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van Sluis J, Boellaard R, Dierckx RAJO, van Esch ELM, Croes DA, de Ruijter LK, van de Donk PP, de Vries EGE, Noordzij W, Brouwers AH. Optimisation of scan duration and image quality in oncological 89Zr immunoPET imaging using the Biograph Vision PET/CT. Eur J Nucl Med Mol Imaging 2023; 50:2258-2270. [PMID: 36947185 PMCID: PMC10250429 DOI: 10.1007/s00259-023-06194-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Monoclonal antibody (mAb)-based PET (immunoPET) imaging can characterise tumour lesions non-invasively. It may be a valuable tool to determine which patients may benefit from treatment with a specific monoclonal antibody (mAb) and evaluate treatment response. For 89Zr immunoPET imaging, higher sensitivity of state-of-the art PET/CT systems equipped with silicon photomultiplier (SiPM)-based detector elements may be beneficial as the low positron abundance of 89Zr causes a low signal-to-noise level. Moreover, the long physical half-life limits the amount of activity that can be administered to the patients leading to poor image quality even when using long scan durations. Here, we investigated the difference in semiquantitative performance between the PMT-based Biograph mCT, our clinical reference system, and the SiPM-based Biograph Vision PET/CT in 89Zr immunoPET imaging. Furthermore, the effects of scan duration reduction using the Vision on semiquantitative imaging parameters and its influence on image quality assessment were evaluated. METHODS Data were acquired on day 4 post 37 MBq 89Zr-labelled mAb injection. Five patients underwent a double scan protocol on both systems. Ten patients were scanned only on the Vision. For PET image reconstruction, three protocols were used, i.e. one camera-dependent protocol and European Association of Nuclear Medicine Research Limited (EARL) standards 1 and 2 compliant protocols. Vision data were acquired in listmode and were reprocessed to obtain images at shorter scan durations. Semiquantitative PET image parameters were derived from tumour lesions and healthy tissues to assess differences between systems and scan durations. Differently reconstructed images obtained using the Vision were visually scored regarding image quality by two nuclear medicine physicians. RESULTS When images were reconstructed using 100% acquisition time on both systems following EARL standard 1 compliant reconstruction protocols, results regarding semiquantification were comparable. For Vision data, reconstructed images that conform to EARL1 standards still resulted in comparable semiquantification at shorter scan durations (75% and 50%) regarding 100% acquisition time. CONCLUSION Scan duration of 89Zr immunoPET imaging using the Vision can be decreased up to 50% compared with using the mCT while maintaining image quality using the EARL1 compliant reconstruction protocol.
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Affiliation(s)
- Joyce van Sluis
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Radiology and Nuclear Medicine, University Medical Centers Amsterdam, Free University of Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Rudi A J O Dierckx
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Evelien L M van Esch
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Demi A Croes
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Laura Kist de Ruijter
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Pim P van de Donk
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Walter Noordzij
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - Adrienne H Brouwers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Nakaichi T, Nakamura S, Ito K, Takahashi K, Takemori M, Kashihara T, Kunito K, Murakami N, Iijima K, Chiba T, Nakayama H, Mikasa S, Nishio T, Okamoto H, Itami J, Kurihara H, Igaki H. Analyzing spatial distribution between 18F-fluorodeoxyglucose and 18F-boronophenylalanine positron emission tomography to investigate selection indicators for boron neutron capture therapy. EJNMMI Phys 2022; 9:89. [PMID: 36536190 PMCID: PMC9763526 DOI: 10.1186/s40658-022-00514-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND 18F-FDG PET is often utilized to determine BNCT selection due to the limited availability of 18F-BPA PET, which is performed by synthesizing 18F into the boron drug used for BNCT, although the uptake mechanisms between those are different. Additionally, only a few non-spatial point parameters, such as maximum SUV (SUVmax), have reported a correlation between those in previous studies. This study aimed to investigate the spatial accumulation pattern between those PET images in tumors, which would be expected to either show higher uptake on 18F-BPA PET or be utilized in clinical, to verify whether 18F-FDG PET could be used as a selection indicator for BNCT. METHODS A total of 27 patients with 30 lesions (11 squamous cell carcinoma, 9 melanoma, and 10 rhabdomyosarcoma) who received 18F-FDG and 18F-BPA PET within 2 weeks were enrolled in this study. The ratio of metabolic tumor volumes (MTVs) to GTV, histogram indices (skewness/kurtosis), and the correlation of total lesion activity (TLA) and non-spatial point parameters (SUVmax, SUVpeak, SUVmin, maximum tumor-to-normal tissue ratio (Tmax/N), and Tmin/N) were evaluated. After local rigid registration between those images, distances of locations at SUVmax and the center of mass with MTVs on each image and similarity indices were also assessed along its coordinate. RESULTS In addition to SUVmax, SUVpeak, and Tmax/N, significant correlations were found in TLA. The mean distance in SUVmax was [Formula: see text] and significantly longer than that in the center of mass with MTVs. The ratio of MTVs to GTV, skewness, and kurtosis were not significantly different. However, the similarities of MTVs were considerably low. The similarity indices of Dice similarity coefficient, Jaccard coefficient, and mean distance to agreement for MTV40 were [Formula: see text], [Formula: see text], and [Formula: see text] cm, respectively. Furthermore, it was worse in MTV50. In addition, spatial accumulation patterns varied in cancer types. CONCLUSIONS Spatial accumulation patterns in tumors showed low similarity between 18F-FDG and 18F-BPA PET, although the various non-spatial point parameters were correlated. In addition, the spatial accumulation patterns were considerably different in cancer types. Therefore, the selection for BNCT using 18F-FDG PET should be compared carefully with using 18F-FBPA PET.
