Yonglin Pu

Shanghai Jiao Tong University, Shanghai, Shanghai Shi, China

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Publications (67)187.73 Total impact

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    ABSTRACT: Objectives: The objective of this study was to test the hypothesis that the metabolic tumor volume (MTV) of primary non-small-cell lung cancer is not sensitive to differences in F-fluorodeoxyglucose (F-FDG) uptake time, and to compare this consistency of MTV measurements with that of standardized uptake value (SUV) and total lesion glycolysis (TLG). Methods: Under Institutional Review Board approval, 134 consecutive patients with histologically proven non-small-cell lung cancer underwent F-FDG PET/computed tomography scanning at about 1 h (early) and 2 h (delayed) after intravenous injection of F-FDG. MTV, SUV, and TLG of the primary tumor were all measured. Student's t-test and Wilcoxon's signed-rank test for paired data were used to compare MTV, SUV, and TLG between the two scans. The intraclass correlation coefficient (ICC) was used to assess agreement in PET parameters between the two scans and between the measurements made by two observers. Results: MTV was not significantly different (P=0.17) between the two scans. However, SUVmax, SUVmean, SUVpeak, and TLG increased significantly from the early to the delayed scans (P<0.0001 for all). The median percentage change between the two scans in MTV (1.65%) was smaller than in SUVmax (11.76%), SUVmean(10.57%), SUVpeak(13.51%), and TLG (14.34%); the ICC of MTV (0.996) was greater than that of SUVmax (0.933), SUVmean (0.952), SUVpeak (0.928), and TLG (0.982). Interobserver agreement between the two radiologists was excellent for MTV, SUV, and TLG on both scans (ICC: 0.934-0.999). Conclusion: MTV is not sensitive to common clinical variations in F-FDG uptake time, its consistency is greater than that of SUVmax, SUVmean, SUVpeak, and TLG, and it has excellent interobserver agreement.
    No preview · Article · Sep 2015 · Nuclear Medicine Communications
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    ABSTRACT: Metabolic tumor burden (MTB) measurements including metabolic tumor volume and total lesion glycolysis have been shown to have prognostic value in non-small-cell lung cancer (NSCLC). The calculation of MTB typically utilizes software to semiautomatically draw volumes of interest around the tumor, which are subsequently manually adjusted by the radiologist to include the entire tumor. The manual adjustment step can be time-consuming and observer-dependent. We compared the agreement of MTB values obtained using the semiautomatic method with and without manual adjustment in NSCLC patients. This IRB-approved prospective study included 134 patients with histologically proven NSCLC who underwent fluorine-18 fluorodeoxyglucose PET/computed tomography. The MTB of the primary tumor was measured with a semiautomatic gradient-based method without manual adjustment (the semiautomatic gradient method) and with manual adjustment (the manually adjusted semiautomatic gradient method) by two radiologists using the MIM PETedge tool. The paired t-test, Wilcoxon signed-rank test, and concordance correlation coefficient (CCC) were calculated to evaluate the agreement between MTB measures obtained with these two methods, as well as agreement between the two radiologists for each method. Maximum standardized uptake value was identical between the two methods. No statistically significant difference was present for peak standardized uptake value, metabolic tumor volume, and total lesion glycolysis values between the two methods (P=0.23, 0.45, and 0.37, respectively). Excellent agreement between the two methods was found in terms of CCC (CCC>0.98 for all measures). Interobserver reliability was excellent for all measures (CCC>0.90). The semiautomatic gradient-based tumor-segmentation method can be used without the additional manual adjustment step for MTB quantification of primary NSCLC tumors.
