scholarly journals FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0

2009 ◽  
Vol 37 (1) ◽  
pp. 181-200 ◽  
Author(s):  
Ronald Boellaard ◽  
Mike J. O’Doherty ◽  
Wolfgang A. Weber ◽  
Felix M. Mottaghy ◽  
Markus N. Lonsdale ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Fdg Pet ◽  
Procedure Guidelines ◽  
Pet Ct

scholarly journals Automated quantification of baseline imaging PET metrics on FDG PET/CT images of pediatric Hodgkin lymphoma patients

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Amy J. Weisman ◽  
Jihyun Kim ◽  
Inki Lee ◽  
Kathleen M. McCarten ◽  
Sandy Kessel ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Correlation Coefficient ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Relative Difference ◽  
Ct Images ◽  
Imaging Features ◽  
Pediatric Hodgkin Lymphoma ◽  
Pet Ct ◽  
Fdg Pet Ct

Abstract Purpose For pediatric lymphoma, quantitative FDG PET/CT imaging features such as metabolic tumor volume (MTV) are important for prognosis and risk stratification strategies. However, feature extraction is difficult and time-consuming in cases of high disease burden. The purpose of this study was to fully automate the measurement of PET imaging features in PET/CT images of pediatric lymphoma. Methods 18F-FDG PET/CT baseline images of 100 pediatric Hodgkin lymphoma patients were retrospectively analyzed. Two nuclear medicine physicians identified and segmented FDG avid disease using PET thresholding methods. Both PET and CT images were used as inputs to a three-dimensional patch-based, multi-resolution pathway convolutional neural network architecture, DeepMedic. The model was trained to replicate physician segmentations using an ensemble of three networks trained with 5-fold cross-validation. The maximum SUV (SUVmax), MTV, total lesion glycolysis (TLG), surface-area-to-volume ratio (SA/MTV), and a measure of disease spread (Dmaxpatient) were extracted from the model output. Pearson’s correlation coefficient and relative percent differences were calculated between automated and physician-extracted features. Results Median Dice similarity coefficient of patient contours between automated and physician contours was 0.86 (IQR 0.78–0.91). Automated SUVmax values matched exactly the physician determined values in 81/100 cases, with Pearson’s correlation coefficient (R) of 0.95. Automated MTV was strongly correlated with physician MTV (R = 0.88), though it was slightly underestimated with a median (IQR) relative difference of − 4.3% (− 10.0–5.7%). Agreement of TLG was excellent (R = 0.94), with median (IQR) relative difference of − 0.4% (− 5.2–7.0%). Median relative percent differences were 6.8% (R = 0.91; IQR 1.6–4.3%) for SA/MTV, and 4.5% (R = 0.51; IQR − 7.5–40.9%) for Dmaxpatient, which was the most difficult feature to quantify automatically. Conclusions An automated method using an ensemble of multi-resolution pathway 3D CNNs was able to quantify PET imaging features of lymphoma on baseline FDG PET/CT images with excellent agreement to reference physician PET segmentation. Automated methods with faster throughput for PET quantitation, such as MTV and TLG, show promise in more accessible clinical and research applications.

Validation of the International Harmonization Project (IHP) Guidelines in Early Stage Hodgkin Lymphoma (HL) Treated with Adriamycin, Vinblastine and Gemcitabine (AVG) (CALGB 50203): Early Results.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 1460-1460
Author(s):  
Lale Kostakoglu ◽  
David J. Straus ◽  
Heiko Schöder ◽  
Ann S. LaCasce ◽  
Nancy L Bartlett ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Fdg Pet ◽  
Early Stage ◽  
International Workshop ◽  
Response Evaluation ◽  
Treatment Change ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Early Results ◽  
Pet Ct

