Objective To compare the PET response criteria in solid tumors (PERCIST) and response evaluation criteria in solid tumors (RECIST) in the evaluation of therapeutic response in 49 non-small-cell lung cancer(NSCLC) patients.Methods Forty-nine NSCLC patients who received chemotherapy but no surgery were studied.Therapeutic responses were evaluated using 18 F-FDG PET and CT according to the RECIST and PERCIST methods.The PET-CT scans were obtained before chemotherapy and about 2 or 6 weeks after completion of chemotherapy.Firstly the reduction rates of tumor diameter and reduction rates of tumor standardized uptake value were compared with paired t-test.Then the response was classed into 4 levels according to RECIST and PERCIST:PD and PMD =1,SD and SMD =2,PR and PMR =3,CR and CMR =4.Pearson and Chi-square test was used to compare the proportion of four levels in RECIST and PERCIST.Finally one target lesion and two target lesions were compared for RECIST therapeutic evaluation in 33 cases with two target lesions.Results The diameter was (3.52 ± 1.65) cm before the therapy and (2.39 ± 1.43)cm after the therapy.The standardized uptake value was 8.78 ±4.18 vs.5.06 ±3.62 before and after therapy for the first target lesions in 49 patients.The differences of reduction rates between tumor diameter and standardized uptake value were not significant because of selection bias (0.32 ± 0.27 vs.0.28 ±0.64,t =0.176,P ＞0.05).However,there was a significant difference when the reduction rate was compared only in 39 patients in which the standardized uptake values were reduced after therapy (0.39 ± 0.29 vs.0.52 ±0.28,t =-4.08,P ＜0.01).The results of classification were 1/13 for CR/CMR,25/16 for PR/PMR,22/15 for SD/SMD,1/5 for PD/PMD,and 33 cases had no consistent results from RECIST and PERCIST.There was a significant difference in response classification between RECIST and PERCIST (x2 =16.252,P ＜ 0.01).No significant difference was found between one target lesion and two target lesions for RECIST evaluation results in 33 cases (x2 =1.171,P ＞ 0.05),but results of response classification were changed in 5 cases.Conclusions PERCIST criteria may be more sensitive in NSCLC therapeutic evaluation comparing to RECIST criteria.There is a higher proportion with CMR and PMD in PERCIST,but its effect on the prognosis is not yet clear.The number of target lesions may affect the results of therapeutic evaluation with RECIST criteria.

Objective To assess the value of CT or PET-CT with fluorine-18-labeled fluorodeoxyglucose (FDG) for the diagnosis of pulmonary mucosa-associated lymphoid tissue (MALT) type lymphoma. Methods The CT or FDG PET-CT findings in 14 patients with pathologically proved pulmonary MALT lymphoma were retrospectively analyzed. Results Lung lesions were unilateral in 7 patients and bilateral in 7 patients. Lesions presented as a single mass in 3 patients, as a single consolidation in 3 patients, as a nodule in 1 patient, as multiple nodules in 1 patient, as multiple patchy consolidations in 4 patients, as a mass with multiple nodules and patchy consolidations in 1 patients, as diffuse interstitial change in 1 patients. Air bronchogram was found in 9 patients and CT angiogram sign in 5 patients. On PET-CT, lesions showed heterogeneous FDG uptake in 2 patients, maximum standard uptake value was higher than 2. 5. Conclusion Imaging characteristics of pulmonary MALT lymphoma are single or multiple nodules or consolidations with air bronchogram on CT, and heterogeneous high FDG uptake on PET-CT.

Objective To evaluate the clinical value of 18F-FDG PET-CT in monitoring response to therapy in patients with follicular lymphoma (FL) staging Ⅲ-Ⅳ.Methods The clinical data of 20 patients with FL were analyzed retrospectively.All patients underwent PET-CT at three times:baseline,after 3-4 cycles of chemotherapy,and end of treatment.Kaplan-Meier method was used to analyze the survival of patients.Results 14 patients achieved CR at the interim PET-CT,all patients achieved CR at post therapy PET-CT:all patients were alive with no evidence of disease in the follow-up.2 patiens achieved PR at the interim PET-CT,and 1 patient achieved CR,and 1 patient was PD,at post therapy PET-CT,all patients were relapsed in the follow-up.4 patients achieved PD,and all patients were changed the chemotherapy plan.At post therapy PET-CT,2 patients achieved CR,1 patient achieved PR,and 1 patient was PD,1 patient was no evidence of disease,2 patients were relapsed,and another was died in the follow-up.The negative predictive values (NPV) of the interim and the post therapy PET-CT were 100 ％ (14/14),88.2 ％ (15/17) respectively.The interim PET-CT was no significantly correlated with PFS (P =0.135),while the post therapy PET-CT was significantly correlated with PFS (P =0.0006).Conclusion 18F-FDG PET-CT is useful to monitor response to chemotherapy in patients with FL staging Ⅲ-Ⅳ,and set personalized treatment plan.

