量研学術機関リポジトリ「QST-Repository」は、国立研究開発法人 量子科学技術研究開発機構に所属する職員等が生み出した学術成果（学会誌発表論文、学会発表、研究開発報告書、特許等）を集積しインターネット上で広く公開するサービスです。 Welcome to QST-Repository where we accumulates and discloses the academic research results(Journal Publications, Conference presentation, Research and Development Report, Patent, etc.) of the members of National Institutes for Quantum Science and Technology.
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Aim: The differentiation of local recurrence from a primary tumor and radiation pneumonitis (RP) is critically important for selecting optimal clinical therapeutic strategies to manage post carbon-ion radiotherapy (CIRT) in patients with non-small cell lung cancer (NSCLC). Although 18F-FDG PET/CT (FDG-PET/CT) plays a key role in the metabolic imaging of patients with NSCLC who require CIRT management, PET/CT diagnosis based on SUVmax cannot always distinguish between NSCLC and RP. The present study aimed to determine whether FDG-PET/CT texture parameters can differentiate NSCLC from RP after CIRT.
Material and Methods: We retrospectively analyzed FDG-PET/CT image data from 32 patients with histopathologically proven NSCLC who were scheduled to undergo CIRT, and 31 patients who were diagnosed with RP after CIRT (50.0 Gy in 4 fractions/day). Radiation pneumonitis was diagnosed by biopsy or at clinical follow-up > 1 year after CIRT. Volumes of interest (VOI) on tumors were delineated using a threshold of 40% of the maximum standard uptake value (SUVmax) in each lesion. The SUV parameters of SUVmax, SUVpeak, SUVmean, metabolic tumor volume (MTV), total lesion glycolysis (TLG) and seven typical texture parameters of FDG-PET/CT were determined using PETSTAT image-analysis software. Data were statistically compared between NSCLC and RP using nonparametric Wilcoxon rank sum tests. Diagnostic accuracy was assessed using ROC curves.
Results: Among SUV parameters, MTV (p < 0.0001) and TLG (p = 0.001) significantly differed between NSCLC and RP. The feature quantities of texture parameters, namely, GLRLM, GLSZM, NGLCM3D, NGLCM and NGTDM significantly differed between NSCLC and RP. The areas under the receiver operating characteristics (ROC) curves (AUC) were as follows: SUVmax 0.64, MTV 0.86, TLG 0.75, GLRLM 0.83, GLSZM 0.76, NGLCM3D 0.71, NGLCM 0.72 and GTDM 0.82. Diagnostic accuracy was better using GLRLRM or NGTDM than SUVmax (p < 0.01).
Conclusion: The texture parameters of FDG-PET/CT were useful to differentiate NSCLC from radiation pneumonitis after CIRT, and GLRLM and NGTDM in particular would be promising parameters with excellent diagnostic accuracy.
Assesment of F-FDG PET/CT texture analysis to discriminate NSCLC from radiation pneumonitis after CIRT