Abstract Clinical trials are underway using FDG PET imaging as a response surrogate for risk-adapted treatments to achieve favorable long term outcome while reducing therapy-related toxicities in patients with HL. The IHP provided “guidelines” to standardize FDG PET-based response evaluation. Before implementation in clinical practice, further validation of these guidelines is necessary. Our objective was to validate IHP criteria for response evaluation after 2 cycles of therapy with prospectively collected data in CALGB 50203, a trial of AVG for the initial treatment of stages I and II non-bulky HL. IHP-based PET interpretation was also compared with CT-based lesion size changes. Methods: Treatment consisted of doxorubicin 25 mg/m2, vinblastine 6 mg/m2 and gemcitabine 800mg/m2 every 2 weeks for 12 treatments (6 cycles). Responses were assessed according to the International Workshop criteria (JCO1999:17: 1244–53). FDG-PET imaging (PET/CT: 60 pts, PET alone: 15 pts) and a separate dedicated diagnostic CT scan of involved sites was performed at baseline and after two cycles of AVG (PET-2). No treatment change was allowed on the basis of the PET-2 results. Of 99 assessable patients, 75 had PET-alone (14) or PET/CT (61) after 2 cycles; median age:34 yrs (18–80), 32% were ≥45 yrs, stages: 78% IA-IIA, 22% IIB. The primary interpretation of PET-2 studies was based on IHP criteria (JCO2007;25:571). The % change in the sum of the products of the diameter (%SPD) of all measurable lesions were compared between baseline and at cycle-2 CT. PET-2 and cycle-2 CT data were correlated with progression free survival (PFS). Results: Fifty-six patients (75%) achieved a CR/CRu, 21% a partial response (PR), 4% had stable disease (SD). After a median follow up of 2.1 yrs (1.2–3.4 years), 19 of 75 patients relapsed/progressed, with an estimated 2-year PFS of 0.87 (95% CI [0.74,0.94]Only 10 of 56 patients (18%) with CR/CRu were PET positive at PET-2 compared to 13/19 (68%) of those with SD or PR (p<0.0001). Twelve of 23 (52%) PET-2 positive patients relapsed compared to 7 of 52 (13.5%) who were PET-2 negative. The 2-yr probability of PFS was 0.87, [95% CI (0.74,0.94)] among PET-2 negative patients vs. 0.47 [95% CI (0.26,0.66)] in those who were PET-2 positive, p=0.0001. In an exclusive analysis of PET/CT scans, the 2-yr probability of PFS was 0.90, [95% CI (0.75,0.96)] among PET-2 negative patients vs. 0.35 [95% CI (0.13,0.59)] in those who were PET-2 positive, p<0.0001. The best PFS cut-point for %SPD change at cycle-2 was 70%. After cycle-2, PET-negative patients had a higher %SPD change compared to PET-positive patients (74.5% vs. 64.5%, p=0.003). Adjusted for baseline SPD, patients with <70% change were at 5.3 times higher risk of relapse. The 2-yr probability of PFS was 0.89, [95% CI (0.73,0.95)] among patients with > 70% change vs. 0.55 [95% CI (0.36,0.71)] in those with < 70% change, p=0.003. Conclusion: IHP-based interpretation of FDG PET after 2 cycles of chemotherapy yields a high correlation with 2-year PFS, in particular for combined PET/CT, thus, it could be used as a response surrogate for risk-adapted treatments. The prediction of PFS using FDG-PET is superior to %SPD change after 2 cycles of therapy. Ongoing studies will prospectively define the role of interim FDG PET in tailoring treatment to optimize benefits and minimize risks.

FDG PET/CT (FDG PET) in evaluation of response in patients with multiple myeloma (MM) treated with bortezomib, pegylated liposomal doxorubicin, and dexamethasone

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 8533-8533
Author(s):  
N. Pandit-Taskar ◽  
R. L. Comenzo ◽  
H. Hassoun ◽  
E. Hoover ◽  
S. Borkar ◽  
...  
Keyword(s):  
High Risk ◽  
Soft Tissue ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Liposomal Doxorubicin ◽  
Therapeutic Response ◽  
Pegylated Liposomal Doxorubicin ◽  
Newly Diagnosed ◽  
Disease Response ◽  
Pet Ct

