Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Radiol Oncol. 2024 Sep 15;58(3):335-347. doi: 10.2478/raon-2024-0045. eCollection 2024 Sep 1.
To evaluate the role of the novel quantitative imaging biomarker (QIB) SUV of F-FDG uptake extracted from early F-FDG-PET/CT scan at 4 weeks for the detection of immune-related adverse events (rAE) in a cohort of patients with metastatic melanoma (mM) patients receiving immune-checkpoint inhibitors (ICI).
In this prospective non-interventional, one-centre clinical study, patients with mM, receiving ICI treatment, were regularly followed by F-FDG PET/CT. Patients were scanned at baseline, early point at week four (W4), week sixteen (W16) and week thirty-two (W32) after ICI initiation. A convolutional neural network (CNN) was used to segment three organs: lung, bowel, thyroid. QIB of irAE - SUV - was analyzed within the target organs and correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance.
A total of 242 F-FDG PET/CT images of 71 mM patients were prospectively collected and analysed. The early W4 scan showed improved detection only for the thyroid gland compared to W32 scan (p=0.047). The AUROC for detection of irAE in the three target organs was highest when SUV was extracted from W16 scan and was 0.76 for lung, 0.53 for bowel and 0.81 for thyroid. SUV extracted from W4 scan did not improve detection of irAE compared to W16 scan (lung: p = 0.54, bowel: p = 0.75, thyroid: p = 0.3, DeLong test), as well as compared to W32 scan in lungs (p = 0.32) and bowel (p = 0.3).
Early time point F-FDG PET/CT at W4 did not lead to statistically significant earlier detection of irAE. However, organ F-FDG uptake as quantified by SUV proved to be a consistent QIB of irAE. To better assess the role of F-FDG PET/CT in irAE detection, the time evolution of F-FDG PET/CT quantifiable inflammation would be of essence, only achievable in multi centric studies.
评估新型定量成像生物标志物（QIB）在 4 周时从早期 F-FDG-PET/CT 扫描中提取的 F-FDG 摄取 SUV 用于检测接受免疫检查点抑制剂（ICI）治疗的转移性黑色素瘤（mM）患者队列中免疫相关不良事件（rAE）的作用。
在这项前瞻性非干预性、单中心临床研究中，接受 ICI 治疗的 mM 患者定期接受 F-FDG PET/CT 检查。患者在 ICI 开始后基线、第 4 周（W4）、第 16 周（W16）和第 32 周（W32）进行扫描。使用卷积神经网络（CNN）对三个器官进行分割：肺、肠道、甲状腺。在目标器官内分析 irAE-SUV-QIB，并与临床 irAE 状态相关联。使用接收者操作特征曲线（AUROC）下面积来量化 irAE 检测性能。
前瞻性收集并分析了 71 名 mM 患者的 242 张 F-FDG PET/CT 图像。与 W32 扫描相比，早期 W4 扫描仅显示甲状腺的检测得到改善（p=0.047）。从 W16 扫描中提取 SUV 时，三个目标器官中 irAE 的检测 AUROC 最高，分别为 0.76、0.53 和 0.81。与 W16 扫描相比，从 W4 扫描中提取的 SUV 并不能提高 irAE 的检测（肺：p=0.54，肠：p=0.75，甲状腺：p=0.3，DeLong 检验），与 W32 扫描相比也是如此（肺：p=0.32，肠：p=0.3）。
W4 时的早期 F-FDG PET/CT 并未导致 irAE 的检测显著提前。然而，SUV 定量的器官 F-FDG 摄取被证明是 irAE 的一致 QIB。为了更好地评估 F-FDG PET/CT 在 irAE 检测中的作用，只有在多中心研究中才能实现，F-FDG PET/CT 可量化炎症的时间演变将至关重要。