    Full-text · Article · Apr 2015 · Nuclear Medicine Communications
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    ABSTRACT: Whole-body metabolic tumor volume (MTVWB) has been shown of prognostic value for non-small cell lung cancer (NSCLC) beyond that of TNM stage, age, gender, performance status, and treatment selection. The current TNM staging system does not incorporate tumor volumetric information. We propose a new PET/CT volumetric prognostic (PVP) index that combines the prognostic value of MTVWB and TNM stage. Based on 328 consecutive NSCLC patients with a baseline PET/CT scan before treatment, from which MTVWB was measured semi-automatically, we estimated hazard ratios (HRs) for ln(MTVWB) and TNM stage from a Cox proportional hazard regression model that consisted of only ln(MTVWB) and TNM stage as prognostic variables of overall survival. We used the regression coefficients, which gave rise to the HRs, as weights to formulate the PET/CT volumetric prognostic (PVP) index. We also compared the prognostic value of the PVP index against that of TNM stage alone and ln(MTVWB) alone with univariate and multivariate survival analyses and C-statistics. Univariate analysis C-statistic for the PVP index (C=0.71) was statistically significantly greater than those for TNM stage alone (C=0.67, p<0.01) and for ln(MTVWB) alone (C=0.69, p=0.033). Multivariate analyses showed that the PVP index yielded significantly greater discriminatory power (C=0.74) than similar models based on either TNM stage (C=0.72, p<0.01) or ln(MTVWB) (C=0.73, p<0.01). Lower values of the PVP index were associated with significantly better overall survival (adjusted HR=2.70, 95%CI [2.16, 3.37]). The PVP index provides a practical means for clinicians to combine the prognostic value of MTVWB and TNM stage and offers significantly better prognostic accuracy for overall survival of NSCLC patients than the current TNM staging system or metabolic tumor burden alone. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Apr 2015 · Lung cancer (Amsterdam, Netherlands)
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    ABSTRACT: Purpose: To test the hypothesis that whole-body metabolic tumor burden (MTBWB) on postsurgical fluorodeoxyglucose (FDG) positron emission tomographic (PET)/computed tomographic (CT) images in patients with non-small cell lung cancer (NSCLC) is associated with their overall survival (OS). Materials and methods: The institutional review board approved this study and waived the requirement for obtaining informed consent. One hundred forty-two patients with NSCLC (69 men, 73 women; median age, 67.7 years) who underwent postsurgical FDG PET/CT were retrospectively reviewed. The whole-body metabolic tumor volume (MTVWB), whole-body total lesion glycolysis (TLGWB), and whole-body maximum standardized uptake value (SUVWBmax) were measured. OS served as the primary end point of the study. Kaplan-Meier curves and Cox regression were used to assess the association between PET/CT markers and OS. Results: The interobserver variability was low, as demonstrated with intraclass correlation coefficients higher than 0.94 for SUVWBmax, MTVWB, and TLGWB. When compared with those with negative postsurgical FDG PET/CT findings, a significant decrease of OS was found in patients with the presence of FDG-avid tumor on the basis of both a log-rank test (P = .001) and a univariate Cox model (hazard ratio = 2.805, P = .001). In patients with FDG-avid tumor, there was a significant association between OS and ln MTVWB (P < .001), ln TLGWB (P < .001), and ln SUVWBmax (P < .010) in either univariate or multivariate analysis, after adjusting for patient age, sex, TNM restage, and therapy after postsurgical PET/CT studies. The OS differences between the groups dichotomized by the median value of MTVWB (11.54 mL, P = .004), TLGWB (32.38 mL, P < .001), or SUVWBmax (4.93, P = .023) were significant. Conclusion: MTBWB and tumor maximum standardized uptake at postsurgical FDG PET/CT are related to the patient's OS in NSCLC, independent of age, sex, TNM restaging, and therapy after postsurgical PET/CT studies.
    No preview · Article · Jan 2015 · Radiology
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    ABSTRACT: We hypothesize and demonstrate that artificial neural networks (ANN) can perform better than multiple linear regression models in overcoming the limitations of the current TNM staging system for predicting the overall survival time of patients with non-small cell lung cancer (NSCLC). Better prognostication of survival was achieved by including additional prognostic factors, such as FDG-PET measurements and other clinical and pathological prognostic factors. The use of an ANN resulted in a substantial improvement in correlation between actual and predicted months of survival in 328 patients with NSCLC. The ANN resulted in an increase in R 2 , from 0.66 to 0.774, and a reduction in standard deviation, from 17.4 months to 14 months, when compared to multiple linear regressions. Furthermore, the cross-validation results of R 2 =0.608 suggests that the ANN model was capable of predicting survival for patients who were not included in the database for building the ANN model.
    Full-text · Conference Paper · Jul 2014
  • Piotr Obara · Yonglin Pu
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    ABSTRACT: Accurate prognosis in patients with lung cancer is important for clinical decision making and treatment selection. The TNM staging system is currently the main method for establishing prognosis. Using this system, patients are grouped into one of four stages based on primary tumor extent, nodal disease, and distant metastases. However, each stage represents a range of disease extent and may not on its own be the best reflection of individual patient prognosis. (18)F-fluorodeoxyglucose-positron emission tomography ((18)F-FDG-PET) can be used to evaluate the metabolic tumor burden affecting the whole body with measures such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG). MTV and TLG have been shown to be significant prognostic factors in patients with lung cancer, independent of TNM stage. These metabolic tumor burden measures have the potential to make lung cancer staging and prognostication more accurate and quantitative, with the goal of optimizing treatment choices and outcome predictions.
