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Optimal 68Ga-PSMA and 18F-PSMA PET window levelling for gross tumour volume delineation in primary prostate cancer

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

Abstract

Purpose

This study proposes optimal tracer-specific threshold-based window levels for PSMA PET–based intraprostatic gross tumour volume (GTV) contouring to reduce interobserver delineation variability.

Methods

Nine 68Ga-PSMA-11 and nine 18F-PSMA-1007 PET scans including GTV delineations of four expert teams (GTVmanual) and a majority-voted GTV (GTVmajority) were assessed with respect to a registered histopathological GTV (GTVhisto) as the gold standard reference. The standard uptake values (SUVs) per voxel were converted to a percentage (SUV%) relative to the SUVmax. The statistically optimised SUV% threshold (SOST) was defined as those that maximises accuracy for threshold-based contouring. A leave-one-out cross-validation receiver operating characteristic (ROC) curve analysis was performed to determine the SOST for each tracer. The SOST analysis was performed twice, first using the GTVhisto contour as training structure (GTVSOST-H) and second using the GTVmajority contour as training structure (GTVSOST-MA) to correct for any limited misregistration. The accuracy of both GTVSOST-H and GTVSOST-MA was calculated relative to GTVhisto in the ‘leave-one-out’ patient of each fold and compared with the accuracy of GTVmanual.

Results

ROC curve analysis for 68Ga-PSMA-11 PET revealed a median threshold of 25 SUV% (range, 22–27 SUV%) and 41 SUV% (40–43 SUV%) for GTVSOST-H and GTVSOST-MA, respectively. For 18F-PSMA-1007 PET, a median threshold of 42 SUV% (39–45 SUV%) for GTVSOST-H and 44 SUV% (42–45 SUV%) for GTVSOST-MA was found. A significant pairwise difference was observed when comparing the accuracy of the GTVSOST-H contours with the median accuracy of the GTVmanual contours (median, − 2.5%; IQR, − 26.5–0.2%; p = 0.020), whereas no significant pairwise difference was found for the GTVSOST-MA contours (median, − 0.3%; IQR, − 4.4–0.6%; p = 0.199).

Conclusions

Threshold-based contouring using GTVmajority-trained SOSTs achieves an accuracy comparable with manual contours in delineating GTVhisto. The median SOSTs of 41 SUV% for 68Ga-PSMA-11 PET and 44 SUV% for 18F-PSMA-1007 PET form a base for tracer-specific window levelling.

Trial registration

Clinicaltrials.gov; NCT03327675; 31-10-2017

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Acknowledgments

We thank the team of Kim Serdons for the production of 68Ga-PSMA-11 and 18F-PSMA-1007. We thank Kwinten Porters and Jef Van Loock for performing PSMA PET/MRI acquisitions. We thank Lotte Lutkenhaus, Laurence Delombaerde and Kenneth Poels for their efforts in the data transfer and IT support.

Funding

Robin De Roover is funded by a Kom op tegen Kanker (Stand up to Cancer) grant from the Flemish Cancer Society.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium

    Cédric Draulans, Robin De Roover, Sofie Isebaert & Karin Haustermans

  2. Department of Oncology, KU Leuven, Leuven, Belgium

    Cédric Draulans, Robin De Roover, Sofie Isebaert & Karin Haustermans

  3. Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Uulke A. van der Heide & Floris Pos

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

    Linda Kerkmeijer, Robert J. Smeenk & Martina Kunze-Busch

  5. Department of Radiation Oncology, University Medical Centre, Utrecht, The Netherlands

    Linda Kerkmeijer

  6. Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands

    Wouter V. Vogel

  7. Department of Radiology & Nuclear Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands

    James Nagarajah & Marcel Janssen

  8. Department of Electrical Engineering, ESAT/PSI, KU Leuven, Leuven, Belgium

    Frederik Maes

  9. Medical Imaging Research Centre, University Hospitals Leuven, Leuven, Belgium

    Frederik Maes

  10. Department of Radiology, University Hospitals Leuven, Leuven, Belgium

    Cindy Mai & Raymond Oyen

  11. Department of Urology, University Hospitals Leuven, Leuven, Belgium

    Steven Joniau

  12. Department of Development and Regeneration, KU Leuven, Leuven, Belgium

    Steven Joniau

  13. Department of Nuclear Medicine, University Hospitals Leuven, Leuven, Belgium

    Karolien Goffin

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  1. Cédric Draulans
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Corresponding authors

Correspondence to Cédric Draulans or Karin Haustermans.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted in accordance with the principles of the Declaration of Helsinki, and institutional review board approval has been obtained.

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Oncology - Genitourinary

Karolien Goffin and Karin Haustermans are shared last authors.

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Draulans, C., De Roover, R., van der Heide, U.A. et al. Optimal 68Ga-PSMA and 18F-PSMA PET window levelling for gross tumour volume delineation in primary prostate cancer. Eur J Nucl Med Mol Imaging 48, 1211–1218 (2021). https://doi.org/10.1007/s00259-020-05059-4

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