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Affiliation(s)
- Tetsu Nakaichi
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Satoshi Nakamura
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.136593.b0000 0004 0373 3971Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita City, Osaka 565-0871 Japan
| | - Kimiteru Ito
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kana Takahashi
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Mihiro Takemori
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.265074.20000 0001 1090 2030Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo 116-8551 Japan
| | - Tairo Kashihara
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kouji Kunito
- Euro MediTech Co., Ltd., 2-20-4, Higashigotanda, Shinagawa-ku, Tokyo 141-0022 Japan
| | - Naoya Murakami
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kotaro Iijima
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Takahito Chiba
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.265074.20000 0001 1090 2030Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo 116-8551 Japan
| | - Hiroki Nakayama
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.265074.20000 0001 1090 2030Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo 116-8551 Japan
| | - Shohei Mikasa
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Teiji Nishio
- grid.136593.b0000 0004 0373 3971Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita City, Osaka 565-0871 Japan
| | - Hiroyuki Okamoto
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Jun Itami
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Hiroaki Kurihara
- grid.414944.80000 0004 0629 2905Department of Diagnostic Radiology, Kanagawa Cancer Center, 2-3-2 Nakano, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Hiroshi Igaki
- grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
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Malaih AA, Dunn JT, Nygård L, Kovacs DG, Andersen FL, Barrington SF, Fischer BM. Test-retest repeatability and interobserver variation of healthy tissue metabolism using 18F-FDG PET/CT of the thorax among lung cancer patients. Nucl Med Commun 2022; 43:549-559. [PMID: 35081091 PMCID: PMC7612596 DOI: 10.1097/mnm.0000000000001537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES The aim of this study was to assess the test-retest repeatability and interobserver variation in healthy tissue (HT) metabolism using 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) PET/computed tomography (PET/CT) of the thorax in lung cancer patients. METHODS A retrospective analysis was conducted in 22 patients with non-small cell lung cancer who had two PET/CT scans of the thorax performed 3 days apart with no interval treatment. The maximum, mean and peak standardized uptake values (SUVs) in different HTs were measured by a single observer for the test-retest analysis and two observers for interobserver variation. Bland-Altman plots were used to assess the repeatability and interobserver variation. Intrasubject variability was evaluated using within-subject coefficients of variation (wCV). RESULTS The wCV of test-retest SUVmean measurements in mediastinal blood pool, bone marrow, skeletal muscles and lungs was less than 20%. The left ventricle (LV) showed higher wCV (>60%) in all SUV parameters with wide limits of repeatability. High interobserver agreement was found with wCV of less than 10% in SUVmean of all HT, but up to 22% was noted in the LV. CONCLUSION HT metabolism is stable in a test-retest scenario and has high interobserver agreement. SUVmean was the most stable metric in organs with low FDG uptake and SUVpeak in HTs with moderate uptake. Test-retest measurements in LV were highly variable irrespective of the SUV parameters used for measurements.
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Affiliation(s)
- Afnan A Malaih
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
| | - Joel T Dunn
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
| | - Lotte Nygård
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital
| | - David G Kovacs
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Flemming L Andersen
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Sally F Barrington
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
| | - Barbara M Fischer
- Department of Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, PET Imaging Centre, St Thomas Hospital, King's College London, London, UK
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Zhang Y, Hu Y, Zhao S, Cui C. The Utility of PET/CT Metabolic Parameters Measured Based on Fixed Percentage Threshold of SUVmax and Adaptive Iterative Algorithm in the New Revised FIGO Staging System for Stage III Cervical Cancer. Front Med (Lausanne) 2021; 8:680072. [PMID: 34395472 PMCID: PMC8358139 DOI: 10.3389/fmed.2021.680072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives: The main aim of this study was to evaluate the differences in metabolic parameters of positron emission tomography with 2-deoxy-2-[fluorine-18] fluoro-D-glucose integrated with computed tomography (18F-FDG PET/CT) measured based on fixed percentage threshold of maximum standard uptake value (SUVmax) and adaptive iterative algorithm (AT-AIA) in patients with cervical cancer. Metabolic parameters in stage III patients subdivided into five groups according to FIGO and T staging (IIIB-T3B, IIIC1-T2B, IIIC1-T3B, IIIC2-T2B, IIIC2-T3B) were compared. Methods: In total, 142 patients with squamous cell cervical cancer subjected to 18F-FDG-PET/CT before treatment were retrospectively reviewed. SUVmax, mean standard uptake value (SUVmean), maximum glucose homogenization (GNmax), mean glucose homogenization (GNmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and glucose homogenization total lesion glycolysis (GNTLG) values measured based on the above two measurement methods of all 142 patients (IIB-IVB) and 102 patients in the above five groups were compared. Results: MTV measured based on fixed percentage threshold of SUVmax was lower than that based on AT-AIA (p < 0.05). MTV40%, MTV0.5, TLG0.5, GNTLG40%, and GNTLG0.5 values were significantly different among the five groups (p < 0.05) while the rest parameters were comparable (p > 0.05). All metabolic parameters of group IIIB-T3B were comparable to those of the other four groups. MTV40%, MTV0.5, GNTLG40%, and GNTLG0.5 in group IIIC1-T2B relative to IIIC1-T3B and those of group IIIC2-T2B relative to group IIIC2-T3B were significantly different. All metabolic parameters of group IIIC1-T2B relative to IIIC2-T2B and those of group IIIC1-T3B relative to group IIIC2-T3B were not significantly different. Conclusion: Metabolic parameters obtained with the two measurement methods showed a number of differences. Selection of appropriate methods for measurement of 18F-FDG-PET/CT metabolic parameters is important to facilitate advances in laboratory research and clinical applications. When stage III patients had the same T stage, their metabolic parameters of local tumor were not significantly different, regardless of the presence or absence of lymph node metastasis, location of metastatic lymph nodes in the pelvic cavity or para-abdominal aorta. These results support the utility of the revised FIGO system for stage III cervical cancer, although our T-staging of stage III disease is incomplete.