    No preview · Article · Dec 2013 · Chinese Journal of Cancer Research
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    ABSTRACT: Objective To assess the prognostic value of metabolic tumor burden as measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG) on 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT), independent of current Union Internacional Contra la Cancrum/American Joint Committee on Cancer tumor, node, and metastasis (TNM) stage; in comparison with that of standardized uptake value (SUV) in surgical patients with non–small-cell lung cancer (NSCLC). Material and Methods This study retrospectively reviewed 104 consecutive surgical patients (47 males, 57 females, median age at PET/CT scan of 67.92 years) with diagnosed stage I to IV NSCLC who had baseline 18F-FDG PET/CT scans. The 18F-FDG PET/CT scans were performed in accordance with National Cancer Institute guidelines. The MTV of tumors in the whole body (MTVWB), TLG of tumors in the whole body (TLGWB), the maximum standardized uptake value of tumors in the whole body (SUVmaxWB) as well as the mean standardized uptake value of tumor in the whole body (SUVmeanWB) were measured. The median follow-up among 67 survivors was 42.07 months from the PET/CT (range 2.82–80.95 months). Statistical methods included Kaplan-Meier curves, Cox regression, and C-statistics. The interobserver variability of SUVmaxWB, SUVmeanWB, MTVWB, and TLGWB between two observers was analyzed using concordance correlation coefficients (CCCs). Results The interobserver variability of SUVmaxWB, SUVmeanWB, MTVWB and TLGWB was very low with CCCs greater than 0.882. There was a statistically significant association of stage with overall survival (OS). The hazard ratio (HR) of stage III and stage IV as compared with stage I was 3.60 (P = .001) and 4.00 (P = .013), respectively. The MTVWB was significantly associated with OS with a HR for 1-unit increase of ln(MTVWB) of 1.40/1.32 (P = .004/.039), before/after adjusting for stage and other prognostic factors including chemoradiation therapy, and surgical procedure, respectively. TLGWB had a statistically significant association with OS before and after adjusting for stage and the other prognostic factors. The HR for 1-unit increase in ln(TLGWB) was 1.26 (P = .011) and 1.25 (P = .031), before and after the adjustment, respectively. Subjects with conditions that led to pneumonectomy (HR = 2.82, P = .035) or segmental resection (HR = 3.44, P = .044) had significantly worse survival than those needing lobectomy. There was no statistically significant association between OS and age, gender, tumor histology, ln(SUVmaxWB), and ln(SUVmeanWB) (all P > .05). There were 37 deaths during follow-up. Conclusion Baseline whole-body metabolic tumor burden as measured with MTVWB and TLGWB on FDG PET is a prognostic measure independent of clinical stage and other prognostic factors including chemoradiation therapy and surgical procedure with low interobserver variability and may be used to further risk stratify surgical patients with NSCLC. This study also suggests that MTV and TLG are better prognostic measures than SUVmax and SUVmean. These results will need to be validated in larger cohorts in a prospective study.
    Full-text · Article · Jan 2013 · Academic radiology
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    ABSTRACT: PURPOSE Current evaluation of patients with suspected urinary tract obstruction is retrospective, and requires loss of progressive renal function for diagnosis. Furthermore, prospective studies such as diuretic renal scintigraphy (DRS) using half-time (T ½) of tracer clearance have shown low positive predictive value. The objective of this study is to assess the utility of renal pelvic appearance time (PAT) to diagnose ureteropelvic junction (UPJ) obstruction that would benefit from surgical intervention. METHOD AND MATERIALS An IRB-approved retrospective review was performed on 55 patients with clinically-suspected UPJ obstruction treated with pyeloplasty. Each patient had undergone a pre and post surgical DRS. The pre-surgical split kidney function (SKF), T ½ tracer clearance, and PAT were calculated on each patient. The ability of the PAT difference in seconds between the affected and contra-lateral kidneys in predicting improvement in post-surgical renal function was determined using the gold standard of split kidney function improvement > 5%. Area under the Receiver Operating Characteristic (ROC) curve (AUC) was used to assess the performance in distinguishing between patients with improved renal function and those without post surgery. The AUC of the PAT difference was compared with the T1/2 and SKF of the affected kidney. RESULTS Of the 55 patients who underwent pyeloplasty, 10 patients demonstrated a SKF improvement greater than 5% on the affected surgical side and 8 patients demonstrated a SKF decrease greater than 5%. AUC values for predicting improvement of renal function greater than 5% in the PAT difference between the affected and contra-lateral kidneys as well as the SKF and T ½ tracer clearance of the affected kidney were found to be 0.73 (SE=0.07), 0.68 (SE=0.09), and 0.63 (SE=0.14) respectively. AUC values for these same variables in predicting decline of SKF greater than 5% was found to be 0.74 (SE=0.11), 0.55 (SE=0.11), and 0.77 (SE=0.13) respectively. CONCLUSION This study shows the potential of PAT in patients with clinically suspected UPJ obstruction by predicting which patients would show improvement or decline in SKF following surgical pyeloplasty. CLINICAL RELEVANCE/APPLICATION PAT may help clinicians determine which patients with suspected UPJ obstruction will benefit from pyeloplasty, and could potentially decrease unnecessary surgeries as well as time to treatment.
