New Application of Dual Point 18F-FDG PET/CT in the Evaluation of Neoadjuvant Chemoradiation Response of Locally Advanced Rectal Cancer

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FDG PET/CT has been suggested as the most reliable modality to predict pathological tumor responses after neoadjuvant chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). However, several confounding factors including radiation-induced inflammation could not be easily avoided with the commonly used single-point FDG PET/CT. Our aim was to evaluate the accuracy of a dual-point PET/CT protocol in LARC response prediction to CRT.

Patients and Methods

Sixty-one LARC patients were enrolled and treated with neoadjuvant CRT. PET/CT was performed before and after CRT. Dual-point acquisition was applied to post-CRT PET/CT. Post-CRT SUVmax (postSUV), pre/post-CRT SUVmax change (RI), and dual-point index (DI) of post-CRT PET/CT were compared with the Dworak tumor regression grade (TRG) as a gold standard. Univariate and multivariate analyses, as well as receiver operating characteristic curve analysis, were used to evaluate the predictive ability of demographic, clinical, and metabolic PET parameters.


Fifteen patients of TRG3-4 were defined as pathological responders, and 46 patients of TRG1-2 were nonresponders. The resulting response index (RI) ranged from −13 to 94.8% (59.1 ± 22.0%), and delay index (DI) ranged from −45.2 to 25.0% (−9.1 ± 12.1%). Univariate analysis resulted in PET parameters (postSUV, RI, and DI) as significant predictors (P = 0.004, P < 0.001, P < 0.0001). According to multivariate analysis, RI and DI remained as significant predictors (P = 0.04 and P = 0.0004). Receiver operating characteristic analysis showed that DI had significantly higher area under the curve compared with RI (0.906 vs 0.696, P = 0.018). Delay index had 86.7% sensitivity, 87.0% specificity, 68.4% positive predictive value, 95.2% negative predictive value, and 86.9% accuracy.


Dual-point post-CRT PET/CT can predict pathological tumor response better than conventional single time point pre- and post-CRT PET/CT.

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