Anatomical testing with CCTA as the initial noninvasive diagnostic modality in patients with suspected CAD resulted in lower risk of nonfatal MI than usual care with functional testing, at the expense of more frequent use of invasive procedures.

No abstract

We investigated whether a biological and radiological score, derived from neutrophilia and quantitative imaging biomarkers extracted from FDG-PET scans, could predict outcome in locally advanced cervical cancer (LACC) patients treated with definitive chemoradiation plus image-guided adaptive brachytherapy (IGABT). Materials/Methods: We included retrospectively and consecutively patients treated in our institution between 2006 and 2013 with both baseline FDG-PET/CT and complete blood count prior to any treatment. We divided patients into two groups depending on the PET device used: the training set (TS) and the validation set (VS). Tumors were semi-automatically delineated by applying a threshold of 40% of maximum SUV (Standardized Uptake Value) in a manually drawn region of interest. Images from TS were resampled to VS-voxel grid to reduce differences between devices. LIFEx software was used to calculate 42 conventional and textural imaging features. The optimal index for recurrence prediction was selected using time-dependent Area Under the Curve (td-AUC) for 3-year Local Control (LC) and cutoff using Youden Index. We defined the "Neutrophil SUV Grade" (NSG) score according to the number of risk factors (i) neutrophilia; (ii) high-risk radiomic index: 0 if none, 1 if one, 2 if both. The prognostic value of the proposed score was evaluated for LC and overall survival (OS). Results: 108 patients were identified. Estimated 3-year LC was 72% (95% CI: 62e84%) in TS (nZ69), 65% (95%CI: 51e82%) in VS (nZ39). Using 7 G/L cutoff to define neutrophilia, 19 patients (27%) and 12 patients (31%) had neutrophilia in TS and VS respectively (pZ0.72). Td-AUC for neutrophil count to predict 3-year LC was 0.61 in TS. In TS, SUV peak (defined as the maximum average SUV within a 1 mL sphere located in the tumor) was selected as the strongest index associated with 3year LC (td-AUCZ0.75), and optimal cutoff was 10. There was no interaction on LC between neutrophilia and high-risk SUV peak (pZ0.074). In univariate analysis, hazard ratio (HR) for worse LC was 2.6 for neutrophilia, 4.4 for high-risk SUV peak , and 9.2 for both (NSGZ2) in TS. In multivariate analysis, both neutrophilia (HRZ3.0, pZ0.017) and high-risk SUV peak (HRZ1.4, pZ0.007) independently predicted poor LC in TS. NSG scoreZ2 independently decreased LC (HRZ7.5, p<0.001) and OS (HRZ5.8, pZ0.001) in TS. NSG scoreZ2 was validated in VS (HRZ5.2 for OS and 3.5 for LC, p<0.02). Conclusion: In our series, SUV peak was superior to other individual radiomic indices. In LACC, NSG score combining neutrophilia and FDG-PET-derived SUV peak predicts worse OS and LC. FDG-PET-derived SUV peak combined with neutrophilia may be an independent biomarker that could allow the early identification of patients with poor outcome to drive personalized therapeutic strategies.