Correlation of the Apparent Diffusion Coefficient (ADC) and Standardized Uptake Values (SUV) with overall survival in patients with primary Non-Small Cell Lung Cancer (NSCLC) using 18F-FDG PET/MRI

Abstract Objectives To investigate if the combined analysis of the apparent diffusion coefficient (ADC) and standardized uptake values (SUV) measured in 18F-fluoro-deoxy-glucose-positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) examinations correlates with overall survival in non-small cell lung cancer (NSCLC). Material and methods A total of 92 patients with newly diagnosed, histopathologically proven NSCLC (44 women and 48 men, mean age 63.1 ± 9.9y) underwent a dedicated thoracic 18F-FDG PET/MRI examination. A manually drawn polygonal region of interest (ROI), encompassing the entire primary tumor mass, was placed over the primary tumor on fused PET/MR images to determine the maximum and mean standardized uptake values (SUVmax; SUVmean) as well as on the ADC maps to quantify the mean and minimum ADC values (ADCmean, ADCmin). The impact of these parameters to predict patient’s overall survival was tested using hazard ratios (HR). Pearson’s correlation coefficients were calculated to assess dependencies between the different values. A p-value Results In all 92 patients (n = 59 dead at time of retrospective data collection, mean time till death: 19 ± 16 month, n = 33 alive, mean time to last follow-up: 56 ± 22 month) the Hazard ratios (HR) as independent predictors for overall survival (OS) of SUVmax were 2.37 (95% CI: 1.23-4.59, p = 0.008) and for SUVmean 1.85 (95% CI: 1.05-3.26, p = 0.03) while ADCmin showed a HR of 0.95 (95% CI: 0.57-1.59, p = 0.842) and ADCmean a HR of 2.01 (95% CI: 1.2-3.38, p = 0.007). Furthermore, a combined analysis for SUVmax/ADCmean, SUVmax / ADCmin and SUVmean/ADCmean revealed a HR of 2.01 (95% CI: 1.10-3.67, p = 0.02), 1.75 (95% CI: 0.97-3.15, p = 0.058) and 1.78 (95% CI: 1.02-3.10, p = 0.04). Conclusion SUVmax and SUVmean of the primary tumor are predictors for OS in therapy-naive NSCLC patients, whereas the combined analysis of SUV and ADC values does not improve these results. Therefore, ADC values do not further enhance the diagnostic value of SUV as a prognostic biomarker in NSCLC.