Objective: To explore the imaging manifestation and clinical characteristics of primary salivary gland-type lung cancer using ¹⁸F-fluorodeoxy glucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET-CT). Methods: From March 2009 to January 2017, 12 patients with pathologically confirmed primary salivary gland-type lung cancer were enrolled in First Affiliated Hospital of Nanjing Medical University. Their images and clinicopathological data were retrospectively analyzed. Results: Six out of 12 patients had mucoepidermoid carcinoma (MEC), and the other six patients had adenoid cystic carcinoma (ACC). Five MEC were located in the main bronchus, and the other one was in segmental bronchus. Intrabronchial nodule or mass with smooth or lobulated margin and calcification(n=3) was the main ¹⁸F-FDG PET-CT features of MEC. Two ACC involved trachea, two involved the main bronchi, and the other two involved lobular bronchi. The main ¹⁸F-FDG PET-CT features of ACC were diffuse or circumferential irregular thickness of the bronchial wall, distorted lumen, and the longitudinal extent of the tumor was greater than its transverse axis. The ¹⁸F-FDG uptake of all lesions was increased in varying degree. The median (25th percentile, 75th percentile) value of maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were 5.1(3.1, 8.1), 5.7(1.2, 21.4)cm³ and 18.6(0.6, 93.7), respectively. All of them were related to pathological grading and nodal tumor involvement( all P<0.05), but not associated with tumor location or pathological type( all P>0.05). MTV and TLG were also related to clinical stage( all P<0.05). Tumor size was correlated with MTV, TLG of primary lesions(r=0.607, P=0.036; r=0.579, P=0.049), but not with SUVmax(r=0.568, P=0.054). Conclusions Primary salivary gland-type lung cancer mainly occurs in segmental bronchus. The MTV and TLG of the tumor calculated by ¹⁸F-FDG PET-CT are correlated with clinicopathological characteristics, and are helpful for clinical diagnosis and treatment.

Objective: To investigated the prognostic value of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) in extensive-stage small cell lung cancer (ES -SCLC). Methods: Fifty-five patients with ES-SCLC who underwent pretreatment ¹⁸F-FDG PET-CT were retrospectively recruited in this study. The correlations of maximum standardized uptake value (SUVmax) of primary lesion, metabolic tumor volume (MTV) of primary lesion (MTVp), total lesion glycolysis (TLG) of primary lesion (TLGp), the highest SUVmax of all lesions, the sum of metabolic volume (MTV sum), the sum of total lesions glycolysis (TLGsum) and clinical factors were analyzed. Results: The SUVmax, MTVp, TLGp, the highest SUVmax, MTVsum and TLGsum of 55 patients were 11.34±7.02, 29.61 cm^3, 207.72, 13.61±7.10, 123.57 cm³ and 988.48, respectively. The SUVmax of primary lesion, MTVp and TLGp were correlated with tumor type and the maximal tumor length, respectively(all P<0.05). The correlations were also found between MTVp, TLGp and hydrothorax, respectively(both P<0.05). MTVsum and TLGsum were correlated with number of lesions, hydrothorax, LDH, hemoglobin and ECOG, respectively(all P<0.05). The association was also found between TLGsum and the maximal tumor length (P=0.039). 51 patients were progressive or recurrent with the median 6.9 months of progression free survival (PFS); and 50 patients were died with the median 11.7 months of overall survival (OS). Univariate analysis showed that MTVsum, TLGsum, number of lesions, ECOG, live metastasis, bone metastasis, the cycle of chemotherapy and thoracic radiation therapy were all associated with PFS and OS (all P<0.05); LDH and hemoglobin were only associated with PFS(both P<0.05). Multivariate analysis demonstrated that LDH, ECOG, live metastasis, the cycle of chemotherapy, MTVsum, TLGsum were the independent predictors of PFS (all P<0.05); and ECOG and TLG sum were the independent predictors of OS (all P<0.05). Conclusions ¹⁸F-FDG PET-CT has certain prognostic value of patients with ES-SCLC. MTVsum and TLGsum are the independent predictors of PFS, and TLGsum is also an independent predictor of OS.

