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Quartuccio N, Byun BH, Alongi P, Caobelli F, Kong CB, Lim SM, Cistaro A. Assessment of response to treatment in paediatric bone sarcomas by means of PET imaging. Clin Transl Imaging 2016; 4:41-55. [DOI: 10.1007/s40336-015-0160-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Humbert O, Riedinger JM, Charon-Barra C, Berriolo-Riedinger A, Desmoulins I, Lorgis V, Kanoun S, Coutant C, Fumoleau P, Cochet A, Brunotte F. Identification of Biomarkers Including 18FDG-PET/CT for Early Prediction of Response to Neoadjuvant Chemotherapy in Triple-Negative Breast Cancer. Clin Cancer Res 2015; 21:5460-8. [DOI: 10.1158/1078-0432.ccr-15-0384] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 06/23/2015] [Indexed: 12/31/2022]
Abstract
Abstract
Purpose: To investigate the value of the metabolic tumor response assessed with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), compared with clinicobiologic markers to predict pathologic complete response (pCR) to neoadjuvant chemotherapy (NAC) in women with triple-negative breast cancer (TNBC).
Experimental Design: Fifty consecutive women with TNBC and an indication for NAC were prospectively included. Different pretreatment clinical, biologic, and pathologic biomarkers, including SBR grade, the Ki-67 proliferation index, androgen receptor expression, EGF receptor (EGFR), and cytokeratin 5/6 staining, were assessed. Tumor glucose metabolism at baseline and its change after the first cycle of NAC (ΔSUVmax) were assessed using FDG-PET.
Results: The pCR rate was 42%. High Ki-67 proliferation index (P = 0.016), negative EGFR status (P = 0.042), and high ΔSUVmax (P = 0.002) were significantly associated with pCR. In multivariate logistic regression, both negative EGFR status (OR, 6.4; P = 0.043) and high ΔSUVmax (OR, 7.1; P = 0.014) were independent predictors of pCR. Using a threshold at −50%, tumor ΔSUVmax predicted pCR with a negative, a positive predictive value, and an accuracy of 79%, 70%, and 75%, respectively. Combining a low ΔSUVmax and positive EGFR status could predict non-pCR with an accuracy of 92%.
Conclusions: It is important to define the chemosensitivity of TNBC to NAC early. Combining EGFR status and the metabolic response assessed with FDG-PET can help the physician to early predict the probability of achieving pCR or not. Given these results, the interest of response-guided tailoring of the chemotherapy might be tested in multicenter trials. Clin Cancer Res; 21(24); 5460–8. ©2015 AACR.
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Affiliation(s)
- Olivier Humbert
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - Jean-Marc Riedinger
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 3Departments of Biology and Pathology, Centre GF Leclerc, Dijon, France
| | | | | | | | - Véronique Lorgis
- 4Department of Medical Oncology, Centre GF Leclerc, Dijon, France
| | - Salim Kanoun
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
- 5Imaging Department, CHU Le Bocage, Dijon, France
| | | | - Pierre Fumoleau
- 4Department of Medical Oncology, Centre GF Leclerc, Dijon, France
| | - Alexandre Cochet
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
| | - François Brunotte
- 1Department of Nuclear Medicine, Centre GF Leclerc, Dijon, France
- 2Université de Bourgogne, UMR CNRS 6306, Dijon, France
- 5Imaging Department, CHU Le Bocage, Dijon, France
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Rahmim A, Schmidtlein CR, Jackson A, Sheikhbahaei S, Marcus C, Ashrafinia S, Soltani M, Subramaniam RM. A novel metric for quantification of homogeneous and heterogeneous tumors in PET for enhanced clinical outcome prediction. Phys Med Biol 2015; 61:227-42. [PMID: 26639024 DOI: 10.1088/0031-9155/61/1/227] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Oncologic PET images provide valuable information that can enable enhanced prognosis of disease. Nonetheless, such information is simplified significantly in routine clinical assessment to meet workflow constraints. Examples of typical FDG PET metrics include: (i) SUVmax, (2) total lesion glycolysis (TLG), and (3) metabolic tumor volume (MTV). We have derived and implemented a novel metric for tumor quantification, inspired in essence by a model of generalized equivalent uniform dose as used in radiation therapy. The proposed metric, denoted generalized effective total uptake (gETU), is attractive as it encompasses the abovementioned commonly invoked metrics, and generalizes them, for both homogeneous and heterogeneous tumors, using a single parameter a. We evaluated this new metric for improved overall survival (OS) prediction on two different baseline FDG PET/CT datasets: (a) 113 patients with squamous cell cancer of the oropharynx, and (b) 72 patients with locally advanced pancreatic adenocarcinoma. Kaplan-Meier survival analysis was performed, where the subjects were subdivided into two groups using the median threshold, from which the hazard ratios (HR) were computed in Cox proportional hazards regression. For the oropharyngeal cancer dataset, MTV, TLG, SUVmax, SUVmean and SUVpeak produced HR values of 1.86, 3.02, 1.34, 1.36 and 1.62, while the proposed gETU metric for a = 0.25 (greater emphasis on volume information) enabled significantly enhanced OS prediction with HR = 3.94. For the pancreatic cancer dataset, MTV, TLG, SUVmax, SUVmean and SUVpeak resulted in HR values of 1.05, 1.25, 1.42, 1.45 and 1.52, while gETU at a = 3.2 (greater emphasis on SUV information) arrived at an improved HR value of 1.61. Overall, the proposed methodology allows placement of differing degrees of emphasis on tumor volume versus uptake for different types of tumors to enable enhanced clinical outcome prediction.
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Affiliation(s)
- Arman Rahmim
- Department of Radiology and Radiological Science, Johns Hopkins University, Baltimore, MD 21287, USA. Department of Electrical & Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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Laffon E, Burger IA, Lamare F, de Clermont H, Marthan R. SUVpeak Performance in Lung Cancer: Comparison to Average SUV from the 40 Hottest Voxels. J Nucl Med 2015; 57:85-8. [DOI: 10.2967/jnumed.115.161968] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/08/2015] [Indexed: 11/16/2022] Open
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Schatka I, Weiberg D, Reichelt S, Owsianski-Hille N, Derlin T, Berding G, Bengel FM. A randomized, double-blind, crossover comparison of novel continuous bed motion versus traditional bed position whole-body PET/CT imaging. Eur J Nucl Med Mol Imaging 2015; 43:711-7. [DOI: 10.1007/s00259-015-3226-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
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Hope TA, Verdin EF, Bergsland EK, Ohliger MA, Corvera CU, Nakakura EK. Correcting for respiratory motion in liver PET/MRI: preliminary evaluation of the utility of bellows and navigated hepatobiliary phase imaging. EJNMMI Phys 2015; 2:21. [PMID: 26501822 PMCID: PMC4573645 DOI: 10.1186/s40658-015-0125-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/11/2015] [Indexed: 12/21/2022] Open
Abstract
Background The purpose of this study was to evaluate the utility of bellows-based respiratory compensation and navigated hepatobiliary phase imaging to correct for respiratory motion in the setting of dedicated liver PET/MRI. Methods Institutional review board approval and informed consent were obtained. Six patients with metastatic neuroendocrine tumor were imaged using Ga-68 DOTA-TOC PET/MRI. Whole body imaging and a dedicated 15-min liver PET acquisition was performed, in addition to navigated and breath-held hepatobiliary phase (HBP) MRI. Liver PET data was reconstructed three ways: the entire data set (liver PET), gated using respiratory bellows (RC-liver PET), and a non-gated data set reconstructed using the same amount of data used in the RC-liver PET (shortened liver PET). Liver lesions were evaluated using SUVmax, SUVpeak, SUVmean, and Volisocontour. Additionally, the displacement of each lesion between the RC-liver PET images and the navigated and breath-held HBP images was calculated. Results Respiratory compensation resulted in a 43 % increase in SUVs compared to ungated data (liver vs RC-liver PET SUVmax 26.0 vs 37.3, p < 0.001) and a 25 % increase compared to a non-gated reconstruction using the same amount of data (RC-liver vs shortened liver PET SUVmax 26.0 vs 32.6, p < 0.001). Lesion displacement was minimized using navigated HBP MRI (1.3 ± 1.0 mm) compared to breath-held HBP MRI (23.3 ± 1.0 mm). Conclusions Respiratory bellows can provide accurate respiratory compensation when imaging liver lesions using PET/MRI, and results in increased SUVs due to a combination of increased image noise and reduced respiratory blurring. Additionally, navigated HBP MRI accurately aligns with respiratory compensated PET data.