8533 Background: In a high risk population of pts with newly diagnosed or primary refractory MM, we prospectively studied FDG PET imaging to determine the value of PET/CT in assessing therapeutic response. Methods: Forty pts with high-risk MM defined as ISS II, ISS III or presence of extramedullary plasmacytoma have been enrolled on study and treated using a combination of bortezomib, pegylated liposomal doxorubicin hydrochloride (Doxil), and dexamethasone (BDD) for 3 cycles followed by 2 cycles of thalidomide and dexamethasone for patients achieving at least PR. Pts were assessed using serial FDG PET imaging: at baseline (BL), after 3 cycles of BDD and at end of study (EOS). FDG PET response was determined using European Organization for research and treatment of cancer (EORTC) recommendations. MM disease response was assessed according to the International Myeloma Working Group (IMWG) criteria. Results: Median age of pts enrolled was 59 yrs (range 41–80), 62% male, 38% ISS II, 47% ISS III, and 15% ISS I with soft-tissue disease. Thirty-five percent (14/40) had soft-tissue involvement with MM. At completion of protocol therapy, the ORR was 79%, with 44% of pts achieving CR/nCR and 59% ≥ VGPR. Ninety FDG PET scans were performed in 40 pts; 25 pts were evaluable for FDG PET response. The other pts are as follows: 2 had negative FDG PET at BL, 6 were taken off study (5 for toxicity and 1 with CR), 1 FDG PET was unable to be compared due to technical differences and 6 pts have not completed treatment. Seventeen of the 25 pts had PR by FDG PET, 5 had SD and 3 PD; none of the pts had CR. There was little agreement between MM disease response and FDG PET responses (Kappa statistic, 0.05). Three pts with PD by FDG PET, had PR (n=2) or CR (n=1) by IMWG criteria. One had granulomatous disease rather than MM at biopsy. In 1 pt with progression of disease with a progressive skull-based plasmacytoma, FDG PET was scored as PR by EORTC criteria. Conclusions: There was poor agreement between FDG PET response and MM disease response by IMWG criteria. Serial FDG PET did not provide additional information for therapeutic response assessment in pts with newly diagnosed or primary refractory MM. [Table: see text]

scholarly journals Clinically feasible semi-automatic workflows for measuring metabolically active tumour volume in metastatic melanoma

2020 ◽  
Author(s):  
Joyce van Sluis ◽  
Ellen C. de Heer ◽  
Mayke Boellaard ◽  
Mathilde Jalving ◽  
Adrienne H. Brouwers ◽  
...  
Keyword(s):  
Overall Survival ◽  
Metastatic Melanoma ◽  
Pet Imaging ◽  
Fdg Pet ◽  
Tumour Volume ◽  
Imaging Biomarker ◽  
Manual Segmentation ◽  
Pet Ct ◽  
Segmentation Methods ◽  
Automatic Methods

Abstract Purpose Metabolically active tumour volume (MATV) is a potential quantitative positron emission tomography (PET) imaging biomarker in melanoma. Accumulating data indicate that low MATV may predict increased chance of response to immunotherapy and overall survival. However, metastatic melanoma can present with numerous (small) tumour lesions, making manual tumour segmentation time-consuming. The aim of this study was to evaluate multiple semi-automatic segmentation workflows to determine reliability and reproducibility of MATV measurements in patients with metastatic melanoma. Methods An existing cohort of 64 adult patients with histologically proven metastatic melanoma was used in this study. 18F-FDG PET/CT diagnostic baseline images were acquired using a European Association of Nuclear Medicine (EANM) Research Limited–accredited Siemens Biograph mCT PET/CT system (Siemens Healthineers, Knoxville, USA). PET data were analysed using manual, gradient-based segmentation and five different semi-automatic methods: three direct PET image–derived delineations (41MAX, A50P and SUV40) and two based on a majority-vote approach (MV2 and MV3), without and with (suffix ‘+’) manual lesion addition. Correlation between the different segmentation methods and their respective associations with overall survival was assessed. Results Correlation between the MATVs derived by the manual segmentation and semi-automated tumour segmentations ranged from R2 = 0.41 for A50P to R2 = 0.85 for SUV40+ and MV2+, respectively. Manual MATV segmentation did not differ significantly from the semi-automatic methods SUV40 (∆MATV mean ± SD 0.08 ± 0.60 mL, P = 0.303), SUV40+ (∆MATV − 0.10 ± 0.51 mL, P = 0.126), MV2+ (∆MATV − 0.09 ± 0.62 mL, P = 0.252) and MV3+ (∆MATV − 0.03 ± 0.55 mL, P = 0.615). Log-rank tests showed statistically significant overall survival differences between above and below median MATV patients for all segmentation methods with areas under the ROC curves of 0.806 for manual segmentation and between 0.756 [41MAX] and 0.807 [MV3+] for semi-automatic segmentations. Conclusions Simple and fast semi-automated FDG PET segmentation workflows yield accurate and reproducible MATV measurements that correlate well with manual segmentation in metastatic melanoma. The most readily applicable and user-friendly SUV40 method allows feasible MATV measurement in prospective multicentre studies required for validation of this potential PET imaging biomarker for clinical use.