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Affiliation(s)
- Yun Zhang
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxiao Hu
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Shuang Zhao
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Can Cui
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
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Akerele MI, Zein SA, Pandya S, Nikolopoulou A, Gauthier SA, Raj A, Henchcliffe C, Mozley PD, Karakatsanis NA, Gupta A, Babich J, Nehmeh SA. Population-based input function for TSPO quantification and kinetic modeling with [ 11C]-DPA-713. EJNMMI Phys 2021; 8:39. [PMID: 33914185 PMCID: PMC8085191 DOI: 10.1186/s40658-021-00381-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/29/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Quantitative positron emission tomography (PET) studies of neurodegenerative diseases typically require the measurement of arterial input functions (AIF), an invasive and risky procedure. This study aims to assess the reproducibility of [11C]DPA-713 PET kinetic analysis using population-based input function (PBIF). The final goal is to possibly eliminate the need for AIF. MATERIALS AND METHODS Eighteen subjects including six healthy volunteers (HV) and twelve Parkinson disease (PD) subjects from two [11C]-DPA-713 PET studies were included. Each subject underwent 90 min of dynamic PET imaging. Five healthy volunteers underwent a test-retest scan within the same day to assess the repeatability of the kinetic parameters. Kinetic modeling was carried out using the Logan total volume of distribution (VT) model. For each data set, kinetic analysis was performed using a patient-specific AIF (PSAIF, ground-truth standard) and then repeated using the PBIF. PBIF was generated using the leave-one-out method for each subject from the remaining 17 subjects and after normalizing the PSAIFs by 3 techniques: (a) Weightsubject×DoseInjected, (b) area under AIF curve (AUC), and (c) Weightsubject×AUC. The variability in the VT measured with PSAIF, in the test-retest study, was determined for selected brain regions (white matter, cerebellum, thalamus, caudate, putamen, pallidum, brainstem, hippocampus, and amygdala) using the Bland-Altman analysis and for each of the 3 normalization techniques. Similarly, for all subjects, the variabilities due to the use of PBIF were assessed. RESULTS Bland-Altman analysis showed systematic bias between test and retest studies. The corresponding mean bias and 95% limits of agreement (LOA) for the studied brain regions were 30% and ± 70%. Comparing PBIF- and PSAIF-based VT estimate for all subjects and all brain regions, a significant difference between the results generated by the three normalization techniques existed for all brain structures except for the brainstem (P-value = 0.095). The mean % difference and 95% LOA is -10% and ±45% for Weightsubject×DoseInjected; +8% and ±50% for AUC; and +2% and ± 38% for Weightsubject×AUC. In all cases, normalizing by Weightsubject×AUC yielded the smallest % bias and variability (% bias = ±2%; LOA = ±38% for all brain regions). Estimating the reproducibility of PBIF-kinetics to PSAIF based on disease groups (HV/PD) and genotype (MAB/HAB), the average VT values for all regions obtained from PBIF is insignificantly higher than PSAIF (%difference = 4.53%, P-value = 0.73 for HAB; and %difference = 0.73%, P-value = 0.96 for MAB). PBIF also tends to overestimate the difference between PD and HV for HAB (% difference = 32.33% versus 13.28%) and underestimate it in MAB (%difference = 6.84% versus 20.92%). CONCLUSIONS PSAIF kinetic results are reproducible with PBIF, with variability in VT within that obtained for the test-retest studies. Therefore, VT assessed using PBIF-based kinetic modeling is clinically feasible and can be an alternative to PSAIF.
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Affiliation(s)
- Mercy I Akerele
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA.
| | - Sara A Zein
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Sneha Pandya
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
| | | | - Susan A Gauthier
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, 10021, USA
- Feil Family Brain and Mind Institute, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Ashish Raj
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Claire Henchcliffe
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
- Department of Neurology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - P David Mozley
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
| | | | - Ajay Gupta
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - John Babich
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
| | - Sadek A Nehmeh
- Department of Radiology, Weill Cornell Medical College, New York, NY, 10021, USA
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Maebatake A, Morita K, Akamatsu G, Tsutsui Y, Himuro K, Baba S, Sasaki M. The Influence of Minimal Misalignment on the Repeatability of PET Images Examined by the Repositioning of Point Sources. J Nucl Med Technol 2019; 47:55-59. [DOI: 10.2967/jnmt.118.208835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 08/23/2018] [Indexed: 11/16/2022] Open
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Mohamed ASR, Cardenas CE, Garden AS, Awan MJ, Rock CD, Westergaard SA, Brandon Gunn G, Belal AM, El-Gowily AG, Lai SY, Rosenthal DI, Fuller CD, Aristophanous M. Patterns-of-failure guided biological target volume definition for head and neck cancer patients: FDG-PET and dosimetric analysis of dose escalation candidate subregions. Radiother Oncol 2017; 124:248-255. [PMID: 28774596 DOI: 10.1016/j.radonc.2017.07.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 07/01/2017] [Accepted: 07/16/2017] [Indexed: 01/03/2023]
Abstract
BACKGROUND To identify the radio-resistant subvolumes in pretreatment FDG-PET by mapping the spatial location of the origin of tumor recurrence after IMRT for head-and-neck squamous cell cancer to the pretreatment FDG-PET/CT. METHODS Patients with local/regional recurrence after IMRT with available FDG-PET/CT and post-failure CT were included. For each patient, both pre-therapy PET/CT and recurrence CT were co-registered with the planning CT (pCT). A 4-mm radius was added to the centroid of mapped recurrence growth target volumes (rGTV's) to create recurrence nidus-volumes (NVs). The overlap between boost-tumor-volumes (BTV) representing different SUV thresholds/margins combinations and NVs was measured. RESULTS Forty-seven patients were eligible. Forty-two (89.4%) had type A central high dose failure. Twenty-six (48%) of type A rGTVs were at the primary site and 28 (52%) were at the nodal site. The mean dose of type A rGTVs was 71Gy. BTV consisting of 50% of the maximum SUV plus 10mm margin was the best subvolume for dose boosting due to high coverage of primary site NVs (92.3%), low average relative volume to CTV1 (41%), and least average percent voxels outside CTV1 (19%). CONCLUSIONS The majority of loco-regional recurrences originate in the regions of central-high-dose. When correlated with pretreatment FDG-PET, the majority of recurrences originated in an area that would be covered by additional 10mm margin on the volume of 50% of the maximum FDG uptake.
