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Metabolic Volume Measurements

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A special issue of Metabolites (ISSN 2218-1989). This special issue belongs to the section "Cell Metabolism".

Deadline for manuscript submissions: closed (31 October 2021) | Viewed by 15513

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Special Issue Editor

Prof. Dr. Maria Kallergi

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Guest Editor

Department of Biomedical Engineering, University of West Attica, 12243 Athens, Greece
Interests: smart hospital biomedical technology; three-dimensional quantitative imaging; computer aided detection and diagnosis; observer studies

Special Issue Information

Dear Colleagues,

Metabolic volume refers to the volume of a region in PET scans that has a specific clinical interest. Metabolic volume measurements have mostly been applied to oncology for the quantitative analysis of tumors, and several studies suggest that this parameter, termed metabolic tumor volume, may hold significant diagnostic and prognostic value. However, technical issues, lack of measuring standards, and incosistent results may be reasons for the reluctance to clinically adopt this metric to-date. Challenges in region segmentation or in the identification of an optimum marker, such as total lesion glycolycis or actual lesion volume size, need to be further explored in order to clearly demonstrate the clinical value of metabolic volume measurements, which seem to be of consequence, not only to oncology, but also to inflammatory conditions and neurological disorders such as depression or dementia. Therefore, we invite both technical and clinical studies covering a wide range of metabolic volume measurement methodologies and applications. The aim is to offer a diverse, state-of-the-art perspective on the role of metabolic volume in PET studies; explore the clinical significance of this metric; and its impact in treatment planning, patient management, and the prognosis of a disease.

Dr. Maria Kallergi
Guest Editor

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Keywords

Metabolic Volume segmentation
Metabolic Volume measurement standards
Observer studies on Metabolic Volume
Clinical validation of Metabolic Volume
Correlation of Metabolic Volume to other metrics
Oncology and Metabolic Volume
Inflammation and Metabolic Volume
Neurology and Metabolic Volume

Published Papers (6 papers)

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Research

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11 pages, 1855 KiB

Open AccessArticle

Tumor Size Measurements for Predicting Hodgkin’s and Non-Hodgkin’s Lymphoma Response to Treatment

by Maria Kallergi, Alexandros Georgakopoulos, Vassiliki Lyra and Sofia Chatziioannou

Metabolites 2022, 12(4), 285; https://0-doi-org.brum.beds.ac.uk/10.3390/metabo12040285 - 24 Mar 2022

Cited by 1 | Viewed by 1908

Abstract

The purpose of this study was to investigate the value of tumor size measurements as prognostic indicators of treatment outcome of Hodgkin’s and Non-Hodgkin’s lymphomas. ¹⁸F-FDG PET/CT exams before and after treatment were analyzed and metabolic and anatomic parameters—tumor maximum diameter, tumor maximum area, tumor volume, and maximum standardized uptake value (SUVmax)—were determined manually by an expert and automatically by a computer algorithm on PET and CT images. Results showed that the computer algorithm measurements did not correlate well with the expert’s standard maximum tumor diameter measurements but yielded better three dimensional metrics that could have clinical value. SUVmax was the strongest prognostic indicator of the clinical outcome after treatment, followed by the automated metabolic tumor volume measurements and the expert’s metabolic maximum diameter measurements. Anatomic tumor measurements had poor prognostic value. Metabolic volume measurements, although promising, did not significantly surpass current standard of practice, but automated measurements offered a significant advantage in terms of time and effort and minimized biases and variances in the PET measurements. Overall, considering the limited value of tumor size in predicting response to treatment, a paradigm shift seems necessary in order to identify robust prognostic markers in PET/CT; radiomics, namely combinations of anatomy, metabolism, and imaging, may be an option. Full article

(This article belongs to the Special Issue Metabolic Volume Measurements)

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11 pages, 2500 KiB

Open AccessArticle

Prognostic Value of ¹⁸F-FDG PET/CT Volume-Based Metabolic Parameters in Patients with Node-Negative Stage II Esophageal Squamous Cell Carcinoma

by Daniel Hueng-Yuan Shen, Hung-Pin Chan, Fu-Ren Tsai, Chin Hu, Allan Yi-Nan Chen, Hung-Yen Chan, Che-Hsin Lee, Kuo-Pin Chuang, Ming-Hui Yang and Yu-Chang Tyan

Metabolites 2022, 12(1), 7; https://0-doi-org.brum.beds.ac.uk/10.3390/metabo12010007 - 22 Dec 2021

