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Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The standardized added metabolic activity (SAM) is a new marker of total lesion glycolysis that avoids partial volume effect (PVE) and thresholding. SAM is calculated by drawing a volume of interest (VOI1) around the tumour and a larger VOI (VOI2) around VOI1. Subtracting the background activity in VOI2-VOI1 from VOI1 yields SAM. If VOI1 is set at a reasonable distance from the tumour, PVE are avoided. Phantom and initial clinical validation data are presented.

Methods

Spheres of a Jaszczak phantom were filled with a 5.4, 3.64 and 2.0 times higher concentration relative to background activity and positron emission tomography (PET) data were acquired during 10 min. SAM of all spheres was expressed as a percentage of the expected value (the actual activity ratio minus 1). In 15 patients a 10-min list-mode acquisition PET study centred on their primary squamous cell carcinoma (PSCC) was performed and images of 1-10 min reconstructed. SAM1-9min values of PSCC were expressed as a percentage of SAM10min. Nineteen patients suffering from liver metastases treated with chemotherapy underwent PET/CT prior to (scan 1) and after 3–6 cycles of chemotherapy (scan 2). SAM and maximum standardized uptake values (SUVmax) of the liver lesions on scan 1 (SAM1 and SUVmax1) and the percentage reduction between both ΔSAM and ΔSUVmax were related to Response Evaluation Criteria in Solid Tumors (RECIST) response.

Results

For the phantom acquisitions, the mean normalized SAM/sphere volume calculated was 94.9 % (SD 5.9 %) of the expected value. In the PSCC patients, the mean difference between SAM1min and SAM10min was only 4 % (SD 5 %). SUVmax1min and SUVmax10min proved to be not significantly different, but the variability was slightly larger than that of SAM (SD 6.4 %). SAM1 and ΔSAM values for responders versus non-responders were, respectively, 57 (SD 119) versus 297 (SD 625) for SAM1 (p = 0.2) and 99 % (SD 3 %) versus 32 % (SD 44 %) for ΔSAM (p = 0.001). SUVmax1 and ΔSUVmax values in responders versus non-responders were, respectively, 3.9 (SD 2.4) versus 6.3 (SD 3.1) for SUVmax1 (p = 0.08) and 94 % (SD 17) versus 7 % (SD 40 %) for ΔSUVmax (p = 0.0001). The AUC of ΔSAM and ΔSUVmax were not significantly different on receiver-operating characteristic (ROC) analysis (AUC 1.0 and 0.99, respectively, p = 0.6).

Conclusion

SAM is a promising parameter for tumour response assessment of liver metastases by means of 18F-fluorodeoxyglucose PET.

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Acknowledgments

No financial support was received. The hours of practical and administrative work by Dr. Berwouts Dieter and Mw. Blanken Tamara as well as the support of the whole administrative, nursing, radiopharmaceutical, engineering and medical staff of the nuclear medicine department at the University Hospital of Ghent were all much appreciated.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium

    Jeroen Mertens, André Dobbeleir, Hamphrey Ham, Yves D’Asseler, Ingeborg Goethals & Christophe Van de Wiele

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  1. Jeroen Mertens
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  2. André Dobbeleir
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  3. Hamphrey Ham
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  4. Yves D’Asseler
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  6. Christophe Van de Wiele
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Correspondence to Christophe Van de Wiele.

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Mertens, J., Dobbeleir, A., Ham, H. et al. Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases. Eur J Nucl Med Mol Imaging 39, 1441–1448 (2012). https://doi.org/10.1007/s00259-012-2166-0

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  • DOI: https://doi.org/10.1007/s00259-012-2166-0

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