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Reproducibility of functional volume and activity concentration in 18F-FDG PET/CT of liver metastases in colorectal cancer

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Abstract

Purpose

Several studies showed potential for monitoring response to systemic therapy in metastatic colorectal cancer patients with 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET). Before 18F-FDG PET can be implemented for response evaluation the repeatability should be known. This study was performed to assess the magnitude of the changes in standardized uptake value (SUV), volume and total lesion glycolysis (TLG) in colorectal liver metastases and validate the biological basis of 18F-FDG PET in colorectal liver metastases.

Methods

Twenty patients scheduled for liver metastasectomy underwent two 18F-FDG PET scans within 1 week. Bland-Altman analysis was performed to assess repeatability of SUVmax, SUVmean, volume and TLG. Tumours were delineated using an adaptive threshold method (PETSBR) and a semiautomatic fuzzy locally adaptive Bayesian (FLAB) delineation method.

Results

Coefficient of repeatability of SUVmax and SUVmean were ∼39 and ∼31 %, respectively, independent of the delineation method used and image reconstruction parameters. However, repeatability was worse in recently treated patients. The FLAB delineation method improved the repeatability of the volume and TLG measurements compared to PETSBR, from coefficients of repeatability of over 85 % to 45 % and 57 % for volume and TLG, respectively. Glucose transporter 1 (GLUT1) expression correlated to the SUVmean. Vascularity (CD34 expression) and tumour hypoxia (carbonic anhydrase IX expression) did not correlate with 18F-FDG PET parameters.

Conclusion

In conclusion, repeatability of SUVmean and SUVmax was mainly affected by preceding systemic therapy. The repeatability of tumour volume and TLG could be improved using more advanced and robust delineation approaches such as FLAB, which is recommended when 18F-FDG PET is utilized for volume or TLG measurements. Improvement of repeatability of PET measurements, for instance by dynamic PET scanning protocols, is probably necessary to effectively use PET for early response monitoring.

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Acknowledgment

Supported by a grant from the Dutch Cancer Society (KWF Kankerbestrijding), no. KUN 2008–4098.

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Authors and Affiliations

  1. Department of Medical Oncology 452, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands

    Linda Heijmen & Hanneke W. M. van Laarhoven

  2. Department of Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands

    Lioe-Fee de Geus-Oei, Eric P. Visser & Wim J. G. Oyen

  3. Department of Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands

    Johannes H. W. de Wilt

  4. Department of Radiation Oncology, Radboud University Medical Centre, Nijmegen, The Netherlands

    Johan Bussink

  5. INSERM U1101, LaTIM, Brest, France

    Dimitris Visvikis & Mathieu Hatt

  6. Department of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands

    Cornelis J. A. Punt & Hanneke W. M. van Laarhoven

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  1. Linda Heijmen
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Correspondence to Linda Heijmen.

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Heijmen, L., de Geus-Oei, LF., de Wilt, J.H.W. et al. Reproducibility of functional volume and activity concentration in 18F-FDG PET/CT of liver metastases in colorectal cancer. Eur J Nucl Med Mol Imaging 39, 1858–1867 (2012). https://doi.org/10.1007/s00259-012-2233-6

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  • DOI: https://doi.org/10.1007/s00259-012-2233-6

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