Li Xian, Liu Hanhui, Zhang Shenghong, Zhang Han, Zhang Jiajia, Qin Shanshan, Yu Fei
Department of Nuclear Medicine, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, China.
Institute of Nuclear Medicine, Tongji University School of Medicine, Shanghai, 200072, China.
Mol Imaging Biol. 2025 May 20. doi: 10.1007/s11307-025-02017-0.
The progression rate and course of radioiodine refractory differentiated thyroid cancer (RAIR-DTC) vary significantly, yet there lacks a precise method for predicting its progression. We hypothesized that using the liver as a reference organ can enable selective patient stratification. We aimed to establish fluorine-18 fluorodeoxyglucose positron emission tomography ([F] FDG-PET) tumor to-liver ratio (TLR score) to predict outcome for RAIR-DTC.
This study included 64 patients with RAIR-DTC undergoing baseline F-FDG PET/CT. Patients were categorized by visual TLR (vTLR) into high (most lesions show higher uptake than the liver) or low (most lesions show lower uptake than the liver) groups using 3D maximum intensity projection (MIP) images. Quantitative TLR (qTLR) scores, including qTLR max (tumor SUVmax/liver SUVmax) and qTLRmean (tumor SUVmean/liver SUVmean), were semiautomatically derived from baseline PET, with high (≥ 1.5) and low (< 1.5) groups defined. Outcome data were progression-free survival (PFS).
Among 64 patients, the distribution of high-TLR versus low-TLR groups varied across scoring methods: vTLR score allocated 36 (56.3%) high vs 28 (43.7%) low, qTLRmax score identified 29 (45.3%) high vs 35 (54.7%) low, and qTLRmean score demonstrated the most divergent pattern with 21 (32.8%) high vs 43 (67.2%) low. Agreement among qTLRmax, vTLR and qTLRmean score was moderate (Fleiss weighted k, 0.579). The median PFS of the high and low groups by vTLR score was 16.0, 29.0 months (P = 0.010) respectively, by qTLRmax score was 14.0, 27.0 months (P = 0.041), respectively, by qTLRmean score was 14.0, 28.0 months (P = 0.004), respectively.
The TLR score was prognostic for PFS of RAIR-DTC. The vTLR score assessed on 3D MIP PET images yielded substantial reproducibility and combining qTLR score provided reliable prognostic value.
放射性碘难治性分化型甲状腺癌（RAIR-DTC）的进展速度和病程差异显著，但缺乏预测其进展的精确方法。我们假设以肝脏作为参照器官能够实现对患者的选择性分层。我们旨在建立氟-18氟脱氧葡萄糖正电子发射断层扫描（[F]FDG-PET）肿瘤与肝脏比值（TLR评分）以预测RAIR-DTC的预后。
本研究纳入了64例接受基线F-FDG PET/CT检查的RAIR-DTC患者。使用三维最大强度投影（MIP）图像，根据视觉TLR（vTLR）将患者分为高（大多数病灶摄取高于肝脏）或低（大多数病灶摄取低于肝脏）组。定量TLR（qTLR）评分，包括qTLR max（肿瘤SUVmax/肝脏SUVmax）和qTLRmean（肿瘤SUVmean/肝脏SUVmean），通过基线PET半自动得出，并定义了高（≥1.5）和低（<1.5）组。预后数据为无进展生存期（PFS）。
在64例患者中，高TLR组与低TLR组的分布在不同评分方法间有所不同：vTLR评分中，高分组36例（56.3%），低分组28例（43.7%）；qTLRmax评分中，高分组29例（45.3%），低分组35例（54.7%）；qTLRmean评分呈现出最不同的模式，高分组21例（32.8%），低分组43例（67.2%）。qTLRmax、vTLR和qTLRmean评分之间的一致性为中等（Fleiss加权k，0.579）。vTLR评分的高、低分组的中位PFS分别为16.0、29.0个月（P = 0.010），qTLRmax评分分别为14.0、27.0个月（P = 0.041），qTLRmean评分分别为14.0、28.0个月（P = 0.004）。
TLR评分对RAIR-DTC的PFS具有预后价值。在三维MIP PET图像上评估的vTLR评分具有较高的可重复性，结合qTLR评分可提供可靠的预后价值。
