Purpose: To directly compare the utility for therapeutic outcome prediction of dynamic first-pass contrast-enhanced (CE)-perfusion area-detector computed tomography (ADCT), MR imaging assessed with the same mathematical method and 2-[fluorine-18]-fluoro-2-deoxy-d-glucose-positron emission tomography combined with CT (PET/CT) for non-small cell lung cancer (NSCLC) patients treated with chemoradiotherapy.
Materials and methods: Forty-three consecutive stage IIIB NSCLC patients, consisting of 25 males (mean age ± standard deviation: 66.6 ± 8.7 years) and 18 females (66.4 ± 8.2 years) underwent PET/CT, dynamic CE-perfusion ADCT and MR imaging, chemoradiotherapy, and follow-up examination. In each patient, total, pulmonary arterial, and systemic arterial perfusions were calculated from both perfusion data and SUVmax on PET/CT, assessed for each targeted lesion, and averaged to determine final values. Receiver operating characteristics analyses were performed to compare the utility for distinguishing responders from non-responders using Response Evaluation Criteria in Solid Tumor (RECIST) 1.1 criteria. Overall survival (OS) assessed with each index were compared between two groups by means of the Kaplan-Meier method followed by the log-rank test.
Results: Area under the curve (Az) for total perfusion on ADCT was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Az of total perfusion on MR imaging was significantly larger than that of pulmonary arterial perfusion (P < 0.05). Mean OS of responder and non-responder groups were significantly different for total and systemic arterial (P < 0.05) perfusion.
Conclusion: Dynamic first-pass CE-perfusion ADCT and MR imaging as well as PET/CT are useful for early prediction of treatment response by NSCLC patients treated with chemoradiotherapy.
Keywords: computed tomography; magnetic resonance imaging; non-small cell lung cancer; positron emission tomography combined with computed tomography; therapeutic effect.