Gastric cancer and image-derived quantitative parameters: Part 2-a critical review of DCE-MRI and 18F-FDG PET/CT findings

Abstract

There is yet no consensus on the application of functional imaging and qualitative image interpretation in the management of gastric cancer. In this second part, we will discuss the role of image-derived quantitative parameters from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in gastric cancer, as both techniques have been shown to be promising and useful tools in the clinical decision making of this disease. We will focus on different aspects including aggressiveness assessment, staging and Lauren type discrimination, prognosis prediction and response evaluation. Although both the number of articles and the patients enrolled in the studies were rather small, there is evidence that quantitative parameters from DCE-MRI such as Ktrans, Ve, Kep and AUC could be promising image-derived surrogate parameters for the management of gastric cancer. Data from 18F-FDG PET/CT studies showed that standardised uptake value (SUV) is significantly associated with the aggressiveness, treatment response and prognosis of this disease. Along with the results from diffusion-weighted MRI and contrast-enhanced multidetector computed tomography presented in Part 1 of this critical review, there are additional image-derived quantitative parameters from DCE-MRI and 18F-FDG PET/CT that hold promise as effective tools in the diagnostic pathway of gastric cancer. KEY POINTS: • Quantitative analysis from DCE-MRI and18F-FDG PET/CT allows the extrapolation of multiple image-derived parameters. • Data from DCE-MRI (Ktrans, Ve, Kep and AUC) and 18F-FDG PET/CT (SUV) are non-invasive, quantitative image-derived parameters that hold promise in the evaluation of the aggressiveness, treatment response and prognosis of gastric cancer.

Keywords: Biomarkers; Magnetic resonance imaging; Positron emission tomography; Quantitative parameters; Stomach neoplasms.

Conflict of interest statement

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.

Figures

Fig. 1

Flow diagrams showing the outcome of the initial searches resulting in the full studies included in the review for dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) (a) and 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) (b)

Fig. 2

DCE-MRI showing a tumour of the gastric antrum (a) in a 73-year-old male. The Ktrans (b) was 0.279 min−1, the Kep (c) was 0.605 min−1 and the Ve (d) was 0.482. Final pathology (e): diffuse type (Lauren classification), staged as pT4aN3. DCE-MRI of a tumour of the gastro-oesophageal junction (Siewert III) (f) in a 68-year-old male. The Ktrans (g) was 0.117 min−1, the Kep (h) was 0.461 min−1 and the Ve (i) was 0.253. Final pathology (j): mixed type (Lauren classification), staged as pT3N1. DCE-MRI of a tumour of the gastric antrum (k) in a 49-year-old male. The Ktrans (l) was 0.016 min−1, the Kep (m) was 0.575 min−1 and the Ve (n) was 0.029. Final pathology (o): intestinal type (Lauren classification), staged as pT4aN2

Fig. 3

DCE-MRI showing a tumour of the gastric antrum (a) in a 66-year-old female. In the pretreatment scan, the Ktrans (b) was 0.078 min−1, the Kep (c) was 0.237 min−1 and the Ve (d) was 0.347. The tumour was confirmed at biopsy (e). In the posttreatment scan, there was a reduction in tumour size (f), and the Ktrans (g) was 0.070 min−1, the Kep (h) was 0.295 min−1 and the Ve (i) was 0.263. Final pathology (j): intestinal type (Lauren classification), staged as ypT1bN0 (tumour regression grade 1)

Fig. 4

DCE-MRI of a tumour of the gastric antrum (a) in a 61-year-old female. In the pretreatment scan, the Ktrans (b) was 0.085 min−1, the Kep (c) was 0.176 min−1 and the Ve (d) was 0.539. The tumour was confirmed at biopsy (e). In the posttreatment scan, the tumour is still visible (f), and the Ktrans (g) was 0.128 min−1, the Kep (h) was 0.297 min−1 and the Ve (i) was 0.455. Final pathology (j): diffuse type (Lauren classification), staged as ypT3N0 (tumour regression grade 3)

Fig. 5

18F-FDG PET/CT scan of a 72-year-old man with gastro-oesophageal junction cancer (a–d) demonstrated by an intense uptake of 18F-FDG before treatment (SUVmax = 10.7) (c). After two cycles of chemotherapy (paclitaxel + cisplatin + fluorouracil) (e–h), the SUVmax of the lesion decreased to 4.8 (g), showing good response to the therapy. Final pathology (i) ypT3N0 (tumour regression grade 1)

Fig. 6

18F-FDG PET/CT scan of a 48-year-old woman with gastric cancer (a–d) demonstrated by an intense uptake of 18F-FDG before treatment (SUVmax = 4.7) (c). After one cycle of chemotherapy (capecitabine + paclitaxel) (e–h), no significant changes in 18F-FDG uptake (SUVmax = 4.8) were observed (g). Final pathology (i) ypT4aN1 (tumour regression grade 3)