Change of Maximum Standardized Uptake Value Slope in Dynamic Triphasic [{sup 18}F]-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Distinguishes Malignancy From Postradiation Inflammation in Head-and-Neck Squamous Cell Carcinoma: A Prospective Trial
- Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States)
- Department of Nuclear Medicine, University of Iowa, Iowa City, Iowa (United States)
- Department of Biostatistics, University of Iowa, Iowa City, Iowa (United States)
- Department of Otolaryngology—Head and Neck Surgery, University of Iowa, Iowa City, Iowa (United States)
Purpose: To evaluate dynamic [{sup 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{sub max}) of regions of interest were measured at 60, 90, and 120 minutes. The SUV{sub max} slope between 60 and 120 minutes and change of SUV{sub 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{sub max} slope after 90 minutes more accurately identified nonrecurrence in positive or equivocal sites than our current standard of SUV{sub 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{sub max} slope, accurately distinguishing tumor from inflammation on positive and equivocal scans.
- OSTI ID:
- 22458615
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 91, Issue 3; Other Information: Copyright (c) 2015 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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