The Maximum Standardized Uptake Value of 18F-FDG PET/CT in Diabetic Patients with Metastatic Pancreatic Ductal Adenocarcinoma

  • Kyu-hyun Paik (Department of Internal Medicine, Eulji University College of Medicine) ;
  • Hyoung Woo Kim (Departments of Internal Medicine, College of Medicine and Medical Research Institute, Chungbuk National University) ;
  • Jong-chan Lee (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Jingu Kang (Department of Internal Medicine, Hallym University Medical School) ;
  • Yoon Suk Lee (Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine) ;
  • Jaihwan Kim (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Jin-Hyeok Hwang (Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital)
  • 투고 : 2017.11.03
  • 심사 : 2017.12.14
  • 발행 : 2017.12.31

초록

Background: To evaluate whether DM affects the SUVmax of metastatic lesions on 18F-FDG PET/CT and whether the SUVmax can influence the prognosis of metastatic PDAC patients. Methods: We conducted a retrospective study of 86 patients with metastatic PDAC who underwent PET/CT before treatment. The SUVmax of primary and metastatic lesions and the ratios of the SUVmax were measured. Long-term survival was evaluated using clinical parameters. Results: The mean SUVmax of primary lesion was lower in the DM group than in the non-DM group (4.74 vs. 5.96, p=0.009). The SUVmax for all metastatic lesions, except those in the lung, were lower in the DM group than in the non-DM group, and these differences were statistically significant in the lymph nodes and peritoneum. In the 35 patients with hepatic metastasis, higher ratios of the liver SUVmax significantly correlated with shorter OS (HR, 2.625; p=0.013). Conclusion: DM can influence the lower SUVmax of metastatic lesions as well as primary lesions. The SUVmax ratio of hepatic metastasis could influence on prognosis in metastatic PDAC patients.

키워드

과제정보

The authors thank the Medical Research Collaborating Center at Seoul National University Bundang Hospital for statistical analyses. The authors are indebted to J. Patrick Barron, Professor Emeritus, Tokyo Medical University and Adjunct Professor, Seoul National University Bundang Hospital for his pro bono editing of this manuscript.

참고문헌

  1. Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg 1996;223:506-511; discussion 11-12.
  2. Amikura K, Kobari M, Matsuno S. The time of occurrence of liver metastasis in carcinoma of the pancreas. Int J Pancreatol 1995;17:139-146.
  3. Chung KH, Park JK, Lee SH, et al. Lower maximum standardized uptake value of fluorine-18 fluorodeoxyglucose positron emission tomography coupled with computed tomography imaging in pancreatic ductal adenocarcinoma patients with diabetes. Am J Surg 2015;209:709-716.
  4. Kato T, Fukatsu H, Ito K, et al. Fluorodeoxyglucose positron emission tomography in pancreatic cancer: an unsolved problem. Eur J Nucl Med 1995;22:32-39.
  5. Stollfuss JC, Glatting G, Friess H, Kocher F, Berger HG, Reske SN. 2-(fluorine-18)-fluoro-2-deoxy-D-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation. Radiology 1995;195:339-344.
  6. Bares R, Klever P, Hauptmann S, et al. F-18 fluorodeoxyglucose PET in vivo evaluation of pancreatic glucose metabolism for detection of pancreatic cancer. Radiology 1994;192:79-86.
  7. Roy FN, Beaulieu S, Boucher L, Bourdeau I, Cohade C. Impact of intravenous insulin on 18F-FDG PET in diabetic cancer patients. J Nucl Med 2009;50:178-183.
  8. American Diabetes A. Diagnosis and classification of diabetes mellitus. Diabetes Care 2010;33 Suppl 1:S62-69.
  9. Tann M, Sandrasegaran K, Jennings SG, Skandarajah A, McHenry L, Schmidt CM. Positron-emission tomography and computed tomography of cystic pancreatic masses. Clin Radiol 2007;62:745-751.
  10. Sperti C, Pasquali C, Chierichetti F, Liessi G, Ferlin G, Pedrazzoli S. Value of 18-fluorodeoxyglucose positron emission tomography in the management of patients with cystic tumors of the pancreas. Ann Surg 2001;234:675-680.
  11. Zimny M, Fass J, Bares R, et al. Fluorodeoxyglucose positron emission tomography and the prognosis of pancreatic carcinoma. Scand J Gastroenterol 2000;35:883-888.
  12. Diederichs CG, Staib L, Vogel J, et al. Values and limitations of 18F-fluorodeoxyglucose-positron-emission tomography with preoperative evaluation of patients with pancreatic masses. Pancreas 2000;20:109-116.
  13. Delbeke D, Martin WH. Positron emission tomography imaging in oncology. Radiol Clin North Am 2001;39:883-917.
  14. Hustinx R, Benard F, Alavi A. Whole-body FDG-PET imaging in the management of patients with cancer. Semin Nucl Med 2002;32:35-46.
  15. Patronas NJ, Di Chiro G, Kufta C, et al. Prediction of survival in glioma patients by means of positron emission tomography. J Neurosurg 1985;62:816-822.
  16. Sperti C, Pasquali C, Chierichetti F, Ferronato A, Decet G, Pedrazzoli S. 18-Fluorodeoxyglucose positron emission tomography in predicting survival of patients with pancreatic carcinoma. J Gastrointest Surg 2003;7:953-9; discussion 9-60.
  17. Nakata B, Nishimura S, Ishikawa T, et al. Prognostic predictive value of 18F-fluorodeoxyglucose positron emission tomography for patients with pancreatic cancer. Int J Oncol 2001;19:53-58.
  18. Nakata B, Chung YS, Nishimura S, et al. 18F-fluorodeoxyglucose positron emission tomography and the prognosis of patients with pancreatic adenocarcinoma. Cancer 1997;79:695-699.
  19. Kim HW, Lee JC, Paik KH, Lee YS, Hwang JH, Kim J. Initial Metastatic Site as a Prognostic Factor in Patients With Stage IV Pancreatic Ductal Adenocarcinoma. Medicine (Baltimore) 2015;94:e1012.
  20. Forssell H, Wester M, Akesson K, Johansson S. A proposed model for prediction of survival based on a follow-up study in unresectable pancreatic cancer. BMJ Open 2013;3:e004064.
  21. Morizane C, Okusaka T, Morita S, et al. Construction and validation of a prognostic index for patients with metastatic pancreatic adenocarcinoma. Pancreas 2011;40:415-421.
  22. Park JC, Lee JH, Cheoi K, et al. Predictive value of pretreatment metabolic activity measured by fluorodeoxyglucose positron emission tomography in patients with metastatic advanced gastric cancer: the maximal SUV of the stomach is a prognostic factor. Eur J Nucl Med Mol Imaging 2012;39:1107-1116.
  23. Higashi T, Saga T, Nakamoto Y, et al. Diagnosis of pancreatic cancer using fluorine-18 fluorodeoxyglucose positron emission tomography (FDG PET) - usefulness and limitations in "clinical reality". Ann Nucl Med 2003;17:261-279.