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Research ArticleClinical Investigations

Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer

Ralph A. Bundschuh, Julia Dinges, Larissa Neumann, Martin Seyfried, Norbert Zsótér, Laszló Papp, Robert Rosenberg, Karen Becker, Sabrina T. Astner, Martin Henninger, Ken Herrmann, Sibylle I. Ziegler, Markus Schwaiger and Markus Essler
Journal of Nuclear Medicine June 2014, 55 (6) 891-897; DOI: https://doi.org/10.2967/jnumed.113.127340
Ralph A. Bundschuh
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
2Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Wuerzburg, Germany
3Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn, Germany
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Julia Dinges
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Larissa Neumann
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Martin Seyfried
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Norbert Zsótér
4Mediso Medical Imaging Systems Ltd., Budapest, Hungary
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Laszló Papp
4Mediso Medical Imaging Systems Ltd., Budapest, Hungary
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Robert Rosenberg
5Chirurgische Klinik, Kantonsspital Baden, Baden, Switzerland
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Karen Becker
6Institut für Pathologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Sabrina T. Astner
7Klinik und Poliklinik für Radioonkolgie und Strahlentherapie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany; and
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Martin Henninger
8Institut für Röntgendiagnostik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Ken Herrmann
2Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Wuerzburg, Germany
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Sibylle I. Ziegler
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Markus Schwaiger
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
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Markus Essler
1Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
3Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Bonn, Bonn, Germany
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Article Figures & Data

Figures

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  • FIGURE 1.
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    FIGURE 1.

    Individual COV values for histopathologic responders (A) and nonresponders (B) on PET/CT before, 2 wk after start, and after completion of nRCT. Squares indicate mean values over all patients in each group; solid lines indicate changes during therapy.

  • FIGURE 2.
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    FIGURE 2.

    Correlation between COV and lesion volume at time point 1 (A), between changes in COV and volume early in therapy (time points 1 to 2) (B), and between changes in COV and volume after end of therapy (time points 1 to 3) (C).

  • FIGURE 3.
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    FIGURE 3.

    Kaplan–Meier plots and number-at-risk tables for probability of progression-free survival. Low-risk group (solid lines) was identified by COV measured on 18F-FDG PET/CT before start of nRCT (A), by changes in COV (ΔCOV) between baseline and 2 wk after start of nRCT (early response assessment) (B), and by ΔCOV between baseline and 18F-FDG PET/CT 2 wk after completion of nRCT (late response assessment) (C). n = number of individuals in each group; e = number of events in each group. Time of censoring is marked by a dot.

  • FIGURE 4.
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    FIGURE 4.

    Kaplan–Meier plots and number-at-risk tables for probability of overall survival. Responders (solid lines) were identified by COV measured on 18F-FDG PET/CT before start of nRCT (A), by changes in COV (ΔCOV) between baseline and 2 wk after start of nRCT (early response assessment) (B), and by ΔCOV between baseline and 18F-FDG PET/CT 2 wk after completion of nRCT (late response assessment) (C). n = number of individuals in each group; e = number of events in each group. Time of censoring is marked by a dot.

Tables

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    TABLE 1

    Results of ROC Analysis for Predictive Value of Pretherapeutic PET/CT

    ParameterAUC95% confidence interval
    SUVmax0.520.32–0.71
    Skewness0.550.33–0.75
    Kurtosis0.610.39–0.81
    SUVmean0.680.48–0.85
    Diameter0.680.48–0.85
    COV0.730.53–0.88
    Volume0.750.55–0.90
    TLG0.790.59–0.92
    • View popup
    TABLE 2

    Results of ROC Analysis

    ParameterAUC95% confidence interval
    Early response*
     Kurtosis0.500.29–0.71
     Skewness0.500.29–0.71
     SUVmean0.570.36–0.75
     TLG0.600.39–0.78
     Volume0.660.45–0.83
     Diameter0.680.48–0.85
     SUVmax0.680.48–0.85
     COV0.830.63–0.94
    Late response†
     Volume0.510.31–0.70
     SUVmean0.510.32–0.71
     Diameter0.680.47–0.87
     SUVmax0.740.53–0.89
     TLG0.740.54–0.89
     Skewness0.740.52–0.90
     Kurtosis0.740.53–0.90
     COV0.890.71–0.98
    • ↵* Time point 1→time point 2.

    • ↵† Time point 1→time point 3.

    • View popup
    TABLE 3

    Median Survival Estimates for Kaplan–Meier Analysis

    Time pointMean progression-free survival (d)Mean overall survival (d)
    1, COV ≥ 0.372,2102,362
    1, COV < 0.371,4451,967
    1→2, ΔCOV ≥ −0.092,1922,351
    1→2, ΔCOV < −0.091,5182,056
    1→3, ΔCOV ≥ 0.112,2612,351
    1→3, ΔCOV < 0.111,4452,056
    Overall patients2,0532,274
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Journal of Nuclear Medicine: 55 (6)
Journal of Nuclear Medicine
Vol. 55, Issue 6
June 1, 2014
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Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer
Ralph A. Bundschuh, Julia Dinges, Larissa Neumann, Martin Seyfried, Norbert Zsótér, Laszló Papp, Robert Rosenberg, Karen Becker, Sabrina T. Astner, Martin Henninger, Ken Herrmann, Sibylle I. Ziegler, Markus Schwaiger, Markus Essler
Journal of Nuclear Medicine Jun 2014, 55 (6) 891-897; DOI: 10.2967/jnumed.113.127340

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Textural Parameters of Tumor Heterogeneity in 18F-FDG PET/CT for Therapy Response Assessment and Prognosis in Patients with Locally Advanced Rectal Cancer
Ralph A. Bundschuh, Julia Dinges, Larissa Neumann, Martin Seyfried, Norbert Zsótér, Laszló Papp, Robert Rosenberg, Karen Becker, Sabrina T. Astner, Martin Henninger, Ken Herrmann, Sibylle I. Ziegler, Markus Schwaiger, Markus Essler
Journal of Nuclear Medicine Jun 2014, 55 (6) 891-897; DOI: 10.2967/jnumed.113.127340
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Keywords

  • rectal cancer
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