Dynamic FDG-PET imaging for differentiating metastatic from non-metastatic lymph nodes of lung cancer

Wumener, Xieraili; Zhang, Yarong; Wang, Zhenguo; Zhang, Maoqun; Zang, Zihan; Huang, Bin; Liu, Ming; Huang, Shengyun; Huang, Yong; Wang, Peng; Liang, Ying; Sun, Tao

doi:10.3389/fonc.2022.1005924

Cited by 15 publications

(15 citation statements)

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“…In a later study, normal values for [ 18 F]FDG uptake in selected tissues were estimated and no difference was observed between malignant and non-malignant [ 18 F]FDG avid lesions in MR FDG images [ 34 ]. In contrast to this, a study examining 135 LN in 29 patients with lung cancer found that values could discriminate malignant from benign LN [ 40 ], while an additional, pathological verified, liver lesion was detected in a population of 18 oncological patients [ 37 ]. In the present study, the assessment of MR FDG images resulted in the identification of two extra potential locoregional LN metastasis, one in the axillary level I and one located parasternal.…”

Section: Discussionmentioning

confidence: 99%

Increased lesion detectability in patients with locally advanced breast cancer—A pilot study using dynamic whole-body [18F]FDG PET/CT

Pedersen,

Dias,

Hjorthaug

et al. 2024

EJNMMI Res

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Background Accurate diagnosis of axillary lymph node (ALN) metastases is essential for prognosis and treatment planning in breast cancer. Evaluation of ALN is done by ultrasound, which is limited by inter-operator variability, and by sentinel lymph node biopsy and/or ALN dissection, none of which are without risks and/or long-term complications. It is known that conventional 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has limited sensitivity for ALN metastases. However, a recently developed dynamic whole-body (D-WB) [18F]FDG PET/CT scanning protocol, allowing for imaging of tissue [18F]FDG metabolic rate (MRFDG), has been shown to have the potential to increase lesion detectability. The study purpose was to examine detectability of malignant lesions in D-WB [18F]FDG PET/CT compared to conventional [18F]FDG PET/CT. Results This study prospectively included ten women with locally advanced breast cancer who were referred for an [18F]FDG PET/CT as part of their diagnostic work-up. They all underwent D-WB [18F]FDG PET/CT, consisting of a 6 min single bed dynamic scan over the chest region started at the time of tracer injection, a 64 min dynamic WB PET scan consisting of 16 continuous bed motion passes, and finally a contrast-enhanced CT scan, with generation of MRFDG parametric images. Lesion visibility was assessed by tumor-to-background and contrast-to-noise ratios using volumes of interest isocontouring tumors with a set limit of 50% of SUVmax and background volumes placed in the vicinity of tumors. Lesion visibility was best in the MRFDG images, with target-to-background values 2.28 (95% CI: 2.04–2.54) times higher than target-to-background values in SUV images, and contrast-to-noise values 1.23 (95% CI: 1.12–1.35) times higher than contrast-to-noise values in SUV images. Furthermore, five imaging experts visually assessed the images and three additional suspicious lesions were found in the MRFDG images compared to SUV images; one suspicious ALN, one suspicious parasternal lymph node, and one suspicious lesion located in the pelvic bone. Conclusions D-WB [18F]FDG PET/CT with MRFDG images show potential for improved lesion detectability compared to conventional SUV images in locally advanced breast cancer. Further validation in larger cohorts is needed. Clinical trial registration The trial is registered in clinicaltrials.gov, NCT05110443, https://www.clinicaltrials.gov/study/NCT05110443?term=NCT05110443&rank=1.

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Section: Discussionmentioning

confidence: 99%

Increased lesion detectability in patients with locally advanced breast cancer—A pilot study using dynamic whole-body [18F]FDG PET/CT

Pedersen,

Dias,

Hjorthaug

et al. 2024

EJNMMI Res

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“…In terms of diagnostic efficacy, the previous study performed by Skawran et al in 60 cancer lesions and 17 inflammatory/infectious lesions has shown that using a cut-off value for Kimax-60 min of 0.026 ml/g/min delivers a sensitivity of 63.3% and a specificity of 82% for the detection of cancer lesions [ 42 ]. And previous research by our team also found that a cut-off value of Ki-65 min of 0.022 ml/g/min was identified as the optimal compromise point between sensitivity and specificity, with values of 39.50% and 91.80%, respectively, in discriminating between metastatic ( n = 86) and non-metastatic LNs ( n = 49) of lung cancer, and concluded that Ki with high specificity provided a complementary value to SUVmax [ 8 ]. The study performed by Ye Q et al strongly indicated that Ki from dynamic PET can provide superior discrimination between benign and malignant lung nodules than SUV [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

“…While comparing the rate constant values of K1, k2, and k3 estimated by 18 F-FDG, Ki was more commonly used and had been shown to be useful for characterizing tumor metabolism and assessing therapy response by reflecting more accurate changes after therapy [ 11 – 15 ]. The Ki was superior to SUV in differential diagnosing solitary lung nodules and lymph nodes (LNs), as well as in delineating tumor volume [ 6 – 8 , 16 ]. However, the long acquisition time, single bed-position dynamic acquisition (axial extent of view of 15-25 cm), invasive arterial blood sampling, large volume of post-processed data, and the relatively complex process limit the routine use of dynamic PET in clinical practice [ 5 , 17 – 19 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical feasibility study of early 30-minute dynamic FDG-PET scanning protocol for patients with lung lesions