    No preview · Conference Paper · Nov 2012
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    ABSTRACT: PURPOSE In this study we explore the utility and performance of a dedicated high resolution molecular breast imaging device, positron emission mammography (PEM), in noninvasively staging the axillae in patients with newly diagnosed breast cancer. METHOD AND MATERIALS 33 patients with biopsy-proven, newly diagnosed breast cancer were imaged on a Flex Solo II PEM Scanner (Naviscan, San Diego, CA) following intravenous foot injection of 10 mCi of FDG. Standard tomographic medial-lateral oblique and cranio-caudal views with additional dedicated axillary (AX) views were acquired for both breasts. Images were reviewed by 2 radiologists experienced in PEM. Axillary lymph node (LN) uptake was graded subjectively as absent, mild, or marked. In addition, semiquantitative PEM uptake values (PUV) and lesion to background (LTB) ratios were calculated. Results were compared with pathologic axillary LN findings after surgery. RESULTS For the 33 patients, 65 AX views were obtained. 22 axillae demonstrated mild LN uptake (in 16 patients) and 7 axillae demonstrated marked LN uptake (in 7 patients). After surgery, 12 axillae in 12 patients were found to have axillary LN metastases on pathology. Using mild or greater uptake as a cutoff, the sensitivity and specificity of PEM in detecting LN metastases was 75% and 74%, respectively. Using marked uptake as a cutoff, the sensitivity and specificity was 50% and 98%. PUV (range 0.3-1.5) was not found to correlate with the presence of LN metastases. However, using a LTB threshold of 2.7 (range 1.5-25.0), 8 of 9 patients' axillae were true negatives and 9 of 10 patients were true positives (TP) . Using a LTB threshold of 4.0, 6 of 6 patients' axillae were TP. At path, the smallest volume of LN tumor detected by mild uptake was 1-mm3 and by marked uptake was 4-mm3. In 38% of patients, the additional AX views were deemed necessary for optimal axillary evaluation. In 62%, standard views were sufficient. CONCLUSION Qualitative visual analysis of the axillae using PEM is highly specific but only moderately sensitive in detecting LN metastases in patients with breast cancer. Semiquantitative LTB ratios may also be very useful in identifying tumor. Micrometastases as small as 1-mm may be seen. CLINICAL RELEVANCE/APPLICATION Given its high specificity, patients with axillae abnormal on PEM could potentially skip sentinel LN procedures and have assumed LN metastases. Semiquantitative LTB analysis also appears promising.
    No preview · Conference Paper · Nov 2012
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    Hao Zhang · Kristen Wroblewski · Yonglin Pu
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    ABSTRACT: No study to test the feasibility and prognostic value of the number of primary tumors, the number of positive lymph nodes, and the total number of tumors in the whole body as tumor burden measurements on FDG PET/CT imaging has been reported. To determine whether the number of tumors seen in 18F-FDG PET scans can be a prognostic factor in non-surgical patients with non-small cell lung cancer (NSCLC). One hundred and forty patients with histologically proven NSCLC and baseline 18F-FDG PET scan before therapy were identified in this retrospective analysis. The total number of tumors (TTn) in the whole body, the number of primary tumors (Tn), positive lymph nodes (Nn), and distant metastases (Mn), along with the maximum standardized uptake values (SUV(max)) of the tumors were measured. Inter-observer variability of the total number of tumors, counted by two radiologists, was assessed. Survival analyses were performed to determine the prognostic value of the number of tumors. Concordance correlation coefficients for the TTn, Tn, Nn, and Mn were all greater than 0.85. TTn and Nn were strong prognostic factors of NSCLC patients' overall survival (OS). In univariate Cox regression models, gender, stage, TTn, Nn, and Mn were statistically significant factors (P = 0.016, 0.032, <0.001, <0.001, and 0.006, respectively). In multivariate Cox regression models, TTn and Nn remained as statistically significant predictors for survival with hazard ratios (HR) of 1.06 (P = 0.001) and 1.11 (P = 0.002), respectively, after adjusting for clinical stage based 7th edition of TNM staging system, age, gender, and SUV(max). Patients with a TTn ≤4 (cutpoint based on median value) had a median OS of 15.2 months compared with 9.0 months for those with TTn >4. Measuring the number of tumors on FDG PET imaging is easy to perform with minimal inter-observer variability. The total number of tumors and number of nodal metastases, as metabolic tumor burden measurements in 18F-FDG PET/CT, are prognostic markers independent of clinical stage, age, gender, and SUV measurement in non-surgical patients with NSCLC.
