The aim of this study was to prospectively investigate the predictive value of (18)F-FDG PET/CT semiquantitative parameters for locally advanced low rectal cancer (LARC) treated by neoadjuvant ...chemoradiation therapy (nCRT).
68 patients with LARC had (18)F-FDG PET/CT scans twice (baseline and 5-6 weeks post-nCRT). All patients underwent surgery with preservation of the sphincter 8 weeks later. (18)F-FDG PET/CT analysis was performed by visual response assessment (VRA) and semiquantitative parameters: SUVmax(baseline), SUVmean(baseline), MTV(baseline), TLG(baseline), SUVmax(post-nCRT), SUVmean(post-nCRT), MTV(post-nCRT), TLG(post-nCRT); ΔSUVmax and mean and Response indexes (RImax% and RImean%). Assessment of nCRT tumor response was performed according to the Mandard's Tumor Regression Grade (TRG) and (y)pTNM staging on the surgical specimens. Concordances of VRA with TRG, and with (y)pTNM criteria were evaluated by Cohen's K. Results were compared by t student test for unpaired groups. ROC curve analysis was performed.
VRA analysis of post-nCRT (18)F-FDG PET/CT scan for the (y)pTNM outcome showed sensitivity, specificity, accuracy, PPV, and NPV of 87.5%, 66.7%, 83.8%, 92.5%, and 53.3%, respectively. Concordances of VRA with TRG and with (y)pTNM were moderate. For the outcome variable TRG, the statistical difference between responders and non-responders was significant for SUVmax(post-nCRT) and RImean%; for the outcome variable (y)pTNM, there was a significant difference for MTV(baseline), SUVmax(post-nCRT), SUVmean(post-nCRT), MTV(post-nCRT), RImax%, and RImean%. ROC analysis showed better AUCs: for the outcome variable TRG for SUVmax(post-nCRT), SUVmean(post-nCRT), and RImean%; for the outcome variable (y)pTNM for MTVbaseline, SUVmax(post-nCRT), SUVmean(post-nCRT), MTV(post-nCRT), RImax%, and RImean%. No significant differences among parameters were found.
Qualitative and semiquantitative evaluations for (18)F-FDG PET/CT are the optimal approach; a valid parameter for response prediction has still to be established.
Purpose
The aim of this study was to prospectively investigate the predictive value of
18
F-FDG PET/CT semiquantitative parameters for locally advanced low rectal cancer (LARC) treated by neoadjuvant ...chemoradiation therapy (nCRT).
Methods
68 patients with LARC had
18
F-FDG PET/CT scans twice (baseline and 5–6 weeks post-nCRT). All patients underwent surgery with preservation of the sphincter 8 weeks later.
18
F-FDG PET/CT analysis was performed by visual response assessment (VRA) and semiquantitative parameters: SUVmax
baseline
, SUVmean
baseline
, MTV
baseline
, TLG
baseline
, SUVmax
post-nCRT
, SUVmean
post-nCRT
, MTV
post-nCRT
, TLG
post-nCRT
; ΔSUVmax and mean and Response indexes (RImax% and RImean%). Assessment of nCRT tumor response was performed according to the Mandard’s Tumor Regression Grade (TRG) and (y)pTNM staging on the surgical specimens. Concordances of VRA with TRG, and with (y)pTNM criteria were evaluated by Cohen’s K. Results were compared by
t
student test for unpaired groups. ROC curve analysis was performed.
Results
VRA analysis of post-nCRT
18
F-FDG PET/CT scan for the (y)pTNM outcome showed sensitivity, specificity, accuracy, PPV, and NPV of 87.5%, 66.7%, 83.8%, 92.5%, and 53.3%, respectively. Concordances of VRA with TRG and with (y)pTNM were moderate. For the outcome variable TRG, the statistical difference between responders and non-responders was significant for SUVmax
post-nCRT
and RImean%; for the outcome variable (y)pTNM, there was a significant difference for MTV
baseline
, SUVmax
post-nCRT
, SUVmean
post-nCRT
, MTV
post-nCRT
, RImax%, and RImean%. ROC analysis showed better AUCs: for the outcome variable TRG for SUVmax
post-nCRT
, SUVmean
post-nCRT,
and RImean%; for the outcome variable (y)pTNM for MTVbaseline, SUVmax
post-nCRT
, SUVmean
post-nCRT
, MTV
post-nCRT
, RImax%, and RImean%. No significant differences among parameters were found.
Conclusions
Qualitative and semiquantitative evaluations for
18
F-FDG PET/CT are the optimal approach; a valid parameter for response prediction has still to be established.
A one year clinical activity of instrumental angiological diagnostics (doppler c.w. examinations) was evaluated and analysed. 970 outpatient continuous wave doppler have been performed: 37% ...examinations of epiaortic vessels (TSA), 31% examinations of lower limb veins, 28% examinations of lower limbs arteries. The question has been inappropriate (normal exam) in 81% of TSA, in 67% of AIA and in 52% of AIV. The authors think that the reasons for these results are a large misinformation from the physicians postulant and a consequent abuse of the instrumental method. It's therefore necessary to put a clinical filter to regulate the access to the instrumental (high technological) examinations, too often unnecessary.
Echocardiography was used to asses parameters of cardiovascular function in order to identify the main cardiac adjustment mechanisms to arterial hypertension. In addition to morphological parameters ...of septal and parietal thickness and diameter, telesystolic (Ses) and telediastolic (Spk) stress, EF, Vcfm, the index of left ventricular mass (ILVM), hypertrophy ratio (h/r), contractility index (Do), peripheral resistances (RPT) and Tarazi's index (SAC) were evaluated. In comparison to control subjects, higher levels of PwTs, h/r, SAC, RPT and ILVM (at the limit of significance) were found in hypertensive patients, which were reflected by higher Spk and Do values. From the further analysis of data to identify patients with signs of left ventricular hypertrophy (h/r greater than 0.40 and/or ILVM greater than 140) it was concluded that the hypertrophy ratio (h/r) is the functional parameter which most closely reveals the type of myocardial adjustment. Irrespective of absolute values of ILVM, the adequacy of myocardial hypertrophy to the dimensions of the cavity is accompanied by the normalisation of stress and the return of Do values close to normal levels. Hearts with low h/r those with the highest stress levels, as well as preesting the lowest EF and the highest Do values.
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