Amide Proton Transfer-Weighted Imaging and Multiple Models Intravoxel Incoherent Motion-Based 18 F-FDG PET/MRI for Predicting Progression-Free Survival in Non-Small Cell Lung Cancer

Nan Meng; Han Jiang; Jing Sun; Lei Shen; Xinhui Wang; Yihang Zhou; Yaping Wu; Fangfang Fu; Jianmin Yuan; Yang Yang; Zhe Wang; Meiyun Wang

doi:10.1002/jmri.29037

Amide Proton Transfer-Weighted Imaging and Multiple Models Intravoxel Incoherent Motion-Based ¹⁸ F-FDG PET/MRI for Predicting Progression-Free Survival in Non-Small Cell Lung Cancer

J Magn Reson Imaging. 2023 Oct 18. doi: 10.1002/jmri.29037. Online ahead of print.

Authors

Nan Meng^{1

2

3}, Han Jiang⁴, Jing Sun⁵, Lei Shen^{1

2}, Xinhui Wang^{1

2}, Yihang Zhou⁴, Yaping Wu^{1

2}, Fangfang Fu^{1

2}, Jianmin Yuan⁶, Yang Yang⁷, Zhe Wang⁶, Meiyun Wang^{1

2

3}

Affiliations

¹ Department of Medical Imaging, Henan Provincial People's Hospital & Zhengzhou University People's Hospital, Zhengzhou, China.
² Laboratory of Brain Science and Brain-Like Intelligence Technology, Institute for Integrated Medical Science and Engineering, Henan Academy of Sciences, Zhengzhou, China.
³ Biomedical Research Institute, Henan Academy of Sciences, Zhengzhou, China.
⁴ Department of Medical Imaging, Xinxiang Medical University People's Hospital & Henan Provincial People's Hospital, Zhengzhou, China.
⁵ Department of Pediatrics, Zhengzhou Central Hospital Affiliated to Zhengzhou University & Zhengzhou Central Hospital, Zhengzhou, China.
⁶ Central Research Institute, United Imaging Healthcare Group, Shanghai, China.
⁷ Beijing United Imaging Research Institute of Intelligent Imaging, United Imaging Healthcare Group, Beijing, China.

PMID: 37850873
DOI: 10.1002/jmri.29037

Abstract

Background: Amide proton transfer-weighted imaging (APTWI) and multiple models intravoxel incoherent motion (IVIM) based ¹⁸ F-FDG PET/MR could reflect the microscopic information of the tumor from multiple perspectives. However, its value in the prognostic assessment of non-small cell lung cancer (NSCLC) still needs to be further explored.

Purpose: To determine whether pretreatment APTWI, mono-, bi-, and stretched-exponential model IVIM, and ¹⁸ F-FDG PET-derived parameters of the primary lesion may be associated with progression-free survival (PFS) in NSCLC.

Study type: Prospective.

Population: Seventy-seven patients (mean age, 62 years, range, 20-81 years) with 37 men and 40 women were included.

Field strength/sequence: 3.0 T ¹⁸ F-FDG PET/MRI, single shot echo planar imaging sequences for IVIM and fast spin-echo sequences with magnetization transfer pulses for APTWI.

Assessment: Patient clinical characteristics (age, sex, smoke, subtype, TNM stage, and surgery), PFS (chest CT every 3 months, median follow-up was 18 months, range, 4-27 months), and APTWI (MTRasym(3.5 ppm)), IVIM (ADC_stand , D, D*, f, DDC, and α), and ¹⁸ F-FDG PET (SUV_max , MTV, and TLG) parameters were recorded.

Statistical tests: Proportional hazards model, concordance index, calibration curve, decision curve analysis (DCA), and Log-rank test. A P value <0.05 was considered statistically significant.

Results: Histological subtype, TNM stage, MTV, D*, and MTRasym(3.5 ppm) were all independent predictors of PFS. A prediction model based on these predictors was developed with a C-index of 0.895 (95% CI: 0.839-0.951), which was significantly superior to each of the above predictors alone (C-index = 0.629, 0.707, 0.692, 0.678, and 0.558, respectively). The calibration curve and DCA indicated good consistency and clinical utility of the prediction model, respectively. Log-rank test results showed a significant difference in PFS between the high- and low-risk groups.

Data conclusion: APTWI and multiple models IVIM based ¹⁸ F-FDG PET/MRI can be used for PFS assessment in NSCLC.

Evidence level: 3 TECHNICAL EFFICACY: Stage 2.

Keywords: 18F-Fluorodeoxyglucose positron emission tomography; amide proton transfer-weighted imaging; intravoxel incoherent motion; non-small cell lung cancer; progression-free survival.

Abstract

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