    Preview · Article · Jun 2012 · Acta Radiologica
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    ABSTRACT: Purpose To determine whether whole-body metabolic tumor burden, measured as either metabolic tumor volume (MTVWB) or total lesion glycolysis (TLGWB), using FDG-PET/CT is an independent prognostic marker in non-small cell lung cancer (NSCLC). Methods 328 patients with histologically proven NSCLC were identified for this retrospective analysis. This study was approved by our Institutional Review Board. All patients underwent baseline 18F-FDG-PET/CT scan imaging before therapy. The MTVWB, TLGWB, maximum standardized uptake value (SUVmaxWB) and mean standardized uptake value (SUVmeanWB) of tumors throughout the whole body were measured from FDG-PET images with semi-automated 3D contouring software. Results In univariate analysis, there was a statistically significant association of overall survival (OS) with the MTVWB (hazard ratio (HR) = 1.62, p < 0.001), TLGWB (HR = 1.47, p < 0.001). The patients with a MTVWB ≤ median of 65.7 ml and TLGWB ≤ median of 205.11 SUVmean * ml had a median OS of 41.1 and 35.4 months compared with 9.5 and 9.7 months for those with a MTVWB > 65.7 ml and TLGWB > 205.11 SUVmean * ml, respectively. From a series of multivariate Cox regression models, the MTVWB and TLGWB were significantly better than SUVmaxWB and SUVmeanWB at prognostication and significantly associated with patients’ OS with HRs of 1.50 (p < 0.001) and 1.42 (p < 0.001), respectively, after adjustment for patient’s age, gender and treatment intent as well as the tumor SUVmaxWB, histology and stage. Conclusions MTVWB and TLGWB as metabolic tumor burden measurements in 18F-FDG-PET/CT are independent prognostic markers and are significantly better than SUVmaxWB and SUVmeanWB at prognostication.
    No preview · Article · May 2012 · International Journal of Computer Assisted Radiology and Surgery
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    ABSTRACT: Presented at European Congress of the European Association of Nuclear Medicine - Milan, Italy 2012
    Full-text · Conference Paper · Mar 2012
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    ABSTRACT: Stage IV non-small-cell lung cancer (NSCLC) consists of a heterogeneous group of patients with different prognoses. We assessed the prognostic value of baseline whole body tumor burden as measured by metabolic tumor volume (MTV), total lesion glycolysis (TLG), and standardized uptake values (SUV(max) and SUV(mean)) of all tumors in nonsurgical patients with Stage IV NSCLC. Ninety-two consecutive patients with newly diagnosed Stage IV NSCLC who had a pretreatment F-18 fludeoxyglucose positron emission tomography/computed tomography scan were retrospectively reviewed. The MTV, TLG, SUV(mean), and SUV(max) of whole-body (WB) tumors were measured with the MIMvista workstation with manual adjustment. There was a statistically significant association between overall survival (OS) and ln(MTV)/ln(TLG) at the level of WB tumor burden (MTV(WB)) and of primary tumor (MTV(T)). The hazard ratio (HR) for a 1-unit increase of ln(MTV(WB)) and ln(MTV(T)) before and after adjusting for age and gender was 1.48/1.48 (both P < .001) and 1.25/1.25 (P = .006, .007), respectively. The HR for a 1-unit increase of ln(TLG(WB)) and ln(TLG(T)) before and after adjusting for age and gender was 1.37/1.37 (both P = .001) and 1.19/1.19 (P = .001, .017), respectively. There was no statistically significant association between OS and ln(SUV(max)) and ln(SUV(mean)) at WB tumor burden, primary tumor, nodal metastasis, or distant metastasis (P > .05). There was low interobserver variability between two radiologists with concordance correlation coefficients of 0.90 for ln(MTV(WB)) and greater than 0.90 for SUV(maxWB), SUV(meanWB), and ln(TLG(WB)). Baseline WB metabolic tumor burden, as measured with MTV and TLG, is a prognostic measurement in patients within Stage IV NSCLC with low interobserver variability. This study also suggests pretreatment MTV and TLG measurements may be used to further stratify patients with Stage IV NSCLC and are better prognostic measures than SUV(max) and SUV(mean) measurements.
