18F-Fluorodeoxyglucose PET/CT and dynamic contrast-enhanced MRI as imaging biomarkers in malignant pleural mesothelioma

Our plain-English summary of 18F-Fluorodeoxyglucose PET/CT and dynamic contrast-enhanced MRI as imaging biomarkers in malignant pleural mesothelioma, by D.O. Hall, C.E. Hooper, J. Searle, et al (Nuclear Medicine Communications, 2018).

The study

• Authors: D.O. Hall, C.E. Hooper, J. Searle, M. Darby, P. White, J.E. Harvey, J.P. Braybrooke, N.A. Maskell, V. Masani, I.D. Lyburn
• Journal: Nuclear Medicine Communications
• Published: 2018;39(2):161-170
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Purpose: The purpose of this study was to compare the use of fluorine-18-fluorodeoxyglucose (F-FDG) PET with computed tomography (CT) and dynamic contrast-enhanced (DCE) MRI to predict prognosis and monitor treatment in malignant pleural mesothelioma.

Patients And Methods: F-FDG PET/CT and DCE-MRI studies carried out as part of the South West Area Mesothelioma Pemetrexed trial were used. F-FDG PET/CT and DCE-MRI studies were carried out before treatment, and after two cycles of chemotherapy, on patients treated with pemetrexed and cisplatin. A total of 73 patients were recruited, of whom 65 had PET/CT and DCE-MRI scans. Baseline measurements from F-FDG PET/CT (maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis) and DCE-MRI (integrated area under the first 90s of the curve and washout slope) were compared with overall survival (OS) using Kaplan-Meier and Cox regression analyses, and changes in imaging measurements were compared with disease progression.

Results: PET/CT and DCE-MRI measurements were not correlated with each other. Maximum standardized uptake value, metabolic tumour volume and total lesion glycolysis were significantly related to OS with Cox regression analysis and Kaplan-Meir analysis, and DCE-MRI washout curve shape was significantly related to OS. DCE-MRI curve shape can be combined with F-FDG PET/CT to give additional prognostic information. Changes in measurements were not related to progression-free survival.

Conclusions: F-FDG PET/CT and DCE-MRI give prognostic information in malignant pleural mesothelioma. Neither PET/CT nor DCE-MRI is useful for monitoring disease progression.

In plain English

This study used imaging from the South West Area Mesothelioma and Pemetrexed (SWAMP) trial. In that trial, 73 patients with biopsy-proven malignant pleural mesothelioma were recruited at seven UK centres between 2008 and 2011. Of these, 58 received chemotherapy and 15 who declined it received best supportive care. Patients were offered PET/CT and dynamic contrast-enhanced MRI scans before treatment and after two cycles of chemotherapy. Measurements from the two kinds of scan were not significantly correlated with each other. Among chemotherapy patients, those with PET/CT measurements above the group median had shorter median survival. For example, median survival was 268 days with maximum uptake (SUVmax) above 10.6, compared with 525 days below it (P = 0.001). The shape of the MRI washout curve was also related to survival (P = 0.023), but another MRI measure was not (P = 0.07). Changes in scan measurements after treatment were not related to disease progression. The authors concluded that neither scan is recommended for follow-up and that PET/CT gives prognostic information. The study did not examine asbestos exposure.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Imaging substudy of a multi-centre trial (the SWAMP trial), comparing two scan types against survival and disease progression
• Who was studied: 73 patients with biopsy-proven malignant pleural mesothelioma recruited at seven UK centres from 2008 to 2011. 58 received chemotherapy and 15 who declined chemotherapy received best supportive care. 65 had baseline PET/CT and 61 had baseline DCE-MRI available.
• Exposure: Asbestos exposure was not studied. The study examined measurements from 18F-FDG PET/CT and dynamic contrast-enhanced (DCE) MRI scans in patients offered chemotherapy with pemetrexed and cisplatin or carboplatin.
• Main results:
  • In all patients, baseline PET/CT and DCE-MRI measurements were not significantly correlated with each other. For example, SUVmax compared with IAUC90 gave r = 0.25, P = 0.055.
  • In chemotherapy patients, median overall survival was 268 days for those with SUVmax above the median (10.6) and 525 days for those below it (P = 0.001).
  • In chemotherapy patients, median overall survival was 264 days for those with metabolic tumour volume above the median (460 ml) and 562 days for those below it (P = 0.0001). Total lesion glycolysis gave the same figures.
  • In univariate Cox regression, the only significant factors for survival were histology and the PET/CT measures SUVmax, MTV and TLG.
  • The MRI measure IAUC90 was not significantly related to survival in chemotherapy patients: median 270 days above the median versus 506 days below it (P = 0.07).
  • MRI washout curve type was significantly related to survival in chemotherapy patients: type 1 (n = 13) median 562 days, type 2 (n = 6) median 256 days, type 3 (n = 31) median 274 days (P = 0.023).
  • When SUVmax and washout curve type were combined, chemotherapy patients with SUVmax below 10.6 and type 1 curves had the longest median survival, 735 days.
  • Changes in measurements after treatment were not related to progression-free survival. Change in washout slope at 7 to 9 weeks, and in MTV and TLG at 9 months, reached P less than 0.05, but not after correcting for multiple comparisons.
  • Among chemotherapy patients, epithelioid histology was associated with a median survival of 456 days, compared with 197 days for nonepithelioid histology (P less than 0.001).
• The authors' conclusion: The authors concluded that PET/CT and DCE-MRI are not recommended for follow-up in malignant pleural mesothelioma, that PET/CT gives prognostic information, and that DCE-MRI gives some but PET/CT should be used instead where available.
• Limitations the authors state:
  • Breathing-related motion made lung MRI difficult.
  • MRI analysis used a single slice, while PET analysis covered the whole tumour in three dimensions.
  • Scans taken before and after treatment were not registered (aligned) with each other.
  • Some visible tumour fell below the PET uptake threshold and was left out of the tumour volume.
  • Scanning was available at only one centre, which caused problems with recruitment and follow-up imaging.
  • Subgroup analysis, for example by histology, was more difficult.
  • The long MRI frame length may have lost information about initial enhancement.
  • Groups in the combined analysis were too small to calculate confidence intervals for survival.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Biomarker, Pleural Mesothelioma, Prognosis, Mesothelioma, Pemetrexed (Alimta), Chemotherapy, Cisplatin, Overall Survival.

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