Evaluation of strategies towards harmonization of FDG PET/CT studies in multicentre trials: comparison of scanner validation phantoms and data analysis procedures

  • Nikolaos E. Makris
  • Marc C. Huisman
  • Paul E. Kinahan
  • Adriaan A. Lammertsma
  • Ronald Boellaard
Original Article

Abstract

Purpose

PET quantification based on standardized uptake values (SUV) is hampered by several factors, in particular by variability in PET acquisition settings and data analysis methods. Quantitative PET/CT studies acquired during a multicentre trial require harmonization of imaging procedures to maximize study power. The aims of this study were to determine which phantoms are most suitable for detecting differences in image quality and quantification, and which methods for defining volumes of interest (VOI) are least sensitive to these differences.

Methods

The most common accreditation phantoms used in oncology FDG PET/CT trials were scanned on the same scanner. These phantoms were those used by the Society of Nuclear Medicine Clinical Trials Network (SNM-CTN), the European Association of Nuclear Medicine/National Electrical Manufacturers Association (EANM/NEMA) and the American College of Radiology (ACR). In addition, tumour SUVs were derived from ten oncology whole-body examinations performed on the same PET/CT system. Both phantom and clinical data were reconstructed using different numbers of iterations, subsets and time-of-flight kernel widths. Subsequently, different VOI methods (VOIA50%, VOImax, VOI3Dpeak, VOI2Dpeak) were applied to assess the impact of changes in image reconstruction settings on SUV and recovery coefficients (RC).

Results

All phantoms demonstrated sensitivity for detecting changes in SUV and RC measures in response to changes in image reconstruction settings and VOI analysis methods. The SNM-CTN and EANM/NEMA phantoms showed almost equal sensitivity in detecting RC differences with changes in image characteristics. Phantom and clinical data demonstrated that the VOI analysis methods VOIA50% and VOImax gave SUV and RC values with large variability in relation to image characteristics, whereas VOI3Dpeak and VOI2Dpeak were less sensitive to these differences.

Conclusion

All three phantoms may be used to harmonize parameters for data acquisition, processing and analysis. However, the SNM-CTN and EANM/NEMA phantoms are the most sensitive to parameter changes and are suitable for harmonizing SUV quantification based on 3D VOIs, such as VOIA50% and VOI3Dpeak, and VOImax. Variability in SUV quantification after harmonization could be further minimized using VOI3Dpeak analysis, which was least sensitive to residual variability in image quality and quantification.

