Younis Jehan Ahmed, Al Antably Ismael Mohammed, Zamzam Manal, Salem Hala Taha, Zaki Eman Mohammed, Hassanian Omneya Ahmed
Department of Oncology and Nuclear Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Nuclear Medicine, National Cancer Institute, Children Cancer Hospital, Cairo, Egypt.
World J Nucl Med. 2019 Dec 18;18(4):378-388. doi: 10.4103/wjnm.WJNM_52_18. eCollection 2019 Oct-Dec.
The aim of our study was to evaluate the role of F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and magnetic resonance imaging (MRI) in prediction of response to neoadjuvant chemotherapy (NAC) in pediatric osteosarcoma (OS) patients compared to percentage of tumor necrosis after surgical excision of the tumor. Forty-six pediatric OS patients treated with neoadjuvant chemotherapy and surgery were underwent PET/CT and MRI before, after 3 cycles, and after the completion of neoadjuvant chemotherapy. Imaging parameters include maximum standardized uptake value (SUVmax1, 2, and 3), tumor liver ratio (TLR 1, 2, and 3), and MRI tumor volume (MRTV 1, 2, and 3) at initial assessment before starting NAC, after finishing three cycles and after finishing 6 cycles before tumor excision, respectively. Cutoff values of the PET/CT and MRI parameters were determined using receiver operating characteristic (ROC) curve analysis and percentage of tumor necrosis of postsurgical specimen. Fourteen patients were good responders (30.4%), with more than 90% tumor necrosis, while 31 patients were poor responders (67.4%). The results of one patient were missed. We noticed that higher sensitivity for detecting poor responders was detected by SUVmax3/1, TLR3/1, and MRTV2/1 ratio cutoff values, while higher specificity was detected by TRL2 and SUVmax3 cutoff values. ROC curve analysis of MRTV2/1 and MRTV3/1 ratio was fair in predicting poor responders. PET/CT parameters are capable of predicting histological response to NAC in OS patients with overall sensitivity and specificity higher than MRI parameters.
我们研究的目的是评估氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（PET/CT）和磁共振成像（MRI）在预测小儿骨肉瘤（OS）患者新辅助化疗（NAC）反应中的作用，并与肿瘤手术切除后的肿瘤坏死百分比进行比较。46例接受新辅助化疗和手术治疗的小儿OS患者在新辅助化疗前、3个周期后以及新辅助化疗完成后接受了PET/CT和MRI检查。成像参数包括在开始NAC前的初始评估时、完成三个周期后以及肿瘤切除前完成6个周期后，分别测量的最大标准化摄取值（SUVmax1、2和3）、肿瘤肝脏比值（TLR 1、2和3）以及MRI肿瘤体积（MRTV 1、2和3）。使用受试者操作特征（ROC）曲线分析和手术标本的肿瘤坏死百分比来确定PET/CT和MRI参数的临界值。14例患者为良好反应者（30.4%），肿瘤坏死率超过90%，而31例患者为不良反应者（67.4%）。1例患者的结果缺失。我们注意到，通过SUVmax3/1、TLR3/1和MRTV2/1比值临界值检测不良反应者的敏感性较高，而通过TRL2和SUVmax3临界值检测的特异性较高。MRTV2/1和MRTV3/1比值的ROC曲线分析在预测不良反应者方面表现一般。PET/CT参数能够预测OS患者对NAC的组织学反应，其总体敏感性和特异性高于MRI参数。
