• Korean Journal of Radiology
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• 제25권2호
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• pp.189-198
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• 2024

Objective: To investigate the prognostic utility of radiomics features extracted from ¹⁸F-fluorodeoxyglucose (FDG) PET/CT combined with clinical factors and metabolic parameters in predicting progression-free survival (PFS) and overall survival (OS) in individuals diagnosed with extranodal nasal-type NK/T cell lymphoma (ENKTCL). Materials and Methods: A total of 126 adults with ENKTCL who underwent ¹⁸F-FDG PET/CT examination before treatment were retrospectively included and randomly divided into training (n = 88) and validation cohorts (n = 38) at a ratio of 7:3. Least absolute shrinkage and selection operation Cox regression analysis was used to select the best radiomics features and calculate each patient's radiomics scores (RadPFS and RadOS). Kaplan-Meier curve and Log-rank test were used to compare survival between patient groups risk-stratified by the radiomics scores. Various models to predict PFS and OS were constructed, including clinical, metabolic, clinical + metabolic, and clinical + metabolic + radiomics models. The discriminative ability of each model was evaluated using Harrell's C index. The performance of each model in predicting PFS and OS for 1-, 3-, and 5-years was evaluated using the time-dependent receiver operating characteristic (ROC) curve. Results: Kaplan-Meier curve analysis demonstrated that the radiomics scores effectively identified high- and low-risk patients (all P < 0.05). Multivariable Cox analysis showed that the Ann Arbor stage, maximum standardized uptake value (SUVmax), and RadPFS were independent risk factors associated with PFS. Further, β2-microglobulin, Eastern Cooperative Oncology Group performance status score, SUVmax, and RadOS were independent risk factors for OS. The clinical + metabolic + radiomics model exhibited the greatest discriminative ability for both PFS (Harrell's C-index: 0.805 in the validation cohort) and OS (Harrell's C-index: 0.833 in the validation cohort). The time-dependent ROC analysis indicated that the clinical + metabolic + radiomics model had the best predictive performance. Conclusion: The PET/CT-based clinical + metabolic + radiomics model can enhance prognostication among patients with ENKTCL and may be a non-invasive and efficient risk stratification tool for clinical practice.

• 대한핵의학회지
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• 제33권3호
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• pp.327-336
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• 1999

목적: 이 연구의 목적은 3D FDG-PET 뇌영상의 정량적 정확도와 임상적 유용성을 연구하는 것이다. 대상 및 방법: 24명의 환자에게 약 370 MBq의 FDG를 주사하고 섭취되기까지 30분을 대기한 후 GE $Advance^{TM}$ PET을 사용하여 30분간의 2D 영상과 10분간의 3D 영상을 얻었다. 백질, 회백질, 병변, 정상조직의 관심영역 분석을 통하여 영상대비와 FDG 섭취비를 구하여 비교하였다. 3D PET의 효율을 최대화하기 위하여 투과스캔을 사용한 경우와 사용하지 않은 경우의 감쇠보정 효과를 비교하였다. 결과 3D 영상의 영상대비는 2D 영상이 1 일 때 산란보정을 실행한 경우 회백질 대 백질에서 $0.95{\pm}0.12$, 정상 대 병변에서 $0.96{\pm}0.05$이었다. 2D 영상의 FDG 섭취비가 1일 때 3D 영상의 FDG 섭취비는 산란보정을 실행한 경우 $1.02{\pm}0.08$이었다. 3D 영상은 영상대비, 분해능, 영상 잡음에 대한 순위 척도평가에서 각각 81%, 83%, 81%에 해당되는 등급을 받아 선호도가 우수하였다. 3D 영상에서 계산감쇠보정 방법은 측정감쇠보정 방법에 필적하는 결과를 얻었다. 결론: 산란보정과 계산감쇠보정을 실시한 3D 영상은 일반적인 2D 영상과 비교하여 정량적으로 정확한 결과를 나타냈으며 정성적으로 유용하였다. 3D 영상은 일상 임상환경에 충분히 적용할 수 있으며 환자 스캔 시간을 단축하고 방사능 피폭량을 감소시키는 장점이 있었다.

