Christensen Tine Nøhr, Langer Seppo W, Villumsen Katrine Engholm, Johannesen Helle Hjorth, Löfgren Johan, Keller Sune Høgild, Hansen Adam Espe, Kjaer Andreas, Fischer Barbara Malene
Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Cluster for Molecular Imaging, University of Copenhagen, Copenhagen, Denmark.
Eur J Hybrid Imaging. 2020 Jan 27;4(1):2. doi: 10.1186/s41824-019-0071-5.
Small cell lung cancer (SCLC) is an aggressive cancer often presenting in an advanced stage and prognosis is poor. Early response evaluation may have impact on the treatment strategy.
We evaluated F-fluorothymidine-(FLT)-PET/diffusion-weighted-(DW)-MRI early after treatment start to describe biological changes during therapy, the potential of early response evaluation, and the added value of FLT-PET/DW-MRI.
Patients with SCLC referred for standard chemotherapy were eligible. FLT-PET/DW-MRI of the chest and brain was acquired within 14 days after treatment start. FLT-PET/DW-MRI was compared with pretreatment FDG-PET/CT. Standardized uptake value (SUV), apparent diffusion coefficient (ADC), and functional tumor volumes were measured. FDG-SUV, FLT-SUV, and ADC; spatial distribution of aggressive areas; and voxel-by-voxel analyses were evaluated to compare the biological information derived from the three functional imaging modalities. FDG-SUV, FLT-SUV, and ADC were also analyzed for ability to predict final treatment response.
Twelve patients with SCLC completed FLT-PET/MRI 1-9 days after treatment start. In nine patients, pretreatment FDG-PET/CT was available for comparison. A total of 16 T-sites and 12 N-sites were identified. No brain metastases were detected. FDG-SUV was 2.0-22.7 in T-sites and 5.5-17.3 in N-sites. FLT-SUV was 0.6-11.5 in T-sites and 1.2-2.4 in N-sites. ADC was 0.76-1.74 × 10 mm/s in T-sites and 0.88-2.09 × 10 mm/s in N-sites. FLT-SUV correlated with FDG-SUV, and voxel-by-voxel correlation was positive, though the hottest regions were dissimilarly distributed in FLT-PET compared to FDG-PET. FLT-SUV was not correlated with ADC, and voxel-by-voxel analyses and spatial distribution of aggressive areas varied with no systematic relation. LT-SUV was significantly lower in responding lesions than non-responding lesions (mean FLT-SUV in T-sites: 1.5 vs. 5.7; p = 0.007, mean FLT-SUV in N-sites: 1.6 vs. 2.2; p = 0.013).
FLT-PET and DW-MRI performed early after treatment start may add biological information in patients with SCLC. Proliferation early after treatment start measured by FLT-PET is a promising predictor for final treatment response that warrants further investigation.
Clinicaltrials.gov, NCT02995902. Registered 11 December 2014 - Retrospectively registered.
小细胞肺癌（SCLC）是一种侵袭性癌症，常于晚期出现，预后较差。早期反应评估可能会影响治疗策略。
我们在治疗开始后早期评估¹⁸F-氟胸苷（FLT）-PET/扩散加权（DW）-MRI，以描述治疗期间的生物学变化、早期反应评估的潜力以及FLT-PET/DW-MRI的附加价值。
符合标准化疗的SCLC患者入选。在治疗开始后14天内进行胸部和脑部的FLT-PET/DW-MRI检查。将FLT-PET/DW-MRI与治疗前的¹⁸F-FDG-PET/CT进行比较。测量标准化摄取值（SUV）、表观扩散系数（ADC）和功能性肿瘤体积。评估¹⁸F-FDG-SUV、FLT-SUV和ADC；侵袭性区域的空间分布；以及逐像素分析，以比较从三种功能成像模式获得的生物学信息。还分析¹⁸F-FDG-SUV、FLT-SUV和ADC预测最终治疗反应的能力。
12例SCLC患者在治疗开始后1 - 9天完成了FLT-PET/MRI检查。9例患者有治疗前的¹⁸F-FDG-PET/CT可供比较。共识别出16个原发灶（T）部位和12个区域淋巴结（N）部位。未检测到脑转移。原发灶部位¹⁸F-FDG-SUV为2.0 - 22.7，区域淋巴结部位为5.5 - 17.3。原发灶部位FLT-SUV为0.6 - 11.5，区域淋巴结部位为1.2 - 2.4。原发灶部位ADC为0.76 - 1.74×10⁻³mm²/s，区域淋巴结部位为0.88 - 2.09×10⁻³mm²/s。FLT-SUV与¹⁸F-FDG-SUV相关，逐像素相关性为正，尽管与¹⁸F-FDG-PET相比，FLT-PET中最热区域的分布不同。FLT-SUV与ADC不相关，逐像素分析和侵袭性区域的空间分布各不相同，无系统关系。治疗有反应的病灶中FLT-SUV显著低于无反应的病灶（原发灶部位平均FLT-SUV：1.5 vs. 5.7；p = 0.007，区域淋巴结部位平均FLT-SUV：1.6 vs. 2.2；p = 0.013）。
治疗开始后早期进行的FLT-PET和DW-MRI可能会为SCLC患者增加生物学信息。通过FLT-PET测量的治疗开始后早期增殖是最终治疗反应的一个有前景的预测指标，值得进一步研究。
Clinicaltrials.gov，NCT02995902。2014年12月11日注册 - 回顾性注册。
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