Volumetric and texture analysis of pretherapeutic 18 F-FDG PET can predict overall survival in medullary thyroid cancer patients treated with Vandetanib

Rudolf A. Werner, Ralph A. Bundschuh, Takahiro Higuchi, Mehrbod S. Javadi, Steven P. Rowe, Norbert Zsótér, Matthias Kroiss, Martin Fassnacht, Andreas K. Buck, Michael C. Kreissl, Constantin Lapa

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


Purpose: The metabolically most active lesion in 2-deoxy-2-( 18 F)fluoro-D-glucose ( 18 F-FDG) PET/CT can predict progression-free survival (PFS) in patients with medullary thyroid carcinoma (MTC) starting treatment with the tyrosine kinase inhibitor (TKI) vandetanib. However, this metric failed in overall survival (OS) prediction. In the present proof of concept study, we aimed to explore the prognostic value of intratumoral textural features (TF) as well as volumetric parameters (total lesion glycolysis, TLG) derived by pre-therapeutic 18 F-FDG PET. Methods: Eighteen patients with progressive MTC underwent baseline 18 F-FDG PET/CT prior to and 3 months after vandetanib initiation. By manual segmentation of the tumor burden at baseline and follow-up PET, intratumoral TF and TLG were computed. The ability of TLG, imaging-based TF, and clinical parameters (including age, tumor marker doubling times, prior therapies and RET (rearranged during transfection) mutational status) for prediction of both PFS and OS were evaluated. Results: The TF Complexity and the volumetric parameter TLG obtained at baseline prior to TKI initiation successfully differentiated between low- and high-risk patients. Complexity allocated 10/18 patients to the high-risk group with an OS of 3.3 y (vs. low-risk group, OS = 5.3 y, 8/18, AUC = 0.78, P = 0.03). Baseline TLG designated 11/18 patients to the high-risk group (OS = 3.5 y vs. low-risk group, OS = 5 y, 7/18, AUC = 0.83, P = 0.005). The Hazard Ratio for cancer-related death was 6.1 for Complexity (TLG, 9.5). Among investigated clinical parameters, the age at initiation of TKI treatment reached significance for PFS prediction (P = 0.02, OS, n.s.). Conclusions: The TF Complexity and the volumetric parameter TLG are both independent parameters for OS prediction.

Original languageEnglish
Pages (from-to)293-300
Number of pages8
Issue number2
Publication statusPublished - Feb 15 2019
Externally publishedYes


  • 2-deoxy-2-( F)fluoro-D-glucose
  • F-FDG
  • Medullary thyroid carcinoma
  • Personalized medicine
  • Positron emission tomography
  • TKI
  • Tyrosine kinase inhibitor
  • Vandetanib

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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