2) 239-249; DOI: https://doi.org/10.2967/jnumed.108.056655

Article Figures & Data

Figures

  • FIGURE 1. 
    FIGURE 1. 

    Images showing no changes in unidimensional or bidimensional measurements but enlargement of tumor along z-axis. (A) Baseline transverse CT image shows tumor contour (outlined in white), greatest diameter, and greatest perpendicular diameter (crossed lines in black) determined by semiautomated segmentation algorithm. (B) Three-dimensional view of segmented tumor on baseline. (C and D) On corresponding follow-up CT images obtained 24 d later, 3-dimensional tumor is seen from same angle along z-axis. Changes in unidimensional, bidimensional, and volumetric measurements are 0.4%, −4.4%, and 33.2%, respectively. (Reprinted with permission of (16).)

  • FIGURE 2. 
    FIGURE 2. 

    Images showing no change in tumor size but decrease in tumor density (ghost scenario). (A) Baseline transverse CT image with computer-generated tumor contour, greatest diameter, and 3-dimensional view. (B) On corresponding follow-up CT image obtained 21 d later, tumor is seen from same angle along z-axis. (C) Density histograms of tumor on baseline (white) and follow-up scans (red). Changes in unidimensional and volumetric measurements were 2.1% and −7.8%, respectively. Change in tumor average intensity was −189 Hounsfield unit.

  • FIGURE 3. 
    FIGURE 3. 

    CT and 18F-FDG PET of bronchioalveolar cell carcinoma, with lesions on baseline CT (A), lesions on corresponding 18F-FDG PET (B), and CT fused with 18F-FDG PET (C). Only regions on PET containing pixels with SUVmax greater than or equal to 2 are visible on fused PET/CT image.

  • FIGURE 4. 
    FIGURE 4. 

    18F-FDG PET/CT of NSCLC tumor. (A) Baseline hybrid PET/CT performed on patient who had discontinued treatment with gefitinib. One target lesion (arrow) in right lung is indicated on CT (upper row) and on corresponding PET (lower row). (B) PET/CT after 3 wk of no gefitinib treatment. Both size (i.e., maximal tumor diameter) measured on CT and SUVmax measured on 18F-FDG PET increased. Patient then resumed treatment with gefitinib at dose patient was receiving before study entry. (C) PET/CT 3 wk after resumption of treatment. Size did not change, but SUVmax dropped.

  • FIGURE 5. 
    FIGURE 5. 

    18F-FLT uptake in gastric cancer (arrow) is indicator of rapid tumor cell proliferation: companion CT image through region of stomach mass (upper left), transaxial PET image showing 18F-FLT uptake in gastric mass (arrow; upper right), coronal PET image showing 18F-FLT uptake in gastric mass adjacent to left lobe of liver (bottom right), and fusion image of PET and CT showing 18F-FLT uptake in gastric mass (arrow; bottom left).

  • FIGURE 6. 
    FIGURE 6. 

    Actively metabolizing tumor with pre- and posttreatment uptake of 18F-FDHT, an androgen ligand radiotracer, in multiple lumbar vertebrae before (left) and after (right) treatment with Medivation, a high-affinity androgen receptor being studied under approved protocol at MSKCC.

  • FIGURE 7. 
    FIGURE 7. 

    Progression of molecular imaging radioprobe from laboratory to clinic for MSKCC radiotracer that targets HER 2 receptor: 68Ga-Fab′2 trastuzumab (75). Animal studies with human breast tumor xenografts are imaged with small-animal PET (left), and initial study in human patient with metastatic breast cancer (right) causing lytic skull lesion (companion CT image, leftmost image of right panel), with positive uptake on fusion image (rightmost image of right panel).

Tables

  • TABLE 1

    Molecular Imaging Probes Used at MSKCC

    RadiotracerFunction
    18F-FDG (48)Glycolysis
    18F-FLTProliferation
    11C-methionine (49–51), anti-1-amino-3-[18F]fluorocyclobutyl-carboxylic acid (52)Amino acid transport
    18F-FES (53)Estrogen receptor
    18F-FDHT (54–56)Androgen receptor
    Na 124INIS
    11C-acetateKrebs cycle, FA syn
    18F-FMISO (57)Hypoxia
    68Ga-Fab′2 trastuzumabHER 2
    124I-cG250Carbonic anhydrase IX
    124I-A33A33 antigen
    124I-3F8GD2
    64Cu-trastuzumabHER 2
    124I-Fluoroiodoarabinosylurideine* (58)Thymidine kinase (herpes virus)
    18F-Fluoroethanylarabinosyluridine* (59)Thymidine kinase (herpes virus)

    • ↵* Gene expression imaging.

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