A pilot study for texture analysis of 18F-FDG and 18F-FLT-PET/CT to predict tumor recurrence of patients with colorectal cancer who received surgery

  • Masatoyo NakajoEmail author
  • Yoriko Kajiya
  • Atsushi Tani
  • Megumi Jinguji
  • Masayuki Nakajo
  • Masaki Kitazono
  • Takashi Yoshiura
Original Article



This retrospective study was done to examine whether the heterogeneity in primary tumor F-18-fluorodeoxyglucose (18F-FDG) and 18F-3′-fluoro-3′-deoxythymidine (18F-FLT) distribution can predict prognosis of patients with colorectal cancer who received surgery.


The enrolled 32 patients with colorectal cancer underwent both 18F-FDG- and 18F-FLT-PET/CT studies before surgery. Clinicopathological factors, stage, SUVmax, SUVmean, metabolic tumor volume (SUV ≥ 2.5), total lesion glycolysis, total lesion proliferation and seven texture heterogeneity parameters (coefficient of variation, local parameters: entropy, homogeneity, and dissimilarity; and regional parameters: intensity variability [IV], size-zone variability [SZV], and zone percentage [ZP]) were obtained. Progression free survival (PFS) was calculated by the Kaplan-Meier method. Prognostic significance was assessed by Cox proportional hazards analysis.


Eight patients had eventually come to progression, and 24 patients were alive without progression during clinical follow-up [mean follow-up PFS; 55.9 months (range, 1-72)]. High stage (p = 0.004), high 18F-FDG-IV (p = 0.015), high 18F-FDG-SZV (p = 0.013) and high 18F-FLT-entropy (p = 0.015) were significant in predicting poor 5-year PFS. Other parameters did not predict the disease outcome. At bivariate analysis, disease event hazards ratios for 18F-FDG-IV and 18F-FDG-SZV remained significant when adjusted for stage and 18F-FLT-entropy (18F-FDG-IV; p = 0.004 [adjusted for stage], 0.007 [adjusted for 18F-FLT-entropy]; 18F-FDG-SZV; p = 0.028 [adjusted for stage], 0.040 [adjusted for 18F-FLT-entropy]).


18F-FDG PET heterogeneity parameters, IV and SZV, have a potential to be strong prognostic factors to predict PFS of patients with surgically resected colorectal cancer and are more useful than 18F-FLT-PET/CT heterogeneity parameters.


Colorectal cancer Prognosis 18F-FDG-PET/CT 18F-FLT-PET/CT Texture analysis 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was waived by the institutional review board for this retrospective study.

Supplementary material

259_2017_3787_MOESM1_ESM.docx (51 kb)
ESM 1 (DOCX 50.8 kb)


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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Masatoyo Nakajo
    • 1
    Email author
  • Yoriko Kajiya
    • 2
  • Atsushi Tani
    • 1
  • Megumi Jinguji
    • 1
  • Masayuki Nakajo
    • 2
  • Masaki Kitazono
    • 3
  • Takashi Yoshiura
    • 1
  1. 1.Department of Radiology, Graduate School of Medical and Dental SciencesKagoshima UniversityKagoshimaJapan
  2. 2.Department of RadiologyNanpuh HospitalKagoshimaJapan
  3. 3.Department of SurgeryNanpuh HospitalKagoshimaJapan

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