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Test–Retest Repeatability of Patlak Slopes versus Standardized Uptake Values for Hypermetabolic Lesions and Normal Organs in an Oncologic PET/CT Population

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Abstract

Purpose

We aimed to determine the test–retest repeatability of quantitative metrics based on the Patlak slope (PS) versus the standardized uptake value (SUV) among lesions and normal organs on oncologic [18F]FDG-PET/CT.

Procedures

This prospective, single-center study enrolled adults undergoing standard-of-care oncologic [18F]FDG-PET/CTs. Early (35–50 min post-injection) and late (75–90 min post-injection) SUV and PS images were reconstructed from dynamic whole-body PET data. Repeat imaging occurred within 7 days. Relevant quantitative metrics were extracted from lesions and normal organs. Repeatability was assessed via mean test–retest percent changes [T-RT %Δ], within-subject coefficients of variation (wCVs), and intra-class correlation coefficients (ICCs).

Results

Nine subjects (mean age, 61.7 ± 6.2 years; 6 females) completed the test–retest protocol. Four subjects collectively had 17 [18F]FDG-avid lesions. Lesion wCVs were higher (i.e., worse repeatability) for PS-early-max (16.2%) and PS-early-peak (15.6%) than for SUV-early-max (8.9%) and SUV-early-peak (8.1%), with similar early metric ICCs (0.95–0.98). Lesion wCVs were similar for PS-late-max (8.5%) and PS-late-peak (6.4%) relative to SUV-late-max (9.7%) and SUV-late-peak (7.2%), with similar late metric ICCs (0.93–0.98). There was a significant bias toward higher retest SUV and PS values in the lesion analysis (T-RT %Δ [95% CI]: SUV-late-max, 10.0% [2.6%, 17.0%]; PS-late-max, 20.4% [14.3%, 26.4%]) but not in the normal organ analysis.

Conclusions

Among [18F]FDG-avid lesions, the repeatability of PS-based metrics is similar to equivalent SUV-based metrics at late post-injection time points, indicating that PS-based metrics may be suitable for tracking response to oncologic therapies. However, further validation is required in light of our study’s limitations, including small sample size and bias toward higher retest values for some metrics.

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Data Availability

The data supporting the findings of this study, if not already provided in the manuscript or supplemental materials, are available from the corresponding author by reasonable request.

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Acknowledgements

There are no relevant acknowledgements.

Funding

This work was supported by a research grant from Siemens Healthineers to Washington University.

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Authors and Affiliations

  1. Department of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd, Campus Box 8131, St. Louis, MO, 63110, USA

    Semra Ince, Richard Laforest, Richard L. Wahl & Tyler J. Fraum

  2. Siemens Medical Solutions USA, Inc., 810 Innovation Drive, Knoxville, TN, 37932, USA

    Saeed Ashrafinia & Anne M. Smith

  3. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, USA

    Richard L. Wahl

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  1. Semra Ince
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  2. Richard Laforest
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  6. Tyler J. Fraum
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Contributions

S.I. – acquisition, analysis, and interpretation of data; manuscript revision

R.L. – acquisition, analysis, and interpretation of data; manuscript revision

S.A. – conceptualization; manuscript review/feedback

A.M.S. – conceptualization; manuscript review/feedback

R.L.W. – conceptualization; manuscript revision

T.J.F. – conceptualization; acquisition, analysis, and interpretation of data; manuscript drafting

Corresponding author

Correspondence to Tyler J. Fraum.

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Conflict of Interest

This work was supported by a research grant from Siemens Healthineers to Washington University. This grant included salary support for Dr. Fraum. Note that all subjects were imaged on a Siemens Healthineers PET/CT scanner and that two authors (Dr. Ashrafinia, Dr. Smith) are full-time employees of Siemens Medical Solutions USA, Inc. Dr. Ashrafinia and Dr. Smith participated in the initial study design, provided occasional technical support, and critically reviewed the manuscript. However, all data collection/analysis and manuscript drafting was performed exclusively by the authors from Washington University, independent of any individuals affiliated with Siemens.

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Ince, S., Laforest, R., Ashrafinia, S. et al. Test–Retest Repeatability of Patlak Slopes versus Standardized Uptake Values for Hypermetabolic Lesions and Normal Organs in an Oncologic PET/CT Population. Mol Imaging Biol 26, 284–293 (2024). https://doi.org/10.1007/s11307-024-01909-x

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  • DOI: https://doi.org/10.1007/s11307-024-01909-x

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