    No preview · Article · Jan 2012 · Academic radiology
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    ABSTRACT: PURPOSE To assess the prognostic value of baseline whole body tumor burden as measured by metabolic tumor volume (MTV), total lesion glycolysis (TLG) and standardized uptake value (SUVmax and SUVmean) of all tumors in patients non-small cell lung cancer (NSCLC ) who were treated surgically. METHOD AND MATERIALS 92 consecutive patients (47 males, 45 females) with newly diagnosed NSCLC who had FDG PET/CT scans before the surgery were retrospectively reviewed. The FGD PET/CT scans were performed in accordance with National Cancer Institute guidelines. The MTV, TLG as well as the SUVmean and SUVmax of whole-body tumors were measured with the PETedge tool on MIMvista workstation with manual adjustment. The median follow-up among 62 survivors is 50 months from initial diagnosis (range of 3 to 81 months). Statistical methods included log-rank tests and Cox regression. RESULTS Mean±SD levels at baseline for log MTV, log TLG, SUVmean, and SUVmax were: 2.9±1.6, 3.9±2.1, 3.4±1.9, and 7.9±5.9, respectively. There were a total of 30 deaths during follow-up. Median overall survival (OS) was not yet reached. There was a statistically significant association, after adjusting for cancer stage, between OS and log MTV (Hazard Ratio [HR] for 1 SD increase=1.41, 95% CI (1.09,1.81, p=0.008), and log TLG (HR for 1 SD increase=1.30, 95% CI (1.06, 1.60, p=0.012) measured on baseline PET/CT but not log SUVmax and log SUVmean (p=0.083 and 0.092, respectively). There was a statistically significant association, after adjusting for cancer stage, between progression-free survival and log MTV (Hazard Ratio [HR] for 1 SD increase=1.26, 95% CI (1.03,1.54, p = 0.028), log TLG (HR for 1 SD increase=1.18, 95% CI (1.01, 1.38, p = 0.042 ) measured on baseline PET/CT but not log SUVmax and log SUVmean (p=0.201, and 0.227). CONCLUSION Baseline whole-body metabolic tumor burden as measured with MTV or TLG on PET/CT is a prognostic measurement independent on the patient’s clinical TNM staging in NSCLC treated surgically. CLINICAL RELEVANCE/APPLICATION Whole-body metabolic tumor burden in surgical patients with NSCLC on the baseline PET/CT may help to further stage the patients for more appropriate therapy or clinical trial.
    No preview · Conference Paper · Nov 2011
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    ABSTRACT: The objective of this study was to assess the prognostic value of metabolic tumor burden on 2-deoxy-2-[(18)F]fluoro-D-glucose ((18)F-FDG) positron emission tomography (PET)/CT measured with metabolic tumor volume (MTV) and total lesion glycolysis (TLG), independent of Union Internationale Contra la Cancrum (UICC)/American Joint Committee on Cancer (AJCC) tumor, node, and metastasis (TNM) stage, in comparison with that of standardized uptake value (SUV) in nonsurgical patients with non-small cell lung cancer (NSCLC). This study retrospectively reviewed 169 consecutive nonsurgical patients (78 men, 91 women, median age of 68 years) with newly diagnosed NSCLC who had pretreatment (18)F-FDG PET/CT scans. The (18)F-FDG PET/CT scans were performed in accordance with National Cancer Institute guidelines. The MTV of whole-body tumor (MTV(WB)), of primary tumor (MTV(T)), of nodal metastases (MTV(N)), and of distant metastases (MTV(M)); the TLG of whole-body tumor (TLG(WB)), of primary tumor (TLG(T)), of nodal metastases (TLG(N)), and of distant metastases (TLG(M)); the SUV(max) of whole-body tumor (SUV(maxWB)), of primary tumor (SUV(maxT)), of nodal metastases (SUV(maxN)), and of distant metastases (SUV(maxM)) as well as the SUV(mean) of whole-body tumor (SUV(meanWB)), of primary tumor (SUV(meanT)), of nodal metastases (SUV(meanN)), and of distant metastases (SUV(meanM)) were measured with the PETedge tool on a MIMvista workstation with manual adjustment. The median follow-up among survivors was 35 months from the PET/CT (range 2-82 months). Statistical methods included Kaplan-Meier curves, Cox