• Nuclear Medicine and Molecular Imaging
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• 제40권5호
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• pp.243-248
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• 2006

목적: 다른 기관들에 비해 간에서는 상대적으로 FDG 섭취 양상이 매우 불규칙하며, 악성 병변이 없는 간에서 비정상적으로 FDG 섭취가 증가하기도 한다. 하지만, 이제까지 이러한 다양한 간의 FDG 섭취를 간의 다른 양성 질환과 연관시킨 연구가 없어, 저자들은 이 연구에서 간에서의 FDG 섭취 양상과 지방간, 간 기능 검사, 지질 프로필을 포함하는 다양한 임상 요인과의 관계를 밝히고자 하였다. 대상 및 방법: 건강검진 목적으로 $^{18}F-FDG$ PET/CT를 시행한 188명 (남/여: 120/68, 평균나이: $50{\pm}9$세)을 대상으로 분석하였다. 간의 FDG 섭취에 영향을 줄 수 있는 당뇨 및 내당증 장애 환자, 심한 간질환이나 오랜 약물 복용의 기왕력이 있는 환자는 연구대상에서 제외하였다. PET/CT의 횡단면에서 간의 5번 분절에 해당하는 부위에 관심영역을 설정하고 이 부위의 평균 SUV를 구하여, 지방간이 있는 군과 없는 군 사이의 차이를 분석하였다. 또한 혈중 간 기능(ALT, AST), 알코올성 간질환(${\gamma}-GT$), 총 콜레스테롤, 중성지방 수치와 간의 FDC 섭취와의 관계를 알아보았다. 지방간 환자들의 체질량지수, 음주력을 조사하여 이 인자들이 간의 FDG 섭취에 미치는 영향도 분석하였다 결과 지방간이 있는 군의 평균 SUV가 지방간이 없는 군보다 통계적으로 유의하게 높았다(p<0.05). 혈중 총 콜레스테롤과 중성지방 수치는 간의 FDG 섭취와 유의한 상관관계를 보인 반면, 다른 요인들은 상관관계를 보이지 않았다. 또한, 지방간 환자에서 음주나 체질량 지수의 위험군과 비위험군 사이에 간의 FDG 섭취 정도는 차이는 보이지 않았다. 다변량 분석 결과, 지방간의 유무와 혈중 중성지방 수치가 간의 평균 SUV에 영향을 주는 유의한 독립 인자였다. 결론: 결론적으로 간의 FDG 섭취 정도는 지방간의 유무에 영향을 받으며, 중성지방 수치와 유의한 상관관계를 보였다.

• Nuclear Medicine and Molecular Imaging
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• 제40권5호
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• pp.249-256
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• 2006

