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Lee, Lee, and Kim: Prognostic Significance of Adipose Tissue and Fluorodeoxyglucose PET/CT Melanoma of the Imaging Parameters Bone Marrow on F-18 in Patients with Malignant
Original Article

J Korean Soc Radiol 2019;80(6):1132-1144.

Published online: 20 January 2019

DOI: https://doi.org/10.3348/jksr.2019.80.6.1132

Prognostic Significance of Adipose Tissue and Fluorodeoxyglucose PET/CT Melanoma of the Imaging Parameters Bone Marrow on F-18 in Patients with Malignant

Ju Ha Lee, MD1, Sang Mi Lee, MD2, ∗, Jung Eun Kim, MD3

1Department of Radiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

2Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

3Department of Dermatology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea

∗Corresponding author Sang Mi Lee, MD Department of Nuclear Medicine, Soonchunhyang Univeristy Cheonan Hospital, 44 Suncheonhyang 4-gil, Dongnam-gu, Cheonan 31151, Korea. Tel 82-41-570-3540 Fax 82-41-572-4655 E-mail gareen@naver.com

Received 18 December 2018       Revised 25 March 2019       Accepted 6 June 2019

Copyright © 2019 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Fluorodeoxyglucose (FDG) uptake of bone marrow (BM) and adipose tissue is known to reflect systemic inflammatory response to cancer cell. The objective of this study was to evaluate the prognostic value of F-18 FDG uptake of BM and determine characteristics of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) on PET/CT images in malignant melanoma.

Materials and Methods

We retrospectively reviewed 33 patients histopathologically diagnosed with malignant melanoma via FDG PET/CT staging. BM-to-liver uptake ratio (BLR), volume of VAT and SAT, CT Hounsfield unit (HU), and mean of standardized uptake value (SU-Vmean) of VAT and SAT on PET/CT were measured and prognostic values of these parameters for prediction of disease progression-free survival (DPFS) were evaluated.

Results

Patients with stage III–IV melanoma had higher CT HU and SUVmean for SAT and VAT but lower volume of VAT compared with patients at stage I–II (p < 0.05). Survival analysis, patients with high CT HU of VAT and SAT, high SUVmean of VAT and SAT, and high BLR showed worse DPFS (allp < 0.05), indicating significant association. However, volume of SAT or VAT failed to show significant association with DPFS (p > 0.05).

Conclusion

CT HU, SUVmean of SAT and VAT, and BLR provide prognostic information for DPFS in malignant melanoma.

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Fig. 1.
Example of measurement of adipose tissue. A, B. On consecutive transaxial CT images at L3/L4 level. The area of adipose tissue was automatically computed using a CT attenuation range from −50 to −200 HU. C, D. Within the areas of adipose tissue on the 3 images, the volume and mean HU were automatically calculated. E, F. The areas of adipose tissue on the 3 CT images were then exported to the corresponding fluorodeoxy-glucose PET/CT images. HU = Hounsfield unit
jksr-80-1132f1.tif
Fig. 2.
Example of measurement of bone marrow. Maximum intensity projection (A), sagittal PET (B), and sagittal fused PET/CT images of FDG PET/ CT (C). Spheroid-shaped five VOIs were drawn in vertebral bodies of thoracic and lumbar spines, and the average SUV of those VOIs was calculated. Primary malignant lesion was located left toe (arrow). FDG = fluorodeoxyglucose, SUV = standardized uptake value, VOI = volume of interest
jksr-80-1132f2.tif
Fig. 3.
Kaplan-Meier curves for distant progression-free survival according to different parameters: BLR (A), SUV of VAT (B), SUV of SAT (C), HU of VAT (D), HU of SAT (E), and stage (F). BLR = bone marrow-to-liver uptake ratio, SAT = subcutaneous adipose tissue, SUV = standardized uptake value, HU = Hounsfield unit, VAT = visceral adipose tissue
jksr-80-1132f3.tif
Table 1.
Clinical Characteristics of Enrolled Patients (n = 33)
Characteristics No. of Patients (%) Median (Range)
Age, years   69 (60–75)
Sex    
Sex Female 14 (42)� �  
Female Male 14 (42)19 (58)� �  
Male Location 19 (58)  
Extremity 13 (39.4)  
Body 11 (33.3)  
Body Others 11 (33.3) 9 (27.3)  
Others T stage 9 (27.3)  
T1 5 (15.2)  
T2 7 (21.2)  
T2 T3 7 (21.2) 6 (18.2)  
T3T4 6 (18.2) 15 (45.5)  
T4 N stage 15 (45.5)  
N0 26 (78.8)  
N0 N1 26 (78.8) 3 (0.1)  
N2 0 (0.00)  
N3 4 (12.1)  
N3 M stage 4 (12.1)  
M0 30 (90.9)  
M1 5 (15.1)  
M1 TNM stage 5 (15.1)  
Stage I–II 26 (78.8)  
Stage III–IV 7 (21.2)  
Stage III–IV BMI, kg/m2 7 (21.2) 24.91 (14.61–32.87)
BMI, kg/m WBC, × 1012 cells/L   24.91 (14.61–32.87) 6.04 (4.25–14.17)
Hemoglobin, g/dL   13.40 (8.40–17.70)
NLR   1.97 (0.86–6.25)
NLR CRP, mg/L   1.97 (0.866.25) 1.16 (0.07–70.90)
LDH, IU/L   179.50 (102.00–437.00)
SUVtumor∗   7.30 (2.89–24.00)
BM SUVmean   1.70 (1.18–2.50)
BM SUVmeanBLR   1.70 (1.18–2.50) 0.73 (0.48–1.34)
BLR SAT   0.73 (0.48–1.34)
SAT Volume, cm3   68.28 (2.07–156.26)
SUVmean   0.35 (0.25–0.53)
SUVmean HU   0.35 (0.25–0.53) −100.85 (−109.39–-62.47)
HU VAT   -100.85 (−109.39–-62.47)
Voume, cm3   42.74 (1.38–113.06)
SUVmean   0.70 (0.49–1.38)
HU   -94.60 (−108.43–-78.14)
Treatment    
Operation 28 (84.9)  
Radiation therapy 2 (6.1)  
Radiation therapy Target therapy 2 (6.1) 3 (9.1)  

