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Research ArticleOncology

18F-FDG PET/MRI for Therapy Response Assessment of Isolated Limb Perfusion in Patients with Soft-Tissue Sarcomas

Johannes Grueneisen, Benedikt Schaarschmidt, Aydin Demircioglu, Michal Chodyla, Ole Martin, Stefanie Bertram, Axel Wetter, Sebastian Bauer, Wolfgang Peter Fendler, Lars Podleska, Michael Forsting, Ken Herrmann and Lale Umutlu
Journal of Nuclear Medicine November 2019, 60 (11) 1537-1542; DOI: https://doi.org/10.2967/jnumed.119.226761
Johannes Grueneisen
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Benedikt Schaarschmidt
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Aydin Demircioglu
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Michal Chodyla
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Ole Martin
2Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany
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Stefanie Bertram
3Institute of Pathology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Axel Wetter
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Sebastian Bauer
4Sarcoma Center, Western German Cancer Center, University of Duisburg–Essen, Essen, Germany
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Wolfgang Peter Fendler
5Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
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Lars Podleska
6Sarcoma Surgery Division, Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Michael Forsting
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Ken Herrmann
5Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
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Lale Umutlu
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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  • FIGURE 1.
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    FIGURE 1.

    A 56-y-old patient with a leiomyosarcoma of the left limb (arrows). The tumor manifestation does not show significant changes in tumor size (diameter: from 243 to 256 mm), contrast-enhancing tumor parts and metabolic activity (SUVpeak: from 3.9 to 3.6). Histopathologic analysis revealed a regression grade 5 (histopathologic nonresponder).

  • FIGURE 2.
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    FIGURE 2.

    Receiver-operating-characteristic curves of ratings according to RECIST, Choi criteria, and PERCIST.

  • FIGURE 3.
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    FIGURE 3.

    A 60-y-old patient with an undifferentiated pleomorphic sarcoma of the right limb (arrows). The tumor reveals an extensive tumor necrosis and a significant reduction of 18F-FDG uptake (SUVpeak: from 15.3 to 4.1) between pre- (A–C) and posttherapeutic (D–F) examinations, whereas tumor size remains substantially stable (diameter: from 99 to 97 mm). Histopathologic analysis revealed a regression grade 3 (histopathologic responder).

  • FIGURE 4.
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    FIGURE 4.

    Receiver-operating-characteristic curves of quantitative variables for assessment of therapeutic response to ILP.

Tables

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    TABLE 1

    Distribution of Histologic Subtypes of STS

    Histologic subtypePatients (n)
    Undifferentiated pleomorphic sarcoma9
    Synovial sarcoma9
    Undifferentiated spindle cell sarcoma8
    Myxofibrosarcoma7
    Liposarcoma4
    Epitheloid sarcoma2
    Leiomyosarcoma2
    Clear cell sarcoma1
    Angiosarcoma1
    Fibrosarcoma1
    Malignant peripheral nerve sheath tumor1
    Total45
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    TABLE 2

    Tumor Grades of All Patients, According to 6-Stage Salzer-Kuntschik Regression Scale

    Tumor gradePatients (n)
    I6
    II8
    III13
    IV10
    V7
    VI1
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    TABLE 3

    Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value, Diagnostic Accuracy, and AUC of the 3 Response Criteria for Differentiation Between Responders and Nonresponders

    Response criteriaSensitivitySpecificityPositive predictive valueNegative predictive valueAccuracyAUC
    RECIST22.2%88.9%75.0%43.2%48.9%0.556
    Choi criteria70.4%44.4%65.5%50.0%60.0%0.574
    PERCIST85.2%77.8%85.2%77.8%82.2%0.815
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    TABLE 4

    P Values for Comparison of RECIST, Choi criteria, and PERCIST

    ParameterRECIST vs. ChoiRECIST vs. PERCISTChoi vs. PERCIST
    Sensitivity0.0016*0.0003*0.2482
    Specificity0.0140*0.31730.0286*
    Positive predictive value0.82050.82050.0202*
    Negative predictive value0.48210.0014*0.0995
    Accuracy0.39720.0057*0.0727
    AUC0.81970.0016*0.0069*
    • ↵* Statistically significant difference.

Additional Files

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Journal of Nuclear Medicine: 60 (11)
Journal of Nuclear Medicine
Vol. 60, Issue 11
November 1, 2019
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18F-FDG PET/MRI for Therapy Response Assessment of Isolated Limb Perfusion in Patients with Soft-Tissue Sarcomas
Johannes Grueneisen, Benedikt Schaarschmidt, Aydin Demircioglu, Michal Chodyla, Ole Martin, Stefanie Bertram, Axel Wetter, Sebastian Bauer, Wolfgang Peter Fendler, Lars Podleska, Michael Forsting, Ken Herrmann, Lale Umutlu
Journal of Nuclear Medicine Nov 2019, 60 (11) 1537-1542; DOI: 10.2967/jnumed.119.226761

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18F-FDG PET/MRI for Therapy Response Assessment of Isolated Limb Perfusion in Patients with Soft-Tissue Sarcomas
Johannes Grueneisen, Benedikt Schaarschmidt, Aydin Demircioglu, Michal Chodyla, Ole Martin, Stefanie Bertram, Axel Wetter, Sebastian Bauer, Wolfgang Peter Fendler, Lars Podleska, Michael Forsting, Ken Herrmann, Lale Umutlu
Journal of Nuclear Medicine Nov 2019, 60 (11) 1537-1542; DOI: 10.2967/jnumed.119.226761
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Keywords

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