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Research ArticleOncology

Evaluation of 18F-FDG PET and DWI Datasets for Predicting Therapy Response of Soft-Tissue Sarcomas Under Neoadjuvant Isolated Limb Perfusion

Michal Chodyla, Aydin Demircioglu, Benedikt M. Schaarschmidt, Stefanie Bertram, Nils Martin Bruckmann, Jennifer Haferkamp, Yan Li, Sebastian Bauer, Lars Podleska, Christoph Rischpler, Michael Forsting, Ken Herrmann, Lale Umutlu and Johannes Grueneisen
Journal of Nuclear Medicine March 2021, 62 (3) 348-353; DOI: https://doi.org/10.2967/jnumed.120.248260
Michal Chodyla
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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Benedikt M. Schaarschmidt
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Stefanie Bertram
2Institute of Pathology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Nils Martin Bruckmann
3Department of Diagnostic and Interventional Radiology, University Hospital Dusseldorf, University of Dusseldorf, Dusseldorf, Germany
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Jennifer Haferkamp
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Yan Li
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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Lars Podleska
5Sarcoma Surgery Division, Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
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Christoph Rischpler
6Department of Nuclear Medicine, 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
6Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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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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Johannes Grueneisen
1Department of Diagnostic and Interventional Radiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
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Abstract

Our purpose was to evaluate and compare the clinical utility of simultaneously obtained quantitative 18F-FDG PET and diffusion-weighted MRI datasets for predicting the histopathologic response of soft-tissue sarcoma (STS) to neoadjuvant isolated limb perfusion (ILP). Methods: In total, 37 patients with a confirmed STS of the extremities underwent 18F-FDG PET/MRI before and after ILP with melphalan and tumor necrosis factor-α. For each patient, the maximum tumor size, metabolic activity (SUV), and diffusion restriction (apparent diffusion coefficient, ADC) were determined in pre- and posttherapeutic examinations, and percentage changes during treatment were calculated. Mann–Whitney U testing and receiver-operating-characteristic analysis were used to compare the results of the different quantitative parameters to predict the histopathologic response to therapy. Results from histopathologic analysis after tumor resection served as the reference standard, and patients were defined as responders or nonresponders based on the grading scale by Salzer-Kuntschik. Results: Histopathologic analysis categorized 22 (59%) patients as responders (grades I–III) and 15 (41%) as nonresponders (grades IV–VI). Under treatment, tumors in responders showed a mean reduction in size (−9.7%) and metabolic activity (SUVpeak, −51.9%; SUVmean, −43.8%), as well as an increase of the ADC values (ADCmin, +29.4%; ADCmean, +32.8%). The percentage changes in nonresponders were −6.2% in tumor size, −17.3% in SUVpeak, −13.9% in SUVmean, +15.3% in ADCmin, and +14.6% in ADCmean. Changes in SUV and ADCmean significantly differed between responders and nonresponders (<0.01), whereas differences in tumor size and ADCmin did not (>0.05). The corresponding AUCs were 0.63 for tumor size, 0.87 for SUVpeak, 0.82 for SUVmean, 0.63 for ADCmin, 0.84 for ADCmean, and 0.89 for ratio of ADCmean to SUVpeak. Conclusion: PET- and MRI-derived quantitative parameters (SUV and ADCmean) and their combination performed well in predicting the histopathologic therapy response of STS to neoadjuvant ILP. Therefore, integrated PET/MRI could serve as a valuable tool for pretherapeutic assessment as well as monitoring of neoadjuvant treatment strategies of STS.

  • soft-tissue sarcoma
  • isolated limb perfusion
  • 18F-FDG PET
  • DWI
  • therapy response prediction

Footnotes

  • Published online Jul. 31, 2020.

  • © 2021 by the Society of Nuclear Medicine and Molecular Imaging.
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Journal of Nuclear Medicine: 62 (3)
Journal of Nuclear Medicine
Vol. 62, Issue 3
March 1, 2021
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Evaluation of 18F-FDG PET and DWI Datasets for Predicting Therapy Response of Soft-Tissue Sarcomas Under Neoadjuvant Isolated Limb Perfusion
Michal Chodyla, Aydin Demircioglu, Benedikt M. Schaarschmidt, Stefanie Bertram, Nils Martin Bruckmann, Jennifer Haferkamp, Yan Li, Sebastian Bauer, Lars Podleska, Christoph Rischpler, Michael Forsting, Ken Herrmann, Lale Umutlu, Johannes Grueneisen
Journal of Nuclear Medicine Mar 2021, 62 (3) 348-353; DOI: 10.2967/jnumed.120.248260

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Evaluation of 18F-FDG PET and DWI Datasets for Predicting Therapy Response of Soft-Tissue Sarcomas Under Neoadjuvant Isolated Limb Perfusion
Michal Chodyla, Aydin Demircioglu, Benedikt M. Schaarschmidt, Stefanie Bertram, Nils Martin Bruckmann, Jennifer Haferkamp, Yan Li, Sebastian Bauer, Lars Podleska, Christoph Rischpler, Michael Forsting, Ken Herrmann, Lale Umutlu, Johannes Grueneisen
Journal of Nuclear Medicine Mar 2021, 62 (3) 348-353; DOI: 10.2967/jnumed.120.248260
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Keywords

  • soft-tissue sarcoma
  • isolated limb perfusion
  • 18F-FDG PET
  • DWI
  • therapy response prediction
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