regression, and C-statistics. There were a total of 139 deaths during follow-up. Median overall survival (OS) was 10.9 months [95% confidence interval (CI) 9.0-13.2 months]. The MTV was statistically associated with OS. The hazard ratios (HR) for 1 unit increase of ln(MTV(WB)), √(MTV(T)), √(MTV(N)), and √(MTV(M)) before/after adjusting for stage were: 1.47/1.43 (p < 0.001/<0.001), 1.06/1.05 (p < 0.001/<0.001), 1.11/1.10 (p < 0.001/<0.001), and 1.04/1.03 (p = 0.007/0.043), respectively. TLG had statistically significant associations with OS with the HRs for 1 unit increase in ln(TLG(WB)), √(TLG(T)), √(TLG(N)), and √(TLG(M)) before/after adjusting for stage being 1.36/1.33 (p < 0.001/<0.001), 1.02/1.02 (p = 0.001/0.002), 1.05/1.04 (p < 0.001/<0.001), and 1.02/1.02 (p = 0.003/0.024), respectively. The ln(SUV(maxWB)) and √(SUV(maxN)) were statistically associated with OS with the corresponding HRs for a 1 unit increase before/after adjusting for stage being 1.46/1.43 (p = 0.013/0.024) and 1.22/1.16 (p = 0.002/0.040). The √(SUV(meanN)) was statistically associated with OS before and after adjusting for stage with HRs for a 1 unit increase of 1.32 (p < 0.001) and 1.24 (p = 0.015), respectively. The √(SUV(meanM)) and √(SUV(maxM)) were statistically associated with OS before adjusting for stage with HRs for a 1 unit increase of 1.26 (p = 0.017) and 1.18 (p = 0.007), respectively, but not after adjusting for stage (p = 0.127 and 0.056). There was no statistically significant association between OS and √(SUV(maxT)), ln(SUV(meanWB)), or √(SUV(meanT)). There was low interobserver variability among three radiologists with intraclass correlation coefficients (ICC) greater than 0.94 for SUV(maxWB), ln(MTV(WB)), and ln(TLG(WB)). Interobserver variability was higher for SUV(meanWB) with an ICC of 0.806. Baseline metabolic tumor burdens at the level of whole-body tumor, primary tumor, nodal metastasis, and distant metastasis as measured with MTV and TLG on FDG PET are prognostic measures independent of clinical stage with low inter-observer variability and may be used to further stratify nonsurgical patients with NSCLC. This study also suggests MTV and TLG are better prognostic measures than SUV(max) and SUV(mean). These results will need to be validated in larger cohorts in a prospective study.
    No preview · Article · Sep 2011 · European Journal of Nuclear Medicine
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    ABSTRACT: In order to aid radiologists' routine work for interpreting bone scan images, we developed a computerized method for temporal subtraction (TS) images which can highlight interval changes between successive whole-body bone scans, and we performed a prospective clinical study for evaluating the clinical utility of the TS images. We developed a TS image server which includes an automated image-retrieval system, an automated image-conversion system, an automated TS image-producing system, a computer interface for displaying and evaluating TS images with five subjective scales, and an automated data-archiving system. In this study, the radiologist could revise his/her report after reviewing the TS images if the findings on the TS image were confirmed retrospectively on our clinical picture archiving and communication system. We had 256 consenting patients of whom 143 had two or more whole-body bone scans available for TS images. In total, we obtained TS images successfully in 292 (96.1%) pairs and failed to produce TS images in 12 pairs. Among the 292 TS studies used for diagnosis, TS images were considered as "extremely beneficial" or "somewhat beneficial" in 247 (84.6%) pairs, as "no utility" in 44 pairs, and as "somewhat detrimental" in only one pair. There was no TS image for any pairs that was considered "extremely detrimental." In addition, the radiologists changed their initial reported impression in 18 pairs (6.2%). The benefit to the radiologist of using TS images in the routine interpretation of successive whole-body bone scans was significant, with negligible detrimental effects.