Du,

Wumener,

Zhang

et al. 2024

EJNMMI Phys

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Purpose This study aimed to evaluate the clinical feasibility of early 30-minute dynamic 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography (PET) scanning protocol for patients with lung lesions in comparison to the standard 65-minute dynamic FDG-PET scanning as a reference. Methods Dynamic 18F-FDG PET images of 146 patients with 181 lung lesions (including 146 lesions confirmed by histology) were analyzed in this prospective study. Dynamic images were reconstructed into 28 frames with a specific temporal division protocol for the scan data acquired 65 min post-injection. Ki images and quantitative parameters Ki based on two different acquisition durations [the first 30 min (Ki-30 min) and 65 min (Ki-65 min)] were obtained by applying the irreversible two-tissue compartment model using in-house Matlab software. The two acquisition durations were compared for Ki image quality (including visual score analysis and number of lesions detected) and Ki value (including accuracy of Ki, the value of differential diagnosis of lung lesions and prediction of PD-L1 status) by Wilcoxon’s rank sum test, Spearman’s rank correlation analysis, receiver operating characteristic (ROC) curve, and the DeLong test. The significant testing level (alpha) was set to 0.05. Results The quality of the Ki-30 min images was not significantly different from the Ki-65 min images based on visual score analysis (P > 0.05). In terms of Ki value, among 181 lesions, Ki-65 min was statistically higher than Ki-30 min (0.027 ± 0.017 ml/g/min vs. 0.026 ± 0.018 ml/g/min, P < 0.05), while a very high correlation was obtained between Ki-65 min and Ki-30 min (r = 0.977, P < 0.05). In the differential diagnosis of lung lesions, ROC analysis was performed on 146 histologically confirmed lesions, the area under the curve (AUC) of Ki-65 min, Ki-30 min, and SUVmax was 0.816, 0.816, and 0.709, respectively. According to the Delong test, no significant differences in the diagnostic accuracies were found between Ki-65 min and Ki-30 min (P > 0.05), while the diagnostic accuracies of Ki-65 min and Ki-30 min were both significantly higher than that of SUVmax (P < 0.05). In 73 (NSCLC) lesions with definite PD-L1 expression results, the Ki-65 min, Ki-30 min, and SUVmax in PD-L1 positivity were significantly higher than that in PD-L1 negativity (P < 0.05). And no significant differences in predicting PD-L1 positivity were found among Ki-65 min, Ki-30 min, and SUVmax (AUC = 0.704, 0.695, and 0.737, respectively, P > 0.05), according to the results of ROC analysis and Delong test. Conclusions This study indicates that an early 30-minute dynamic FDG-PET acquisition appears to be sufficient to provide quantitative images with good-quality and accurate Ki values for the assessment of lung lesions and prediction of PD-L1 expression. Protocols with a shortened early 30-minute acquisition time may be considered for patients who have difficulty with prolonged acquisitions to improve the efficiency of clinical acquisitions.

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“…The use of FDG PET images to discover the heterogeneous metabolic response to treatment in patients with NSCLC found patients with a high metabolic response are significantly associated with poor prognosis [ 39 ]. The additional kinetic parameters such as K1, k2, Ki, and Ki/K1 in the dynamic PET scan, compared with SUV max , were associated with not only the metabolic condition of the lesion but also its blood flow and microenvironment [ 40 ], in order to differentiate metastatic and non-metastatic LNs. It appears that the combination of imaging biomarkers and serum metabolites or protein levels could become a feasible tool in the prediction of the prognosis of patients with lung cancers.…”

Section: Discussionmentioning

confidence: 99%

Glycolytic Plasticity of Metastatic Lung Cancer Captured by Noninvasive 18F-FDG PET/CT and Serum 1H-NMR Analysis: An Orthotopic Murine Model Study

Chung

Hung

et al. 2023

Metabolites

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We aim to establish a noninvasive diagnostic platform to capture early phenotypic transformation for metastasis using 18F-FDG PET and 1H-NMR-based serum metabolomics. Mice with implantation of NCI-H460 cells grew only primary lung tumors in the localized group and had both primary and metastatic lung tumors in the metastatic group. The serum metabolites were analyzed using 1H-NMR at the time of PET/CT scan. The glycolysis status and cell proliferation were validated by Western blotting and staining. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of SUVmean and serum metabolites in metastasis. In the metastatic mice, the SUVmean of metastatic tumors was significantly higher than that of primary lung tumors in PET images, which was supported by elevated glycolytic protein expression of HK2 and PKM2. The serum pyruvate level in the metastatic group was significantly lower than that in the localized group, corresponding to increased pyruvate-catalyzed enzyme and proliferation rates in metastatic tumors. In diagnosing localized or metastatic tumors, the areas under the ROC curves of SUVmean and pyruvate were 0.92 and 0.91, respectively, with p < 0.05. In conclusion, the combination of 18F-FDG PET and 1H-NMR-based serum metabolomics demonstrated the feasibility of a glycolytic platform for diagnosing metastatic lung cancers.

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Dynamic FDG-PET imaging for differentiating metastatic from non-metastatic lymph nodes of lung cancer

Cited by 15 publications

References 50 publications

Increased lesion detectability in patients with locally advanced breast cancer—A pilot study using dynamic whole-body [18F]FDG PET/CT

Increased lesion detectability in patients with locally advanced breast cancer—A pilot study using dynamic whole-body [18F]FDG PET/CT

Clinical feasibility study of early 30-minute dynamic FDG-PET scanning protocol for patients with lung lesions

Glycolytic Plasticity of Metastatic Lung Cancer Captured by Noninvasive 18F-FDG PET/CT and Serum 1H-NMR Analysis: An Orthotopic Murine Model Study

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