Marked Improvement in Detecting the Number of Involved Nodal Areas in Lymphoma, Using 18 F- FDG - PET and CT Scan.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 1344-1344
Author(s):  
Juan Chalapud ◽  
Pedro Sobrevilla-Calvo ◽  
Silvia Rivas-Vera ◽  
Javier Altamirano-Levy
Keyword(s):  
Pet Imaging ◽  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
Cell Lymphoma ◽  
International Prognostic Index ◽  
Tertiary Care ◽  
Prognostic Index ◽  
Hodgkin's Lymphoma ◽  
Pet Scanning ◽  
Pet Ct

Abstract Positron emission tomography (PET) imaging with 18-fluoro-2-deoxiglucose (FDG) is used increasingly for the initial evaluation and staging of patients with Hodgkin’s lymphoma (HL) and non- Hodgkin’s lymphoma (NHL). However, the degree of concordance of PET and TAC scanning for each nodal and extra nodal site are not well defined. The number of nodal areas involved is a new prognostic factor in follicular lymphomas as was demonstrated in the Follicular Lymphoma (FL) International prognostic index (FLIPI), and their use may be useful for the LNH and HL. In this study, we examined the performance of CT versus FDG-PET scanning, comparing each one of the nodal and extra nodal areas, as it is described in the FLIPI, in a retrospective cohort of lymphoma patients (pts) with HL and NHL. We reviewed the charts of 56 patients with diagnosis of HL and NHL in the initial and relapse staging, in a single tertiary care center. All patients had FDG-PET imaging study, clinical examination and CT scans. The Ann Arbor stage, each nodal site (cervical, mediastinal, axillary, mesenteric, para aortic, inguinal), and extra nodal sites were evaluated on the basis of FDG-PET scanning and were compared with the findings derived from CT. Bone marrow biopsy results were excluded from this initial analysis. The histopathological diagnoses included diffuse large B-cell Lymphomas in 20/56 pts (36%), HL 15/56 pts (27%), anaplastic large cell lymphoma 8/56 pts (14%), FL 5/56 pts (9%), peripheral T-cell Lymphoma 4/56 (7%) and others 7%. Among the 56 pts, 22 (39%) had discordant results between FDG-PET scanning and CT scanning, that lead to a change in stage assignment. Among the discordant cases FDG-PET resulted in upstaging in 18/56 pts (32%), and down staging in 4/56 pts (7%). Forty for pts (79%) had discordant results in the number of nodal areas, among the discordant cases FDG-PET detected more nodal areas in 36/56 pts (64%) and CT in 8/56 pts (14%). The discordant cases were distributed as it is shown in the table. In conclusion Pet and CT in combination detects more involved nodal areas than each method by itself. Summary of PET/CT correlation with nodal areas Nodal areas Cervical(n) Axillar (n) Mediastinal(n) Paraaortic(n) Inguinal (n) positive total 40 26 26 24 17 Only Positive FDG-PET 16 12 13 7 11 Only Positive CT 7 3 2 2 1 Positive FGD-PET + CT 17 11 11 15 5

Use of FDG-PET Imaging for Patients with Disseminated Cancer of the Appendix

2010 ◽  
Vol 76 (12) ◽  
pp. 1338-1344 ◽  
Author(s):  
Payam Rohani ◽  
Stephen D. Scotti ◽  
Perry Shen ◽  
John H. Stewart ◽  
Gregory B. Russell ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Fdg Pet ◽  
Peritoneal Dissemination ◽  
Low Grade ◽  
High Grade ◽  
Positron Emission ◽  
Pet Ct ◽  
The Mean ◽  
Ct Data ◽  
Abdominal Quadrant