∗Measured in 17 patients. BLR = BM-to-liver uptake ratio, BM = bone marrow, BMI = body mass index, CRP = C-reactive protein, HU = Hounsfield unit, LDH = lactate dehydrogenase, NLR = neutrophil-to-lymphocyte ratio, SAT = subcutaneous adipose tissue, SUVmean = mean of standardized uptake value, SUVtumor = maximum fluorodeoxyglucose uptake of primary tumor, VAT = visceral adipose tissue, WBC = white blood cell

Table 2.
Univariate Analysis of Disease Progression-Free Survival
Variables p-Value
Location (extremity vs. body vs. others) 0.579
BMI (25 kg/m2) 0.311
NLR (< 2.50 vs. ≥ 2.50) 0.863
CRP (< 5.00 mg/dL vs. ≥ 5.00 mg/dL) 0.050
BM SUVmean (< 1.73 vs. ≥ 1.73) 0.223
BLR (< 0.63 vs. ≥ 0.63) 0.033
Volume of SAT (< 90.00 cm3 vs. ≥ 90.00 cm3) 0.151
SUVmean of SAT (< 0.30 vs. ≥ 0.30) 0.038
HU of SAT (< −102.15 vs. ≥ −102.15) 0.010
Volume of VAT (< 23.65 cm3 vs. ≥ 23.65 cm3) 0.214
SUVmean of VAT (< 0.75 vs. ≥ 0.75) 0.041
HU of VAT (< −100.00 vs. ≥ −100.00) 0.045
HU of VAT (< −100.00 vs. ≥ −100.00) TNM stage (stage I–II vs. stage III–IV) 0.045 0.033
T stage (1–2 vs. 3–4) 0.911
N stage (0 vs. 1) 0.347
M stage (0 vs. 1) 0.297

BLR = BM-to-liver uptake ratio, BM = bone marrow, BMI = body mass index, CRP = C-reactive protein, HU = Hounsfield unit, NLR = neutrophil-to-lymphocyte ratio, SAT = subcutaneous adipose tissue, SUVmean = mean of standardized uptake value, VAT = visceral adipose tissue

Table 3.
Recurrence Rates According to Staging and Fluorodeoxyglucose Uptake of Adipose Tissue
Stage Stage I, II Stage III, IV
SUVmean of SAT < 0.30 1/7 (14.29) 0/1 (0)
SUVmean of SAT ≥ 0.30 4/19 (21.05) 3/6 (50)
p-Value > 0.99 > 0.99
SUVmean of VAT < 0.75 3/19 (15.79) 0/2 (0)
SUVmean of VAT ≥ 0.75 2/7 (28.57) 3/5 (60)
p-Value 0.588 0.429

SAT = subcutaneous adipose tissue, SUVmean = mean of standardized uptake value, VAT = visceral adipose tissue

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