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. 2024 Apr 24;12(5):944.
doi: 10.3390/biomedicines12050944.

Prognostic Significance of the Bone Marrow-to-Aorta Uptake Ratio on 2-Deoxy-2-[18F]fluoro-d-glucose Positron Emission Tomography/Computed Tomography in Patients with Cholangiocarcinoma

Jeong Won Lee  1 , Ik Dong Yoo  1 , Sun-Pyo Hong  1 , Beodeul Kang  2 , Jung Sun Kim  2 , Yung Kil Kim  3 , Sang Ho Bae  3 , Su Jin Jang  4 , Sang Mi Lee  1
Affiliations

Prognostic Significance of the Bone Marrow-to-Aorta Uptake Ratio on 2-Deoxy-2-[18F]fluoro-d-glucose Positron Emission Tomography/Computed Tomography in Patients with Cholangiocarcinoma

Jeong Won Lee et al. Biomedicines. .

Abstract

2-Deoxy-2-[18F]fluoro-d-glucose (FDG) uptake of the reticuloendothelial system on positron emission tomography/computed tomography (PET/CT) is known to be related to systemic inflammatory response to cancer cells in patients with diverse malignancies. This retrospective study aimed to investigate whether FDG uptake by the reticuloendothelial system had a prognostic value in predicting progression-free survival (PFS) and overall survival (OS) in 138 cholangiocarcinoma patients. Quantifying FDG uptake of the aorta, bone marrow (BM), liver, and spleen from staging FDG PET/CT images, we found significant correlations between the BM-to-aorta uptake ratio (BAR), spleen-to-aorta uptake ratio, and BM-to-liver uptake ratio with tumor stage and serum inflammatory markers. In the multivariate survival analysis, BAR was an independent predictor of PFS (p = 0.016; hazard ratio, 2.308) and OS (p = 0.030; hazard ratio, 2.645). Patients with stages III-IV of the disease and a high BAR exhibited low 1-year PFS (35.8%) and OS (60.2%) rates, while those with stages I-II of the disease and low BAR showed robust rates of 90.0% and 96.7%, respectively. BAR measured on staging FDG PET/CT might be a potential imaging biomarker offering insights into the systemic inflammatory response and predicting prognosis in cholangiocarcinoma. This study highlights BAR as a promising, independent predictor with potential for personalized prognostication and treatment strategies.

Keywords: F-18 fluorodeoxyglucose; bone marrow; cholangiocarcinoma; positron emission tomography; spleen.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Maximum intensity projection image (a), transaxial images (b–e), and sagittal image (f) of FDG PET/CT showing VOIs for calculating FDG uptake of the aorta, bone marrow, liver, and spleen. A 60-year-old man underwent FDG PET/CT for staging work-up for histopathologically confirmed perhilar cholangiocarcinoma (arrows on (a,b)). A spherical 1 cm sized VOI was drawn in the intra-aorta area to measure FDG uptake of the aorta (blue circle in (c)). To measure FDG uptake of the liver and spleen, a spherical 3 cm sized VOI in the liver (blue circle in (d)) and a spherical 2 cm sized VOI in the spleen (green circle in (d)) were drawn. FDG uptake of bone marrow was measured by placing six spherical VOIs in the vertebral body of the thoracic and lumbar spines (blue circles in (e,f)). Because the patient had compression fractures in L3–4 spines, VOIs were drawn in T9–T12 spines and L1–2 spines.
Figure 2
Figure 2
Kaplan–Meier curves of progression-free survival (a) and overall survival (b) according to the bone marrow-to-aorta uptake ratio (BAR).
Figure 3
Figure 3
Kaplan–Meier curves of progression-free survival (a) and overall survival (b) according to TNM stage and bone marrow-to-aorta uptake ratio (BAR).
See this image and copyright information in PMC

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