Zhun Huang1,2, Xiaochen Li2,3, Zhixue Wang4, Nan Meng2,3, Fangfang Fu2,3, Hui Han5, Dujuan Li3, Yan Bai2,3, Wei Wei2,3, Ting Fang2,3, Pengyang Feng1,2, Jianmin Yuan6, Yang Yang7, Meiyun Wang1,2,3. 1. Department of Medical Imaging, Henan University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, China. 2. Henan Key Laboratory for Medical Imaging of Neurological Diseases, Zhengzhou, China. 3. Department of Medical imaging, Zhengzhou University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, China. 4. Department of Radiology, The First Affiliated Hospital of Henan University, Kaifeng, China. 5. Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA. 6. Central Research Institute, UIH Group, Shanghai, China. 7. Beijing United Imaging Research Institute of Intelligent Imaging, Beijing, China.
Abstract
BACKGROUND: Ki-67 proliferation index (PI) is important for providing information on tumor behavior, treatment response, and prognosis. Integrated positron emission tomography/magnetic resonance (PET/MR) may have the potential to assess Ki-67 PI in patients with lung adenocarcinoma. PURPOSE: To explore the value of simultaneous 18 F-fluorodeoxyglucose (18 F-FDG) PET/MR-derived parameters in assessing the proliferation status of lung adenocarcinoma and to determine the best combination of parameters. STUDY TYPE: Prospective. POPULATION: Seventy-eight patients with lung adenocarcinoma and with Ki-67 PI. FIELD STRENGTH/SEQUENCE: 3.0 T, simultaneous PET/MRI including diffusion-weighted imaging (DWI) and 18 F-FDG PET. ASSESSMENT: DWI-derived parameters, namely, apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), diffusion heterogeneity index (α), and distributed diffusion coefficient (DDC); and PET-derived parameters, namely, maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), and total lesion glycolytic volume (TLG), were calculated and compared between the high (>25%) and low (≤25%) Ki-67 PI groups. The correlations between PET-derived parameters and DWI-derived parameters were analyzed. STATISTICAL TESTS: Student's t-test, Mann-Whitney U test, chi-square test, and receiver operating characteristic (ROC) curves. A P-value <0.05 was considered statistically significant. RESULTS: The SUVmax , MTV, TLG, ADC, D, and DDC values were significantly different between the high (N = 35) and low Ki-67 PI groups (N = 43). D, SUVmax , and MTV independently predicted the Ki-67 PI status. The combination of D, SUVmax , and MTV had the largest area under the ROC curve (AUC = 0.900), which was significantly larger than the AUC alone of DDC (AUC = 0.725), SUVmax (AUC = 0.815), MTV (AUC = 0.774), or TLG (AUC = 0.783). The perfusion fraction did not correlate with SUVmax , MTV, or TLG (r = -0.03, -0.11, and -0.04, respectively; P = 0.786, 0.348, and 0.733). DATA CONCLUSION: The combination of D, SUVmax , and MTV may predict Ki-67 PI status. No correlation was observed between perfusion parameters and metabolic parameters. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.
BACKGROUND: Ki-67 proliferation index (PI) is important for providing information on tumor behavior, treatment response, and prognosis. Integrated positron emission tomography/magnetic resonance (PET/MR) may have the potential to assess Ki-67 PI in patients with lung adenocarcinoma. PURPOSE: To explore the value of simultaneous 18 F-fluorodeoxyglucose (18 F-FDG) PET/MR-derived parameters in assessing the proliferation status of lung adenocarcinoma and to determine the best combination of parameters. STUDY TYPE: Prospective. POPULATION: Seventy-eight patients with lung adenocarcinoma and with Ki-67 PI. FIELD STRENGTH/SEQUENCE: 3.0 T, simultaneous PET/MRI including diffusion-weighted imaging (DWI) and 18 F-FDG PET. ASSESSMENT: DWI-derived parameters, namely, apparent diffusion coefficient (ADC), true diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), diffusion heterogeneity index (α), and distributed diffusion coefficient (DDC); and PET-derived parameters, namely, maximum standardized uptake value (SUVmax ), metabolic tumor volume (MTV), and total lesion glycolytic volume (TLG), were calculated and compared between the high (>25%) and low (≤25%) Ki-67 PI groups. The correlations between PET-derived parameters and DWI-derived parameters were analyzed. STATISTICAL TESTS: Student's t-test, Mann-Whitney U test, chi-square test, and receiver operating characteristic (ROC) curves. A P-value <0.05 was considered statistically significant. RESULTS: The SUVmax , MTV, TLG, ADC, D, and DDC values were significantly different between the high (N = 35) and low Ki-67 PI groups (N = 43). D, SUVmax , and MTV independently predicted the Ki-67 PI status. The combination of D, SUVmax , and MTV had the largest area under the ROC curve (AUC = 0.900), which was significantly larger than the AUC alone of DDC (AUC = 0.725), SUVmax (AUC = 0.815), MTV (AUC = 0.774), or TLG (AUC = 0.783). The perfusion fraction did not correlate with SUVmax , MTV, or TLG (r = -0.03, -0.11, and -0.04, respectively; P = 0.786, 0.348, and 0.733). DATA CONCLUSION: The combination of D, SUVmax , and MTV may predict Ki-67 PI status. No correlation was observed between perfusion parameters and metabolic parameters. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 2.