목적: 대장-직장암에서 간전이 여부를 진단하기 위한 영상 검사 방법으로 기존에는 CT 촬영을 시행하여 왔다. 최근에는 MR 및 FDG PET을 간전이 진단에 적극적으로 활용하고 있는 추세이다. 이에 이 연구에서는 대장-직장암 환자에서 간전이에 대한 FDG PET의 진단적 가치를 MR과 비교하여 보고자 하였다. 대상 및 방법 대장: 직장암으로 확진된 환자들 중에 간전이를 진단 또는 배제하기 위하여 CT 이외에도 MR 및 F-18-FDG PET (conventional PET 및 fusion PET)을 모두 시행한 환자는 26명이었다. 이 연구에서는 26명의 환자들에게서 영상화 된 35개의 병변을 분석의 대상으로 삼고, FDG PET과 MR의 민감도 및 특이도를 간분엽절제술 및 종양절제술을 통해 얻어진 병리소견 및 임상소견 또는 추적 영상 소견을 표준으로 하여 각각 구하였다. FDG PET과 MR은 평균 7일 간격으로 시행되었으며, 두 검사 사이에 치료적 요법을 시행 받은 환자는 한 명도 없었다. 결과: 병리 결과, 35개의 병변 중에서 18개(51.4%)의 병변은 간전이로 판명되었으며, 나머지 17개(48.6%)는 낭종, 지방, 혈관종, 농양, 호산구성농양 등의 양성 병변으로 판명되었다. 35개의 병변 중 MR과 FDG PET의 진단이 일치한 병변은 간전이 17개(94.4%)와 양성 병변 13개(76.5%)로 전체적으로는 85.7%의 일치도를 보였다. FDG PET의 민감도는 94.4% (17/18), 특이도는 94.1% (16/17)였으며 MR의 민감도는 100% (18/18), 특이도는 82.4% (14/17)이었다. MR에서 위양성을 보였던 3개의 병변은 낭종과 호산구성농양이었고, FDG PET에서 위음성을 보였던 1개의 병변은 직경 8 mm의 작은 병변이었다. 직경 10 mm 이하인 병변들만 분석했을 때, 총 20개의 병변에 대하여 FDG PET은 민감도 85.7%(6/7), 특이도 92.3%(12/13), MR은 민감도 100%(7/7), 특이도 76.9%(10/13)를 보였다. 그 외에도 간전이 병변의 평균 maxSUV는 $6.7{\pm}3.8$로 간전이와 양성병변을 최적으로 감별할 수 있는 maxSUV의 cutoff value는 3.1 이었다. (AUC=0.897, p<0.001, 민감도 83.3%, 특이도 94.1%) 결론: FDG PET은 간전이를 진단하는데 MR과 대등한 민감도와 특이도를 보였다. 통계적으로 유의한 차이를 보이지는 않았지만 간전이에 대한 FDG PET의 음성예측도는 MR보다 높았으며, 직경 10 mm 미만의 작은 병변에 대해서도 FDG PET은 우수한 성적을 보였다. 향후 대장암의 간전이 진단에 FDG PET이 유용하게 이용될 것이다.

• Radiation Oncology Journal
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• 제37권1호
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• pp.30-36
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• 2019

Purpose: This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). Materials and Methods: Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. Results: The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progression-free survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). Conclusion: SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.

• Nuclear Medicine and Molecular Imaging
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• 제42권6호
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• pp.488-490
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• 2008

A 75-year-old man with non-small cell lung cancer (NSCLC) underwent F-18 fluorodeoxyglucose (FDG) PET/CT for staging. PET/CT showed distant metastases to intra-abdominal lymph nodes (LNs) as well as bilateral mediastinal LNs (stage IV), He underwent PET/CT (restaging PET/CT) 1week after the completion of first-line chemotherapy (docetaxel+carboplatin). It showed markedly increased FDG uptake in primary tumor, whereas tumor size decreased significantly, compared to prior PET/CT. This lesion was aggravated on follow-up CT 3 months after the completion of chemotherapy. Although there are several reports that FDG PET has potential to evaluate early response to chemotherapy and prognosis, there are a few cases to show mismatch between FDG uptake and size on PET/CT. Thus we report a case of NSCLC showed increased FDG uptake of primary tumor while decreased tumor size on restaging PET/CT.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10171-10174
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• 2015