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Affiliation(s)
- Thomas A Hope
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA. .,Department of Radiology, San Francisco VA Medical Center, San Francisco, CA, USA.
| | - Emily F Verdin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Emily K Bergsland
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA.,Department of Radiology, San Francisco General Hospital, San Francisco, CA, USA
| | - Carlos U Corvera
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Eric K Nakakura
- Division of Surgical Oncology, Department of Surgery, University of California, San Francisco, San Francisco, CA, USA
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Akamatsu G, Nishida H, Fujino A, Ohnishi A, Ikari Y, Nishio T, Maebatake A, Sasaki M, Senda M. [Harmonization of Standardized Uptake Value among Different Generation PET/ CT Cameras Based on a Phantom Experiment -Utility of SUV(peak)]. Nihon Hoshasen Gijutsu Gakkai Zasshi 2015; 71:735-745. [PMID: 26400557 DOI: 10.6009/jjrt.2015_jsrt_71.9.735] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Standardized uptake value (SUV) has been widely used as a semi-quantitative metric of uptake in FDGPET/ CT for diagnosis of malignant tumors and evaluation of tumor therapies. However, the SUV depends on various factors including PET/CT scanner specifications and reconstruction parameters. The purpose of this study is to harmonize the SUV among two PET/CT models of different generation: two units of Discovery ST Elite Performance(DSTEP) and Discovery 690 (D690) PET/CT scanners. The NEMA body phantom filled with 18F solution was scanned for 30 minutes in list-mode. The D690 PET images were reconstructed with OSEM, OSEM+TOF, and OSEM+PSF. Gaussian post-filters of 4-9 mm FWHM were applied to find the parameters that provides harmonized SUV. We determined the SUV-harmonized parameter for each reconstruction algorithm. Then, the 10 PET images simulating clinical scan conditions were respectively generated to evaluate the bias and variability of SUV(max) and SUV(peak). The SUV(max) strongly depended not only on spatial resolution but also on image noise. On the other hand, the SUV(peak) was a robust metric to image noise level. TOF improved the variability of SUV(max) and SUV(peak). Thus, we were able to harmonize the spatial resolution using SUV(peak) based on the phantom study. Because SUV(max) was also strongly affected by image noise, sufficient count statistics is essential for SUV(max) harmonization. We recommended that TOF reconstruction and SUV(peak) metric should be used to harmonize SUV.
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Affiliation(s)
- Go Akamatsu
- Department of Radiological Technology, Institute of Biomedical Research and Innovation
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158
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Kuhnert G, Boellaard R, Sterzer S, Kahraman D, Scheffler M, Wolf J, Dietlein M, Drzezga A, Kobe C. Impact of PET/CT image reconstruction methods and liver uptake normalization strategies on quantitative image analysis. Eur J Nucl Med Mol Imaging 2015; 43:249-258. [PMID: 26280981 DOI: 10.1007/s00259-015-3165-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 08/05/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND In oncological imaging using PET/CT, the standardized uptake value has become the most common parameter used to measure tracer accumulation. The aim of this analysis was to evaluate ultra high definition (UHD) and ordered subset expectation maximization (OSEM) PET/CT reconstructions for their potential impact on quantification. PATIENTS AND METHODS We analyzed 40 PET/CT scans of lung cancer patients who had undergone PET/CT. Standardized uptake values corrected for body weight (SUV) and lean body mass (SUL) were determined in the single hottest lesion in the lung and normalized to the liver for UHD and OSEM reconstruction. Quantitative uptake values and their normalized ratios for the two reconstruction settings were compared using the Wilcoxon test. The distribution of quantitative uptake values and their ratios in relation to the reconstruction method used were demonstrated in the form of frequency distribution curves, box-plots and scatter plots. The agreement between OSEM and UHD reconstructions was assessed through Bland-Altman analysis. RESULTS A significant difference was observed after OSEM and UHD reconstruction for SUV and SUL data tested (p < 0.0005 in all cases). The mean values of the ratios after OSEM and UHD reconstruction showed equally significant differences (p < 0.0005 in all cases). Bland-Altman analysis showed that the SUV and SUL and their normalized values were, on average, up to 60 % higher after UHD reconstruction as compared to OSEM reconstruction. CONCLUSION OSEM and HD reconstruction brought a significant difference for SUV and SUL, which remained constantly high after normalization to the liver, indicating that standardization of reconstruction and the use of comparable SUV measurements are crucial when using PET/CT.
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Affiliation(s)
- Georg Kuhnert
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Sergej Sterzer
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Deniz Kahraman
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Matthias Scheffler
- Lung Cancer Group Cologne, Department I of Internal Medicine, Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Jürgen Wolf
- Lung Cancer Group Cologne, Department I of Internal Medicine, Center for Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Markus Dietlein
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Alexander Drzezga
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
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159
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Akamatsu G, Ikari Y, Nishida H, Nishio T, Ohnishi A, Maebatake A, Sasaki M, Senda M. Influence of Statistical Fluctuation on Reproducibility and Accuracy of SUVmax and SUVpeak: A Phantom Study. J Nucl Med Technol 2015; 43:222-6. [PMID: 26271802 DOI: 10.2967/jnmt.115.161745] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/21/2015] [Indexed: 12/18/2022] Open
Abstract
UNLABELLED Standardized uptake values (SUVs) have been widely used in the diagnosis of malignant tumors and in clinical trials of tumor therapies as semiquantitative metrics of tumor (18)F-FDG uptake. However, SUVs for small lesions are liable to errors due to partial-volume effect and statistical noise. The purpose of this study was to evaluate the reproducibility and accuracy of maximum and peak SUV (SUVmax and SUVpeak, respectively) of small lesions in phantom experiments. METHODS We used a body phantom with 6 spheres in a quarter warm background. The PET data were acquired for 1,800 s in list-mode, from which data were extracted to generate 15 PET images for each of the 60-, 90-, 120-, 150-, and 180-s scanning times. The SUVmax and SUVpeak of the hot spheres in the 1,800-s scan were used as a reference (SUVref,max and SUVref,peak). Coefficients of variation for both SUVmax and SUVpeak in hot spheres (CVmax and CVpeak) were calculated to evaluate the variability of the SUVs. On the other hand, percentage differences between SUVmax and SUVref,max and between SUVpeak and SUVref,peak were calculated for evaluation of the accuracy of SUV. We additionally examined the coefficients of variation of background activity and the percentage background variability as parameters for the physical assessment of image quality. RESULTS Visibility of a 10-mm-diameter hot sphere was considerably different among scan frames. The CVmax and CVpeak increased as the sphere size became smaller and as the acquisition time became shorter. SUVmax was generally overestimated as the scan time shortened and the sphere size increased. The SUVmax and SUVpeak of a 37-mm-diameter sphere for 60-s scans had average positive biases of 28.3% and 4.4%, compared with the reference. CONCLUSION SUVmax was variable and overestimated as the scan time decreased and the sphere size increased. In contrast, SUVpeak was a more robust and accurate metric than SUVmax. The measurements of SUVpeak (or SUVpeak normalized to lean body mass) in addition to SUVmax are desirable for reproducible and accurate quantification in clinical situations.