    Full-text · Article · Aug 2011 · Journal of Digital Imaging
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    Full-text · Conference Paper · Mar 2011
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    ABSTRACT: (18)F-fluoro-2-deoxyglucose positron emission tomography ((18)F-FDG PET) imaging has been shown to be an accurate method for diagnosing pulmonary lesions, and the standardized uptake value (SUV) has been shown to be useful in differentiating benign from malignant lesions. To survey the interobserver variability of SUV(max) and SUV(mean) measurements on (18)F-FDG PET/CT scans and compare them with tumor size measurements on diagnostic CT scans in the same group of patients with focal pulmonary lesions. Forty-three pulmonary nodules were measured on both (18)F-FDG PET/CT and diagnostic chest CT examinations. Four independent readers measured the SUV(max) and SUV(mean) of the (18)F-FDG PET images, and the unidimensional nodule size of the diagnostic CT scans (UD(CT)) in all nodules. The region of interest (ROI) for the SUV measurements was drawn manually around each tumor on all consecutive slices that contained the nodule. The interobserver reliability and variability, represented by the intraclass correlation coefficient (ICC) and coefficient of variation (COV), respectively, were compared among the three parameters. The correlation between the SUV(max) and SUV(mean) was also analyzed. There was 100% agreement in the SUV(max) measurements among the 4 readers in the 43 pulmonary tumors. The ICCs for the SUV(max), SUV(mean), and UD(CT) by the four readers were 1.00, 0.97, and 0.97, respectively. The root-mean-square values of the COVs for the SUV(max), SUV(mean), and UD(CT) by the four readers were 0%, 13.56%, and 11.03%, respectively. There was a high correlation observed between the SUV(max) and SUV(mean) (Pearson's r=0.958; P <0.01). This study has shown that the SUV(max) of lung nodules can be calculated without any interobserver variation. These findings indicate that SUV(max) is a more valuable parameter than the SUV(mean) or UD(CT) for the evaluation of therapeutic effects of chemotherapy or radiation therapy on serial studies.
    No preview · Article · Sep 2010 · Acta Radiologica
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    ABSTRACT: The authors report the fluorodeoxyglucose (FDG)-positron emission tomography(PET)/computed tomography (CT) findings of a rare case of growth hormone-secreting pituitary carcinoma with multiple metastatic lesions to the skeleton. A 31-year-old male had presented with acromegaly and had received transsphenoidal resection of a pituitary tumor and adjuvant radiotherapy. However, the tumor recurred with local invasions and the patient underwent more resections and adjuvant chemotherapy. Several months later, the patient developed rising levels of insulin-like growth factor 1 and whole-body FDG-PET/CT scanning revealed multiple hypermetabolic lesions throughout the skeleton compatible with metastasis.
    Preview · Article · Mar 2010 · Cancer Imaging
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    ABSTRACT: PURPOSE To compare the reproducibility of the maximal standardized uptake value (SUV) on FDG PET with that of the tumor size measurement on diagnostic CT. METHOD AND MATERIALS We retrospectively reviewed 36 PET/CT scans and 44 diagnostic CT scans in 29 consecutive patients with biopsy-proven lymphoma for initial staging and restaging after chemotherapy. Scans were performed with a PET/CT scanner one hour after the injection of 10 to 20 mCi FDG. All CT scans were obtained with spiral CT scanners. The PET, PET/CT fusion and non-diagnostic CT images were reviewed and maximal SUV (SUVmax) were measured independently by two nuclear medicine physicians with CT experience. The SUVmax of a discrete tumor or of a cluster of confluent tumors was measured on each FDG PET scan using a PET workstation. All slices that contained the tumor(s) were used in the measurement of the SUVmax so that the whole tumor(s) was included in the region of interest. The maximal length and width of the tumor(s) were measured on the axial slice on which the tumor(s) had the maximal cross-sectional dimension using our Stentor PACS system. ANOVA was used to estimate the inter-observer variability with SPSS 10.01. The mean square errors between two sets of the measurements by two physicians were used to determine the inter-observer variability of the PET and CT measurements. RESULTS The inter-observer mean square errors of SUVmax on PET/CT, the length of the tumor on CT and the tumor width on CT are 0.00, 215.16 mm 2, and 24.36 mm2, respectively. CONCLUSION Although many physiological and technical factors can affect SUVmax measurement, they are considered to have a negligible effect on assessing change of SUVmax on initial and follow-up scans. Our study shows that SUVmax measurement is not observer-dependent and without inter-observer variation. However, CT measurements of the tumor length and width are observer-dependent with an inter-observer variability. CLINICAL RELEVANCE/APPLICATION Knowing reproducibility difference between SUVmax on PET/CT and CT tumor size measurements is important in the evaluating therapeutic response of tumors, especially in clinical trials.
    No preview · Conference Paper · Nov 2007

Publication Stats

998 Citations
187.73 Total Impact Points

Institutions

  • 2015
    • Shanghai Jiao Tong University
      • Department of Nuclear Medicine
      Shanghai, Shanghai Shi, China
  • 2006-2015
    • University of Chicago
      • Department of Radiology
      Chicago, Illinois, United States
  • 1999-2001
    • University of Texas Health Science Center at San Antonio
      • • Research Imaging Institute
      • • Department of Physiology
      San Antonio, Texas, United States
  • 2000
    • University of Texas Health Science Center at Tyler
      Tyler, Texas, United States