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Respiratory gated [18F]FDG PET/CT for target volume delineation in stereotactic radiation treatment of liver metastases

Stellenwert der atemgetriggerten [18F]FDG-PET/CT in der Zielvolumendefinition für die stereotaktische Bestrahlung von Lebermetastasen

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Abstract

Purpose

The use of 4D-[18F]fluorodeoxyglucose (FDG) PET/CT in combination with respiratory gated magnet resonance imaging (MRI) in target volume definition for stereotactic radiation of liver metastases was investigated.

Methods and materials

A total of 18 patients received respiration gated FDG-PET/CT and MRI. Data were fused using a rigid co-registration algorithm. The quality of the co-registration was rated on a scale from 1 (excellent) to 5 (poor) for co-registration of MRI with gated PET and ungated PET. Gross tumor volume (GTV) was delineated in CT (GTV CT), MRI (GTVMRI), and PET (GTVPET). MRI- and PET-based GTVs were defined by three observers each. Interobserver variability was calculated for all patients as well as for subgroups with and without previous treatment of liver metastases. All GTVs were compared for all patients and separately for patients with previous local therapy. In addition, a semiautomatic segmentation algorithm was applied on the PET images.

Results

Co-registration  between MR and PET images was rated with 3.3 in average when non-gated PET was used and improved significantly (p < 0.01) to 2.1 using gated PET. The average GTVCT  was 51.5 ml, GTVMRI  51.8 ml, and the average GTVPET  48.1 ml. Volumes delineated in MRI were 9.9% larger compared to those delineated in CT. Volumes delineated in PET were 13.8% larger than in MRI. The differences between the GTVs were more pronounced in patients with previous treatment. The GTVs defined in MRI showed an interobserver variability of 47.9% (84.1% with previous treatment and 26.2% without previous treatment). The PET-defined GTVs showed an interobserver variability of 21% regardless of previous treatment. Semiautomatic segmentation did not provide satisfying results.

Conclusion

FDG-PET can distinguish vital tumor tissue and scar tissue, and therefore alters the GTV especially in patients with previous local treatment. In addition, it reduces the interobserver variability significantly compared to MRI. However, respiratory gated PET is necessary for good co-registration of PET and MRI.

Zusammenfassung

Ziel

Ziel der Studie war es, den Einfluss der 4D-[18F]Fluorodesoxglucose (FDG)-PET/CT in Kombination mit der atemgetriggerten Magnetresonanztomographie (MRT) auf die Zielvolumendefinition bei der stereotaktischen Bestrahlung von Lebermetastasen zu untersuchen.

Material und Methoden

18 Patienten wurden mit atemgetriggerter FDG-PET/CT und MRT untersucht. Die Daten beider Modalitäten wurden mit Hilfe eines rigiden Algorithmus koregistriert. Die Qualität der Koregistrierung von MRT und atemgetriggerter bzw. nichtatemgetriggerter PET wurde anhand einer Skala von 1 (sehr gut) bis 5 (mangelhaft) bewertet. Das „Gross Tumor Volumen“ (GTV) wurde anhand der CT (GTVCT), der MRT (GTVMRI) und der PET (GTVPET) bestimmt. Die auf PET und MRT basierten GTVs wurden jeweils von drei Befundern definiert. Die Interobserver-Variabilität für GTVPET und GTVMRT wurde sowohl für das gesamte Patientenkollektiv als auch separat je für die bereits vorbehandelten Patienten und für Patienten mit Ersttherapie betrachtet. Die GTVs wurden in gleicher Weise für das gesamte Kollektiv und die vorbehandelten und nicht vorbehandelten Patienten individuell verglichen. Zusätzlich wurde auf die PET-Bilder ein semiautomatischer Algorithmus zur Definition des GTV angewendet.

Ergebnisse

Die Koregistrierung zwischen MRT und nichtatemgetriggerten PET-Bildern wurde im Mittel mit 3,3 bewertet und verbesserte sich bei der Verwendung von atemgetriggerten PET-Bildern signifikant (p<0,01) auf 2,1. Das mittlere GTVCT betrug 51,5 ml, GTVMRI 51,8 ml und das mittlere GTVPET 48,1 ml. Die in den MR-Bildern definierten Zielvolumina waren im Mittel 9,9% größer als die CT-definierten. Die GTVPET waren im Mittel 13,8% größer als die GTVMRI. Der Unterschied der Zielvolumina war besonders in der Gruppe der vorbehandelten Patienten stärker ausgeprägt. Die Interobserver-Variabilität betrug bei den MRT-basierten Zielvolumina 47,9% (mit Vorbehandlung 84,1%, ohne 26,2%). Die PET-basierten GTVs zeigten eine Interobserver-Variabiliät von 21% unabhängig von einer etwaigen Therapie. Der semiautomatische Segmentierungsalgorithmus lieferte keine zufriedenstellenden Ergebnisse.

Schlussfolgerung

FDG-PET ermöglicht die Differenzierung zwischen vitalem Tumorgewebe und Narbengewebe. Dadurch wird das GTV insbesondere bei vorbehandelten Patienten beeinflusst. Zusätzlich wird verglichen mit der MRT-Bildgebung die Interobserver-Variabilität durch die PET signifikant reduziert. Für eine gute Koregistrierung zwischen PET und MRT ist allerdings eine atemgetriggerte PET-Aufnahme notwendig.

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Conflict of interest

The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Nuklearmedizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Str. 22, 81675, Munich, Germany

    R.A. Bundschuh, J. Dinges, S.I. Ziegler, M. Schwaiger & M. Essler

  2. Klinik und Poliklinik für Strahlentherapie und Radiologische Onkologie, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany

    N. Andratschke, M.N. Duma, S.T. Astner & M. Molls

  3. Institut für Röntgendiagnostik, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany

    M. Brügel

  4. Nuklearmedizinische Klinik und Poliklinik, Universitätsklinikum Würzburg, Oberdürrbacher Str 22, 81675, Würzburg, Germany

    R.A. Bundschuh

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  1. R.A. Bundschuh
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  2. N. Andratschke
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  3. J. Dinges
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  4. M.N. Duma
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  5. S.T. Astner
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  6. M. Brügel
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  7. S.I. Ziegler
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  8. M. Molls
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  9. M. Schwaiger
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  10. M. Essler
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Corresponding author

Correspondence to R.A. Bundschuh.

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The first two authors contributed equally.

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Bundschuh, R., Andratschke, N., Dinges, J. et al. Respiratory gated [18F]FDG PET/CT for target volume delineation in stereotactic radiation treatment of liver metastases. Strahlenther Onkol 188, 592–598 (2012). https://doi.org/10.1007/s00066-012-0094-3

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  • DOI: https://doi.org/10.1007/s00066-012-0094-3

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