Journal of Nuclear Medicine

1672 Objectives : It is not certain whether the magnitude of FDG uptake has a prognostic significance in newly diagnosed non-Hodgkin’s lymphoma (NHL) patients. We evaluated a parameter that reflects both the magnitude of FDG uptake and the metabolic size of tumor as a prognostic indicator of NHL. Methods : Forty-four NHL patients (age, 55±17 y; male/female = 28/16; 41 aggressive and 3 indolent; Stage I/II/III/IV = 4/16/16/8), who underwent FDG-PET before initiation of chemotherapy, were enrolled. Among masses shown on PET images, the mass with the highest maximum standardized uptake value (MaxSUV) was selected and the size-incorporated MaxSUV (SIMaxSUV) of the mass was calculated as MaxSUV×metabolic size (the greatest diameter (mm) on transaxial images). Eight variables including age, disease stage, serum beta-2-microglobulin and LDH levels, international prognostic index (IPI), %Ki-67 expression, MaxSUV, and SIMaxSUV were evaluated for prognostic significance. The mean duration of patient follow-up was 302±207 days. Results : Seven (16%) of the 44 patients died during a mean follow-up of 239±172 days. Univariate analysis revealed that among variables SIMaxSUV and IPI were significant parameters for survival (p=0.025 and p=0.032, respectively). Multivariate Cox proportional analysis identified SIMaxSUV as the single determinant for survival (p=0.025). Patients with SIMaxSUV ≥ 800 (n=7) had a lower 1-year survival rate (42%) than those with SIMaxSUV < 800 (n=37, 94%). Conclusions : These results suggest that the FDG-PET parameter SIMaxSUV that reflects both the magnitude of FDG uptake and the metabolic size of tumor may be of use as a prognostic indicator of NHL. Also, they suggest that a mass with the highest FDG uptake may represent chemo-resistant clones of NHL. ![Graphic][1] [1]: /embed/inline-graphic-1.gif

1760 Objectives : FDG uptake mediated by glucose transporter type 1 (Glut-1) provides prognostic information in patients with non–small cell lung cancer (NSCLC). Tumor proliferative activity assessed by Ki-67 expression is another prognostic marker. Direct comparisons among FDG uptake and Glut-1 and Ki-67 expressions as prognostic indicators of NSCLC have not been reported. We investigated the prognostic significance of FDG uptake and Glut-1 and Ki-67 expressions and their correlations in patients with NSCLC. Methods : NSCLC patients (n=53, F:M=16:37, age 61.9±12.1 y) who underwent cure-intent resection after performing FDG PET were enrolled. Thirty-one patients had stage I, 15 with stage II and 7 with stage III. Patients were treated with surgery only (n=12), surgery plus adjuvant oral chemotherapy (n=32), or surgery plus adjuvant intravenous chemo- or radiotherapy (n=9). Maximum standardized FDG uptake values (maxSUV) and Glut-1 and Ki-67 expressions of the resected tumors were analyzed for their correlations and relations with tumor recurrence. The median follow-up duration was 15 mo. Results : Thirteen (24.5%) of 53 patients had a recurrence during a median follow-up of 8 mo. There were significant correlations among maxSUV and Glut-1 and Ki-67 expressions (r=0.48-0.79, p<0.001). Univariate analysis revealed that disease-free survival was significantly correlated with maxSUV (<7 vs. ≥7, p=0.001), % Ki-67 expression (<25% vs. ≥25%, p=0.047), tumor size (<3 cm vs. ≥3 cm, p=0.027), and differentiation of tumor cells (well/moderate vs. poor, p=0.025). However, multivariate Cox proportional analysis identified maxSUV as the single determinant for disease-free survival (p=0.027). Patients with maxSUV≥7 (n=14) had a significantly lower 1-year disease-free survival rate (57.1%) than those with maxSUV <7 (n=39, 89.7%). Conclusions : There were significant correlations among FDG uptake and Glut-1 and Ki-67 expressions. It seems that among various parameters FDG uptake is the most valuable prognostic indicator for tumor recurrence in patients with resected NSCLC. ![Graphic][1] [1]: /embed/inline-graphic-1.gif

Because randomized coronary revascularization trials in stable coronary artery disease (CAD) have shown no reduced myocardial infarction (MI) or mortality, the threshold of quantitative myocardial perfusion severity was analyzed for association with reduced death, MI, or stroke after revascularization within 90 d after PET. Methods: In a prospective long-term cohort of stable CAD, regional, artery-specific, quantitative myocardial perfusion by PET, coronary revascularization within 90 d after PET, and all-cause death, MI, and stroke (DMS) at 9-y follow-up (mean ± SD, 3.0 ± 2.3 y) were analyzed by multivariate Cox regression models and propensity analysis. Results: For 3,774 sequential rest–stress PET scans, regional, artery-specific, severely reduced coronary flow capacity (CFC) (coronary flow reserve ≤ 1.27 and stress perfusion ≤ 0.83 cc/min/g) associated with 60% increased hazard ratio for major adverse cardiovascular events and 30% increased hazard of DMS that was significantly reduced by 54% associated with revascularization within 90 d after PET ( P = 0.0369), compared with moderate or mild CFC, coronary flow reserve, other PET metrics or medical treatment alone. Depending on severity threshold for statistical certainty, up to 19% of this clinical cohort had CFC severity associated with reduced DMS after revascularization. Conclusion: CFC by PET provides objective, regional, artery-specific, size–severity physiologic quantification of CAD severity associated with high risk of DMS that is significantly reduced after revascularization within 90 d after PET, an association not seen for moderate to mild perfusion abnormalities or medical treatment alone.