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Affiliation(s)
- Go Akamatsu
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan; and Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiko Ikari
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan; and
| | - Hiroyuki Nishida
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan; and
| | - Tomoyuki Nishio
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan; and
| | - Akihito Ohnishi
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan; and
| | - Akira Maebatake
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Sasaki
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Michio Senda
- Division of Molecular Imaging, Institute of Biomedical Research and Innovation, Kobe, Japan; and
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161
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Yan J, Chu-Shern JL, Loi HY, Khor LK, Sinha AK, Quek ST, Tham IWK, Townsend D. Impact of Image Reconstruction Settings on Texture Features in 18F-FDG PET. J Nucl Med 2015; 56:1667-73. [PMID: 26229145 DOI: 10.2967/jnumed.115.156927] [Citation(s) in RCA: 199] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/06/2015] [Indexed: 12/21/2022] Open
Abstract
UNLABELLED Evaluation of tumor heterogeneity based on texture parameters has recently attracted much interest in the PET imaging community. However, the impact of reconstruction settings on texture parameters is unclear, especially relating to time-of-flight and point-spread function modeling. Their effects on 55 texture features (TFs) and 6 features based on first-order statistics (FOS) were investigated. Standardized uptake value (SUV) measures were also evaluated as peak SUV (SUVpeak), maximum SUV, and mean SUV (SUVmean). METHODS This study retrospectively recruited 20 patients with lesions in the lung who underwent whole-body (18)F-FDG PET/CT. The coefficient of variation (COV) of each feature across different reconstructions was calculated. RESULTS SUVpeak, SUVmean, 18 TFs, and 1 FOS were the most robust (COV ≤ 5%) whereas skewness, cluster shade, and zone percentage were the least robust (COV > 20%) with respect to reconstruction algorithms using default settings. Heterogeneity parameters had different sensitivities to iteration number. Twenty-four parameters including SUVpeak and SUVmean exhibited variation with a COV less than 5%; 28 parameters, including maximum SUV, showed variation with a COV in the range of 5%-10%. In addition, skewness, cluster shade, and zone percentage were the most sensitive to iteration number. In terms of sensitivity to full width at half maximum (FWHM), 15 TFs and 1 FOS had the best performance with a COV less than 5%, whereas SUVpeak and SUVmean had a COV between 5% and 10%. Grid size had the largest impact on image features, which was demonstrated by only 11 features, including SUVpeak and SUVmean, having a COV less than 10%. CONCLUSION Different image features have different sensitivities to reconstruction settings. Iteration number and FWHM of the gaussian filter have a similar impact on the image features. Grid size has a larger impact on the features than iteration number and FWHM. The features that exhibited large variations such as skewness in FOS, cluster shade, and zone percentage should be used with caution. The entropy in FOS, difference entropy, inverse difference normalized, inverse difference moment normalized, low gray-level run emphasis, high gray-level run emphasis, and low gray-level zone emphasis are the most robust features.
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Affiliation(s)
- Jianhua Yan
- A*STAR-NUS, Clinical Imaging Research Center, Singapore
| | | | - Hoi Yin Loi
- Department of Diagnostic Radiology, National University Hospital, Singapore; and
| | - Lih Kin Khor
- Department of Diagnostic Radiology, National University Hospital, Singapore; and
| | - Arvind K Sinha
- Department of Diagnostic Radiology, National University Hospital, Singapore; and
| | - Swee Tian Quek
- Department of Diagnostic Radiology, National University Hospital, Singapore; and
| | - Ivan W K Tham
- A*STAR-NUS, Clinical Imaging Research Center, Singapore Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - David Townsend
- A*STAR-NUS, Clinical Imaging Research Center, Singapore Department of Diagnostic Radiology, National University Hospital, Singapore; and
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Quak E, Le Roux PY, Hofman MS, Robin P, Bourhis D, Callahan J, Binns D, Desmonts C, Salaun PY, Hicks RJ, Aide N. Harmonizing FDG PET quantification while maintaining optimal lesion detection: prospective multicentre validation in 517 oncology patients. Eur J Nucl Med Mol Imaging 2015. [PMID: 26219870 PMCID: PMC4623085 DOI: 10.1007/s00259-015-3128-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Point-spread function (PSF) or PSF + time-of-flight (TOF) reconstruction may improve lesion detection in oncologic PET, but can alter quantitation resulting in variable standardized uptake values (SUVs) between different PET systems. This study aims to validate a proprietary software tool (EQ.PET) to harmonize SUVs across different PET systems independent of the reconstruction algorithm used. METHODS NEMA NU2 phantom data were used to calculate the appropriate filter for each PSF or PSF+TOF reconstruction from three different PET systems, in order to obtain EANM compliant recovery coefficients. PET data from 517 oncology patients were reconstructed with a PSF or PSF+TOF reconstruction for optimal tumour detection and an ordered subset expectation maximization (OSEM3D) reconstruction known to fulfil EANM guidelines. Post-reconstruction, the proprietary filter was applied to the PSF or PSF+TOF data (PSFEQ or PSF+TOFEQ). SUVs for PSF or PSF+TOF and PSFEQ or PSF+TOFEQ were compared to SUVs for the OSEM3D reconstruction. The impact of potential confounders on the EQ.PET methodology including lesion and patient characteristics was studied, as was the adherence to imaging guidelines. RESULTS For the 1380 tumour lesions studied, Bland-Altman analysis showed a mean ratio between PSF or PSF+TOF and OSEM3D of 1.46 (95%CI: 0.86-2.06) and 1.23 (95%CI: 0.95-1.51) for SUVmax and SUVpeak, respectively. Application of the proprietary filter improved these ratios to 1.02 (95%CI: 0.88-1.16) and 1.04 (95%CI: 0.92-1.17) for SUVmax and SUVpeak, respectively. The influence of the different confounding factors studied (lesion size, location, radial offset and patient's BMI) was less than 5%. Adherence to the European Association of Nuclear Medicine (EANM) guidelines for tumour imaging was good. CONCLUSION These data indicate that it is not necessary to sacrifice the superior lesion detection and image quality achieved by newer reconstruction techniques in the quest for harmonizing quantitative comparability between PET systems.
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Affiliation(s)
- Elske Quak
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
| | - Pierre-Yves Le Roux
- Nuclear Medicine Department, University Hospital and EA3878 (GETBO) IFR 148, Brest, France
| | - Michael S Hofman
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne and University of Melbourne, Melbourne, Australia
| | - Philippe Robin
- Nuclear Medicine Department, University Hospital and EA3878 (GETBO) IFR 148, Brest, France
| | - David Bourhis
- Nuclear Medicine Department, University Hospital and EA3878 (GETBO) IFR 148, Brest, France
| | - Jason Callahan
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne and University of Melbourne, Melbourne, Australia
| | - David Binns
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne and University of Melbourne, Melbourne, Australia
| | - Cédric Desmonts
- Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France
| | - Pierre-Yves Salaun
- Nuclear Medicine Department, University Hospital and EA3878 (GETBO) IFR 148, Brest, France
| | - Rodney J Hicks
- Centre for Molecular Imaging, Peter MacCallum Cancer Centre, East Melbourne and University of Melbourne, Melbourne, Australia
| | - Nicolas Aide
- Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.
- Nuclear Medicine Department, University Hospital, Avenue Côte de Nacre, 14000, Caen, France.
- INSERM 1199, François Baclesse Cancer Centre, Caen, France.
- Normandie University, Caen, France.
