Liver SUL<sub>mean</sub>at FDG PET/CT: Interreader Agreement and Impact of Placement of Volume of Interest

Maya, Viner; Mercier, Gustavo; Frank, Hao; Ashish, Malladi; Subramaniam, Rathan M.

doi:10.1148/radiol.12121385

Cited by 28 publications

(26 citation statements)

References 21 publications

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“…The lowest variability of any of the studied organs was in the liver, where the COV was 13.8% for SUV mean and 14.5% for SUL mean , whereas the highest variability was in the spleen (38.7% with SUV mean and 38.8% for SUL mean ). For reference, the COV of the liver with 18 F-FDG PET has been reported to be 21.0%-23.1% using SUL mean (24). Only 1 of the 64 patients included in this study was imaged at more than a single time point, so no data are available on the relative roles of intrapatient (test-retest) versus interpatient variability.…”

Section: Resultsmentioning

confidence: 99%

Semiquantitative Parameters in PSMA-Targeted PET Imaging with ¹⁸F-DCFPyL: Variability in Normal-Organ Uptake

Rowe

Leal

et al. 2016

J Nucl Med

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18 F-DCFPyL is a small-molecule inhibitor of the prostate-specific membrane antigen that has shown promise for evaluation of primary and metastatic prostate cancer using PET. Measuring the variability in normal-organ uptake of 18 F-DCFPyL is necessary to understand its biodistribution, aid image interpretation, judge the reliability of scan quantification, and provide a basis for therapeutic monitoring. Methods: Sixty-five consecutive 18 F-DCFPyL PET/CT scans from 64 patients with a history of prostate cancer were analyzed. Volumes of interest were defined for the lacrimal glands, major salivary glands, liver, spleen, and both kidneys. The mean SUV normalized to body mass or to lean body mass (SUL) was calculated for each volume of interest. The average SUV across all scans, the SD, and the coefficient of variation (COV) for each organ were calculated. The same parameters were also derived for a 3-cm sphere drawn in the center of the right lobe of the liver. Results: The average SUV mean for all selected organs measured was 6.6 6 1.8 for the right lacrimal gland, 6.4 6 1.8 for the left lacrimal gland, 9.1 6 2.0 for the right parotid gland, 9.0 6 2.1 for the left parotid gland, 9.6 6 2.3 for the right submandibular gland, 9.4 6 2.2 for the left submandibular gland, 5.0 6 0.7 for the whole liver, 5.1 6 0.7 for a 3-cm sphere in the liver, 4.0 6 1.5 for the spleen, 20.1 6 4.6 for the right kidney, and 19.4 6 4.5 for the left kidney. SUL mean was lower overall, although demonstrating similar trends. The COV of SUV mean and SUL mean was lower in the liver (13.8% and 14.5%, respectively) than in any other organ and was less than the comparable COV for 18 F-FDG PET. The COV of SUV mean and SUL mean in the 3-cm sphere in the liver was also low and similar to the variability in the whole liver (14.2% and 14.7%, respectively). Conclusion: 18 F-DCFPyL uptake in normal liver demonstrates less variability than in other 18 F-DCFPyL-avid organs, and its variability is less than the reported variability of 18 F-FDG in liver. Variability was slightly less for SUV mean than for SUL mean , suggesting that SUV mean may be the preferable parameter for quantification of images obtained with 18 F-DCFPyL.

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Section: Resultsmentioning

confidence: 99%

Semiquantitative Parameters in PSMA-Targeted PET Imaging with ¹⁸F-DCFPyL: Variability in Normal-Organ Uptake

Rowe

Leal

et al. 2016

J Nucl Med

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“…For the manual VOI 30 , according to our results and previous work from another group [23], the upper VOI was considered least variable between physicians. In order to simplify the analyses, we hereafter included it only into the analysis for (i) automated VOI 30 using 80-mm VOI medium , and (ii) manual VOI 30 placed at upper level.…”

Section: Resultsmentioning

confidence: 99%

“…A recent research report showed that VOI 30 placed in RL manually on the same FDG PET-CT study was reproducible between expert radiologists [23]. One may then argue that the automated method is not necessary.…”

Section: Discussionmentioning

confidence: 99%

A Semi-Automated Technique Determining the Liver Standardized Uptake Value Reference for Tumor Delineation in FDG PET-CT

et al. 2014

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Background 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)-computed tomography (CT) has been an essential modality in oncology. We propose a semi-automated algorithm to objectively determine liver standardized uptake value (SUV), which is used as a threshold for tumor delineation.MethodsA large spherical volume of interest (VOI) was placed manually to roughly enclose the right lobe (RL) of the liver. For each voxel in this VOI, a coefficient of variation of voxel values (CVv) was calculated for neighboring voxels within a radius of d/2. The voxel with the minimum CVv was then selected, where a 30-mm spherical VOI was placed at that voxel in accordance with PERCIST criteria. Two nuclear medicine physicians independently defined 30-mm VOIs manually on 124 studies in 62 patients to generate the standard values, against which the results from the new method were compared.ResultsThe semi-automated method was successful in determining the liver SUV that was consistent between the two physicians in all the studies (d = 80 mm). The liver SUV threshold (mean +3 SD within 30-mm VOI) determined by the new semi-automated method (3.12±0.61) was not statistically different from those determined by the manual method (Physician-1: 3.14±0.58, Physician-2: 3.15±0.58). The semi-automated method produced tumor volumes that were not statistically different from those by experts' manual operation. Furthermore, the volume change in the two sequential studies had no statistical difference between semi-automated and manual methods.ConclusionsOur semi-automated method could define the liver SUV robustly as the threshold value used for tumor volume measurements according to PERCIST. The method could avoid possible subjective bias of manual liver VOI placement and is thus expected to improve clinical performance of volume-based parameters for prediction of cancer treatment response.

