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. 2015 Mar 1;91(3):472-9.
doi: 10.1016/j.ijrobp.2014.11.002. Epub 2015 Jan 30.

Change of maximum standardized uptake value slope in dynamic triphasic [18F]-fluorodeoxyglucose positron emission tomography/computed tomography distinguishes malignancy from postradiation inflammation in head-and-neck squamous cell carcinoma: a prospective trial

Carryn M Anderson  1 , Tangel Chang  2 , Michael M Graham  3 , Michael D Marquardt  2 , Anna Button  4 , Brian J Smith  4 , Yusuf Menda  3 , Wenqing Sun  2 , Nitin A Pagedar  5 , John M Buatti  2
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Change of maximum standardized uptake value slope in dynamic triphasic [18F]-fluorodeoxyglucose positron emission tomography/computed tomography distinguishes malignancy from postradiation inflammation in head-and-neck squamous cell carcinoma: a prospective trial

Carryn M Anderson et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To evaluate dynamic [(18)F]-fluorodeoxyglucose (FDG) uptake methodology as a post-radiation therapy (RT) response assessment tool, potentially enabling accurate tumor and therapy-related inflammation differentiation, improving the posttherapy value of FDG-positron emission tomography/computed tomography (FDG-PET/CT).

Methods and materials: We prospectively enrolled head-and-neck squamous cell carcinoma patients who completed RT, with scheduled 3-month post-RT FDG-PET/CT. Patients underwent our standard whole-body PET/CT scan at 90 minutes, with the addition of head-and-neck PET/CT scans at 60 and 120 minutes. Maximum standardized uptake values (SUV(max)) of regions of interest were measured at 60, 90, and 120 minutes. The SUV(max) slope between 60 and 120 minutes and change of SUV(max) slope before and after 90 minutes were calculated. Data were analyzed by primary site and nodal site disease status using the Cox regression model and Wilcoxon rank sum test. Outcomes were based on pathologic and clinical follow-up.

Results: A total of 84 patients were enrolled, with 79 primary and 43 nodal evaluable sites. Twenty-eight sites were interpreted as positive or equivocal (18 primary, 8 nodal, 2 distant) on 3-month 90-minute FDG-PET/CT. Median follow-up was 13.3 months. All measured SUV endpoints predicted recurrence. Change of SUV(max) slope after 90 minutes more accurately identified nonrecurrence in positive or equivocal sites than our current standard of SUV(max) ≥2.5 (P=.02).

Conclusions: The positive predictive value of post-RT FDG-PET/CT may significantly improve using novel second derivative analysis of dynamic triphasic FDG-PET/CT SUV(max) slope, accurately distinguishing tumor from inflammation on positive and equivocal scans.

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Conflict of interest statement

Conflict of interest statement: The authors declare that no actual or potential conflict of interest exists.

Figures

Figure 1
Figure 1
(A) Recurrence (solid line) versus non-recurrence (dashed line) of triphasic FDG-PET/CT scans at the primary site. (B) Change of SUV max slope of triphasic FDG-PET/CT scans at the primary site
Figure 2
Figure 2
(A) Recurrence (solid line) versus non-recurrence (dashed line) of triphasic FDG-PET/CT scans at the nodal site. (B) Change of SUVmax slope of triphasic FDG-PET/CT scans at the nodal site
Figure 3
Figure 3
Single time point (A) versus dual time point (B) versus triphasic (C) FDG-PET/CT scan
See this image and copyright information in PMC

References

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