The effect of different segmentation methods on primary tumour metabolic volume assessed in 18F-FDG-PET/CT in patients with cervical cancer, for radiotherapy planning

Cegła, Paulina; Burchardt, Ewa; Wierzchoslawska, Ewa; Roszak, A.; Cholewiński, Witold

doi:10.5114/wo.2019.89248

Cited by 6 publications

(8 citation statements)

References 25 publications

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“…MTV together with TLG are volumetric PET parameters using a threshold-based volume of interest 43 . Since according to the current 8th TNM classification, tumour volume plays a crucial role in cancer staging, an analysis performed in a group of cancer patients is meaningful.…”

Section: Discussionmentioning

confidence: 99%

Differences among [18F]FDG PET-derived parameters in lung cancer produced by three software packages

Boś-Liedke

Cegła

Matuszewski

et al. 2021

Sci Rep

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Investigation of differences in derived [18F]FDG PET metabolic and volumetric parameters among three different software programs in lung cancer. A retrospective analysis was performed on a group of 98 lung cancer patients who underwent a baseline [18F]FDG PET/CT study. To assess appropriate delineation methods, the NEMA phantom study was first performed using the following software: Philips EBW (Extended Brilliance Workstation), MIM Software and Rover. Based on this study, the best cut-off methods (dependent on tumour size) were selected, extracted and applied for lung cancer delineation. Several semiquantitative [18F]FDG parameters (SUVmax, SUVmean, TLG and MTV) were assessed and compared among the three software programs. The parameters were assessed based on body weight (BW), lean body mass (LBM) and Bq/mL. Statistically significant differences were found in SUVmean (LBM) between MIM Software and Rover (4.62 ± 2.15 vs 4.84 ± 1.20; p < 0.005), in SUVmean (Bq/mL) between Rover and Philips EBW (21,852.30 ± 21,821.23 vs 19,274.81 ± 13,340.28; p < 0.005) and Rover and MIM Software (21,852.30 ± 21,821.23 vs 19,399.40 ± 10,051.30; p < 0.005), and in MTV between MIM Software and Philips EBW (19.87 ± 25.83 vs 78.82 ± 228.00; p = 0.0489). This study showed statistically significant differences in the estimation of semiquantitative parameters using three independent image analysis tools. These findings are important for performing further diagnostic and treatment procedures in lung cancer patients.

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Section: Discussionmentioning

confidence: 99%

Differences among [18F]FDG PET-derived parameters in lung cancer produced by three software packages

Boś-Liedke

Cegła

Matuszewski

et al. 2021

Sci Rep

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“…Recent cervical cancer studies have independently explored the optimal MTV thresholds [ 13 , 16 , 17 ]. Upasani et al in a study of 74 patients with stage IIB or IIIB squamous cell cervical cancer concluded that MTV 30 and MTV 35 were most optimal using tri-diameter ellipsoid based measurements of T2W MRI as the reference standard [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cegła et al assessed 30 cervical cancer patients and concluded that the MTV 35 was the closest to the MRI reference standard; however, they did not detail the method of MRI volume measurement [ 17 ]. In this study, only three thresholds were evaluated and this limited the scope of outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Both manual outline axial slice × slice profile (5-mm slice thickness plus 1.0-mm intersection gap) Compared with 20% to 60% SUV max (5% increments) Phillips Brilliance Workspace Strong correlation between FDG PET, T2W and DWI-cut off 35% or 40% Zhang et al, Nucl Med Comm [ 15 ] 2014 27 Axial T2W manual outline. Exact method not fully described Volume discrepancies between MR and PET volumes with smaller volumes Phillips Extended Brilliance Workstation 40% Lai et al, BMC Cancer [ 16 ] 2017 29 T2W manual outlines in sagittal and axial oblique multiplied by the slice thickness MTV 30 correlated best with the anatomical volume–derived from T2W MR Advanced volume share on ADW 4.7 workstation (GE Healthcare) 30% threshold Cegła et al, Contemp Oncol [ 17 ] 2019 30 MRI-unclear which sequences or method MTV 35 most closely matched the MRI volume Not disclosed 35% threshold …”

Section: Introductionmentioning

confidence: 99%

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Optimal method for metabolic tumour volume assessment of cervical cancers with inter-observer agreement on [18F]-fluoro-deoxy-glucose positron emission tomography with computed tomography

