Combined morphologic and metabolic pipeline for Positron emission tomography/computed tomography based radiotherapy response evaluation in locally advanced pancreatic adenocarcinoma.
Combined morphologic and metabolic pipeline for Positron emission tomography/computed tomography based radiotherapy response evaluation in locally advanced pancreatic adenocarcinoma.
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基于正电子发射断层扫描/计算机断层扫描的局部晚期胰腺腺癌放疗反应评估的形态学和代谢组合管道。
DOI：
10.1016/j.phro.2018.12.003
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发表时间：
2019
影响因子：
--
通讯作者：
Tuli,Richard
中科院分区：
文献类型：
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作者：
Lao,Yi;David,John;Torosian,Arman;Placencio,Veronica;Wang,Yalin;Hendifar,Andrew;Yang,Wensha;Tuli,Richard
背景与目的胰腺腺癌（PA）的适应性放疗计划依赖于准确的治疗反应评估，而传统的反应评估标准不能有效地表征复杂形态特征或本质上低代谢的肿瘤。为了更好地评估PA的治疗反应，我们量化和比较了放射治疗前和放疗后（RT）三维肿瘤模型的区域形态学和代谢特征。材料与方法对31例PA患者进行rt前后正电子发射断层扫描/计算机断层扫描（PET/CT）评价。生成和注册放疗前和放疗后肿瘤的三维网格，以建立逐点对应关系。为了评估肿瘤反应，计算每位患者放疗前和放疗后肿瘤表面与解剖和代谢融合载体之间的马氏距离（Mdist∣Fusion）。通过总生存期（OS）预测和生存风险分类对Mdist∣fusion进行评估。作为比较，对传统的成像/生理预测指标和仅基于代谢和形态特征的距离测量进行了相同的分析。结果影像学/生理参数中，Mdist∣fusion是预测OS的最佳指标（HR = 0.52, p = 0.008），其他参数均无显著性意义。此外，在患者风险分层中，无论是单独（HR = 11.51, p < 0.001）还是结合年龄（HR = 9.04, p < 0.001），Mdist∣fusion的表现都优于传统的形态学和代谢测量。结论我们引入了一种基于PET/ ct的新型形态学和代谢管道，用于局部晚期PA的疗效评估。融合mdist∣fusion在OS预测和风险分层方面优于传统的形态学、代谢和生理测量。这种新的融合模型可以作为一种新的成像标记物，更准确地表征异质肿瘤RT反应。
Background and purposeAdaptive radiation planning for pancreatic adenocarcinoma (PA) relies on accurate treatment response assessment, while traditional response evaluation criteria inefficiently characterize tumors with complex morphological features or intrinsically low metabolism. To better assess treatment response of PA, we quantify and compare regional morphological and metabolic features of the 3D pre- and post-radiation therapy (RT) tumor models.Materials and methodsThirty-one PA patients with pre and post-RT Positron emission tomography/computed tomography (PET/CT) scans were evaluated. 3D meshes of pre- and post-RT tumors were generated and registered to establish vertex-wise correspondence. To assess tumor response, Mahalanobis distances (Mdist∣Fusion) between pre- and post-RT tumor surfaces with anatomic and metabolic fused vectors were calculated for each patient.Mdist∣Fusionwas evaluated by overall survival (OS) prediction and survival risk classification. As a comparison, the same analyses were conducted on traditional imaging/physiological predictors, and distances measurements based on metabolic and morphological features only.ResultsAmong all the imaging/physiological parameters,Mdist∣Fusionwas shown to be the best predictor of OS (HR = 0.52, p = 0.008), while other parameters failed to reach significance. Moreover,Mdist∣Fusionoutperformed traditional morphologic and metabolic measurements in patient risk stratification, either alone (HR = 11.51, p < 0.001) or combined with age (HR = 9.04, p < 0.001).ConclusionsWe introduced a PET/CT-based novel morphologic and metabolic pipeline for response evaluation in locally advanced PA. The fusedMdist∣Fusionoutperformed traditional morphologic, metabolic, and physiological measurements in OS prediction and risk stratification. The novel fusion model may serve as a new imaging-marker to more accurately characterize the heterogeneous tumor RT response.