Felix N Harder1, Friederike Jungmann1, Georgios A Kaissis1,2, Fabian K Lohöfer1, Sebastian Ziegelmayer1, Daniel Havel1, Michael Quante3, Maximillian Reichert4,5, Roland M Schmid4,5, Ihsan Ekin Demir6, Helmut Friess6, Moritz Wildgruber7, Jens Siveke8, Alexander Muckenhuber9, Katja Steiger9, Wilko Weichert9, Isabel Rauscher10, Matthias Eiber10, Marcus R Makowski1, Rickmer F Braren11,12. 1. Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany. 2. Department of Computing, Faculty of Engineering, Imperial College of Science, Technology and Medicine, London, SW7 2AZ, UK. 3. Internal Medicine II, Faculty of Medicine, Freiburg University Hospital, Freiburg, Germany. 4. Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 5. German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. 6. Department of Surgery, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany. 7. Klinik und Poliklinik für Radiologie, Klinikum der Universität München, Munich, Germany. 8. Institute for Developmental Cancer Therapeutics, West German Cancer Center, University Hospital Essen, Essen, Germany. 9. Institute of Pathology, Technical University of Munich, Munich, Germany. 10. Department of Nuclear Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany. 11. Institute of Diagnostic and Interventional Radiology, School of Medicine, Technical University of Munich, Munich, Germany. rbraren@tum.de. 12. German Cancer Consortium (DKTK), Partner Site Munich, Munich, Germany. rbraren@tum.de.
Abstract
PURPOSE: In this prospective exploratory study, we evaluated the feasibility of [18F]fluorodeoxyglucose ([18F]FDG) PET/MRI-based chemotherapy response prediction in pancreatic ductal adenocarcinoma at two weeks upon therapy onset. MATERIAL AND METHODS: In a mixed cohort, seventeen patients treated with chemotherapy in neoadjuvant or palliative intent were enrolled. All patients were imaged by [18F]FDG PET/MRI before and two weeks after onset of chemotherapy. Response per RECIST1.1 was then assessed at 3 months [18F]FDG PET/MRI-derived parameters (MTV50%, TLG50%, MTV2.5, TLG2.5, SUVmax, SUVpeak, ADCmax, ADCmean and ADCmin) were assessed, using multiple t-test, Man-Whitney-U test and Fisher's exact test for binary features. RESULTS: At 72 ± 43 days, twelve patients were classified as responders and five patients as non-responders. An increase in ∆MTV50% and ∆ADC (≥ 20% and 15%, respectively) and a decrease in ∆TLG50% (≤ 20%) at 2 weeks after chemotherapy onset enabled prediction of responders and non-responders, respectively. Parameter combinations (∆TLG50% and ∆ADCmax or ∆MTV50% and ∆ADCmax) further improved discrimination. CONCLUSION: Multiparametric [18F]FDG PET/MRI-derived parameters, in particular indicators of a change in tumor glycolysis and cellularity, may enable very early chemotherapy response prediction. Further prospective studies in larger patient cohorts are recommended to their clinical impact.
PURPOSE: In this prospective exploratory study, we evaluated the feasibility of [18F]fluorodeoxyglucose ([18F]FDG) PET/MRI-based chemotherapy response prediction in pancreatic ductal adenocarcinoma at two weeks upon therapy onset. MATERIAL AND METHODS: In a mixed cohort, seventeen patients treated with chemotherapy in neoadjuvant or palliative intent were enrolled. All patients were imaged by [18F]FDG PET/MRI before and two weeks after onset of chemotherapy. Response per RECIST1.1 was then assessed at 3 months [18F]FDG PET/MRI-derived parameters (MTV50%, TLG50%, MTV2.5, TLG2.5, SUVmax, SUVpeak, ADCmax, ADCmean and ADCmin) were assessed, using multiple t-test, Man-Whitney-U test and Fisher's exact test for binary features. RESULTS: At 72 ± 43 days, twelve patients were classified as responders and five patients as non-responders. An increase in ∆MTV50% and ∆ADC (≥ 20% and 15%, respectively) and a decrease in ∆TLG50% (≤ 20%) at 2 weeks after chemotherapy onset enabled prediction of responders and non-responders, respectively. Parameter combinations (∆TLG50% and ∆ADCmax or ∆MTV50% and ∆ADCmax) further improved discrimination. CONCLUSION: Multiparametric [18F]FDG PET/MRI-derived parameters, in particular indicators of a change in tumor glycolysis and cellularity, may enable very early chemotherapy response prediction. Further prospective studies in larger patient cohorts are recommended to their clinical impact.
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