Ohno Yoshiharu, Fujisawa Yasuko, Koyama Hisanobu, Kishida Yuji, Seki Shinichiro, Sugihara Naoki, Yoshikawa Takeshi
Division of Functional and Diagnostic Imaging Research, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan; Advanced Biomedical Imaging Research Center, Kobe University Graduate School of Medicine, Kobe, Japan.
Toshiba Medical Systems Corporation, Otawara, Japan.
Eur J Radiol. 2017 Jan;86:83-91. doi: 10.1016/j.ejrad.2016.11.008. Epub 2016 Nov 6.
To directly compare the capability of dynamic first-pass contrast-enhanced (CE-) perfusion area-detector CT (ADCT) and PET/CT for early prediction of treatment response, disease progression and overall survival of non-small cell carcinoma (NSCLC) patients treated with chemoradiotherapy.
Fifty-three consecutive Stage IIIB NSCLC patients who had undergone PET/CT, dynamic first-pass CE-perfusion ADCT, chemoradiotherapy, and follow-up examination were enrolled in this study. They were divided into two groups: 1) complete or partial response (CR+PR) and 2) stable or progressive disease (SD+PD). Pulmonary arterial and systemic arterial perfusions and total perfusion were assessed at targeted lesions with the dual-input maximum slope method, permeability surface and distribution volume with the Patlak plot method, tumor perfusion with the single-input maximum slope method, and SUV, and results were averaged to determine final values for each patient. Next, step-wise regression analysis was used to determine which indices were the most useful for predicting therapeutic effect. Finally, overall survival of responders and non-responders assessed by using the indices that had a significant effect on prediction of therapeutic outcome was statistically compared.
The step-wise regression test showed that therapeutic effect (r=0.63, p=0.01) was significantly affected by the following three factors in order of magnitude of impact: systemic arterial perfusion, total perfusion, and SUV. Mean overall survival showed a significant difference for total perfusion (p=0.003) and systemic arterial perfusion (p=0.04).
Dynamic first-pass CE-perfusion ADCT as well as PET/CT are useful for treatment response prediction in NSCLC patients treated with chemoradiotherapy.
直接比较动态首过对比增强（CE-）灌注面积探测器CT（ADCT）和PET/CT对接受放化疗的非小细胞肺癌（NSCLC）患者治疗反应、疾病进展和总生存期的早期预测能力。
本研究纳入了53例连续的IIIB期NSCLC患者，这些患者均接受了PET/CT、动态首过CE-灌注ADCT、放化疗及随访检查。他们被分为两组：1）完全或部分缓解（CR+PR）组和2）疾病稳定或进展（SD+PD）组。采用双输入最大斜率法评估靶病灶的肺动脉和体动脉灌注及总灌注，采用Patlak图法评估通透性表面和分布容积，采用单输入最大斜率法评估肿瘤灌注，并计算SUV，将结果进行平均以确定每位患者的最终值。接下来，采用逐步回归分析确定哪些指标对预测治疗效果最有用。最后，对使用对治疗结果预测有显著影响的指标评估的反应者和无反应者的总生存期进行统计学比较。
逐步回归检验显示，治疗效果（r=0.63，p=0.01）受以下三个因素的显著影响，影响程度依次为：体动脉灌注、总灌注和SUV。总灌注（p=0.003）和体动脉灌注（p=0.04）的平均总生存期显示出显著差异。
动态首过CE-灌注ADCT以及PET/CT对接受放化疗的NSCLC患者的治疗反应预测均有用。
