Optimized CT Attenuation and SUV Prediction Thresholds for Differentiating Enostoses From Untreated and Treated Metastases on Attenuation-Corrected 18F-FDG PET/CT.
优化的CT衰减和SUV预测阈值，用于在衰减校正的 18F-FDG PET/CT上区分原发病与未治疗和治疗的转移灶。
- 作者列表："Lee HT","Pryma DA","Sebro R
PURPOSE:The objective of this study was to evaluate the accuracy of using CT attenuation and SUVs to differentiate enostoses from untreated and treated osteoblastic metastases on the attenuation-correction CT component of F-FDG PET/CTs. METHODS:We retrospectively reviewed F-FDG PET/CT studies of 117 patients (169 lesions), of which 65 had imaging of enostoses, and 52 had imaging showing the transition of lesions from untreated to treated osteoblastic metastases. We measured the mean CT attenuations and the SUVmax and SUVmean of each lesion. Receiver operating characteristic curve analyses were used to evaluate the accuracy of each metric in distinguishing enostoses from untreated and treated osteoblastic metastases. RESULTS:For differentiating enostoses from untreated osteoblastic metastases, mean CT attenuation achieved an area under the receiver operating characteristic curve (AUC) of 90.8%, with an optimized threshold of 795 HU. SUVmax achieved an AUC of 94.9%, with an optimized threshold of 2.2. For differentiating enostoses from treated osteoblastic metastases, the AUCs for every metric decreased, with mean CT attenuation being the best at 82.7%. A joint predictive model combining both CT attenuation and SUV increased the AUC to 88.3%, and performance was significantly better than SUVmax or SUVmean alone (P = 0.029 and P = 0.049, respectively). CONCLUSIONS:CT attenuation and SUV can reliably distinguish between enostoses and metastases on F-FDG PET/CT. However, the accuracy of these metrics decreases when used to differentiate enostoses from treated metastases. A joint prediction model combining CT attenuation with SUV can improve accuracy.
用途: 本研究的目的是评价在F-FDG PET/CTs的衰减校正CT成分上使用CT衰减和SUVs区分原发病与未治疗和治疗的成骨转移瘤的准确性。 方法: 我们回顾性分析了 117 例患者 (169 个病灶) 的F-FDG PET/CT研究，其中 65 例有结石病的影像学检查，52 例影像学显示病灶从未治疗到治疗的成骨细胞转移。我们测量了每个病灶的平均CT衰减和SUVmax和SUVmean。采用受试者工作特征曲线分析评价各指标区分未治疗和治疗的成骨转移瘤的准确性。 结果: 为了鉴别成骨转移瘤和未治疗的成骨转移瘤，平均CT衰减达到 90.8% 的受试者工作特征曲线下面积 (AUC)，优化阈值为 795 HU。SUVmax达到 94.9% 的AUC，优化阈值为 2.2。为了与治疗的成骨转移瘤鉴别，每个指标的auc均降低，平均CT衰减在 82.7% 最佳。结合CT衰减和SUV的联合预测模型将AUC增加至 88.3%，性能显著优于单独使用SUVmax或SUVmean (分别为P = 0.029 和P = 0.049)。 结论: CT衰减和SUV可以可靠地区分F-FDG PET/CT上的结节性病变和转移瘤。然而，当用于区分转移灶和治疗转移灶时，这些指标的准确性降低。CT衰减与SUV相结合的联合预测模型可以提高精度。
METHODS:OBJECTIVE:Large inoperable sacral chordomas show unsatisfactory local control rates even when treated with high dose proton therapy (PT). The aim of this study is assessing feasibility and reporting early results of patients treated with PT and concomitant hyperthermia (HT). METHODS: :Patients had histologically proven unresectable sacral chordomas and received 70 Gy (relative biological effectiveness) in 2.5 Gy fractions with concomitant weekly HT. Toxicity was assessed according to CTCAE_v4. A volumetric tumor response analysis was performed. RESULTS: :Five patients were treated with the combined approach. Median baseline tumor volume was 735 cc (range, 369-1142). All patients completed PT and received a median of 5 HT sessions (range, 2-6). Median follow-up was 18 months (range, 9-26). The volumetric analysis showed an objective response of all tumors (median shrinkage 46%; range, 9-72). All patients experienced acute Grade 2-3 local pain. One patient presented with a late Grade 3 iliac fracture. CONCLUSION:Combining PT and HT in large inoperable sacral chordomas is feasible and causes acceptable toxicity. Volumetric analysis shows promising early results, warranting confirmation in the framework of a prospective trial. ADVANCES IN KNOWLEDGE: :This is an encouraging first report of the feasibility and early results of concomitant HT and PT in treating inoperable sacral chordoma.
METHODS:BACKGROUND:National guidelines recommend screening and treatment for cancer-related bone disease and continued monitoring of bone-modifying agents. It is unclear whether a standardized screening tool is utilized to identify eligible patients and ensure appropriate supportive care is implemented. The purpose of this study was to evaluate current prescribing practices and optimize management of bone-modifying agents. METHODS:A retrospective chart review was performed to identify patients who received hormone deprivation therapy or had bone metastases through Hematology/Oncology or Urology clinics from 1 November 2016 to 31 October 2017. The primary endpoints of this study were the incidence of completed baseline dual-energy X-ray absorptiometry (DEXA) scan for patients on hormone deprivation therapy and percent of patients started on a bone-modifying agent for the prevention of skeletal-related events secondary to bone metastasis. Secondary endpoints included percent of patients with dental examinations prior to initiation, adequate calcium and vitamin D supplementation, incidence of osteonecrosis of the jaw or flu-like symptoms and education, and percent of bisphosphonate doses appropriately adjusted based on renal function. RESULTS:A total of 375 patients were assessed for baseline DEXA scans and bone-modifying therapy. Of the 226 patients on hormone deprivation therapy, 111 (49%) patients were appropriately screened with a DEXA scan prior to initiation of hormone deprivation therapy. Among the 149 patients with bone metastases, only 94 (63.1%) patients were started on a bone-modifying agent. CONCLUSIONS:Opportunities have been identified to optimize management of patients with cancer-related bone disease. Implementation of standardized tools may increase the rate of appropriate screening and initiation of bone-modifying therapy when warranted.
METHODS:PURPOSE:Low skeletal muscle mass has been associated with poor prognosis in patients with advanced lung cancer. However, little is known about the relationship between skeletal muscle mass and overall survival in patients with bone metastases from lung cancer. The objective of the present study was to evaluate the prognostic value of low trunk muscle mass in predicting overall survival in these patients. METHODS:The data from 198 patients who were diagnosed with bone metastases from lung cancer from April 2009 to May 2017 were retrospectively reviewed. The areas of the psoas and paravertebral muscles were measured at the level of the third lumbar vertebra on computed tomography scans taken at the time nearest to the diagnosis of bone metastasis. Muscle area was evaluated for male and female cohorts separately using different cutoff points. Cox proportional hazards analysis was performed to evaluate the factors independently associated with overall survival. RESULTS:The overall survival of patients in the lowest quartile for psoas muscle area or paravertebral muscle area was significantly shorter than that of patients above the 25th percentile for muscle area (p < 0.001). Multivariate analyses showed that paravertebral muscle mass (hazard ratio, 1.73; 95% confidence interval, 1.17-2.56; p = 0.006), epidermal growth factor receptor-targeted therapy, and performance status were independent prognostic factors. CONCLUSIONS:Low paravertebral muscle mass was associated with shorter survival, independently of known prognostic factors.