Objective: To investigate the value of maximum Standardized Uptake Value(SUVmax), Metabolic Tumor Volume (MTV) and Total Lesion Glycolysis (TLG) calculated from ¹⁸F-FDG PET-CT in predicting the presence of epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma. Methods: We retrospectively reviewed 137 lung adenocarcinoma patients with EGFR mutations testing and pretreatment ¹⁸F-FDG PET-CT. Receiver Operating Characteristic (ROC) curve analysis was performed to quantify the predictive value of SUVmax、MTV、TLG. A multivariate logistic regression analysis was used to evaluate the predictive value of EGFR mutation. Results: Among 137 lung adenocarcinoma patients, 86(62.8%, 86/137) were identified with EGFR mutations. The SUVmax, MTV and TLG were 7.4, 5.28 cm^3, 20.20, respectively. The optimal cut-off values of SUVmax, MTV and TLG were 7.99(AUC=0.658, 95% CI=0.566~0.752, P=0.002), 6.09 cm³(AUC=0.644, 95% CI=0.550~0.737, P=0.005), 35.08(AUC=0.650, 95% CI= 0.557~0.744, P=0.003), respectively. Multivariate analysis showed that TLG and smoking status were the most significant predictors of EGFR mutation(all P<0.05). Conclusion TLG in ¹⁸F-FDG PET/CT is an independent factor for predicting EGFR mutation in patients with lung adenocarcinoma, and has certain reference value for predicting EGFR mutation.

Objective: To investigate the relationship between metabolic parameters of primary lesion and clinicopathological features of patients with breast cancer. Methods: Clinical data of 78 patients with breast cancer undergone ¹⁸F-FDG PET/CT before surgery was retrospectively analyzed. SUVmax, SUVmean and metabolic tumor volume (MTV) of primary lesions were measured by horizontal, sagittal and coronal position volume section with a threshold of 40% SUVmax. TLG was calculated and the highest SUVmax among metastatic lymph nodes was measured. Results: SUVmax, SUVmean, MTV, TLG and the maximum diameter of 78 primary lesions were 6.64(1.85, 22.79), 3.88(1.30, 11.42), 13.36(1.66, 129.08)cm^3, 47.92(2.85, 443.28)g and 2.35(1.23, 9.80)cm, respectively. SUVmax of metastatic lymph node was 5.12(2.38, 14.32). There were statistically significant differences of primary lesion metabolic parameters (SUVmax, MTV, TLG) in different pathological stages, T stages, with or without lymph node invasion (all P<0.05). Only TLG of ER negative patients was higher than that of ER positive patients (P<0.05). TLG, MTV of PR negative patients were higher than that of PR positive patients (both P<0.05). No significant differences of metabolic parameters were found between HER-2 negative and positive patients (all P>0.05). SUVmax, MTV, TLG of primary lesion were positively associated with Ki-67 and the maximum diameter (all P<0.05), and the correlation coefficient of TLG was the highest. SUVmax, SUVmean, MTV and TLG were all positively associated with T stage (all P<0.05), and the correlation coefficient of TLG was the highest. None of the parameters had correlation with N stage(all P>0.05). Only TLG had positive correlation with clinical stage (P<0.05). SUVmax of metastatic lymph node was positively associated with metabolic parameters of primary lesion, T stage and clinical stage, respectively (all P<0.05). Conclusions ¹⁸F-FDG PET/CT metabolic parameters, especially TLG has the highest correlation with clinicopathological features of breast cancer. SUVmax of metastatic lymph node was positively associated with metabolic parameters of primary lesion and clinical stage.