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Abstract

Esophageal squamous cell carcinoma (ESCC) is a major cancer prevalent in Asian males. Pretreatment tumor burden can be prognostic for ESCC. We studied the prognostic value of metabolic parameters of 2-deoxy-2-[¹⁸F] fluoro-D-glucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) and the serum squamous cell carcinoma antigen (SCC-Ag) level in node-negative stage II ESCC patients. Eighteen males underwent staging evaluation were included. The volume-based metabolic parameters derived from ¹⁸F-FDG PET/CT, including metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were obtained using the PET Volume Computer Assisted Reading application. The Spearman correlation coefficients were calculated to assess the relationship between metabolic parameters and pretreatment serum SCC-Ag levels. Based on the 5-year follow-up, patients were sub-divided into the demised and the stable groups. Potential prognostic value was assessed by independent t-test and the Mann–Whitney U test. The association of overall survival was assessed using univariate and multivariate Cox regression analyses. The demised group showed significant higher values in serum SCC-Ag, as well as in MTV and TLG, but not SUVmax and SUVmean. The SUVmax, MTV, TLG, and serum SCC-Ag showed significant association with overall survival. Our findings suggest potential usage of pretreatment volume-based metabolic parameters of ¹⁸F-FDG PET/CT and serum SCC-Ag as prognostic factors for node-negative stage II ESCC patients. Full article

(This article belongs to the Special Issue Metabolic Volume Measurements)

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9 pages, 499 KiB

Open AccessArticle

Prognostic Value of Pretherapeutic Primary Tumor MTV from [¹⁸F]FDG PET in Radically Treated Cervical Cancer Patients

by Paulina Cegla, Frank Hofheinz, Witold Cholewiński, Rafał Czepczyński, Anna Kubiak, Jörg van den Hoff, Agnieszka Boś-Liedke, Andrzej Roszak and Ewa Burchardt

Metabolites 2021, 11(12), 809; https://0-doi-org.brum.beds.ac.uk/10.3390/metabo11120809 - 28 Nov 2021

Cited by 5 | Viewed by 2054

Abstract

The aim of this study was to assess the usefulness of pretherapeutic primary tumor metabolic tumor volume (MTV) in the prognosis of radically treated cervical cancer patients. Retrospective, single-centre analysis was performed on a group of 508 cervical cancer patients. All patients underwent a pretreatment [¹⁸F]FDG PET/CT study for the assessment of the disease stage. Several PET-derived parameters—namely, maximum standardized uptake value (SUV_max), mean standardized uptake value (SUV_mean), total lesion glycolysis (TLG) and MTV, as well as the clinical parameters, were analysed in terms of the overall survival (OS), event-free survival (EFS), locoregional control (LRC) and freedom from distant metastases (FFDM). Hyperthermia and brachytherapy were prognostic for EFS, OS, and LRC.FIGO stage > II showed a significant effect on EFS, OS, and FFDM. Moreover, hysterectomy was prognostic for OS and histology was prognostic for FFDM. From the PET-derived parameters only MTV of the primary tumor had a significant influence on OS (cutoff point: >12.7 mL, HR: 2.8, 1.75–4.48 95% CI, p < 0.001), LRC (cutoff point: >13.7 mL, HR 2.82, 1.42–5.61 95% CI, p = 0.003), EFS (cutoff point: >10.4 mL, HR: 2.57, 1.67–3.97 95% CI, p < 0.001) and FFDM (cutoff point: >10.4 mL, HR: 5.04, 1.82–13.99 95% CI, p = 0.002). Pretreatment MTV from the primary tumor is the only independent prognostic parameter in OS, LRC, EFS, and FFDM in radically treated cervical cancer patients and should be used in clinical practice in assessing prognosis in these patients. Full article

(This article belongs to the Special Issue Metabolic Volume Measurements)

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16 pages, 2591 KiB

Open AccessEditor’s ChoiceArticle

Reproducibility of Baseline Tumour Metabolic Volume Measurements in Diffuse Large B-Cell Lymphoma: Is There a Superior Method?

by Florian Eude, Mathieu Nessim Toledano, Pierre Vera, Hervé Tilly, Sorina-Dana Mihailescu and Stéphanie Becker

Metabolites 2021, 11(2), 72; https://0-doi-org.brum.beds.ac.uk/10.3390/metabo11020072 - 26 Jan 2021

Cited by 20 | Viewed by 2221

Abstract

The metabolic tumour volume (MTV) is an independent prognostic indicator in diffuse large B-cell lymphoma (DLBCL). However, its measurement is not standardised and is subject to wide variations depending on the method used. This study aimed to compare the reproducibility of MTV measurement as well as the thresholds obtained for each method and their prognostic values. The baseline MTV was measured in 239 consecutive patients treated at Henri Becquerel Centre by two blinded evaluators. Eight methods were compared: 3 absolute (SUV (standardised uptake value) ≥ 2.5; SUV≥ liver SUVmax; SUV≥ PERCIST SUV), 1 percentage SUV threshold method (SUV ≥ 41% SUVmax) and 4 adaptive methods (Daisne, Nestle, Fitting, Black). The intraclass correlation coefficients were excellent, from 0.91 to 0.96, for the absolute SUV methods, Black and Nestle methods, and good for 41% SUVmax, Fitting and Daisne methods (0.82 to 0.88), with a significantly lower variability with absolute methods compared to 41% SUVmax (p < 0.04). Thresholds were found to be specific to each segmentation method and ranged from 295 to 552 cm³. There was a strong correlation between the MTV and patient prognosis regardless of the segmentation method used (p = 0.001 for PFS and OS). The largest inter-observer cut-off variability was observed in the 41% SUVmax method, which resulted in more inter-observer disagreements in the classification of patients between high and low MTV groups. MTV measurements based on absolute SUV criteria were found to be significantly more reproducible than those based on 41% SUVmax criteria. The threshold was specific for each of eight segmentation methods, but all predicted prognosis. Full article