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Weber WA, Gatsonis CA, Mozley PD, Hanna LG, Shields AF, Aberle DR, Govindan R, Torigian DA, Karp JS, Yu JQM, Subramaniam RM, Halvorsen RA, Siegel BA. Repeatability of 18F-FDG PET/CT in Advanced Non-Small Cell Lung Cancer: Prospective Assessment in 2 Multicenter Trials. J Nucl Med 2015; 56:1137-43. [PMID: 25908829 DOI: 10.2967/jnumed.114.147728] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 03/26/2015] [Indexed: 12/27/2022] Open
Abstract
UNLABELLED PET/CT with the glucose analog (18)F-FDG has several potential applications for monitoring tumor response to therapy in patients with non-small cell lung cancer (NSCLC). A prerequisite for many of these applications is detailed knowledge of the repeatability of quantitative parameters derived from (18)F-FDG PET/CT studies. METHODS The repeatability of the (18)F-FDG signal was evaluated in 2 prospective multicenter trials. Patients with advanced NSCLC (tumor stage III-IV) underwent two (18)F-FDG PET/CT studies while not receiving therapy. Tumor (18)F-FDG uptake was quantified by measurement of the maximum standardized uptake value within a lesion (SUVmax) and the average SUV within a small volume of interest around the site of maximum uptake (SUVpeak). Analysis was performed for the lesion in the chest with the highest (18)F-FDG uptake and a size of at least 2 cm (target lesion) as well as for up to 6 additional lesions per patient. Repeatability was assessed by Bland-Altman plots and calculation of 95% repeatability coefficients (RCs) of the log-transformed SUV differences. RESULTS Test-retest repeatability was assessed in 74 patients (34 from the ACRIN 6678 trial and 40 from the Merck MK-0646-008 trial). SUVpeak was 11.57 ± 7.89 g/mL for the ACRIN trial and 6.89 ± 3.02 for the Merck trial. The lower and upper RCs were -28% (95% confidence interval [CI], -35% to -23%) and +39% (95% CI, 31% to 54%) in the ACRIN trial, indicating that a decrease of SUVpeak by more than 28% or an increase by more than 39% has a probability of less than 2.5%. The corresponding RCs from the Merck trial were -35% (95% CI, -42% to -29%) and +53% (95% CI, 41% to 72%). Repeatability was similar for SUVmax of the target lesion, averaged SUVmax, and averaged SUVpeak of up to 6 lesions per patient. CONCLUSION The variability of repeated measurements of tumor (18)F-FDG uptake in patients with NSCLC is somewhat larger than previously reported in smaller single-center studies but comparable to that of gastrointestinal malignancies in a previous multicenter trial. The variability of measurements supports the definitions of tumor response according to PET Response Criteria in Solid Tumors.
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Affiliation(s)
| | - Constantine A Gatsonis
- Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | | | - Lucy G Hanna
- Department of Biostatistics and Center for Statistical Sciences, Brown University, Providence, Rhode Island
| | - Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan
| | - Denise R Aberle
- University of California-Los Angeles, Los Angeles, California
| | - Ramaswamy Govindan
- Division of Oncology and the Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri
| | - Drew A Torigian
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Joel S Karp
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | | | - Rathan M Subramaniam
- Russell H. Morgan Department of Radiology and Radiological Science and Sidney Kimmel Cancer Center, Johns Hopkins University, Baltimore, Maryland
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Hsieh TC, Hsieh CY, Yang TY, Chen TT, Lin CY, Lin CC, Hua CH, Chiu CF, Yeh SP, Sher YP. [18F]-Fluorodeoxyglucose Positron Emission Tomography Standardized Uptake Value as a Predictor of Adjuvant Chemotherapy Benefits in Patients With Nasopharyngeal Carcinoma. Oncologist 2015; 20:539-45. [PMID: 25876992 DOI: 10.1634/theoncologist.2014-0291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 01/20/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The role of adjuvant chemotherapy for the treatment of nasopharyngeal carcinoma (NPC) is controversial, and the identification of adequate predictive factors is warranted. Therefore, we aimed to investigate whether the mean standardized uptake value (SUV) measured on [(18)F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) could predict the survival benefits for NPC patients that receive adjuvant chemotherapy. MATERIALS AND METHODS The data for 174 NPC patients who underwent PET/computed tomography before chemoradiation between January 2004 and January 2012 were reviewed. The SUV75% was recorded for primary tumors. All patients received intensity-modulated radiotherapy and cisplatin-based chemotherapy. Adjuvant chemotherapy consisted of 3 cycles of 75 mg/m(2) cisplatin and 1,000 mg/m(2) fluorouracil for 4 days. RESULTS The optimal cutoff value was 8.35 for SUV75%, with 112 (64.4%) patients having lower SUV75% and 62 (35.6%) having higher SUV75%. Patients with lower SUV75% had significantly better 5-year overall survival (OS) and distant metastasis-free survival. Multivariate analysis revealed that tumor stage, SUV75%, and adjuvant chemotherapy were significant prognostic factors for OS. Patients with higher SUV75% had significantly higher 5-year OS rates with adjuvant chemotherapy than without adjuvant chemotherapy (84.3% vs. 32.4%, respectively; p < .001). However, in the lower SUV75% group, no differences in 5-year OS were observed between patients who received and those who did not receive adjuvant chemotherapy (92.4% vs. 93.3%, respectively; p = .682). CONCLUSION The SUV75% on FDG PET for primary tumors could successfully identify NPC patients who may benefit from adjuvant chemotherapy.
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Affiliation(s)
- Te-Chun Hsieh
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ching Yun Hsieh
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Tse Yen Yang
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Tzu Ting Chen
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chen Yuan Lin
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Ching-Chan Lin
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chung Hung Hua
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Chang-Fang Chiu
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Su-Peng Yeh
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
| | - Yuh Pyng Sher
- Department of Nuclear Medicine, Department of Biomedical Imaging and Radiological Science, School of Medicine, Department of Internal Medicine, Division of Hematology and Oncology, Molecular and Genomic Epidemiology Center, and Department of Otorhinolaryngology, China Medical University Hospital, Taichung, Taiwan, Republic of China
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Carlier T, Bailly C. State-Of-The-Art and Recent Advances in Quantification for Therapeutic Follow-Up in Oncology Using PET. Front Med (Lausanne) 2015; 2:18. [PMID: 26090365 PMCID: PMC4370108 DOI: 10.3389/fmed.2015.00018] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/09/2015] [Indexed: 12/28/2022] Open
Abstract
18F-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET) is an important tool in oncology. Its use has greatly progressed from initial diagnosis to staging and patient monitoring. The information derived from 18F-FDG-PET allowed the development of a wide range of PET quantitative analysis techniques ranging from simple semi-quantitative methods like the standardized uptake value (SUV) to “high order metrics” that require a segmentation step and additional image processing. In this review, these methods are discussed, focusing particularly on the available methodologies that can be used in clinical trials as well as their current applications in international consensus for PET interpretation in lymphoma and solid tumors.
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Affiliation(s)
- Thomas Carlier
- Nuclear Medicine Department, University Hospital , Nantes , France ; CRCNA, INSERM U892, CNRS UMR 6299 , Nantes , France
| | - Clément Bailly
- Nuclear Medicine Department, University Hospital , Nantes , France
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166
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Byun BH, Kim SH, Lim SM, Lim I, Kong CB, Song WS, Cho WH, Jeon DG, Lee SY, Koh JS, Chung SK. Prediction of response to neoadjuvant chemotherapy in osteosarcoma using dual-phase 18 F-FDG PET/CT. Eur Radiol 2015; 25:2015-24. [DOI: 10.1007/s00330-015-3609-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 12/02/2014] [Accepted: 01/16/2015] [Indexed: 01/10/2023]
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167
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Koivumäki T, Teuho J, Teräs M, Vauhkonen M, Hakulinen MA. A novel respiratory gating method for oncologic positron emission tomography based on bioimpedance approach. Ann Nucl Med 2015; 29:351-8. [DOI: 10.1007/s12149-015-0953-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 01/20/2015] [Indexed: 01/10/2023]
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168
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Chefer S, Reba RC, Leyson CZ, Seidel J, Johnson RF, Blaney JE, Jahrling PB, Dyall J. The effect of volume of interest definition on quantification of lymph node immune response to a monkeypox virus infection assessed by (18)F-FDG-PET. EJNMMI Res 2014; 4:49. [PMID: 26116113 PMCID: PMC4452685 DOI: 10.1186/s13550-014-0049-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 09/04/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND 2-deoxy-2-[(18)F]fluoro-D-glucose-positron emission tomography ((18)F-FDG-PET) is applied in the clinic for infection assessment and is under consideration for investigating the inflammatory/immune response in lymphoid tissue in animal models of viral infection. Assessing changes in (18)F-FDG uptake of lymph nodes (LNs), primary lymphoid tissues targeted during viral infection, requires suitable methods for image analysis. Similar to tumor evaluation, reliable quantitation of the LN function via multiple (18)F-FDG-PET sessions will depend how the volume of interest is defined. Volume of interest definition has a direct effect on statistical outcome. The current study objective is to compare for the first time agreement between conventional and modified VOI metrics to determine which method(s) provide(s) reproducible standardized uptake values (SUVs) for (18)F-FDG uptake in the LN of rhesus macaques. METHODS Multiple (18)F-FDG-PET images of LNs in macaques were acquired prior to and after monkeypox virus intravenous inoculation. We compared five image analysis approaches, SUVmax, SUVmean, SUVthreshold, modified SUVthreshold, and SUVfixed volume, to investigate the impact of these approaches on quantification of the changes in LN metabolic activity denoting the immune response during viral infection progression. RESULTS The lowest data repeatability was observed with SUVmax. The best correspondence was between SUVfixed volume and conventional and modified SUVthreshold. A statistically significant difference in the LN (18)F-FDG uptake between surviving and moribund animals was shown using modified SUVthreshold and SUVfixed volume (adjusted p = 0.0037 and p = 0.0001, respectively). CONCLUSIONS Quantification of the LN (18)F-FDG uptake is highly sensitive to the method applied for PET image analysis. SUVfixed volume and modified SUVthreshold demonstrate better reproducibility for SUV estimates than SUVmax, SUVmean, and SUVthreshold. SUVfixed volume and modified SUVthreshold are capable of distinguishing between groups with different disease outcomes. Therefore, these methods are the preferred approaches for evaluating the LN function during viral infection by (18)F-FDG-PET. Validation of multiple approaches is necessary to choose a suitable method to monitor changes in LN metabolic activity during progression of viral infection.