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Affiliation(s)
- Abdallah S R Mohamed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - Carlos E Cardenas
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Musaddiq J Awan
- Department of Radiation Oncology, Case Western Reserve University, Cleveland, USA
| | - Crosby D Rock
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Sarah A Westergaard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Abdelaziz M Belal
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - Ahmed G El-Gowily
- Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - David I Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Clifton D Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - Michalis Aristophanous
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Steiger S, Arvanitakis M, Sick B, Weder W, Hillinger S, Burger IA. Analysis of Prognostic Values of Various PET Metrics in Preoperative 18F-FDG PET for Early-Stage Bronchial Carcinoma for Progression-Free and Overall Survival: Significantly Increased Glycolysis Is a Predictive Factor. J Nucl Med 2017; 58:1925-1930. [DOI: 10.2967/jnumed.117.189894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 04/20/2017] [Indexed: 12/19/2022] Open
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9
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Lodge MA. Repeatability of SUV in Oncologic 18F-FDG PET. J Nucl Med 2017; 58:523-532. [PMID: 28232605 DOI: 10.2967/jnumed.116.186353] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 02/21/2017] [Indexed: 11/16/2022] Open
Abstract
Quantitative analysis can potentially improve the accuracy and consistency of 18F-FDG PET, particularly for the assessment of tumor response to treatment. Although not without limitations, SUV has emerged as the predominant metric for tumor quantification with 18F-FDG PET. Growing literature suggests that the difference between SUVs measured before and after treatment can be used to predict tumor response at an early stage. SUV is, however, associated with multiple sources of variability, and to best use SUV for response assessment, an understanding of the repeatability of the technique is required. Test-retest studies involve repeated scanning of the same patient on the same scanner using the same protocol no more than a few days apart and provide basic information on the repeatability of the technique. Multiple test-retest studies have been performed to assess SUV repeatability, although a comparison of reports is complicated by the use of different methodologies and statistical metrics. This article reviews the available data, addressing issues such as different repeatability metrics, relative units, log transformation, and asymmetric limits of repeatability. When acquired with careful attention to protocol, tumor SUV has a within-subject coefficient of variation of approximately 10%. In a response assessment setting, SUV reductions of more than 25% and increases of more than 33% are unlikely to be due to measurement variability. Broader margins may be required for sites with less rigorous protocol compliance, but in general, SUV is a highly repeatable imaging biomarker that is ideally suited to monitoring tumor response to treatment in individual patients.
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Affiliation(s)
- Martin A Lodge
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
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10
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MacDonald LR, Perkins AE, Tung CH. Longitudinal monitoring of reconstructed activity concentration on a clinical time-of-flight PET/CT scanner. J Med Imaging (Bellingham) 2016; 4:011004. [PMID: 27921075 DOI: 10.1117/1.jmi.4.1.011004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/28/2016] [Indexed: 11/14/2022] Open
Abstract
Positron emission tomography (PET) images are potential quantitative biomarkers. Understanding long-term (months/years) biomarker variability is important for establishing confidence intervals on studies using such biomarkers over these time frames. PET biomarkers are derived from activity concentration ([Formula: see text]) extracted from PET images. Over 30 months, we measured the stability of decay-normalized counts ([Formula: see text]) and [Formula: see text] by scanning the same 4.5-cm-diameter Ge-68 cylinder weekly, the same Na-22 point source daily, and a refilled 20-cm F-18 cylinder phantom monthly on a clinical TOF-PET/CT scanner. Longitudinal and adjacent-measurement variability was characterized. We found no drift in [Formula: see text] or [Formula: see text] for properly calibrated images over 24 months. During this time, [Formula: see text] ranged [Formula: see text] to 6% for count-matched Ge-68 and F-18 images, with coefficient of variation (COV) across time of 2.3% (Ge-68, 81 scans) and 3.2% (F-18, 24 scans). At typical patient image count levels the Ge-68 [Formula: see text] ([Formula: see text]) COV across time was 6.9% (9.6%). Changes in [Formula: see text] between adjacent F-18 scans ([Formula: see text]) ranged between [Formula: see text], with corresponding date-matched changes in Ge-68 [Formula: see text] ranging [Formula: see text]. We recommend (1) tracking trends in [Formula: see text] with image [Formula: see text] as a check of quantitative data corrections/calibrations and (2) tracking both mean and COV of [Formula: see text] (single time point measures) to hundredths precision using standardized uptake values.
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Affiliation(s)
- Lawrence R MacDonald
- University of Washington , Radiology Department, 1715 Northeast Columbia Road, Box 357987, Seattle, Washington 98195-7987, United States
| | - Amy E Perkins
- Philips Healthcare , 595 Miner Road, Highland Heights, Ohio 44143, United States
| | - Chi-Hua Tung
- Philips Healthcare , 595 Miner Road, Highland Heights, Ohio 44143, United States
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11
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Relationship between the image quality and noise-equivalent count in time-of-flight positron emission tomography. Ann Nucl Med 2016; 30:68-74. [PMID: 26486151 DOI: 10.1007/s12149-015-1032-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 09/27/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between the NEC and TOF-PET image quality. METHODS The National Electrical Manufactures Association and International Electrical Commission (NEMA IEC) body phantom with a 10-mm diameter sphere was filled with an 18F-FDG solution with a 4:1 radioactivity ratio. The PET data were acquired in the three-dimensional list mode for 20 min. We created frame data ranging from 1 to 5 min acquisition time, which were then reconstructed using the baseline ordered-subsets expectation maximization (OSEM), the OSEM + point spread function (PSF) algorithm, OSEM + time-of-flight (TOF) algorithm and OSEM + PSF + TOF algorithm. The PET images were analyzed according to the noise-equivalent count (NEC), the coefficients of variance of the background (CVBG), the maximum count (CVmax) and the contrast (CVCONT). The results were compared with the recommended value according to the guidelines for the oncology FDG-PET/CT protocol. RESULTS The NEC was higher than the recommended value at 3 min or longer acquisition time. The CVBG lower than 15% were obtained at 3 min acquisition time without TOF and at 2 min acquisition time with TOF. The CVBG of 10% or lower were obtained at 5 min or longer acquisition time without TOF and at 4 min or longer acquisition time with TOF. Both the CVmax and CVCONT lower than 10% were obtained at 3 min or longer acquisition time without TOF and at 1 min acquisition or longer with TOF. No particular relationships were observed between the frame number and degree of the variation in the image quality. The CVCONT significantly correlated with the NEC for the data reconstructed without TOF information, while there were no significant correlations between these useful metrics for the data reconstructed with TOF. CONCLUSION This study demonstrated that the NEC is not a useful metric for the evaluation of the image quality on TOF-PET images.
