PT  - JOURNAL ARTICLE
AU  - Fox, Josef J.
AU  - Autran-Blanc, Estelle
AU  - Morris, Michael J.
AU  - Gavane, Somali
AU  - Nehmeh, Sadek
AU  - Van Nuffel, André
AU  - Gönen, Mithat
AU  - Schöder, Heiko
AU  - Humm, John L.
AU  - Scher, Howard I.
AU  - Larson, Steven M.
TI  - Practical Approach for Comparative Analysis of Multilesion Molecular Imaging Using a Semiautomated Program for PET/CT
AID  - 10.2967/jnumed.111.089326
DP  - 2011 Nov 01
TA  - Journal of Nuclear Medicine
PG  - 1727--1732
VI  - 52
IP  - 11
4099  - http://jnm.snmjournals.org/content/52/11/1727.short
4100  - http://jnm.snmjournals.org/content/52/11/1727.full
SO  - J Nucl Med2011 Nov 01; 52
AB  - We propose a standardized approach to quantitative molecular imaging (MI) in cancer patients with multiple lesions. Methods: Twenty patients with castration-resistant prostate cancer underwent 18F-FDG and 18F-16β-fluoro-5-dihydrotestosterone (18F-FDHT) PET/CT scans. Using a 5-point confidence scale, 2 readers interpreted coregistered scan sets on a workstation. Two hundred three sites per scan (specified in a lexicon) were reviewed. 18F-FDG–positive lesion bookmarks were propagated onto 18F-FDHT studies and then manually accepted or rejected. Discordance-positive 18F-FDHT lesions were similarly bookmarked. Lesional SUVmax was recorded. Tracer- and tissue-specific background correction factors were calculated via receiver-operating-characteristic analysis of 65 scan sets. Results: Readers agreed on more than 99% of 18F-FDG– and 18F-FDHT–negative sites. Positive-site agreement was 83% and 85%, respectively. Consensus-lesion maximum standardized uptake value (SUVmax) was highly reproducible (concordance correlation coefficient > 0.98). Receiver-operating-characteristic curves yielded 4 correction factors (SUVmax 1.8–2.6). A novel scatterplot (Larson-Fox-Gonen plot) depicted tumor burden and change in SUVmax for response assessments. Conclusion: Multilesion molecular imaging is optimized with a 5-step approach incorporating a confidence scale, site lexicon, semiautomated PET software, background correction, and Larson-Fox-Gonen graphing.