Department of Medical Imaging and Radiology, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
Department of Surgery, National Taiwan University College of Medicine and Hospital, No 7, Chung-Shan South Rd, Taipei, 10016, Taiwan.
Eur J Nucl Med Mol Imaging. 2018 Jul;45(7):1205-1217. doi: 10.1007/s00259-018-3960-0. Epub 2018 Feb 23.
To correlate the overall survival (OS) with the imaging biomarkers of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy, and glucose metabolic activity derived from integrated fluorine 18 fluorodeoxyglucose positron emission tomography (F-FDG PET)/MRI in patients with pancreatic cancer.
This prospective study was approved by the institutional review board and informed consent was obtained from all participants. Sixty-three consecutive patients (mean age, 62.7 ± 12 y; men/women, 40/23) with pancreatic cancer underwent PET/MRI before treatment. The imaging biomarkers were comprised of DCE-MRI parameters (peak, IAUC , K , k , v ), the minimum apparent diffusion coefficient (ADC), choline level, standardized uptake values, metabolic tumor volume, and total lesion glycolysis (TLG) of the tumors. The relationships between these imaging biomarkers with OS were evaluated with the Kaplan-Meier and Cox proportional hazard models.
Seventeen (27%) patients received curative surgery, with the median follow-up duration being 638 days. Univariate analysis showed that patients at a low TNM stage (≦3, P = 0.041), high peak (P = 0.006), high ADC (P = 0.002) and low TLG (P = 0.01) had better OS. Moreover, high TLG/peak ratio was associated with poor OS (P = 0.016). Multivariate analysis indicated that ADC (P = 0.011) and TLG/peak ratio (P = 0.006) were independent predictors of OS after adjustment for age, gender, tumor size, and TNM stage. The TLG/peak ratio was an independent predictor of OS in a subgroup of patients who did not receive curative surgery (P = 0.013).
The flow-metabolism mismatch reflected by the TLG/peak ratio may better predict OS than other imaging biomarkers from PET/MRI in pancreatic cancer patients.
探讨胰腺癌患者动态对比增强磁共振成像（DCE-MRI）、弥散加权成像（DWI）、磁共振波谱和氟-18 氟代脱氧葡萄糖正电子发射断层扫描（F-FDG PET）/MRI 衍生的葡萄糖代谢活性等影像学生物标志物与总生存期（OS）的相关性。
本前瞻性研究经机构审查委员会批准，并获得所有参与者的知情同意。63 例连续胰腺癌患者（平均年龄 62.7±12 岁；男/女 40/23）在治疗前接受了 PET/MRI 检查。影像学生物标志物包括 DCE-MRI 参数（峰值、IAUC、K、k、v）、最小表观弥散系数（ADC）、胆碱水平、标准化摄取值、代谢肿瘤体积和总病变糖酵解（TLG）。采用 Kaplan-Meier 和 Cox 比例风险模型评估这些影像学生物标志物与 OS 的关系。
17 例（27%）患者接受根治性手术，中位随访时间为 638 天。单因素分析显示，TNM 分期较低（≦3，P=0.041）、峰值较高（P=0.006）、ADC 较高（P=0.002）和 TLG 较低（P=0.01）的患者 OS 较好。此外，高 TLG/峰值比与较差的 OS 相关（P=0.016）。多因素分析表明，在调整年龄、性别、肿瘤大小和 TNM 分期后，ADC（P=0.011）和 TLG/峰值比（P=0.006）是 OS 的独立预测因子。在未接受根治性手术的患者亚组中，TLG/峰值比是 OS 的独立预测因子（P=0.013）。
与来自 PET/MRI 的其他影像学生物标志物相比，TLG/峰值比反映的流量-代谢不匹配可能更好地预测胰腺癌患者的 OS。