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12
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On the Reliability of Automatic Volume Delineation in Low-Contrast [(18)F]FMISO-PET Imaging. Recent Results Cancer Res 2016. [PMID: 27318687 DOI: 10.1007/978-3-662-49651-0_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
Abstract
Hypoxia is a marker of poor prognosis in malignant tumors independent from the selected therapeutic method and the therapy should be intensified in such tumors. Hypoxia imaging with positron emission tomography (PET) is limited by low contrast to noise ratios with every available tracer. In radiation oncology appropriate delineation is required to allow therapy and intensification. While manual segmentation results are highly dependent from experience and observers condition (high inter- and intra observer variability), threshold- and gradient-based algorithms for automatic segmentation frequently fail in low contrast data sets. Likewise, calibration of these algorithms using phantoms is not useful. Complex computational models such as swarm intelligence-based algorithms are promising tools for optimized segmentation results and allow observer independent interpretation of multimodal and multidimensional imaging data.
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13
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Chen MK, Menard DH, Cheng DW. Determining the Minimal Required Radioactivity of 18F-FDG for Reliable Semiquantification in PET/CT Imaging: A Phantom Study. J Nucl Med Technol 2016; 44:26-30. [PMID: 26769598 DOI: 10.2967/jnmt.115.165258] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 11/17/2015] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED In pursuit of as-low-as-reasonably-achievable (ALARA) doses, this study investigated the minimal required radioactivity and corresponding imaging time for reliable semiquantification in PET/CT imaging. METHODS Using a phantom containing spheres of various diameters (3.4, 2.1, 1.5, 1.2, and 1.0 cm) filled with a fixed (18)F-FDG concentration of 165 kBq/mL and a background concentration of 23.3 kBq/mL, we performed PET/CT at multiple time points over 20 h of radioactive decay. The images were acquired for 10 min at a single bed position for each of 10 half-lives of decay using 3-dimensional list mode and were reconstructed into 1-, 2-, 3-, 4-, 5-, and 10-min acquisitions per bed position using an ordered-subsets expectation maximum algorithm with 24 subsets and 2 iterations and a gaussian 2-mm filter. SUVmax and SUVavg were measured for each sphere. RESULTS The minimal required activity (±10%) for precise SUVmax semiquantification in the spheres was 1.8 kBq/mL for an acquisition of 10 min, 3.7 kBq/mL for 3-5 min, 7.9 kBq/mL for 2 min, and 17.4 kBq/mL for 1 min. The minimal required activity concentration-acquisition time product per bed position was 10-15 kBq/mL⋅min for reproducible SUV measurements within the spheres without overestimation. Using the total radioactivity and counting rate from the entire phantom, we found that the minimal required total activity-time product was 17 MBq⋅min and the minimal required counting rate-time product was 100 kcps⋅min. CONCLUSION Our phantom study determined a threshold for minimal radioactivity and acquisition time for precise semiquantification in (18)F-FDG PET imaging that can serve as a guide in pursuit of achieving ALARA doses.
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Affiliation(s)
- Ming-Kai Chen
- Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
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14
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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: 58] [Impact Index Per Article: 6.4] [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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15
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Welsh L, Panek R, McQuaid D, Dunlop A, Schmidt M, Riddell A, Koh DM, Doran S, Murray I, Du Y, Chua S, Hansen V, Wong KH, Dean J, Gulliford S, Bhide S, Leach MO, Nutting C, Harrington K, Newbold K. Prospective, longitudinal, multi-modal functional imaging for radical chemo-IMRT treatment of locally advanced head and neck cancer: the INSIGHT study. Radiat Oncol 2015; 10:112. [PMID: 25971451 PMCID: PMC4438605 DOI: 10.1186/s13014-015-0415-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/30/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Radical chemo-radiotherapy (CRT) is an effective organ-sparing treatment option for patients with locally advanced head and neck cancer (LAHNC). Despite advances in treatment for LAHNC, a significant minority of these patients continue to fail to achieve complete response with standard CRT. By constructing a multi-modality functional imaging (FI) predictive biomarker for CRT outcome for patients with LAHNC we hope to be able to reliably identify those patients at high risk of failing standard CRT. Such a biomarker would in future enable CRT to be tailored to the specific biological characteristics of each patients' tumour, potentially leading to improved treatment outcomes. METHODS/DESIGN The INSIGHT study is a single-centre, prospective, longitudinal multi-modality imaging study using functional MRI and FDG-PET/CT for patients with LAHNC squamous cell carcinomas receiving radical CRT. Two cohorts of patients are being recruited: one treated with, and another treated without, induction chemotherapy. All patients receive radical intensity modulated radiotherapy with concurrent chemotherapy. Patients undergo functional imaging before, during and 3 months after completion of radiotherapy, as well as at the time of relapse, should that occur within the first two years after treatment. Serum samples are collected from patients at the same time points as the FI scans for analysis of a panel of serum markers of tumour hypoxia. DISCUSSION The primary aim of the INSIGHT study is to acquire a prospective multi-parametric longitudinal data set comprising functional MRI, FDG PET/CT, and serum biomarker data from patients with LAHNC undergoing primary radical CRT. This data set will be used to construct a predictive imaging biomarker for outcome after CRT for LAHNC. This predictive imaging biomarker will be used in future studies of functional imaging based treatment stratification for patients with LAHNC. Additional objectives are: defining the reproducibility of FI parameters; determining robust methods for defining FI based biological target volumes for IMRT planning; creation of a searchable database of functional imaging data for data mining. The INSIGHT study will help to establish the role of FI in the clinical management of LAHNC. TRIAL REGISTRATION NCRI H&N CSG ID 13860.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/therapy
- Chemoradiotherapy/mortality
- Female
- Head and Neck Neoplasms/metabolism
- Head and Neck Neoplasms/pathology
- Head and Neck Neoplasms/therapy
- Humans
- Longitudinal Studies
- Magnetic Resonance Imaging/methods
- Male
- Middle Aged
- Multimodal Imaging/methods
- Neoplasm Recurrence, Local/metabolism
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/therapy
- Neoplasm Staging
- Positron-Emission Tomography/methods
- Prognosis
- Prospective Studies
- Radiotherapy Planning, Computer-Assisted/methods
- Radiotherapy, Intensity-Modulated/methods
- Tomography, X-Ray Computed/methods
- Young Adult
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Affiliation(s)
- Liam Welsh
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
- Clinical Research Fellow, Head and Neck Unit, Royal Marsden Hospital, Sutton, Surrey, SM2 5PT, UK.
