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Asphericity of pretherapeutic tumour FDG uptake provides independent prognostic value in head-and-neck cancer

  • Head and Neck
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To propose a novel measure, namely the ‘asphericity’ (ASP), of spatial irregularity of FDG uptake in the primary tumour as a prognostic marker in head-and-neck cancer.


PET/CT was performed in 52 patients (first presentation, n = 36; recurrence, n = 16). The primary tumour was segmented based on thresholding at the volume-reproducible intensity threshold after subtraction of the local background. ASP was used to characterise the deviation of the tumour’s shape from sphere symmetry. Tumour stage, tumour localisation, lymph node metastases, distant metastases, SUVmax, SUVmean, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) were also considered. The association of overall (OAS) and progression-free survival (PFS) with these parameters was analysed.


Cox regression revealed high SUVmax [hazard ratio (HR) = 4.4/7.4], MTV (HR = 4.6/5.7), TLG (HR = 4.8/8.9) and ASP (HR = 7.8/7.4) as significant predictors with respect to PFS/OAS in case of first tumour manifestation. The combination of high MTV and ASP showed very high HRs of 22.7 for PFS and 13.2 for OAS. In case of recurrence, MTV (HR = 3.7) and the combination of MTV/ASP (HR = 4.2) were significant predictors of PFS.


ASP of pretherapeutic FDG uptake in the primary tumour improves the prediction of tumour progression in head-and-neck cancer at first tumour presentation.

Key Points

Asphericity (ASP) characterises the spatial heterogeneity of FDG uptake in tumours

ASP is a promising prognostic parameter in head-and-neck cancer

ASP is useful for identification of high-risk patients with head-and-neck cancer

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Hazard ratio


Human papilloma virus


Metabolic tumour volume


Overall survival


Progression-free survival


Region of interest


Total lesion glycolysis


Volume of interest


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The scientific guarantor of this publication is Prof. W. Brenner. The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. Two of the authors have significant statistical expertise. Institutional Review Board approval was obtained. Written informed consent was waived by the Institutional Review Board. None of the study subjects or cohorts have been previously reported. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Ivayla Apostolova and Ingo G. Steffen contributed equally.

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Correspondence to Ivayla Apostolova.

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Apostolova, I., Steffen, I.G., Wedel, F. et al. Asphericity of pretherapeutic tumour FDG uptake provides independent prognostic value in head-and-neck cancer. Eur Radiol 24, 2077–2087 (2014).

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