Keywords

PET/CT Quantification Standardization Harmonization Accreditation 

References

  1. 1.
    Gupta T, Master Z, Kannan S, Agarwal JP, Ghsoh-Laskar S, Rangarajan V, et al. Diagnostic performance of post-treatment FDG PET or FDG PET/CT imaging in head and neck cancer: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2011;38:2083–95.PubMedCrossRefGoogle Scholar
  2. 2.
    Ung YC, Maziak DE, Vanderveen JA, Smith CA, Gulenchyn K, Lacchetti C, et al. 18Fluorodeoxyglucose positron emission tomography in the diagnosis and staging of lung cancer: a systematic review. J Natl Cancer Inst. 2007;99:1753–67.PubMedCrossRefGoogle Scholar
  3. 3.
    Hicks RJ. Role of 18F-FDG PET in assessment of response in non-small cell lung cancer. J Nucl Med. 2009;50 Suppl 1:31S–42S.PubMedCrossRefGoogle Scholar
  4. 4.
    Czernin J, Weber WA, Herschman HR. Molecular imaging in the development of cancer therapeutics. Annu Rev Med. 2006;57:99–118.PubMedCrossRefGoogle Scholar
  5. 5.
    Frank R, Hargreaves R. Clinical biomarkers in drug discovery and development. Nat Rev Drug Discov. 2003;2:566–80.PubMedCrossRefGoogle Scholar
  6. 6.
    Weber WA. Assessing tumor response to therapy. J Nucl Med. 2009;50 Suppl 1:1S–10S.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber WA, Petersen V, Schmidt B, Tyndale-Hines L, Link T, Peschel C, et al. Positron emission tomography in non-small-cell lung cancer: prediction of response to chemotherapy by quantitative assessment of glucose use. J Clin Oncol. 2003;21:2651–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Stroobants S, Goeminne J, Seegers M, Dimitrijevic S, Dupont P, Nuyts J, et al. 18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Glivec). Eur J Cancer. 2003;39:2012–20.PubMedCrossRefGoogle Scholar
  9. 9.
    Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med. 2004;45:1431–4.PubMedGoogle Scholar
  10. 10.
    Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. AJR Am J Roentgenol. 2010;195:310–20.PubMedCrossRefGoogle Scholar
  11. 11.
    Boellaard R. Standards for PET image acquisition and quantitative data analysis. J Nucl Med. 2009;50 Suppl 1:11S–20S.PubMedCrossRefGoogle Scholar
  12. 12.
    Kinahan PE, Fletcher JW. Positron emission tomography-computed tomography standardized uptake values in clinical practice and assessing response to therapy. Semin Ultrasound CT MR. 2010;31:496–505.PubMedCrossRefGoogle Scholar
  13. 13.
    Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.PubMedGoogle Scholar
  14. 14.
    Fahey FH, Kinahan PE, Doot RK, Kocak M, Thurston H, Poussaint TY. Variability in PET quantitation within a multicenter consortium. Med Phys. 2010;37:3660–6.PubMedCrossRefGoogle Scholar
  15. 15.
    Beyer T, Czernin J, Freudenberg LS. Variations in clinical PET/CT operations: results of an international survey of active PET/CT users. J Nucl Med. 2011;52:303–10.PubMedCrossRefGoogle Scholar
  16. 16.
    Graham MM, Badawi RD, Wahl RL. Variations in PET/CT methodology for oncologic imaging at U.S. academic medical centers: an imaging response assessment team survey. J Nucl Med. 2011;52:311–7.PubMedCrossRefGoogle Scholar
  17. 17.
    Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM, Lonsdale MN, Stroobants SG, et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2010;37:181–200.PubMedCrossRefGoogle Scholar
  18. 18.
    Kelly MD, Declerck JM. SUVref: reducing reconstruction-dependent variation in PET SUV. EJNMMI Res. 2011;1:16.PubMedCrossRefGoogle Scholar
  19. 19.
    National Electrical Manufacturers Association. NEMA standards publication NU 2-2001: performance measurements of positron emission tomographs. Rosslyn: National Electrical Manufacturers Association; 2001.Google Scholar
  20. 20.
    American Association of Physicists in Medicine. PET phantom instructions for evaluation of PET image quality. http://www.aapm.org/meetings/amos2/pdf/49-14437-10688-860.pdf. College Park, MD: American Association of Physicists in Medicine; 2012. Accessed 24 May 2013
  21. 21.
    Surti S, Kuhn A, Werner ME, Perkins AE, Kolthammer J, Karp JS. Performance of Philips Gemini TF PET/CT scanner with special consideration for its time-of-flight imaging capabilities. J Nucl Med. 2007;48:471–80.PubMedGoogle Scholar
  22. 22.
    Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria in solid tumors. J Nucl Med. 2009;50 Suppl 1:122S–50S.PubMedCrossRefGoogle Scholar
  23. 23.
    Cheebsumon P, Yaqub M, van Velden FH, Hoekstra OS, Lammertsma AA, Boellaard R. Impact of [18F]FDG PET imaging parameters on automatic tumour delineation: need for improved tumour delineation methodology. Eur J Nucl Med Mol Imaging. 2011;38:2136–44.PubMedCrossRefGoogle Scholar
  24. 24.
    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.PubMedCrossRefGoogle Scholar
  25. 25.
    Doot RK, Scheuermann JS, Christian PE, Karp JS, Kinahan PE. Instrumentation factors affecting variance and bias of quantifying tracer uptake with PET/CT. Med Phys. 2010;37:6035–46.PubMedCrossRefGoogle Scholar
  26. 26.
    Vanderhoek M, Perlman SB, Jeraj R. Impact of the definition of peak standardized uptake value on quantification of treatment response. J Nucl Med. 2012;53:4–11.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Nikolaos E. Makris
    • 1
  • Marc C. Huisman
    • 1
  • Paul E. Kinahan
    • 2
  • Adriaan A. Lammertsma
    • 1
  • Ronald Boellaard
    • 1
  1. 1.Department of Radiology & Nuclear MedicineVU University Medical CentreAmsterdamThe Netherlands
  2. 2.Imaging Research Laboratory, Department of RadiologyUniversity of WashingtonSeattleUSA

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