| | - Rafal Panek
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Dualta McQuaid
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Alex Dunlop
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Maria Schmidt
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Angela Riddell
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Dow-Mu Koh
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Simon Doran
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Iain Murray
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Yong Du
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Vibeke Hansen
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Kee H Wong
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Jamie Dean
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Sarah Gulliford
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Shreerang Bhide
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Martin O Leach
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Christopher Nutting
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
| | - Kevin Harrington
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, Surrey, SM2 5NG, UK.
| | - Kate Newbold
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK.
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16
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Silva-Rodríguez J, Aguiar P, Sánchez M, Mosquera J, Luna-Vega V, Cortés J, Garrido M, Pombar M, Ruibal A. Correction for FDG PET dose extravasations: Monte Carlo validation and quantitative evaluation of patient studies. Med Phys 2014; 41:052502. [PMID: 24784399 DOI: 10.1118/1.4870979] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Current procedure guidelines for whole body [18F]fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) state that studies with visible dose extravasations should be rejected for quantification protocols. Our work is focused on the development and validation of methods for estimating extravasated doses in order to correct standard uptake value (SUV) values for this effect in clinical routine. METHODS One thousand three hundred sixty-seven consecutive whole body FDG-PET studies were visually inspected looking for extravasation cases. Two methods for estimating the extravasated dose were proposed and validated in different scenarios using Monte Carlo simulations. All visible extravasations were retrospectively evaluated using a manual ROI based method. In addition, the 50 patients with higher extravasated doses were also evaluated using a threshold-based method. RESULTS Simulation studies showed that the proposed methods for estimating extravasated doses allow us to compensate the impact of extravasations on SUV values with an error below 5%. The quantitative evaluation of patient studies revealed that paravenous injection is a relatively frequent effect (18%) with a small fraction of patients presenting considerable extravasations ranging from 1% to a maximum of 22% of the injected dose. A criterion based on the extravasated volume and maximum concentration was established in order to identify this fraction of patients that might be corrected for paravenous injection effect. CONCLUSIONS The authors propose the use of a manual ROI based method for estimating the effectively administered FDG dose and then correct SUV quantification in those patients fulfilling the proposed criterion.
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Affiliation(s)
- Jesús Silva-Rodríguez
- Fundación Ramón Domínguez, Santiago de Compostela, Galicia, Spain; Servicio de Medicina Nuclear, Complexo Hospitalario Universidade de Santiago de Compostela (USC), 15782, Galicia, Spain; and Grupo de Imaxe Molecular, Instituto de Investigación Sanitarias (IDIS), Santiago de Compostela, 15706, Galicia, Spain
| | - Pablo Aguiar
- Fundación Ramón Domínguez, Santiago de Compostela, Galicia, Spain; Servicio de Medicina Nuclear, Complexo Hospitalario Universidade de Santiago de Compostela (USC), 15782, Galicia, Spain; and Grupo de Imaxe Molecular, Instituto de Investigación Sanitarias (IDIS), Santiago de Compostela, 15706, Galicia, Spain
| | - Manuel Sánchez
- Servicio de Radiofísica y Protección Radiológica, Complexo Hospitalario Universidade de Santiago de Compostela (USC), 15782, Galicia, Spain
| | - Javier Mosquera
- Servicio de Radiofísica y Protección Radiológica, Complexo Hospitalario Universidade de Santiago de Compostela (USC), 15782, Galicia, Spain
| | - Víctor Luna-Vega
- Servicio de Radiofísica y Protección Radiológica, Complexo Hospitalario Universidade de Santiago de Compostela (USC), 15782, Galicia, Spain
| | - Julia Cortés
- Servicio de Medicina Nuclear, Complexo Hospitalario Universitario de Santiago de Compostela, 15706, Galicia, Spain and Grupo de Imaxe Molecular, Instituto de Investigación Sanitarias (IDIS), Santiago de Compostela, 15706, Galicia, Spain
| | - Miguel Garrido
- Servicio de Medicina Nuclear, Complexo Hospitalario Universitario de Santiago de Compostela, 15706, Galicia, Spain and Grupo de Imaxe Molecular, Instituto de Investigación Sanitarias (IDIS), Santiago de Compostela, 15706, Galicia, Spain
| | - Miguel Pombar
- Servicio de Radiofísica y Protección Radiológica, Complexo Hospitalario Universitario de Santiago de Compostela, 15706, Galicia, Spain
| | - Alvaro Ruibal
- Servicio de Medicina Nuclear, Complexo Hospitalario Universidade de Santiago de Compostela (USC), 15782, Galicia, Spain; Grupo de Imaxe Molecular, Instituto de Investigación Sanitarias (IDIS), Santiago de Compostela, 15706, Galicia, Spain; and Fundación Tejerina, 28003, Madrid, Spain
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17
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Fürst S, Souvatzoglou M, Martinez-Möller A, Schwaiger M, Nekolla SG, Ziegler SI. Impact of flexible body surface coil and patient table on PET quantification and image quality in integrated PET/MR. Nuklearmedizin 2014; 53:79-87. [PMID: 24658368 DOI: 10.3413/nukmed-0608-13-07] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 12/03/2013] [Indexed: 01/26/2023]
Abstract
AIM The surface coils of the Biograph mMR integrated PET/MR system were optimised for PET, but are otherwise unaccounted for. The patient table is still more massive than those of PET/CT devices. The goal was to assess those hardware effects on quantification, count statistics, image quality and scan time both with phantoms and in patients and to investigate their clinical relevance. PATIENTS, MATERIAL, METHODS PET phantom data were acquired with and without the patient table. Image noise was expressed as relative standard deviation and compared to a state-of-the-art PET/CT scanner. Protocols of the phantom/patient study regarding the surface coils were similar. Thoraces/abdomens of 11 patients were scanned with and without a coil (1 BP, 4 min). Mean uptake and standard deviation in a cubical VOI were derived and expressed as SUV. RESULTS The patient table reduced the number of true coincidences (trues) by 19% (PET/MR) and by 11% (PET/CT). The scan duration for the mMR had to be increased by approximately 30% to achieve a noise level comparable to that of the PET/CT. Decreased SUVs with coil observed in the phantom were confirmed by the patient study. By removing the coil, the mean liver SUV increased by (6 ± 2)%. With (+3 ± 14)%, the average change was similar in lesions, but exceeded 20% in almost one fifth of them. The number of trues grew by (6 ± 1)% for the patients and by 7% for the phantom. CONCLUSION Due to the additional attenuation caused by MR hardware, PET scan durations would have to be increased compared to current PET/CTs to provide similar image noise levels. The effect of the coils is mostly in the order of statistical fluctuations. In tumour lesions, it is more pronounced and shows a larger variability. Therefore, coils should be included in the attenuation correction to ensure accurate quantification and thus comparability across PET/MR and PET/CT scanners and within patient populations.
