Marin-Oyaga Victor A, Salavati Ali, Houshmand Sina, Pasha Ahmed Khurshid, Gharavi Mohammad, Saboury Babak, Basu Sandip, Torigian Drew A, Alavi Abass
Department of Radiology, Perelman School of Medicine, University of Pennsylvania and Hospital of the University of Pennsylvania, Philadelphia, 3400 Spruce Street, PA 19104, USA.
Hell J Nucl Med. 2015 Jan-Apr;18(1):11-8. doi: 10.1967/s002449910162. Epub 2015 Feb 13.
Treatment of malignant pleural mesothelioma (MPM) remains very challenging. Assessment of response to treatment is necessary for modifying treatment and using new drugs. Global disease assessment (GDA) by implementing image processing methods to extract more information out of positron emission tomography (PET) images may provide reliable information. In this study we show the feasibility of this method of semi-quantification in patients with mesothelioma, and compare it with the conventional methods. We also present a review of the literature about this topic.
Nineteen subjects with histologically proven MPM who had undergone fluoride-18-fluorodeoxyglucose PET/computed tomography ((18)F-FDG PET/CT) before and after treatment were included in this study. An adaptive contrast-oriented thresholding algorithm was used for the image analysis and semi-quantification. Metabolic tumor volume (MTV), maximum and mean standardized uptake volume (SUVmax, SUVmean) and total lesion glycolysis (TLG) were calculated for each region of interest. The global tumor glycolysis (GTG) was obtained by summing up all TLG. Treatment response was assessed by the European Organisation for Research and Treatment of Cancer (EORTC) criteria and the changes of GTG. Agreement between global disease assessment and conventional method was also determined.
In patients with progressive disease based on EORTC criteria, GTG showed an increase of 150.7 but in patients with stable or partial response, GTG showed a decrease of 433.1. The SUVmax of patients before treatment was 5.95 (SD: 2.93) and after the treatment it increased to 6.38 (SD: 3.19). Overall concordance of conventional method with GDA method was 57%. Concordance of progression of disease based on conventional method was 44%, stable disease was 85% and partial response was 33%. Discordance was 55%, 14% and 66%.
Adaptive contrast-oriented thresholding algorithm is a promising method to quantify the whole tumor glycolysis in patients with mesothelioma. We are able to assess the total metabolic lesion volume, lesion glycolysis, SUVmax, tumor SUVmean and GTG for this particular tumor. Also we were able to demonstrate the potential use of this technique in the monitoring of treatment response. More studies comparing this technique with conventional and other global disease assessment methods are needed in order to clarify its role in the assessment of treatment response and prognosis of these patients.
恶性胸膜间皮瘤（MPM）的治疗仍然极具挑战性。评估治疗反应对于调整治疗方案和使用新药十分必要。通过实施图像处理方法从正电子发射断层扫描（PET）图像中提取更多信息进行整体疾病评估（GDA），可能会提供可靠信息。在本研究中，我们展示了这种半定量方法在间皮瘤患者中的可行性，并将其与传统方法进行比较。我们还对有关该主题的文献进行了综述。
本研究纳入了19例经组织学证实为MPM且在治疗前后均接受过氟-18-氟脱氧葡萄糖PET/计算机断层扫描（(18)F-FDG PET/CT）的患者。采用一种自适应的基于对比度的阈值算法进行图像分析和半定量。计算每个感兴趣区域的代谢肿瘤体积（MTV）、最大和平均标准化摄取值（SUVmax、SUVmean）以及总病变糖酵解（TLG）。通过汇总所有TLG获得整体肿瘤糖酵解（GTG）。根据欧洲癌症研究与治疗组织（EORTC）标准和GTG的变化评估治疗反应。还确定了整体疾病评估与传统方法之间的一致性。
根据EORTC标准，疾病进展的患者中，GTG增加了150.7，但病情稳定或部分缓解的患者中，GTG减少了433.1。治疗前患者的SUVmax为5.95（标准差：2.93），治疗后增至6.38（标准差：3.19）。传统方法与GDA方法的总体一致性为57%。基于传统方法的疾病进展一致性为44%，病情稳定为85%，部分缓解为33%。不一致性分别为55%、14%和66%。
自适应的基于对比度的阈值算法是一种有前景的方法，可用于量化间皮瘤患者的整体肿瘤糖酵解。我们能够评估这种特定肿瘤的总代谢病变体积、病变糖酵解、SUVmax、肿瘤SUVmean和GTG。我们还能够证明该技术在监测治疗反应中的潜在用途。为了阐明其在评估这些患者的治疗反应和预后中的作用，需要更多将该技术与传统及其他整体疾病评估方法进行比较的研究。
