Original articleReproducibility of Common Semi-quantitative Parameters for Evaluating Lung Cancer Glucose Metabolism with Positron Emission Tomography using 2-Deoxy-2-[18F]Fluoro-D-Glucose
Introduction
Positron emission tomography (PET) using 2-deoxy-2-[18F]fluoro-D-glucose (FDG) is an established diagnostic tool for oncological imaging. 1, 2, 3 In lung cancer, PET can provide useful information regarding differentiation,4, 5, 6, 7, 8, 9 staging,10, 11, 12, 13 recurrence,14 and prognosis.15 PET has also been reported to reduce the cost for management of patients with lung cancer.16
In evaluating lesions with PET, semi–quantitative analysis, including standardized uptake value (SUV), has been often applied for attenuation corrected images. For example, most reports showed higher values of radioactivity in malignant lesions than in benign lesions. In addition, an optimal cut-off value for differentiation between malignant and benign lesions has been suggested.6, 7 In assessment of therapies using quantitative parameters in PET, reproducibility of such parameters is critically important. In order to determine if a tumor has responded to therapy by PET, it is necessary to know how much normal variability there is in the measurement of semiquantitative parameters of glycolysis. We have previously reported the reproducibility of kinetic behavior and SUV on the basis of predicted lean body mass (SUL) of 16 pixels in size within lesions.17 A comparison between the volumes of metabolically active tumors estimated by PET and anatomical volume of the tumor by CT was also reported.18 Effective glycolytic volume (EGV) that is formed by multiplying total tumor average SUL by total tumor volume (Fig. 1), is considered to be a potential measure of active viable cancer cells.19 Therefore, it may be a useful parameter especially when monitoring cancer treatments. Its reproducibility, however, is unknown. Similarly, commercial software available with most PET systems does not routinely provide the maximum 16 pixel ROI in tumor, but generally does provide the maximal single pixel value in a tumor ROI. The reproducibility of the single pixel value, however, has not been assessed. In this work, we investigated the reproducibility of three parameters: maximum single pixel SUL, highest average SUL for 4 × 4 pixels, and EGV for patients with histologically-proven untreated lung cancer.
Section snippets
Patients
The group consisted of 10 patients who were admitted to this investigation if they had a newly detected primary lung cancer or a lung nodule with a high suspicion of malignancy. The patients' profile is shown in Table 1. These patients were prospectively recruited and initial analyses were performed.17 Only patients with a primary lesion diameter measuring at least 2.0 cm in all three orthogonal dimensions (as measured from a CT scan) were included to avoid the need for correction of partial
Results
We summarized sequential quantitative data in 10 patients with lung cancer in Table 2 and mean ± S.D. for each PET study as demonstrated in [ID] Table 3. There were no parameters that showed a significant difference between the two PET studies. Reproducibility between the two PET studies is shown in Figure 2 as to the SULmax, SULmean, EGV, and TV. Figure 3 revealed those data after the adjustment by glucose concentration. All parameters showed high reproducibility, as all ICCs were >0.9.
Discussion
PET enables us to directly quantify lesion radioactivity levels, as an alternative to measuring tumor size. SUV, a commonly used semi-quantative parameter, is also referred to as the dose uptake ratio (DUR), i.e. radioactivity concentration adjusted by body weight and injected dose. There have been several reports describing its characteristics, significance and limitations.23, 24 Indeed, this value acquired in static images is sometimes criticized for its oversimplifications, and kinetic
References (28)
- et al.
The role of positron emission tomography in oncology and other whole-body applications
Semin. Nucl. Med.
(1992) - et al.
Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules. Potential role in evaluation and management
Chest.
(1993) - et al.
Positron emission tomography of lung tumors and mediastinal lymph nodes using [18F]fluorodeoxyglucose. The Members of the PET-Lung Tumor Study Group
Ann. Thorac. Surg.
(1994) - et al.
FDG-PET determination of metabolically active tumor volume and comparison with CT
Clin. Positr. Imag.
(1998) - et al.
Tumor Treatment response based on visual and quantitative changes in global tumor glycolis using PET-FDG imagingThe visual response score and the change in total lesion glycolysis
Clin. Positr. Imag.
(1999) - et al.
Routine production of 2-deoxy-2[18F]fluoro-D-glucose by nucleophilic exchange on a quaternary 4-amino-pyridium resin
Int. J. Rad. Appl. Instrum.
(1990) Positron emission tomographyapplications in oncology
Oncological applications of FDG PET imaging
J. Nucl. Med.
(1999)- et al.
Differential diagnosis of lung tumor with positron emission tomographya prospective study
J. Nucl. Med.
(1990) - et al.
Focal pulmonary abnormalitiesevaluation with F-18 fluorodeoxyglucose PET scanning
Radiology.
(1993)
Probability of malignancy in solitary pulmonary nodules using fluorine-18-FDG and PET
J. Nucl. Med.
Pulmonary abnormalities and PET data analysisa retrospective study
Radiology.
Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion imagespreliminary prospective evaluation
Radiology.
Staging non-small cell lung cancer by whole-body positron emission tomographic imaging
Ann. Thorac. Surg.
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