Objective: To investigate the prognostic value of the maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by pretreatment ¹⁸F-FDG PET-CT in patients with stage Ⅲ~Ⅳ diffuse large B-cell lymphoma (DLBCL). Methods: Clinical data of 72 DLBCL patients with stage Ⅲ~Ⅳ disease undergoing a pretreatment PET-CT scan were retrospectively analyzed. SUVmax, MTV and TLG values of whole-body tumor were calculated from PET-CT images with a threshold of SUVmax 40% of tumor tissues. The optimal cutoff lines of SUVmax, MTV and TLG were obtained by ROC curve analysis. The Kaplan-Meier method and Log-rank test were used to perform univariate survival analysis, while Cox proportional hazards model was done for multivariate analysis. Results: The SUVmax, MTV and TLG of 72 patients were 21.64, 139.48 cm³ and 1 413.77, respectively. The areas under the ROC curve (AUC) of SUVmax, MTV and TLG were 0.411 (95%CI=0.279~0.544, P=0.195), 0.688 (95%CI=0.566~0.811, P=0.006) and 0.526 (95%CI= 0.469~0.672, P=0.123), respectively. The median SUVmax (21.64) and TLG(1 413.77) were used as the cutoff lines due to smaller AUC. The cutoff point of MTV was 69.71 cm³. For DLBCL patients of stage Ⅲ~Ⅳ disease, univariate analysis showed that SUVmax and TLG were not associated with the progression-free survival (PFS) and overall survival (OS) (P>0.05 for all). Multivariate analysis showed that National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) but not MTV was the independent prognostic predictor of PFS and OS (P<0.05 for all). And MTV was not the independent prognostic factor of PFS and OS for stage Ⅲ DLBCL (P>0.05 for all). Conclusions For DLBCL patients with stage Ⅲ~Ⅳ disease, the prognostic value of SUVmax, MTV and TLG before treatment initiation are undetermined, and these indices cannot be used to predict the prognosis.

OBJECTIVETo investigate the prognostic value of interim and post-therapy PET-CT in patients with diffuse large B-cell lymphoma.

METHODSA retrospective analysis was conducted on data from 116 patients with newly diagnosed diffuse large B-cell lymphoma. 43 patients underwent interim PET-CT after 4 cycles of chemotherapy, 48 patients underwent post-therapy PET-CT after 6-8 cycles of chemotherapy, and 25 patients underwent both interim PET-CT and post-therapy PET-CT. The patients were divided into three groups: complete response group, partial response group and no response group. The therapeutic response was assessed by comparing with baseline PET-CT. PET-CT status was assessed for its ability to predict progression-free survival (PFS) and overall survival (OS). The 2-year PFS rate and 3-year OS rate were evaluated using chi-square test. PFS and OS were estimated according to the Kaplan-Meier method and survival curves were compared by log-rank test.

RESULTSInterim PET-CT: The interim PET-CT findings of 42 patients were judged as complete response, 15 were judged as partial response, and the rest 11 were judged as no response. The 2-year PFS rates of the complete response group, partial response group and no response group were 61.9%, 60.0%, and 18.2%, respectively, and the 3-year OS rates were 52.4%, 46.7% and 9.1%, respectively. There were no significant differences between the complete response group and partial response group in 2-year PFS rate and 3-year OS rate (P > 0.05 for both). But there was a significant difference between the partial response group and no response group (P < 0.05). The post-therapy PET-CT findings of 50 patients was judged as complete response, 11 as partial response, and the rest 12 were judged as no response. The 2-year PFS rate of the complete response group, partial response group and no response group were 82.0%, 45.5%, and 8.3%, respectively, and the 3-year OS rates were 88.0%, 54.5%, and 8.3%, respectively. There were significant differences between the complete response group and partial response group in 2-year PFS rate and 3-year OS rate (P < 0.05), and there was a significant difference between the partial response group and no response group (P < 0.05).

CONCLUSIONSCompared with the interim PET-CT, post-therapy PET-CT can accurately evaluate the prognosis of patients with DLBCL. Interim PET-CT cannot define the prognosis of the complete response and partial response patients.

Adult ; Disease-Free Survival ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymphoma, B-Cell ; Lymphoma, Large B-Cell, Diffuse ; diagnostic imaging ; Male ; Middle Aged ; Positron-Emission Tomography ; Prognosis ; Radiography ; Remission Induction ; Retrospective Studies ; Treatment Outcome