title: Relationship of computed tomography perfusion and positron emission tomography to tumour progression in malignant glioma.
abstract: IntroductionThis study aimed to explore the potential for computed tomography (CT) perfusion and 18-Fluorodeoxyglucose positron emission tomography (FDG-PET) in predicting sites of future progressive tumour on a voxel-by-voxel basis after radiotherapy and chemotherapy. MethodsTen patients underwent pre-radiotherapy magnetic resonance (MR), FDG-PET and CT perfusion near the end of radiotherapy and repeated post-radiotherapy follow-up MR scans. The relationships between these images and tumour progression were assessed using logistic regression. Cross-validation with receiver operating characteristic (ROC) analysis was used to assess the value of these images in predicting sites of tumour progression. ResultsPre-radiotherapy MR-defined gross tumour; near-end-of-radiotherapy CT-defined enhancing lesion; CT perfusion blood flow (BF), blood volume (BV) and permeability-surface area (PS) product; FDG-PET standard uptake value (SUV); and SUV:BF showed significant associations with tumour progression on follow-up MR imaging (P < 0.0001). The mean sensitivity (±standard deviation), specificity and area under the ROC curve (AUC) of PS were 0.64 ± 0.15, 0.74 ± 0.07 and 0.72 ± 0.12 respectively. This mean AUC was higher than that of the pre-radiotherapy MR-defined gross tumour and near-end-of-radiotherapy CT-defined enhancing lesion (both AUCs = 0.6 ± 0.1, P ≤ 0.03). The multivariate model using BF, BV, PS and SUV had a mean AUC of 0.8 ± 0.1, but this was not significantly higher than the PS only model. ConclusionPS is the single best predictor of tumour progression when compared to other parameters, but voxel-based prediction based on logistic regression had modest sensitivity and specificity.
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Robarts Research Institute, The University of Western Ontario Ontario, Canada, N6A 5B7 ; Department of Medical Biophysics, The University of Western Ontario Ontario, Canada, N6A 5C1.
authors.forename: Timothy P C
authors.initials: TP
authors.lastname: Yeung
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Department of Medical Biophysics, The University of Western Ontario Ontario, Canada, N6A 5C1 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6.
authors.forename: Slav
authors.initials: S
authors.lastname: Yartsev
authors.affiliation: Robarts Research Institute, The University of Western Ontario Ontario, Canada, N6A 5B7 ; Department of Medical Biophysics, The University of Western Ontario Ontario, Canada, N6A 5C1 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6 ; Department of Medical Imaging, The University of Western Ontario, London Health Sciences Centre, Victoria Hospital Ontario, Canada, N6A 5W9 ; Lawson Health Research Institute, St. Joseph's Health Care London Ontario, Canada, N6A 4V2.
authors.forename: Ting-Yim
authors.initials: TY
authors.lastname: Lee
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6 ; Department of Physics and Astronomy, The University of Western Ontario Ontario, Canada, N6A 3K7.
authors.forename: Eugene
authors.initials: E
authors.lastname: Wong
authors.affiliation: Department of Statistical and Actuarial Sciences, The University of Western Ontario Ontario, Canada, N6A 5B7.
authors.forename: Wenqing
authors.initials: W
authors.lastname: He
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6.
authors.forename: Barbara
authors.initials: B
authors.lastname: Fisher
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6.
authors.forename: Lauren L
authors.initials: LL
authors.lastname: VanderSpek
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6 ; Department of Clinical Neurological Sciences, The University of Western Ontario, London Health Sciences Centre, University Hospital Ontario, Canada, N6A 5A5.
authors.forename: David
authors.initials: D
authors.lastname: Macdonald
authors.affiliation: London Regional Cancer Program, London Health Sciences Centre Ontario, Canada, N6A 4L6 ; Department of Medical Biophysics, The University of Western Ontario Ontario, Canada, N6A 5C1 ; Department of Oncology, The University of Western Ontario, London Health Sciences Centre, London Regional Cancer Program Ontario, Canada, N6A 4L6.
authors.forename: Glenn
authors.initials: G
authors.lastname: Bauman
keywords: 18-Fluorodeoxyglucose PET; CT perfusion; contrast enhancement; malignant glioma; tumour progression