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Affiliation(s)
- S Fürst
- Sebastian Fürst, Dipl.-Phys., Department of Nuclear Medicine, Technische Universität München, Ismaninger Str. 22, 81675 München, Germany Tel. +49/(0)89/41 40 45 72, Fax +49/(0)89/41 40 49 38, E-mail:
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18
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Burger IA, Vargas HA, Apte A, Beattie BJ, Humm JL, Gonen M, Larson SM, Ross Schmidtlein C. PET quantification with a histogram derived total activity metric: superior quantitative consistency compared to total lesion glycolysis with absolute or relative SUV thresholds in phantoms and lung cancer patients. Nucl Med Biol 2014; 41:410-8. [PMID: 24666719 DOI: 10.1016/j.nucmedbio.2014.02.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 02/13/2014] [Accepted: 02/20/2014] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The increasing use of molecular imaging probes as biomarkers in oncology emphasizes the need for robust and stable methods for quantifying tracer uptake in PET imaging. The primary motivation for this research was to find an accurate method to quantify the total tumor uptake. Therefore we developed a histogram-based method to calculate the background subtracted lesion (BSL) activity and validated BSL by comparing the quantitative consistency with the total lesion glycolysis (TLG) in phantom and patient studies. METHODS A thorax phantom and a PET-ACR quality assurance phantom were scanned with increasing FDG concentrations. Volumes of interest (VOIs) were placed over each chamber. TLG was calculated with a fixed threshold at SUV 2.5 (TLG2.5) and a relative threshold at 42% of SUVmax (TLG42%). The histogram for each VOI was built and BSL was calculated. Comparison with the total injected FDG activity (TIA) was performed using concordance correlation coefficients (CCC) and the slope (a). Fifty consecutive patients with FDG-avid lung tumors were selected under an IRB waiver. TLG42%, TLG2.5 and BSL were compared to the reference standard calculating CCC and the slope. RESULTS In both phantoms, the CCC for lesions with a TIA ≤50ml*SUV between TIA and BSL was higher and the slope closer to 1 (CCC=0.933, a=1.189), than for TLG42% (CCC=0.350, a=0.731) or TLG2.5 (CCC=0.761, a=0.727). In 50 lung lesions BSL had a slope closer to 1 compared to the reference activity than TLG42% (a=1.084 vs 0.618 - for high activity lesions) and also closer to 1 than TLG2.5 (a=1.117 vs 0.548 - for low activity lesions). CONCLUSION The histogram based BSL correlated better with TIA in both phantom studies than TLG2.5 or TLG42%. Also in lung tumors, the BSL activity is overall more accurate in quantifying the lesion activity compared to the two most commonly applied TLG quantification methods.
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Affiliation(s)
- Irene A Burger
- Department of Radiology and Nuclear Medicine, University Hospital Zurich, Ramistrasse 100, 8091 Zurich, Switzerland.
| | - Hebert Alberto Vargas
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Aditya Apte
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Bradley J Beattie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - John L Humm
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Mithat Gonen
- Department of Epidemiology-Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - Steven M Larson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
| | - C Ross Schmidtlein
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065
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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: 6] [Impact Index Per Article: 0.6] [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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Bai B, Bading J, Conti PS. Tumor quantification in clinical positron emission tomography. Am J Cancer Res 2013; 3:787-801. [PMID: 24312151 PMCID: PMC3840412 DOI: 10.7150/thno.5629] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 02/11/2013] [Indexed: 12/18/2022] Open
Abstract
Positron emission tomography (PET) is used extensively in clinical oncology for tumor detection, staging and therapy response assessment. Quantitative measurements of tumor uptake, usually in the form of standardized uptake values (SUVs), have enhanced or replaced qualitative interpretation. In this paper we review the current status of tumor quantification methods and their applications to clinical oncology. Factors that impede quantitative assessment and limit its accuracy and reproducibility are summarized, with special emphasis on SUV analysis. We describe current efforts to improve the accuracy of tumor uptake measurements, characterize overall metabolic tumor burden and heterogeneity of tumor uptake, and account for the effects of image noise. We also summarize recent developments in PET instrumentation and image reconstruction and their impact on tumor quantification. Finally, we offer our assessment of the current development needs in PET tumor quantification, including practical techniques for fully quantitative, pharmacokinetic measurements.