Background: The purpose of this study was to determine the prognostic significance of the maximum standardized uptake value (SUVmax) on F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients undergoing surgical treatment for non-small cell lung cancer. Materials and Methods: Seventy-eight consecutive patients (58 with adenocarcinomas, 20 with squamous cell carcinomas) treated with potentially curative surgery were retrospectively reviewed. Results: The SUVmax was significantly higher in the patients with recurrent than with non-recurrent adenocarcinoma (p<0.01). However, among the patients with squamous cell carcinoma, there were no differences with or without recurrence (p=0.69). Multivariate analysis indicated that the SUVmax of adenocarcinoma lesions was a significant predictor of disease-free survival (p=0.04). In addition, an SUVmax of 6.19, the cut-off point based on ROC curve analysis of the patients with pathological IB or more advanced stage adenocarcinomas, was found to be a significant predictor of disease-free survival (p<0.01). Conclusions: SUVmax is a useful predictor of disease-free survival in patients with resected adenocarcinoma, but not squamous cell carcinoma. Patients with adenocarcinoma exhibiting an SUVmax above 6.19 are candidates for more intensive adjuvant therapy.

• Tuberculosis and Respiratory Diseases
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• 제74권4호
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• pp.181-186
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• 2013

We report a rare synchronous presentation of primary lung cancer and adrenal pheochromocytoma. A 59-year-old woman was diagnosed with right upper lobe non-small cell lung carcinoma measuring 2.8 cm and a right adrenal gland mass measuring 3.5 cm, which displayed increased metabolic activity on $^{18}F$-fluorodeoxyglucose positron emission tomography-computed tomography. The adrenal lesion was revealed to be asymptomatic. The patient underwent right adrenalectomy and histological examination revealed a pheochromocytoma. Ten days later, right upper lobectomy was performed for lung cancer. This case indicates that incidental adrenal lesions found in cases of resectable primary lung cancer should be investigated.

• Journal of Yeungnam Medical Science
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• 제25권2호
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• pp.128-133
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• 2008

Acinar cell carcinoma is a rare tumor that represents 1~2% of all pancreatic cancers. Clinical and radiologic findings are inconclusive in this disease. Acinar cell carcinoma is characterized by rapid progression and early metastasis, which lead to its poor prognosis. A 41-year-old man was admitted to our hospital for abdominal pain. Abdominal computed tomography (CT) and positron emission tomography-computed tomography (PET-CT) showed a splenic mass, which was being invaded by a pancreatic tail mass and which had increased $^{18}F$-fluorodeoxyglucose (FDG) uptake. Primary radical distal pancreatectomy and splenectomy were performed. Pathologic findings revealed an acinar cell carcinoma of the pancreas. The patient underwent a total gastrectomy three months later because of gastric recurrence. Four months later, multiple hepatic metastases were discovered, and the patient underwent a left hepatectomy. During treatment with capecitabine, there was no evidence of tumor progression for 14 months. We report a case of metastatic pancreatic acinar cell carcinoma, which did not progress for an extended period while the patient was being treated with capecitabine.

• Radiation Oncology Journal
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• 제36권2호
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• pp.95-102
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• 2018

Purpose: To evaluate the prognostic value of $^{18}F$-fluorodeoxyglucose positron-emission tomography (FDG PET) with computed tomography (CT) before and during radiotherapy (RT) in patients with head and neck cancer. Methods: Twenty patients with primary head and neck squamous cell carcinoma were enrolled in this study, of whom 6 had oropharyngeal cancer, 10 had hypopharyngeal cancer, and 4 had laryngeal cancer. Fifteen patients received concurrent cisplatin and 2 received concurrent cetuximab chemotherapy. FDG PET/CT was performed before RT and in the 4th week of RT. The parameters of maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) of the primary tumor were measured, and the prognostic significance of each was analyzed with the Cox proportional hazards model. Results: Higher TLG (>19.0) on FDG PET/CT during RT was a poor prognostic factor for overall survival (OS) (p = 0.001) and progression-free survival (PFS) (p = 0.007). In the multivariate analysis, TLG during RT as a continuous variable was significantly associated with OS and PFS rate (p = 0.023 and p = 0.016, respectively). Tumor response worse than partial remission at 1 month after RT was another independent prognostic factor for PFS (p = 0.024). Conclusions: Higher TLG of the primary tumor on FDG PET/CT during RT was a poor prognostic factor for OS and PFS in patients with head and neck cancer.