OtherClinical Investigations

Prospective Feasibility Trial of Radiotherapy Target Definition for Head and Neck Cancer Using 3-Dimensional PET and CT Imaging

Christopher Scarfone, William C. Lavely, Anthony J. Cmelak, Dominique Delbeke, William H. Martin, Dean Billheimer and Dennis E. Hallahan
Journal of Nuclear Medicine April 2004, 45 (4) 543-552;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Typical landmarks demonstrate correlation of images for coregistration (patient 6). High-resolution CT anatomic data (A) and corresponding color-enhanced 18F-FDG PET emission image (B). Image pair shows correspondence between alignment points used for registration of the 2 datasets.

  • FIGURE 2.
    FIGURE 2.

    PET contour contained within corresponding CT contour (patient 5). CT (A), corresponding color-enhanced 18F-FDG PET (B), and coregistered images (C). Extent of CT GTV is indicated by blue contour (A and B). Corresponding PET contour is in yellow (A and B). This example demonstrates an 18F-FDG–avid region within CT-defined GTV.

  • FIGURE 3.
    FIGURE 3.

    Example variations in agreement between PET and CT contours (patient 6). Transverse CT (A) and corresponding 18F-FDG PET image (B). In this example there is good agreement between CT (orange) and PET (yellow) contours of right lymph node. PET definition of primary target contour (red), however, includes more tissue laterally when compared with CT contour of this same area (green).

  • FIGURE 4.
    FIGURE 4.

    Primary CT and PET contour overlap (patient 4). CT (A) and corresponding 18F-FDG PET image (B) of right side hypermetabolic lymph node. This slice level shows CT (yellow) and PET (green) contours nearly overlapping. Taking into account slight differences between contours on other slice levels, original CT volume was increased by 3.4 cm3 to include portions of PET-avid regions.

  • FIGURE 5.
    FIGURE 5.

    PET contour extending outside CT-defined contour (patient 2). CT (A) and corresponding 18F-FDG PET image (B). PET definition of right side node (blue contour) extends beyond CT-defined node (green contour) to include other soft tissue. CT-defined GTV (central red contour) shows no corresponding PET uptake in this region at this slice level.

  • FIGURE 6.
    FIGURE 6.

    Visualization of 18F-FDG PET–avid lymph nodes (patient 6). CT (A), 18F-FDG PET (B), and blended view (C). CT contour of right side lymph node is in aqua, and 18F-FDG PET contour of this same node is in red. 18F-FDG PET image (B) indicates 18F-FDG–avid node on left side not visualized on CT.

  • FIGURE 7.
    FIGURE 7.

    IMRT dose distribution (patient 2). Five-field IMRT plan is optimized to CT GTV (red contour in A). Corresponding PET GTV (yellow contour) is also shown in (A). IMRT plan is optimized to combined PET/CT GTV (red contour in B).

Tables

  • TABLE 1

    Patient Demographics, Chemotherapy History, and Total Treatment Dose

    Patient no.Age (y)SexChemoTotal dose (Gy)
    141M+*66
    283F+70
    354M+70
    462F+70
    554F+50.4†
    663M+70

    • ↵* Before PET.

    • ↵† Small cell.

    • Chemo = chemotherapy.

  • TABLE 2

    Target Volume Summary

    Patient no.CT primaryPET primaryCT lymph nodePET lymph nodeFinal primaryFinal lymph node
    123.5n/an/an/an/an/a
    3.5n/an/an/a
    2.3n/an/an/a
    1.8n/an/an/a
    1.6n/an/an/a
    1.5n/an/an/a
    211.86.626.028.314.728.3
    335.942.116.43.441.521.7
    1.316.5
    426.819.8n/an/a30.2n/a
    528.817.31.1n/a31.11.1
    66.613.818.718.28.718.7
    44.955.153.5
    n/a2.37.0
    n/a60.4n/a

    • n/a = not applicable.

    • All volumes are in cm3.

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