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Lodge MA, Chaudhry MA, Wahl RL. Noise considerations for PET quantification using maximum and peak standardized uptake value. J Nucl Med 2012; 53:1041-7. [PMID: 22627001 DOI: 10.2967/jnumed.111.101733] [Citation(s) in RCA: 171] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
UNLABELLED In tumor response monitoring studies with (18)F-FDG PET, maximum standardized uptake value (SUV(max)) is commonly applied as a quantitative metric. Although it has several advantages due to its simplicity of determination, concerns about the influence of image noise on single-pixel SUV(max) persist. In this study, we measured aspects of bias and reproducibility associated with SUV(max) and the closely related peak SUV (SUV(peak)) using real patient data to provide a realistic noise context. METHODS List-mode 3-dimensional PET data were acquired for 15 min over a single bed position in twenty (18)F-FDG oncology patients. For each patient, data were sorted so as to form 2 sets of images: respiration-gated images such that each image had statistical quality comparable to a 3 min/bed position scan, and 5 statistically independent (ungated) images of different durations (1, 2, 3, 4, and 5 min). Tumor SUV(max) and SUV(peak) (12-mm-diameter spheric region of interest positioned so as to maximize the enclosed average) were analyzed in terms of reproducibility and bias. The component of reproducibility due to statistical noise (independent of physiologic and other variables) was measured using paired SUVs from 2 comparable respiration-gated images. Bias was measured as a function of scan duration. RESULTS Replicate tumor SUV measurements had a within-patient SD of 5.6% ± 0.9% for SUV(max) and 2.5% ± 0.4% for SUV(peak). SUV(max) had average positive biases of 30%, 18%, 12%, 4%, and 5% for the 1-, 2-, 3-, 4-, and 5-min images, respectively. SUV(peak) was also biased but to a lesser extent: 11%, 8%, 5%, 1%, and 4% for the 1-, 2-, 3-, 4-, and 5-min images, respectively. CONCLUSION The advantages of SUV(max) are best exploited when PET images have a high statistical quality. For images with noise properties typically associated with clinical whole-body studies, SUV(peak) provides a slightly more robust alternative for assessing the most metabolically active region of tumor.
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Affiliation(s)
- Martin A Lodge
- Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Samarin A, Burger C, Wollenweber SD, Crook DW, Burger IA, Schmid DT, von Schulthess GK, Kuhn FP. PET/MR imaging of bone lesions--implications for PET quantification from imperfect attenuation correction. Eur J Nucl Med Mol Imaging 2012; 39:1154-60. [PMID: 22526955 DOI: 10.1007/s00259-012-2113-0] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/11/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE Accurate attenuation correction (AC) is essential for quantitative analysis of PET tracer distribution. In MR, the lack of cortical bone signal makes bone segmentation difficult and may require implementation of special sequences. The purpose of this study was to evaluate the need for accurate bone segmentation in MR-based AC for whole-body PET/MR imaging. METHODS In 22 patients undergoing sequential PET/CT and 3-T MR imaging, modified CT AC maps were produced by replacing pixels with values of >100 HU, representing mostly bone structures, by pixels with a constant value of 36 HU corresponding to soft tissue, thereby simulating current MR-derived AC maps. A total of 141 FDG-positive osseous lesions and 50 soft-tissue lesions adjacent to bones were evaluated. The mean standardized uptake value (SUVmean) was measured in each lesion in PET images reconstructed once using the standard AC maps and once using the modified AC maps. Subsequently, the errors in lesion tracer uptake for the modified PET images were calculated using the standard PET image as a reference. RESULTS Substitution of bone by soft tissue values in AC maps resulted in an underestimation of tracer uptake in osseous and soft tissue lesions adjacent to bones of 11.2 ± 5.4% (range 1.5-30.8%) and 3.2 ± 1.7% (range 0.2-4%), respectively. Analysis of the spine and pelvic osseous lesions revealed a substantial dependence of the error on lesion composition. For predominantly sclerotic spine lesions, the mean underestimation was 15.9 ± 3.4% (range 9.9-23.5%) and for osteolytic spine lesions, 7.2 ± 1.7% (range 4.9-9.3%), respectively. CONCLUSION CT data simulating treating bone as soft tissue as is currently done in MR maps for PET AC leads to a substantial underestimation of tracer uptake in bone lesions and depends on lesion composition, the largest error being seen in sclerotic lesions. Therefore, depiction of cortical bone and other calcified areas in MR AC maps is necessary for accurate quantification of tracer uptake values in PET/MR imaging.
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Affiliation(s)
- Andrei Samarin
- Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland.
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Burger IA, Huser DM, Burger C, von Schulthess GK, Buck A. Repeatability of FDG quantification in tumor imaging: averaged SUVs are superior to SUVmax. Nucl Med Biol 2012; 39:666-70. [PMID: 22381783 DOI: 10.1016/j.nucmedbio.2011.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 11/15/2011] [Accepted: 11/24/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE Reliable 18F-fluorodeoxyglucose (FDG) uptake quantification is crucial for cancer treatment monitoring. While interobserver variability has been found to be lower for a maximum standard uptake value (SUV)max than for an averaged SUV (SUVmean), the repeatability has not been investigated yet. In this study, we determined the repeatability of SUV values in two sequential measurements 5 min apart. METHODS Positron emission tomography data of malignant chest tumors were acquired dynamically during 45 min in 20 patients. SUV values were derived from the hottest (SUVmax), the mean of the 5 (SUV5) and 10 (SUV10) hottest voxels and the mean of a volume of interest (SUVmean). The repeatability of the SUV measurements was determined as the standard deviation of the difference between the values at 40 and 45 min and represented as Bland-Altman graphs. RESULTS The standard deviation of the difference between the two sequential scans for SUVmax, SUV5, SUV10 and SUVmean was 1.01, 0.53, 0.37 and 0.28. CONCLUSION The repeatability of SUV is markedly increased by deriving the value from multiple voxels. Compared to SUVmax, the variability in SUV measurements is reduced by a factor of 2.7 (2.7=1.01/0.37) if 10 voxels are pooled.
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Affiliation(s)
- Irene A Burger
- Nuclear Medicine, Radiology Department, University Hospital Zurich, CH-8091 Zurich, Switzerland.
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