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Affiliation(s)
- Svetlana Chefer
- />Division of Clinical Research, Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
| | - Richard C Reba
- />Center for Infectious Disease Imaging, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, 10 Center Drive, Bethesda, MD 20892 USA
| | - Christopher Z Leyson
- />Division of Clinical Research, Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
| | - Jurgen Seidel
- />Division of Clinical Research, Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
| | - Reed F Johnson
- />Division of Intramural Research, Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
| | - Joseph E Blaney
- />Division of Intramural Research, Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
| | - Peter B Jahrling
- />Division of Intramural Research, Emerging Viral Pathogens Section, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
| | - Julie Dyall
- />Division of Clinical Research, Integrated Research Facility, National Institute of Allergy and Infectious Diseases, National Institutes of Health, 8200 Research Plaza, Frederick, MD 21702 USA
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Armstrong IS, Kelly MD, Williams HA, Matthews JC. Impact of point spread function modelling and time of flight on FDG uptake measurements in lung lesions using alternative filtering strategies. EJNMMI Phys 2014; 1:99. [PMID: 26501457 PMCID: PMC4545221 DOI: 10.1186/s40658-014-0099-3] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The use of maximum standardised uptake value (SUVmax) is commonplace in oncology positron emission tomography (PET). Point spread function (PSF) modelling and time-of-flight (TOF) reconstructions have a significant impact on SUVmax, presenting a challenge for centres with defined protocols for lesion classification based on SUVmax thresholds. This has perhaps led to the slow adoption of these reconstructions. This work evaluated the impact of PSF and/or TOF reconstructions on SUVmax, SUVpeak and total lesion glycolysis (TLG) under two different schemes of post-filtering. METHODS Post-filters to match voxel variance or SUVmax were determined using a NEMA NU-2 phantom. Images from 68 consecutive lung cancer patients were reconstructed with the standard iterative algorithm along with TOF; PSF modelling - Siemens HD·PET (HD); and combined PSF modelling and TOF - Siemens ultraHD·PET (UHD) with the two post-filter sets. SUVmax, SUVpeak, TLG and signal-to-noise ratio of tumour relative to liver (SNR(T-L)) were measured in 74 lesions for each reconstruction. Relative differences in uptake measures were calculated, and the clinical impact of any changes was assessed using published guidelines and local practice. RESULTS When matching voxel variance, SUVmax increased substantially (mean increase +32% and +49% for HD and UHD, respectively), potentially impacting outcome in the majority of patients. Increases in SUVpeak were less notable (mean increase +17% and +23% for HD and UHD, respectively). Increases with TOF alone were far less for both measures. Mean changes to TLG were <10% for all algorithms for either set of post-filters. SNR(T-L) were greater than ordered subset expectation maximisation (OSEM) in all reconstructions using both post-filtering sets. CONCLUSIONS Matching image voxel variance with PSF and/or TOF reconstructions, particularly with PSF modelling and in small lesions, resulted in considerable increases in SUVmax, inhibiting the use of defined protocols for lesion classification based on SUVmax. However, reduced partial volume effects may increase lesion detectability. Matching SUVmax in phantoms translated well to patient studies for PSF reconstruction but less well with TOF, where a small positive bias was observed in patient images. Matching SUVmax significantly reduced voxel variance and potential variability of uptake measures. Finally, TLG may be less sensitive to reconstruction methods compared with either SUVmax or SUVpeak.
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Affiliation(s)
- Ian S Armstrong
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, UK. .,Institute of Population Health, MAHSC, University of Manchester, Manchester, UK.
| | - Matthew D Kelly
- Molecular Imaging, Healthcare Sector, Siemens PLC, Oxford, UK.
| | - Heather A Williams
- Nuclear Medicine, Central Manchester University Hospitals, Oxford Road, Manchester, UK.
| | - Julian C Matthews
- Institute of Population Health, MAHSC, University of Manchester, Manchester, UK.
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Is the standard uptake value (SUV) appropriate for quantification in clinical PET imaging? - Variability induced by different SUV measurements and varying reconstruction methods. Eur J Radiol 2014; 84:158-162. [PMID: 25467224 DOI: 10.1016/j.ejrad.2014.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 10/17/2014] [Accepted: 10/23/2014] [Indexed: 11/21/2022]
Abstract
INTRODUCTION PET quantification using the standard uptake value (SUV) is very prone to variations by technical factors of the scanner system and patient specific characteristics. Aim of the study was to investigate the reproducibility of SUV values between different measures and different reconstruction algorithms in a PET/CT scanner of the newest generation. METHODS The time-of-flight PET datasets of 27 consecutive oncological patients were reconstructed with OSEM3D in two different matrix sizes (200 × 200 and 400 × 400) as well as in a matrix size of 400 × 400 and additional point-spread-reconstruction. The standardized uptake values SUVmax, SUVmean and SUVpeak in 60 lesions were compared concerning their variability in the three reconstructions. RESULTS The addition of point-spread-reconstruction causes a significant increase of SUV values in comparison to OSEM 3D. SUVpeak showed the highest reproducibility between the different reconstruction algorithms. The variability of SUVmax and SUVmean increases in small lesions <5 ml, while SUVpeak remains more stable. CONCLUSION SUVmax, SUVmean and SUVpeak can be used for PET quantification in principle. However, quantification of small lesions is difficult. SUVpeak is the most robust method when using varying reconstruction methods, especially in small lesions.
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171
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Meij-de Vries A, Knol RJJ, Lazarenko SV, Meijer RW, van der Plas EM, Heij HA. Uptake of (18)F-fluoro-2-deoxyglucose in the Healthy Testes of Young Men as Assessed by Positron Emission Tomography/Computed Tomography; Including the Inter- and Intra-observer Variation. World J Nucl Med 2014; 13:88-93. [PMID: 25191122 PMCID: PMC4150165 DOI: 10.4103/1450-1147.139137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Knowledge of the physiological testicular accumulation of 18F-fluoro-2-deoxyglucose (FDG) is essential in order to discriminate between normal and pathological findings. In this study, the 18F-FDG-uptake in healthy testes of young men was assessed using positron emission tomography/computed tomography (PET/CT)-scans. A total of 40 testes of 20 men with a mean age of 26.5 ± 3.9 years were evaluated. 18F-FDG-uptake was expressed as the standardized uptake value (SUV). Testicular volume was measured on CT and PET. All scans were assessed by three researchers, one of whom assessed every scan twice. Laterality indices and inter- and intra-observer variation were evaluated. Correlation between the SUVmax and SUVpeak, between SUVmean and SUVpeak and between age and SUVpeak were assessed. Testes showed an average SUVmax of 3.42 ± 0.61, SUVpeak of 3.06 ± 0.54 and SUVmean of 2.44 ± 0.44. The average testicular volume on CT was 23.0 ± 6.4 ml, whereas on PET it was 18.0 ± 5.1 ml. Laterality indices were calculated of 0.077 ± 0.065 (SUVmax), 0.074 ± 0.066 (SUVpeak), 0.072 ± 0.063 (SUVmean), 0.245 ± 0.259 (CT), and 0.200 ± 0.188 (PET), respectively. Inter- and intra-observer reliability were found to be perfect for the SUVs (intraclass correlation coefficient [ICC] 0.992-1.0), but poor for testicular volumes (ICC 0.854-0.902). Testicular 18F-FDG uptake in young men can be measured accurately on PET/CT and shows high symmetry. Consequently, 18F-FDG PET/CT has the potential to become a useful instrument in the evaluation of the functioning of the individual testis.
