All that glitters is not gold - new reconstruction methods using Deauville criteria for patient reporting

Barrington, Sally F.; Sulkin, Tom; Forbes, Adam; Johnson, Peter

doi:10.1007/s00259-017-3893-z

Cited by 32 publications

(40 citation statements)

References 16 publications

(14 reference statements)

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“…Apart from harmonising quantitative 18 F-FDG PET-CT reads, it has been reported that also visual assessment, e.g. Deauville scoring of PET-CT lymphoma studies, may be affected by a change in (reconstruction) technology and could affect patient management [25]. The observed changes (increases) in tumor-to-liver ratios for EARL2-versus EARL1-MAX41: Region-growing-based VOI using a threshold equal to 41% of SUVmax; NSCLC: Non-small cell lung cancer; PET: Positron emission tomography; PSF: Point spread function; RSNA: Radiological Society of North America; SNMMI: Society of Nuclear Medicine and Molecular Imaging; SUV: Standardised uptake value; SUV4: Region-growingbased VOI using a threshold of SUV equal to 4; SUV max : Ratio of image-derived maximum (single pixel) radioactivity concentration within a region of interest and the whole body concentration of the injected radioactivity, normalised to bodyweight; SUV mean : Ratio of image-derived average radioactivity concentration within a region of interest and the estimated whole body concentration of the injected radioactivity, normalised to bodyweight; SUV peak : Ratio of imagederived average radioactivity concentration within a 12-mm-diameter spherical volume within the region of interest, positioned to yield the highest uptake, and the whole body concentration of the injected radioactivity, normalised to bodyweight; TLG: Total lesion glycolysis equal to the MATV times SUVmean; TOF: Time of flight; VOI: Volume of interest…”

Section: Discussionmentioning

confidence: 99%

“…Since then, the performance of PET-CT systems has significantly increased and new acquisition and reconstruction technologies have been introduced [23]. A change in technology may also unfavourably affect patient management when previously used quantitative and visual criteria are applied without adaptation to the new images [24,25]. The harmonisation of these newer systems would require an update of the current multicentre accreditation standards (EARL1) to accommodate higher recoveries.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative implications of the updated EARL 2019 PET–CT performance standards

et al. 2019

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Purpose: Recently, updated EARL specifications (EARL2) have been developed and announced. This study aims at investigating the impact of the EARL2 specifications on the quantitative reads of clinical PET-CT studies and testing a method to enable the use of the EARL2 standards whilst still generating quantitative reads compliant with current EARL standards (EARL1). Methods: Thirteen non-small cell lung cancer (NSCLC) and seventeen lymphoma PET-CT studies were used to derive four image datasets-the first dataset complying with EARL1 specifications and the second reconstructed using parameters as described in EARL2. For the third (EARL2F6) and fourth (EARL2F7) dataset in EARL2, respectively, 6 mm and 7 mm Gaussian post-filtering was applied. We compared the results of quantitative metrics (MATV, SUVmax, SUVpeak, SUVmean, TLG, and tumorto-liver and tumor-to-blood pool ratios) obtained with these 4 datasets in 55 suspected malignant lesions using three commonly used segmentation/volume of interest (VOI) methods (MAX41, A50P, SUV4). Results: We found that with EARL2 MAX41 VOI method, MATV decreases by 22%, TLG remains unchanged and SUV values increase by 23-30% depending on the specific metric used. The EARL2F7 dataset produced quantitative metrics best aligning with EARL1, with no significant differences between most of the datasets (p>0.05). Different VOI methods performed similarly with regard to SUV metrics but differences in MATV as well as TLG were observed. No significant difference between NSCLC and lymphoma cancer types was observed. Conclusions: Application of EARL2 standards can result in higher SUVs, reduced MATV and slightly changed TLG values relative to EARL1. Applying a Gaussian filter to PET images reconstructed using EARL2 parameters successfully yielded EARL1 compliant data.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative implications of the updated EARL 2019 PET–CT performance standards

et al. 2019

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“…Two of these patients, who had been initially diagnosed with stage III lymphoma, were quali ed to undergo selective radiation therapy due to positive PET results with remaining high activity in the axillary lymph nodes. In both cases, the follow-up PET/CT examination 3 months after radiotherapy did not show increased 18 F-FDG uptake in these lymph nodes.…”

Section: End Of Treatment Pet/ct (Epet)mentioning

confidence: 68%

“…PET/CT with 18F-uorodeoxyglucose ( 18 F-FDG) has been widely used in patients with both Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) in several stages of management: for precise staging before treatment initiation [11][12][13] and for early and nal assessments of the response to chemotherapy [14]. The treatment response is evaluated by the comparison of the 18 F-FDG uptake in the lymph nodes or organs affected by lymphoma with the uptake in normal tissues. As it has been recommended by expert panels, the systematic, semi-quantitative assessment of the treatment response involves measurement of 18 F-FDG uptake expressed by SUVmax in the areas involved and in the reference regions of the liver and mediastinal blood pool (MBPS).…”

mentioning

confidence: 99%

“…The treatment response is evaluated by the comparison of the 18 F-FDG uptake in the lymph nodes or organs affected by lymphoma with the uptake in normal tissues. As it has been recommended by expert panels, the systematic, semi-quantitative assessment of the treatment response involves measurement of 18 F-FDG uptake expressed by SUVmax in the areas involved and in the reference regions of the liver and mediastinal blood pool (MBPS). The relationship of the measured SUVmax values is scored with the 5point Deauville scale (DS), named after the place of its approval for clinical practice by the First International Workshop on Interim-PET-Scan in Lymphoma [15].…”

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confidence: 99%

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Impact of the Q.Clear reconstruction algorithm on the interpretation of PET/CT images in patients with lymphoma

Wyrzykowski

Siminiak

Kaźmierczak

et al. 2020

Preprint

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Background. Q.Clear is a new Bayesian penalized-likelihood PET reconstruction algorithm. It has been documented that Q.Clear increases the SUVmax values of different malignant lesions. Purpose. As SUVmax values are crucial for interpretation of PET/CT images in patients with lymphoma, particularly when early and final responses to treatment are evaluated. The aim of the study was to systematically analyse the impact of the use of Q.Clear on interpretation of PET/CT in patients with lymphoma.Methods. A total of 280 18F-FDG PET/CT scans in patients with lymphoma were performed for staging (sPET), for early treatment response (iPET), after the end of treatment (ePET) and when a relapse of lymphoma was suspected (rPET). Scans were separately reconstructed with two algorithms, Q.Clear and OSEM, and further compared.Results. The stage of lymphoma was concordantly diagnosed in 69/70 patients with both algorithms on sPET. Discordant assessment of the Deauville score (p<0.001) was found in 11 cases (15.7%) of 70 iPET scans and in 11 cases of 70 ePET scans. An upgrade from a negative to a positive scan by Q.Clear occurred in 3 cases (4.3%) of iPET scans and 7 cases (10.0%) of ePET. The results of all 70 r-PET scans were concordant. The SUVmax values of the target lymphoma lesions measured with Q.Clear were higher than those measured with OSEM in 88.8% of scans. Conclusion. Although the Q.Clear algorithm may alter interpretations of PET/CT in only a small proportion of patients, we recommend using standard OSEM reconstruction for the assessment of treatment response.

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