The goal of this study is to evaluate the use of positron emission tomography (PET) in evaluation of patients with peritoneal dissemination of carcinoma of appendiceal origin (PDA). Thirty-three patients with PDA, who had preoperative PET or PET/CT imaging, were analyzed. Using operative, pathology, and PET ± CT data, presence or absence of disease in each abdominal quadrant was noted and the use of 18fluoro-deoxy-glucose (FDG) PET for each quadrant was evaluated. The mean age was 52, and there were 17 males; 58 per cent had low-grade lesions. PET was positive in only 35 per cent of cases overall (30 and 41% sensitivity for low-grade and high-grade, respectively). PET without CT sensitivity for low-grade and high-grade lesions was 21 and 8 per cent, respectively. PET imaging has limited use for patients with PDA. We do not recommend the use of FDG-PET for patients with PDA from cancer of the appendix.

scholarly journals FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0

2014 ◽  
Vol 42 (2) ◽  
pp. 328-354 ◽  
Author(s):  
Ronald Boellaard ◽  
Roberto Delgado-Bolton ◽  
Wim J. G. Oyen ◽  
Francesco Giammarile ◽  
Klaus Tatsch ◽  
...  
Keyword(s):  
Fdg Pet ◽  
Quantitative Imaging ◽  
Image Interpretation ◽  
Tumour Response ◽  
Imaging Biomarker ◽  
Imaging Biomarkers ◽  
Procedure Guidelines ◽  
Pet Ct ◽  
Repeatability And Reproducibility ◽  
Fdg Pet Ct

Abstract The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.

scholarly journals Prediction of the aggressiveness of non-functional pancreatic neuroendocrine tumors based on the dual-tracer PET/CT

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Susanna Majala ◽  
Hanna Seppänen ◽  
Jukka Kemppainen ◽  
Jari Sundström ◽  
Camilla Schalin-Jäntti ◽  
...  
Keyword(s):  
Pet Imaging ◽  
Fdg Pet ◽  
Tumor Grade ◽  
Pancreatic Neuroendocrine Tumors ◽  
Ki 67 ◽  
Pet Ct ◽  
Well Differentiated ◽  
Fdg Pet Ct ◽  
Dual Tracer

Abstract Background Predicting the aggressive behavior of non-functional pancreatic neuroendocrine tumors (NF-PNET) remains controversial. We wanted to explore, in a prospective setting, whether the diagnostic accuracy can be improved by dual-tracer functional imaging 68Ga-DOTANOC and 18F-FDG-PET/CT in patients with NF-PNETs. Methods Thirty-one patients with NF-PNET (90% asymptomatic) underwent PET-imaging with 18F-FDG and 68Ga-DOTANOC, followed by surgery (n = 20), an endoscopic ultrasonography and fine-needle biopsy (n = 2) or follow-up (n = 9). A focal activity on PET/CT greater than the background that could not be identified as physiological activity was considered to indicate tumor tissue. The imaging results were compared to histopathology. The mean follow-up time was 31.3 months. Results Thirty-one patients presented a total of 53 lesions (40 histologically confirmed) on PET/CT. Thirty patients had a 68Ga-DOTANOC-positive tumor (sensitivity 97%) and 10 patients had an 18F-FDG-positive tumor. In addition, one 68Ga-DOTANOC-negative patient was 18F-FDG-positive. 18F-FDG-PET/CT was positive in 19% (3/16) of the G1 tumors, 63% (5/8) of the G2 tumors and 1/1 of the well-differentiated G3 tumor. 68Ga-DOTANOC-PET/CT was positive in 94% of the G1 tumors, 100% of the G2 tumors and 1/1 of the well-differentiated G3 tumor. Two out of six (33%) of the patients with lymph node metastases (LN+) were 18F-FDG-positive. The 18F-FDG-PET/CT correlated with tumor Ki-67 (P = 0.021). Further, the Krenning score correlated with tumor Ki-67 (P = 0.013). 18F-FDG-positive tumors were significantly larger than the 18F-FDG-negative tumors (P = 0.012). 18F-FDG-PET/CT showed a positive predictive value of 78% in the detection of potentially aggressive tumors (G2, G3, or LN + PNETs); the negative predictive value was 69%. Conclusions 18F-FDG-PET/CT is useful to predict tumor grade but not the LN+ of NF-PNETs. Patients with 18F-FDG-avid NF-PNETs should be referred for surgery. The 68Ga-DOTANOC-PET/CT also has prognostic value since the Krenning score predicts the histopathological tumor grade. Trial registration The study has been registered at ClinicalTrials.gov; Non-functional Pancreatic NET and PET imaging, NCT02621541.

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