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“…Liver SUV mean has also been utilized as normalization factor in PET derived quantitative therapy response formulations, which were further adapted to assess residual disease in colorectal malignancy [3,4]. In our previous work[5], we demonstrated that Liver SUL mean has almost perfect inter-reader reliability, regardless of whether the volume of interest (VOI) is placed at the upper, lower, or portal vein level of the right lobe of the liver and the inter reader variability is least in the upper aspect of the right lobe of the liver.…”

Section: Introductionmentioning

confidence: 99%

Liver Standardized Uptake Value Corrected for Lean Body Mass at FDG PET/CT

Chirindel¹,

Alluri²,

Tahari³

et al. 2015

Clinical Nuclear Medicine

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Objective To establish the magnitude change and inter-reader reliability of Liver SULmean in dual time point imaging at 1 and 2 hours and 1 and 4 hours. Methods Early and Delayed FDG PET/CT scans were included for 28 patients (13 males and 15 females) who had normal liver by CT or US. The average uptake time between the early and delayed scans were 55 minutes (range 44-69) for pancreatic adenocarcinoma patients (n = 19) and 184 minutes (range 140-197) for neurofibromatosis (NF) patients (n = 9). 30-mm- diameter spherical VOI was placed within the right lobe of the liver above, below, and at the level of the main portal vein by two independent readers. Correlation coefficients, Analysis of variance, intraclass correlation coefficient (ICC), and Bland-Altman analysis were performed. Results The mean liver SULmean was between 1.39 and 1.42 and between 1.28 and 1.3 in early and delayed images, respectively (p = 0.001). There is time dependent reduction in the mean Liver SULmean at 2 hour (7-8%) and four hour uptake time (15-21%), compared to one hour. The correlation coefficient between delayed uptake time and Liver SULmean reduction is 0.39 to 0.41 at the upper aspect of liver. The ICC for two readers varied between 0.997 and 0.998 and between 0.995 and 0.999 in early and delayed images, respectively (p=0.001). Conclusion There is time dependent reduction of mean Liver SULmean, about 7-8% within the clinically relevant FDG uptake time, in the same patient with excellent inter-reader agreement in early and delayed images within the right lobe of the liver. Therefore Liver SULmean could represent a useful reference parameter in quantitative analysis of dual-phase FDG PET/CT in malignancy or atypical infection/inflammatory disease. Furthermore, it may be suitable as normalization factor in currently available formulae quantifying therapy response on PET imaging.

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Liver SUL_meanat FDG PET/CT: Interreader Agreement and Impact of Placement of Volume of Interest

Abstract: Liver SUL(mean) at FDG PET/CT has excellent interreader agreement, with similar values and variance whether measured at the upper, lower, or portal vein levels within the right lobe of the liver.

Cited by 28 publications

References 21 publications

Semiquantitative Parameters in PSMA-Targeted PET Imaging with ¹⁸F-DCFPyL: Variability in Normal-Organ Uptake

Semiquantitative Parameters in PSMA-Targeted PET Imaging with ¹⁸F-DCFPyL: Variability in Normal-Organ Uptake

A Semi-Automated Technique Determining the Liver Standardized Uptake Value Reference for Tumor Delineation in FDG PET-CT

Liver Standardized Uptake Value Corrected for Lean Body Mass at FDG PET/CT

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Liver SULmeanat FDG PET/CT: Interreader Agreement and Impact of Placement of Volume of Interest

Abstract: Liver SUL(mean) at FDG PET/CT has excellent interreader agreement, with similar values and variance whether measured at the upper, lower, or portal vein levels within the right lobe of the liver.

Cited by 28 publications

References 21 publications

Semiquantitative Parameters in PSMA-Targeted PET Imaging with 18F-DCFPyL: Variability in Normal-Organ Uptake

Semiquantitative Parameters in PSMA-Targeted PET Imaging with 18F-DCFPyL: Variability in Normal-Organ Uptake

A Semi-Automated Technique Determining the Liver Standardized Uptake Value Reference for Tumor Delineation in FDG PET-CT

Liver Standardized Uptake Value Corrected for Lean Body Mass at FDG PET/CT

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Liver SUL_meanat FDG PET/CT: Interreader Agreement and Impact of Placement of Volume of Interest

Semiquantitative Parameters in PSMA-Targeted PET Imaging with ¹⁸F-DCFPyL: Variability in Normal-Organ Uptake

Semiquantitative Parameters in PSMA-Targeted PET Imaging with ¹⁸F-DCFPyL: Variability in Normal-Organ Uptake