[F-18]FDG PET/MRI enables early chemotherapy response prediction in pancreatic ductal adenocarcinoma

Harder, F. N., Jungmann, F., Kaissis, G. A., Lohofer, F. K., Ziegelmayer, S., Havel, D., Quante, M., Reichert, M., Schmid, R. M., Demir, I. E., Friess, H., Wildgruber, M., Siveke, J., Muckenhuber, A., Steiger, K., Weichert, W., Rauscher, I., Eiber, M., Makowski, M. R., and Braren, R. F. (2021). Ejnmmi Research 11. doi: 10.1186/s13550-021-00808-4


Purpose: In this prospective exploratory study, we evaluated the feasibility of [18F]fluorodeoxyglucose ([18F]FDG) PET/MRI-based chemotherapy response prediction in pancreatic ductal adenocarcinoma at two weeks upon therapy onset.

Material and methods: In a mixed cohort, seventeen patients treated with chemotherapy in neoadjuvant or palliative intent were enrolled. All patients were imaged by [18F]FDG PET/MRI before and two weeks after onset of chemotherapy. Response per RECIST1.1 was then assessed at 3 months [18F]FDG PET/MRI-derived parameters (MTV50%, TLG50%, MTV2.5, TLG2.5, SUVmax, SUVpeak, ADCmax, ADCmean and ADCmin) were assessed, using multiple t-test, Man-Whitney-U test and Fisher's exact test for binary features.

Results: At 72 ± 43 days, twelve patients were classified as responders and five patients as non-responders. An increase in ∆MTV50% and ∆ADC (≥ 20% and 15%, respectively) and a decrease in ∆TLG50% (≤ 20%) at 2 weeks after chemotherapy onset enabled prediction of responders and non-responders, respectively. Parameter combinations (∆TLG50% and ∆ADCmax or ∆MTV50% and ∆ADCmax) further improved discrimination.

Conclusion: Multiparametric [18F]FDG PET/MRI-derived parameters, in particular indicators of a change in tumor glycolysis and cellularity, may enable very early chemotherapy response prediction. Further prospective studies in larger patient cohorts are recommended to their clinical impact.