(This article belongs to the Special Issue Metabolic Volume Measurements)

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Review

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24 pages, 585 KiB

Open AccessReview

Clinical Perspectives for ¹⁸F-FDG PET Imaging in Pediatric Oncology: Μetabolic Tumor Volume and Radiomics

by Vassiliki Lyra, Sofia Chatziioannou and Maria Kallergi

Metabolites 2022, 12(3), 217; https://0-doi-org.brum.beds.ac.uk/10.3390/metabo12030217 - 28 Feb 2022

Cited by 4 | Viewed by 3161

Abstract

Pediatric cancer, although rare, requires the most optimized treatment approach to obtain high survival rates and minimize serious long-term side effects in early adulthood. ¹⁸F-FDG PET/CT is most helpful and widely used in staging, recurrence detection, and response assessment in pediatric oncology. The well-known ¹⁸F-FDG PET metabolic indices of metabolic tumor volume (MTV) and tumor lesion glycolysis (TLG) have already revealed an independent significant prognostic value for survival in oncologic patients, although the corresponding cut-off values remain study-dependent and not validated for use in clinical practice. Advanced tumor “radiomic” analysis sheds new light into these indices. Numerous patterns of texture ¹⁸F-FDG uptake features can be extracted from segmented PET tumor images due to new powerful computational systems supporting complex “deep learning” algorithms. This high number of “quantitative” tumor imaging data, although not decrypted in their majority and once standardized for the different imaging systems and segmentation methods, could be used for the development of new “clinical” models for specific cancer types and, more interestingly, for specific age groups. In addition, data from novel techniques of tumor genome analysis could reveal new genes as biomarkers for prognosis and/or targeted therapies in childhood malignancies. Therefore, this ever-growing information of “radiogenomics”, in which the underlying tumor “genetic profile” could be expressed in the tumor-imaging signature of “radiomics”, possibly represents the next model for precision medicine in pediatric cancer management. This paper reviews ¹⁸F-FDG PET image segmentation methods as applied to pediatric sarcomas and lymphomas and summarizes reported findings on the values of metabolic and radiomic features in the assessment of these pediatric tumors. Full article

(This article belongs to the Special Issue Metabolic Volume Measurements)

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16 pages, 2227 KiB

Open AccessReview

Metabolic Volume Measurements in Multiple Myeloma

by Maria Emilia Seren Takahashi, Irene Lorand-Metze, Carmino Antonio de Souza, Claudio Tinoco Mesquita, Fernando Amorim Fernandes, José Barreto Campello Carvalheira and Celso Dario Ramos

Metabolites 2021, 11(12), 875; https://0-doi-org.brum.beds.ac.uk/10.3390/metabo11120875 - 16 Dec 2021

Cited by 3 | Viewed by 2783

Abstract

Multiple myeloma (MM) accounts for 10–15% of all hematologic malignancies, as well as 20% of deaths related to hematologic malignant tumors, predominantly affecting bone and bone marrow. Positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG-PET/CT) is an important method to assess the tumor burden of these patients. It is often challenging to classify the extent of disease involvement in the PET scans for many of these patients because both focal and diffuse bone lesions may coexist, with varying degrees of FDG uptake. Different metrics involving volumetric parameters and texture features have been proposed to objectively assess these images. Here, we review some metabolic parameters that can be extracted from FDG-PET/CT images of MM patients, including technical aspects and predicting MM outcome impact. Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are volumetric parameters known to be independent predictors of MM outcome. However, they have not been adopted in clinical practice due to the lack of measuring standards. CT-based segmentation allows automated, and therefore reproducible, calculation of bone metabolic metrics in patients with MM, such as maximum, mean and standard deviation of the standardized uptake values (SUV) for the entire skeleton. Intensity of bone involvement (IBI) is a new parameter that also takes advantage of this approach with promising results. Other indirect parameters obtained from FDG-PET/CT images, such as visceral adipose tissue glucose uptake and subcutaneous adipose tissue radiodensity, may also be useful to evaluate the prognosis of MM patients. Furthermore, the use and quantification of new radiotracers can address different metabolic aspects of MM and may have important prognostic implications. Full article

(This article belongs to the Special Issue Metabolic Volume Measurements)

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