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Affiliation(s)
- A Meij-de Vries
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | - R J J Knol
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | - S V Lazarenko
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | - R W Meijer
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
| | | | - H A Heij
- Department of Surgery, Medical Centre, Alkmaar, the Netherlands
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Bahce I, Vos C, Dickhoff C, Hartemink K, Dahele M, Smit E, Boellaard R, Hoekstra O, Thunnissen E. Metabolic activity measured by FDG PET predicts pathological response in locally advanced superior sulcus NSCLC. Lung Cancer 2014; 85:205-12. [DOI: 10.1016/j.lungcan.2014.04.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/11/2014] [Accepted: 04/15/2014] [Indexed: 10/25/2022]
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Harteela M, Hirvi H, Mäkipää A, Teuho J, Koivumäki T, Mäkelä MM, Teräs M. Comparison of end-expiratory respiratory gating methods for PET/CT. Acta Oncol 2014; 53:1079-85. [PMID: 24960580 DOI: 10.3109/0284186x.2014.926028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Respiratory motion in positron emission tomography/computed tomography (PET/CT) causes underestimation of standardized uptake value (SUV) and variation of lesion volume, while PET and CT attenuation correction (CTAC) mismatch may introduce artefacts. The aim was to compare end-expiratory gating methods of PET and CTAC. MATERIAL AND METHODS Three methods named the minimum-constant, slope-based and amplitude-median were developed and evaluated on gating efficiency. Method evaluation and optimization was performed on 23 simulated and 23 recorded signals from a mixed patient group. The optimized methods were applied in PET/CT imaging of seven patients, consisting of non-gated CTAC, whole-body PET and four-dimensional (4D) PET/CT. Gating efficiency was evaluated by preservation of the respiratory signal, PET-CTAC alignment, image noise and measurement of lesion SUV maximum (SUVmax), SUV mean (SUVmean) and volume. The methods were evaluated with non-gated PET and end-expiratory phase of five-bin phase-gated PET. End-expiratory gated 4D-CTAC and averaged CTAC were compared for attenuation correction of end-expiratory gated PET. RESULTS Mean fraction of data preserved was larger (23-34%) with end-expiratory gating compared to phase-gated PET. End-expiratory gating showed increased SUVmax (8.2-8.4 g/ml), SUVmean (5.7-5.8 g/ml) and decreased lesion volume (-11.3-16.8%) compared to non-gated PET (SUVmax 6.2 g/ml, SUVmean 4.7 g/ml) and phase-gated PET (SUVmax 8.0 g/ml, SUVmean 5.6 g/ml). Using averaged CTAC and end-expiratory 4D-CTAC produced similar results concerning SUVmax, with less than 5% difference. Additionally, CTAC-PET-mismatch was minimal when end-expiratory 4D-CTAC was used. CONCLUSION End-expiratory gating in PET/CT results in SUVmax and SUVmean increase and reduced lesion volume compared to non-gated PET and phase-gated PET. End-expiratory 4D-CTAC or averaged CTAC will offer similar accuracy for attenuation correction of end-expiratory gated PET.
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Affiliation(s)
- Markus Harteela
- Department of Mathematics and Statistics, University of Turku , Turku , Finland
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Machtay M, Siegel BA, Duan F, Snyder BS. Reply to J.-S. Ryu et al and A.T. Berman et al. J Clin Oncol 2014; 32:1632-3. [PMID: 24752050 DOI: 10.1200/jco.2013.54.6176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mitchell Machtay
- University Hospitals Seidman Cancer Center, Case Comprehensive Cancer Center and Case Western Reserve University, Cleveland, OH
| | - Barry A Siegel
- Mallinckrodt Institute of Radiology and the Siteman Cancer Center, Washington University School of Medicine, St Louis, MO
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Foster B, Bagci U, Mansoor A, Xu Z, Mollura DJ. A review on segmentation of positron emission tomography images. Comput Biol Med 2014; 50:76-96. [PMID: 24845019 DOI: 10.1016/j.compbiomed.2014.04.014] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Revised: 03/19/2014] [Accepted: 04/16/2014] [Indexed: 11/20/2022]
Abstract
Positron Emission Tomography (PET), a non-invasive functional imaging method at the molecular level, images the distribution of biologically targeted radiotracers with high sensitivity. PET imaging provides detailed quantitative information about many diseases and is often used to evaluate inflammation, infection, and cancer by detecting emitted photons from a radiotracer localized to abnormal cells. In order to differentiate abnormal tissue from surrounding areas in PET images, image segmentation methods play a vital role; therefore, accurate image segmentation is often necessary for proper disease detection, diagnosis, treatment planning, and follow-ups. In this review paper, we present state-of-the-art PET image segmentation methods, as well as the recent advances in image segmentation techniques. In order to make this manuscript self-contained, we also briefly explain the fundamentals of PET imaging, the challenges of diagnostic PET image analysis, and the effects of these challenges on the segmentation results.
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Affiliation(s)
- Brent Foster
- Center for Infectious Disease Imaging, Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD 20892, United States
| | - Ulas Bagci
- Center for Infectious Disease Imaging, Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD 20892, United States.
| | - Awais Mansoor
- Center for Infectious Disease Imaging, Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD 20892, United States
| | - Ziyue Xu
- Center for Infectious Disease Imaging, Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD 20892, United States
| | - Daniel J Mollura
- Center for Infectious Disease Imaging, Department of Radiology and Imaging Sciences, National Institutes of Health (NIH), Bethesda, MD 20892, United States
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Dholakia AS, Chaudhry M, Leal JP, Chang DT, Raman SP, Hacker-Prietz A, Su Z, Pai J, Oteiza KE, Griffith ME, Wahl RL, Tryggestad E, Pawlik T, Laheru DA, Wolfgang CL, Koong AC, Herman JM. Baseline metabolic tumor volume and total lesion glycolysis are associated with survival outcomes in patients with locally advanced pancreatic cancer receiving stereotactic body radiation therapy. Int J Radiat Oncol Biol Phys 2014; 89:539-46. [PMID: 24751410 DOI: 10.1016/j.ijrobp.2014.02.031] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/08/2014] [Accepted: 02/21/2014] [Indexed: 12/29/2022]
Abstract
PURPOSE Although previous studies have demonstrated the prognostic value of positron emission tomography (PET) parameters in other malignancies, the role of PET in pancreatic cancer has yet to be well established. We analyzed the prognostic utility of PET for patients with locally advanced pancreatic cancer (LAPC) undergoing fractionated stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS Thirty-two patients with LAPC in a prospective clinical trial received up to 3 doses of gemcitabine, followed by 33 Gy in 5 fractions of 6.6 Gy, using SBRT. All patients received a baseline PET scan prior to SBRT (pre-SBRT PET). Metabolic tumor volume (MTV), total lesion glycolysis (TLG), and maximum and peak standardized uptake values (SUVmax and SUVpeak) on pre-SBRT PET scans were calculated using custom-designed software. Disease was measured at a threshold based on the liver SUV, using the equation Livermean + [2 × Liversd]. Median values of PET parameters were used as cutoffs when assessing their prognostic potential through Cox regression analyses. RESULTS Of the 32 patients, the majority were male (n=19, 59%), 65 years or older (n=21, 66%), and had tumors located in the pancreatic head (n=27, 84%). Twenty-seven patients (84%) received induction gemcitabine prior to SBRT. Median overall survival for the entire cohort was 18.8 months (95% confidence interval [CI], 15.7-22.0). An MTV of 26.8 cm(3) or greater (hazard ratio [HR] 4.46, 95% CI 1.64-5.88, P<.003) and TLG of 70.9 or greater (HR 3.08, 95% CI 1.18-8.02, P<.021) on pre-SBRT PET scan were associated with inferior overall survival on univariate analysis. Both pre-SBRT MTV (HR 5.13, 95% CI 1.19-22.21, P=.029) and TLG (HR 3.34, 95% CI 1.07-10.48, P=.038) remained independently associated with overall survival in separate multivariate analyses. CONCLUSIONS Pre-SBRT MTV and TLG are potential predictive factors for overall survival in patients with LAPC and may assist in tailoring therapy.