Arshad

Gitau

Tam

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose Cervical cancer metabolic tumour volume (MTV) derived from [18F]-FDG PET/CT has a role in prognostication and therapy planning. There is no standard method of outlining MTV on [18F]-FDG PET/CT. The aim of this study was to assess the optimal method to outline primary cervical tumours on [18F]-FDG PET/CT using MRI-derived tumour volumes as the reference standard. Methods 81 consecutive cervical cancer patients with pre-treatment staging MRI and [18F]-FDG PET/CT imaging were included. MRI volumes were compared with different PET segmentation methods. Method 1 measured MTVs at different SUVmax thresholds ranging from 20 to 60% (MTV20-MTV60) with bladder masking and manual adjustment when required. Method 2 created an isocontour around the tumour prior to different SUVmax thresholds being applied. Method 3 used an automated gradient method. Inter-observer agreement of MTV, following manual adjustment when required, was recorded. Results For method 1, the MTV25 and MTV30 were closest to the MRI volumes for both readers (mean percentage change from MRI volume of 2.9% and 13.4% for MTV25 and − 13.1% and − 2.0% for MTV30 for readers 1 and 2). 70% of lesions required manual adjustment at MTV25 compared with 45% at MTV30. There was excellent inter-observer agreement between MTV30 to MTV60 (ICC ranged from 0.898–0.976 with narrow 95% confidence intervals (CIs)) and moderate agreement at lower thresholds (ICC estimates of 0.534 and 0.617, respectively for the MTV20 and MTV25 with wide 95% CIs). Bladder masking was performed in 86% of cases overall. For method 2, excellent correlation was demonstrated at MTV25 and MTV30 (mean % change from MRI volume of −3.9% and − 8.6% for MTV25 and − 16.9% and 19% for MTV30 for readers 1 and 2, respectively). This method also demonstrated excellent ICC across all thresholds with no manual adjustment. Method 3 demonstrated excellent ICC of 0.96 (95% CI 0.94–0.97) but had a mean percentage difference from the MRI volume of − 19.1 and − 18.2% for readers 1 and 2, respectively. 21% required manual adjustment for both readers. Conclusion MTV30 provides the optimal correlation with MRI volume taking into consideration the excellent inter-reader agreement and less requirement for manual adjustment.

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“…The PET/CT imaging was done according to our study protocol in the bed position (1.3 min for one bed position) and cutting scans 5 mm thick. The optimal contouring method was obtained using the 35% SUV max (standardized uptake value) threshold and was already verified and described in our previous research [ 2 ]. To determine heterogeneity of the primary tumor area under Cumulative SUV-volume histograms the tumor heterogeneity index (AUC-CSH) was used.…”

Section: Methodsmentioning

confidence: 99%

Pretreatment [18F]FDG PET/CT Prognostic Factors in Patients with Squamous Cell Cervical Carcinoma FIGO IIIC1

Burchardt

Cegła

et al. 2021

Diagnostics

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Purpose: This study aims to determine whether semiquantitative parameters obtained from both the primary tumor and metastatic pelvic lymph nodes (PLN) diagnosed in fluoro-18-deoxy-glucose positron emission tomography (FDG-PET-CT) are associated with disease-free survival (DFS), local control (LC), distant metastasis-free survival (DMFS) and overall survival (OS) in patients with locally advanced squamous cervical cancer (LACC) and metastatic pelvic lymph nodes. Materials: Retrospective analysis was performed on 93 female patients with FIGO IIIC1. The median age was 53 years (27–75). The PET parameters both in the primary tumor and metastatic pelvic lymph nodes, including SUVmax, SUVmean, TLG, MTV, heterogeneity, along with clinical variables, before radical cisplatin-based radiochemotherapy (RCT) were analyzed. The p-values < 0.05 were considered statistically significant. Results: Median follow-up was 38 months (4.5–92.6). Three years and five years OS were 75% and 70% respectively. Patients with SUVmax above 12.6, SUVmean above 7.6 and with TLG in tumors >245.7 lived longer (p < 0.05). The higher SUVmax or SUVmean reduced increased DMFS (HR 0.3 95%CI 0.56–0.96 and 0.59 95%CI 0.37–0.93). The clinical factors and other FDG PET CT parameters were not found to be statistically relevant in terms of OS, DFS, DM and LC. Conclusions: This study is the first report showing that in LACC patient population with PLN involvement treated with definitive RCT, high SUVmean, SUVmax and TLG of the primary tumor in FDG-PET-CT were linked with longer OS. Lower SUVmean and SUVmax were linked with shorter DMFS. None of the clinical factors and the nodal FDG-PET-CT parameters influenced the outcome.

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The effect of different segmentation methods on primary tumour metabolic volume assessed in 18F-FDG-PET/CT in patients with cervical cancer, for radiotherapy planning

Cited by 6 publications

References 25 publications

Differences among [18F]FDG PET-derived parameters in lung cancer produced by three software packages

Differences among [18F]FDG PET-derived parameters in lung cancer produced by three software packages

Optimal method for metabolic tumour volume assessment of cervical cancers with inter-observer agreement on [18F]-fluoro-deoxy-glucose positron emission tomography with computed tomography

Pretreatment [18F]FDG PET/CT Prognostic Factors in Patients with Squamous Cell Cervical Carcinoma FIGO IIIC1

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