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; Tangel Chang; Michael M Graham; Michael D Marquardt; Anna Button; Brian J Smith; Yusuf Menda; Wenqing Sun; Nitin A Pagedar; John M Buatti

doi:10.1016/j.ijrobp.2014.11.002

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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

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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, Tangel Chang, Michael M Graham, Michael D Marquardt, Anna Button, Brian J Smith, Yusuf Menda, Wenqing Sun, Nitin A Pagedar and John M Buatti

International journal of radiation oncology, biology, physics, Vol.91(3), pp.472-479

03/01/2015

DOI: 10.1016/j.ijrobp.2014.11.002

PMCID: PMC4335357

PMID: 25680593

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https://www.ncbi.nlm.nih.gov/pmc/articles/4335357View

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Abstract

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). 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. 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). 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.

Fluorodeoxyglucose F18 - pharmacokinetics

Prospective Studies

Mediastinum

Carcinoma, Squamous Cell - metabolism

Humans

Middle Aged

Tomography, X-Ray Computed - methods

Male

Carcinoma, Squamous Cell - diagnostic imaging

Carcinoma, Squamous Cell - radiotherapy

Head and Neck Neoplasms - metabolism

Inflammation - metabolism

Neoplasm Recurrence, Local - diagnostic imaging

Time Factors

Multimodal Imaging - methods

Statistics, Nonparametric

Aged, 80 and over

Adult

Female

Solitary Pulmonary Nodule - metabolism

Inflammation - diagnostic imaging

Diagnosis, Differential

Radiopharmaceuticals - pharmacokinetics

Neoplasm Recurrence, Local - metabolism

Head and Neck Neoplasms - diagnostic imaging

Incidental Findings

Lymph Nodes - metabolism

Positron-Emission Tomography - methods

Head and Neck Neoplasms - radiotherapy

Regression Analysis

Solitary Pulmonary Nodule - diagnostic imaging

Carcinoma, Squamous Cell - secondary

Aged

Lymph Nodes - diagnostic imaging

Radiotherapy, Intensity-Modulated

Details

Title: Subtitle: 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
Creators: Carryn M Anderson - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa. Electronic address: carryn-anderson@uiowa.edu
Tangel Chang - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
Michael M Graham - Department of Nuclear Medicine, University of Iowa, Iowa City, Iowa
Michael D Marquardt - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
Anna Button - Department of Biostatistics, University of Iowa, Iowa City, Iowa
Brian J Smith - Department of Biostatistics, University of Iowa, Iowa City, Iowa
Yusuf Menda - Department of Nuclear Medicine, University of Iowa, Iowa City, Iowa
Wenqing Sun - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
Nitin A Pagedar - Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa
John M Buatti - Department of Radiation Oncology, University of Iowa, Iowa City, Iowa
Resource Type: Journal article
Publication Details: International journal of radiation oncology, biology, physics, Vol.91(3), pp.472-479
DOI: 10.1016/j.ijrobp.2014.11.002
PMID: 25680593
PMCID: PMC4335357
NLM abbreviation: Int J Radiat Oncol Biol Phys
ISSN: 0360-3016
eISSN: 1879-355X
Publisher: Elsevier Inc; United States
Grant note: U01 CA140206 / NCI NIH HHS
Language: English
Date published: 03/01/2015
Academic Unit: Radiology; Biostatistics; Radiation Oncology; Neurosurgery; Otolaryngology; Holden Comprehensive Cancer Center
Record Identifier: 9983997370902771

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