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Affiliation(s)
- Avani S Dholakia
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Muhammad Chaudhry
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jeffrey P Leal
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel T Chang
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Siva P Raman
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amy Hacker-Prietz
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Zheng Su
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Jonathan Pai
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Katharine E Oteiza
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary E Griffith
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard L Wahl
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erik Tryggestad
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Timothy Pawlik
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel A Laheru
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Albert C Koong
- Department of Radiation Oncology, Stanford University School of Medicine, Stanford, California
| | - Joseph M Herman
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Lee HS, Kim HO, Hong YS, Kim TW, Kim JC, Yu CS, Kim JS. Prognostic Value of Metabolic Parameters in Patients with Synchronous Colorectal Cancer Liver Metastasis Following Curative-Intent Colorectal and Hepatic Surgery. J Nucl Med 2014; 55:582-9. [DOI: 10.2967/jnumed.113.128629] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Lindholm H, Staaf J, Jacobsson H, Brolin F, Hatherly R, Sânchez-Crespo A. Repeatability of the Maximum Standard Uptake Value (SUVmax) in FDG PET. Mol Imaging Radionucl Ther 2014; 23:16-20. [PMID: 24653930 PMCID: PMC3957966 DOI: 10.4274/mirt.76376] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 12/23/2013] [Indexed: 12/01/2022] Open
Abstract
Objective: SUVmax is often calculated at FDG PET examinations in systematic studies as well as at clinical examinations. Since SUVmax represents a very small portion of a lesion it may be questioned how statistically reliable the figure is. This was studied by assessing the repeatability of SUVmax between two FDG acquisitions acquired immediately upon each other in patients with chest lesions. Methods: In 100 clinical patients with a known chest lesion, two identical 3 min PET registrations (PET1 and PET2, respectively) were initiated within 224±31 sec of each other. The difference in SUVmax between the lesion for the two PET scans (ΔSUVmax) was calculated and the uncertainty expressed as the coefficient of variation, CV (%). The correlation between ΔSUVmax and the lowest SUVmax from PET1 or PET2, the approximate metabolic lesion volume, the time from FDG injection to PET1 and the time between PET1 and PET2, respectively, was also assessed. Results: In 56 patients SUVmax increased at the second acquisition and in 44 patients it decreased. Mean of SUVmax was 7.8±6.1 and 7.8±6.2 for PET1 and PET2, respectively. The mean percentage difference was 0.9±7.8. The difference was not significant (p=0.20). CV gave an uncertainty of 4.3% between the two measurements which is a strong indicator of equivalence. There was no correlation between ΔSUVmax and any of the assessed four parameters. The difference between the acquisitions, 0.9%, was much lower compared to the 3 previous published similar, but more restricted studies where the difference was 2.5-8.2%. Conclusion: From camera and computational perspectives, SUVmax is a stable parameter Conflict of interest:None declared.
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Affiliation(s)
- Henry Lindholm
- Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Johan Staaf
- Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden
| | - Hans Jacobsson
- Karolinska University Hospital, Department of Radiology, Stockholm, Sweden
| | - Fredrik Brolin
- Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden
| | - Robert Hatherly
- Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden
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179
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Makris NE, Boellaard R, Visser EP, de Jong JR, Vanderlinden B, Wierts R, van der Veen BJ, Greuter HJ, Vugts DJ, van Dongen GA, Lammertsma AA, Huisman MC. Multicenter Harmonization of 89Zr PET/CT Performance. J Nucl Med 2013; 55:264-7. [DOI: 10.2967/jnumed.113.130112] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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180
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A radiologist's guide to treatment response criteria in oncologic imaging: functional, molecular, and disease-specific imaging biomarkers. AJR Am J Roentgenol 2013; 201:246-56. [PMID: 23883206 DOI: 10.2214/ajr.12.9878] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This article reviews the functional, molecular, and disease-specific imaging biomarkers of treatment response. CONCLUSION Substantial progress has been made in the evolution of drugs directed at specific targets of the tumor lifecycle. These novel agents are predominantly cytostatic, and their efficacy may be optimally evaluated by functional, molecular, and disease-specific imaging biomarkers.
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181
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Nakajima N, Kataoka M, Sugawara Y, Ochi T, Kiyoto S, Ohsumi S, Mochizuki T. Volume-based parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography improve disease recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive axillary lymph nodes. Int J Radiat Oncol Biol Phys 2013; 87:738-46. [PMID: 24064322 DOI: 10.1016/j.ijrobp.2013.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/28/2013] [Accepted: 08/02/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE To determine whether volume-based parameters on pretreatment (18)F-fluorodeoxyglucose positron emission tomography/computed tomography in breast cancer patients treated with mastectomy without adjuvant radiation therapy are predictive of recurrence. METHODS AND MATERIALS We retrospectively analyzed 93 patients with 1 to 3 positive axillary nodes after surgery, who were studied with (18)F-fluorodeoxyglucose positron emission tomography/computed tomography for initial staging. We evaluated the relationship between positron emission tomography parameters, including the maximum standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis (TLG), and clinical outcomes. RESULTS The median follow-up duration was 45 months. Recurrence was observed in 11 patients. Metabolic tumor volume and TLG were significantly related to tumor size, number of involved nodes, nodal ratio, nuclear grade, estrogen receptor (ER) status, and triple negativity (TN) (all P values were <.05). In receiver operating characteristic curve analysis, MTV and TLG showed better predictive performance than tumor size, ER status, or TN (area under the curve: 0.85, 0.86, 0.79, 0.74, and 0.74, respectively). On multivariate analysis, MTV was an independent prognostic factor of locoregional recurrence-free survival (hazard ratio 34.42, 95% confidence interval 3.94-882.71, P=.0008) and disease-free survival (DFS) (hazard ratio 13.92, 95% confidence interval 2.65-103.78, P=.0018). The 3-year DFS rate was 93.8% for the lower MTV group (<53.1; n=85) and 25.0% for the higher MTV group (≥53.1; n=8; P<.0001, log-rank test). The 3-year DFS rate for patients with both ER-positive status and MTV<53.1 was 98.2%; and for those with ER-negative status and MTV≥53.1 it was 25.0% (P<.0001). CONCLUSIONS Volume-based parameters improve recurrence prediction in postmastectomy breast cancer patients with 1 to 3 positive nodes. The addition of MTV to ER status or TN has potential benefits to identify a subgroup at higher risk for recurrence.
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Affiliation(s)
- Naomi Nakajima
- Department of Radiation Oncology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan; Department of Radiology, Ehime University, Ehime, Japan.
