Role of quantitative imaging biomarkers in an early FDG-PET/CT for detection of immune-related adverse events in melanoma patients: a prospective study

• Published in: Radiology and oncology 2024-09, Vol.58 (3), p.335-347
• Main Authors: Hribernik, Nezka, Strasek, Katja, Huff, Daniel T, Studen, Andrej, Zevnik, Katarina, Skalic, Katja, Jeraj, Robert, Rebersek, Martina
• Format: Article
• Language: English
• Subjects: 18f-fdg pet/ct; Adult; Adverse events; Aged; Artificial neural networks; Biomarkers; Computed tomography; F-FDG PET/CT; Female; Fluorine isotopes; Fluorodeoxyglucose F18; Humans; Immune checkpoint inhibitors; Immune Checkpoint Inhibitors - adverse effects; immune-related adverse effects; Intestine; Lungs; Male; Medical imaging; Melanoma; Melanoma - diagnostic imaging; Melanoma - immunology; Metastases; Middle Aged; Neural networks; Organs; Patients; Positron emission; Positron emission tomography; Positron Emission Tomography Computed Tomography - methods; Prospective Studies; quantitative imaging biomarkers; Radiopharmaceuticals; ROC Curve; Skin Neoplasms - diagnostic imaging; Skin Neoplasms - pathology; Statistical analysis; SUV percentiles; Target detection; Thyroid; Thyroid gland; Thyroid Gland - diagnostic imaging
• ISSN: 1581-3207; 1318-2099; 1581-3207; 0485-893X
• DOI: 10.2478/raon-2024-0045

To evaluate the role of the novel quantitative imaging biomarker (QIB) SUV of F-FDG uptake extracted from early F-FDG-PET/CT scan at 4 weeks for the detection of immune-related adverse events (rAE) in a cohort of patients with metastatic melanoma (mM) patients receiving immune-checkpoint inhibitors (ICI). In this prospective non-interventional, one-centre clinical study, patients with mM, receiving ICI treatment, were regularly followed by F-FDG PET/CT. Patients were scanned at baseline, early point at week four (W4), week sixteen (W16) and week thirty-two (W32) after ICI initiation. A convolutional neural network (CNN) was used to segment three organs: lung, bowel, thyroid. QIB of irAE - SUV - was analyzed within the target organs and correlated with the clinical irAE status. Area under the receiver-operating characteristic curve (AUROC) was used to quantify irAE detection performance. A total of 242 F-FDG PET/CT images of 71 mM patients were prospectively collected and analysed. The early W4 scan showed improved detection only for the thyroid gland compared to W32 scan (p=0.047). The AUROC for detection of irAE in the three target organs was highest when SUV was extracted from W16 scan and was 0.76 for lung, 0.53 for bowel and 0.81 for thyroid. SUV extracted from W4 scan did not improve detection of irAE compared to W16 scan (lung: p = 0.54, bowel: p = 0.75, thyroid: p = 0.3, DeLong test), as well as compared to W32 scan in lungs (p = 0.32) and bowel (p = 0.3). Early time point F-FDG PET/CT at W4 did not lead to statistically significant earlier detection of irAE. However, organ F-FDG uptake as quantified by SUV proved to be a consistent QIB of irAE. To better assess the role of F-FDG PET/CT in irAE detection, the time evolution of F-FDG PET/CT quantifiable inflammation would be of essence, only achievable in multi centric studies.