PT - JOURNAL ARTICLE AU - Ron Epelbaum AU - Alex Frenkel AU - Riad Haddad AU - Natalia Sikorski AU - Ludwig G. Strauss AU - Ora Israel AU - Antonia Dimitrakopoulou-Strauss TI - Tumor Aggressiveness and Patient Outcome in Cancer of the Pancreas Assessed by Dynamic <sup>18</sup>F-FDG PET/CT AID - 10.2967/jnumed.112.107466 DP - 2013 Jan 01 TA - Journal of Nuclear Medicine PG - 12--18 VI - 54 IP - 1 4099 - http://jnm.snmjournals.org/content/54/1/12.short 4100 - http://jnm.snmjournals.org/content/54/1/12.full SO - J Nucl Med2013 Jan 01; 54 AB - This study aimed to assess the role of a quantitative dynamic PET model in pancreatic cancer as a potential index of tumor aggressiveness and predictor of survival. Methods: Seventy-one patients with 18F-FDG–avid adenocarcinoma of the pancreas before treatment were recruited, including 27 with localized tumors (11 underwent pancreatectomy, and 16 had localized nonresectable tumors) and 44 with metastatic disease. Dynamic 18F-FDG PET images were acquired over a 60-min period, followed by a whole-body PET/CT study. Quantitative data measurements were based on a 2-compartment model, and the following variables were calculated: VB (fractional blood volume in target area), K1 and k2 (kinetic membrane transport parameters), k3 and k4 (intracellular 18F-FDG phosphorylation and dephosphorylation parameters, respectively), and 18F-FDG INF (global 18F-FDG influx). Results: The single significant variable for overall survival (OS) in patients with localized disease was 18F-FDG INF. Patients with a high 18F-FDG INF (&gt;0.033 min−1) had a median OS of 6 and 5 mo for nonresectable and resected tumors, respectively, versus 15 and 19 mo for a low 18F-FDG INF in nonresectable and resected tumors, respectively (P &lt; 0.04). In metastatic disease, multivariate analysis found VB, K1, and k3 to be significant variables for OS (P &lt; 0.043, &lt;0.031, and &lt;0.009, respectively). Prognostic factors for OS in the entire group of patients that were significant at multivariate analysis were stage of disease, VB, K1, and 18F-FDG INF (P &lt; 0.00035, &lt;0.03, &lt;0.024, and &lt;0.008, respectively). Median OS for all patients with a high 18F-FDG INF, low VB, and high K1 was 3 mo, as opposed to 14 mo in patients with a low 18F-FDG INF, high VB, and low K1 (P &lt; 0.021), irrespective of stage and resectability. Conclusion: Quantitative 18F-FDG kinetic parameters measured by dynamic PET in newly diagnosed pancreatic cancer correlated with the aggressiveness of disease. The 18F-FDG INF was the single most significant variable for OS in patients with localized disease, whether resectable or not.