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Evaluation of strategies towards harmonization of FDG PET/CT studies in multicentre trials: comparison of scanner validation phantoms and data analysis procedures. Eur J Nucl Med Mol Imaging 2013; 40:1507-15. [PMID: 23754762 DOI: 10.1007/s00259-013-2465-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/10/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE PET quantification based on standardized uptake values (SUV) is hampered by several factors, in particular by variability in PET acquisition settings and data analysis methods. Quantitative PET/CT studies acquired during a multicentre trial require harmonization of imaging procedures to maximize study power. The aims of this study were to determine which phantoms are most suitable for detecting differences in image quality and quantification, and which methods for defining volumes of interest (VOI) are least sensitive to these differences. METHODS The most common accreditation phantoms used in oncology FDG PET/CT trials were scanned on the same scanner. These phantoms were those used by the Society of Nuclear Medicine Clinical Trials Network (SNM-CTN), the European Association of Nuclear Medicine/National Electrical Manufacturers Association (EANM/NEMA) and the American College of Radiology (ACR). In addition, tumour SUVs were derived from ten oncology whole-body examinations performed on the same PET/CT system. Both phantom and clinical data were reconstructed using different numbers of iterations, subsets and time-of-flight kernel widths. Subsequently, different VOI methods (VOI(A50%), VOI(max), VOI(3Dpeak), VOI(2Dpeak)) were applied to assess the impact of changes in image reconstruction settings on SUV and recovery coefficients (RC). RESULTS All phantoms demonstrated sensitivity for detecting changes in SUV and RC measures in response to changes in image reconstruction settings and VOI analysis methods. The SNM-CTN and EANM/NEMA phantoms showed almost equal sensitivity in detecting RC differences with changes in image characteristics. Phantom and clinical data demonstrated that the VOI analysis methods VOI(A50%) and VOI(max) gave SUV and RC values with large variability in relation to image characteristics, whereas VOI(3Dpeak) and VOI(2Dpeak) were less sensitive to these differences. CONCLUSION All three phantoms may be used to harmonize parameters for data acquisition, processing and analysis. However, the SNM-CTN and EANM/NEMA phantoms are the most sensitive to parameter changes and are suitable for harmonizing SUV quantification based on 3D VOIs, such as VOI(A50%) and VOI(3Dpeak), and VOImax. Variability in SUV quantification after harmonization could be further minimized using VOI(3Dpeak) analysis, which was least sensitive to residual variability in image quality and quantification.
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183
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Boellaard R. Optimisation and harmonisation: two sides of the same coin? Eur J Nucl Med Mol Imaging 2013; 40:982-4. [DOI: 10.1007/s00259-013-2440-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022]
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Harmonizing SUVs in multicentre trials when using different generation PET systems: prospective validation in non-small cell lung cancer patients. Eur J Nucl Med Mol Imaging 2013; 40:985-96. [PMID: 23564036 PMCID: PMC3679414 DOI: 10.1007/s00259-013-2391-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 03/05/2013] [Indexed: 01/07/2023]
Abstract
Purpose We prospectively evaluated whether a strategy using point spread function (PSF) reconstruction for both diagnostic and quantitative analysis in non-small cell lung cancer (NSCLC) patients meets the European Association of Nuclear Medicine (EANM) guidelines for harmonization of quantitative values. Methods The NEMA NU-2 phantom was used to determine the optimal filter to apply to PSF-reconstructed images in order to obtain recovery coefficients (RCs) fulfilling the EANM guidelines for tumour positron emission tomography (PET) imaging (PSFEANM). PET data of 52 consecutive NSCLC patients were reconstructed with unfiltered PSF reconstruction (PSFallpass), PSFEANM and with a conventional ordered subset expectation maximization (OSEM) algorithm known to meet EANM guidelines. To mimic a situation in which a patient would undergo pre- and post-therapy PET scans on different generation PET systems, standardized uptake values (SUVs) for OSEM reconstruction were compared to SUVs for PSFEANM and PSFallpass reconstruction. Results Overall, in 195 lesions, Bland-Altman analysis demonstrated that the mean ratio between PSFEANM and OSEM data was 1.03 [95 % confidence interval (CI) 0.94–1.12] and 1.02 (95 % CI 0.90–1.14) for SUVmax and SUVmean, respectively. No difference was noticed when analysing lesions based on their size and location or on patient body habitus and image noise. Ten patients (84 lesions) underwent two PET scans for response monitoring. Using the European Organization for Research and Treatment of Cancer (EORTC) criteria, there was an almost perfect agreement between OSEMPET1/OSEMPET2 (current standard) and OSEMPET1/PSFEANM-PET2 or PSFEANM-PET1/OSEMPET2 with kappa values of 0.95 (95 % CI 0.91–1.00) and 0.99 (95 % CI 0.96–1.00), respectively. The use of PSFallpass either for pre- or post-treatment (i.e. OSEMPET1/PSFallpass-PET2 or PSFallpass-PET1/OSEMPET2) showed considerably less agreement with kappa values of 0.75 (95 % CI 0.67–0.83) and 0.86 (95 % CI 0.78–0.94), respectively. Conclusion Protocol-optimized images and compliance with EANM guidelines allowed for a reliable pre- and post-therapy evaluation when using different generation PET systems. These data obtained in NSCLC patients could be extrapolated to other solid tumours. Electronic supplementary material The online version of this article (doi:10.1007/s00259-013-2391-1) contains supplementary material, which is available to authorized users.
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Paidpally V, Chirindel A, Lam S, Agrawal N, Quon H, Subramaniam RM. FDG-PET/CT imaging biomarkers in head and neck squamous cell carcinoma. ACTA ACUST UNITED AC 2012; 4:633-647. [PMID: 23482696 DOI: 10.2217/iim.12.60] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This article discusses the value of 18F-fluoro-2-deoxyglucose PET/CT imaging biomarkers in head and neck squamous cell carcinoma. 18F-fluoro-2-deoxyglucose PET/CT is valuable at baseline staging, radiotherapy planning, therapy response assessment and in the follow-up of patients with head and neck squamous cell carcinoma. Maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume and total lesion glycolysis are the common 18F-fluoro-2-deoxyglucose quantitative parameters that have been studied, along with qualitative assessments. These parameters will be evaluated with respect to their established or potential role as noninvasive biomarkers for patient risk stratification, treatment response and survival outcome.
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Affiliation(s)
- Vasavi Paidpally
- Russel H Morgan Department of Radiology & Radiology Science, Johns Hopkins Medical Institutions, 601 North Caroline Street/JHOC 3235, Baltimore, MD 21287, USA
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Reproducibility of functional volume and activity concentration in 18F-FDG PET/CT of liver metastases in colorectal cancer. Eur J Nucl Med Mol Imaging 2012; 39:1858-67. [PMID: 22945372 DOI: 10.1007/s00259-012-2233-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 08/13/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE Several studies showed potential for monitoring response to systemic therapy in metastatic colorectal cancer patients with (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Before (18)F-FDG PET can be implemented for response evaluation the repeatability should be known. This study was performed to assess the magnitude of the changes in standardized uptake value (SUV), volume and total lesion glycolysis (TLG) in colorectal liver metastases and validate the biological basis of (18)F-FDG PET in colorectal liver metastases. METHODS Twenty patients scheduled for liver metastasectomy underwent two (18)F-FDG PET scans within 1 week. Bland-Altman analysis was performed to assess repeatability of SUV(max), SUV(mean), volume and TLG. Tumours were delineated using an adaptive threshold method (PET(SBR)) and a semiautomatic fuzzy locally adaptive Bayesian (FLAB) delineation method. RESULTS Coefficient of repeatability of SUV(max) and SUV(mean) were ∼39 and ∼31 %, respectively, independent of the delineation method used and image reconstruction parameters. However, repeatability was worse in recently treated patients. The FLAB delineation method improved the repeatability of the volume and TLG measurements compared to PET(SBR), from coefficients of repeatability of over 85 % to 45 % and 57 % for volume and TLG, respectively. Glucose transporter 1 (GLUT1) expression correlated to the SUV(mean). Vascularity (CD34 expression) and tumour hypoxia (carbonic anhydrase IX expression) did not correlate with (18)F-FDG PET parameters. CONCLUSION In conclusion, repeatability of SUV(mean) and SUV(max) was mainly affected by preceding systemic therapy. The repeatability of tumour volume and TLG could be improved using more advanced and robust delineation approaches such as FLAB, which is recommended when (18)F-FDG PET is utilized for volume or TLG measurements. Improvement of repeatability of PET measurements, for instance by dynamic PET scanning protocols, is probably necessary to effectively use PET for early response monitoring.
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