Comparative evaluation of CT-based and respiratory-gated PET/CT-based planning target volume (PTV) in the definition of radiation treatment planning in lung cancer: preliminary results

Guerra, Luca; Meregalli, S.; Zorz, Alessandra; Niespolo, R.M.; Ponti, Elena De; Elisei, Federica; Morzenti, Sabrina; Brenna, Sarah; Crespi, A.; Gardani, G; Messa, Cristina

doi:10.1007/s00259-013-2594-5

Cited by 31 publications

(20 citation statements)

References 33 publications

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“…In the context of stereotactic body radiotherapy (SBRT), it has been shown that it may be useful to derive respiratory correlated target volumes from gated (4D) PET/CT scans in addition to 4D‐CTs . However, the current common practice still is to segment the PET volume integrated over the scan time.…”

Section: Discussion Of Segmentation Limitations Dependencies and Immentioning

confidence: 99%

“…[227][228][229] In the context of stereotactic body radiotherapy (SBRT), it has been shown that it may be useful to derive respiratory correlated target volumes from gated (4D) PET/CT scans in addition to 4D-CTs. 228,230,231 However, the current common practice still is to segment the PET volume integrated over the scan time. If PET-AS algorithms are evaluated on clinical images against the activity as seen in the uncorrected PET image, endpoint a) as described in section 4.A, the potential effect of breathing motion in these images is disregarded.…”

Section: E Effect Of Motionmentioning

confidence: 99%

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Classification and evaluation strategies of auto-segmentation approaches for PET: Report of AAPM task group No. 211

et al. 2017

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Purpose The purpose of this educational report is to provide an overview of the present state-of-the-art PET auto-segmentation (PET-AS) algorithms and their respective validation, with an emphasis on providing the user with help in understanding the challenges and pitfalls associated with selecting and implementing a PET-AS algorithm for a particular application. Approach A brief description of the different types of PET-AS algorithms is provided using a classification based on method complexity and type. The advantages and the limitations of the current PET-AS algorithms are highlighted based on current publications and existing comparison studies. A review of the available image datasets and contour evaluation metrics in terms of their applicability for establishing a standardized evaluation of PET-AS algorithms is provided. The performance requirements for the algorithms and their dependence on the application, the radiotracer used and the evaluation criteria are described and discussed. Finally, a procedure for algorithm acceptance and implementation, as well as the complementary role of manual and auto-segmentation are addressed. Findings A large number of PET-AS algorithms have been developed within the last 20 years. Many of the proposed algorithms are based on either fixed or adaptively selected thresholds. More recently, numerous papers have proposed the use of more advanced image analysis paradigms to perform semi-automated delineation of the PET images. However, the level of algorithm validation is variable and for most published algorithms is either insufficient or inconsistent which prevents recommending a single algorithm. This is compounded by the fact that realistic image configurations with low signal-to-noise ratios (SNR) and heterogeneous tracer distributions have rarely been used. Large variations in the evaluation methods used in the literature point to the need for a standardized evaluation protocol. Conclusions Available comparison studies suggest that PET-AS algorithms relying on advanced image analysis paradigms provide generally more accurate segmentation than approaches based on PET activity thresholds, particularly for realistic configurations. However, this may not be the case for simple shape lesions in situations with a narrower range of parameters, where simpler methods may also perform well. Recent algorithms which employ some type of consensus or automatic selection between several PET-AS methods have potential to overcome the limitations of the individual methods when appropriately trained. In either case, accuracy evaluation is required for each different PET scanner and scanning and image reconstruction protocol. For the simpler, less robust approaches, adaptation to scanning conditions, tumor type, and tumor location by optimization of parameters is necessary. The results from the method evaluation stage can be used to estimate the contouring uncertainty. All PET-AS contours should be critically verified by a physician. A standard test, i.e., a benchmark dedicated to ...

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Section: Discussion Of Segmentation Limitations Dependencies and Immentioning

confidence: 99%

Section: E Effect Of Motionmentioning

confidence: 99%

Classification and evaluation strategies of auto-segmentation approaches for PET: Report of AAPM task group No. 211

et al. 2017

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“…The use of respiratory gating in integrated 18 F-FDG PET/CT has been evaluated recently, especially its clinical impact on planning target volumes for radiation therapy. Preliminary results in patients with lung cancer showed that respiratory-gated 18 F-FDG PET/CT, which tailors the target volume to lesion motion, can affect the size and shape of target volumes, leading to improved delineation [40].…”

Section: Radiotherapy Planningmentioning

confidence: 99%

Present and future roles of FDG-PET/CT imaging in the management of lung cancer

et al. 2016

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Integrated positron emission tomography/computed tomography (PET/CT) using 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluation in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool for managing patients with lung cancer. We discuss different patient management stages, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.

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“…For instance, in patient 3, the centrally positioned subcarinal lymph node showed a minimal change in SUV max (2.5/2.6, a 4% gain) whereas the mediastinal lymph nodes, which have greater motion, showed a greater change (2.2/3.0, a 35% gain). SUV mean 42% (g/mL) 1.9 ± 0.5 2.4 ± 1.6 122% ± 24% 0.14 Metabolic volume 42% (mL) 2.6 ± 2.4 1.6 ± 1.4 −19% ± 34% 0.6 TLG 42% (g) 5.8 ± 7.6 3.9 ± 3.5 −5% ± 39% 0.99 SUV peak (lung) (g/mL) 0.52 ± 0.05 0.39 ± 0.14 −25% ± 19% 0.14 Lesion-to-lung SUV peak ratio 3.8 ± 2.9 6.8 ± 6.9 154% ± 41% 0.07 SUV max (patient 2: mediastinal lymph nodes, n 5 5) (g/mL) 2.7 ± 0.5 3.3 ± 0.78 123% ± 14% 0.04 Further PFV PET/CT applications can be envisioned, such as for other lesions affected by respiratory motion (breast, chest wall, liver, pancreas, bile duct and gallbladder, esophagus and stomach, spleen, heart, kidneys), for radiation oncology therapy planning (9), or for image-guided biopsies in interventional radiology. Studies investigating the ability of PFV PET/CT to discriminate between malignant and nonmalignant lesions would be desirable, as would studies using radiopharmaceuticals other than 18 F-FDG.…”

Section: Discussionmentioning

confidence: 99%

Reduction of Respiratory Motion During PET/CT by Pulsatile-Flow Ventilation: A First Clinical Evaluation

et al. 2015

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Respiratory motion negatively affects PET/CT image quality and quantitation. A novel Pulsatile-Flow Ventilation (PFV) system reducing respiratory motion was applied in spontaneously breathing patients to induce sustained apnea during PET/CT. Methods: Four patients (aged 65 ± 14 y) underwent PET/CT for pulmonary nodule staging (mean, 11 ± 7 mm; range, 5-18 mm) at 63 ± 3 min after 18 F-FDG injection and then at 47 ± 7 min afterward, during PFV-induced apnea (with imaging lasting $8.5 min). Anterior-posterior thoracic amplitude, SUV max , and SUV peak (SUV mean in a 1-cm-diameter sphere) were compared. Results: PFV PET/CT reduced thoracic amplitude (80%), increased mean lesion SUV max (29%) and SUV peak (11%), decreased lung background SUV peak (25%), improved lesion detectability, and increased SUV peak lesion-to-background ratio (54%). On linear regressions, SUV max and SUV peak significantly improved (by 35% and 23%, respectively; P # 0.02). Conclusion: PFV-induced apnea reduces thoracic organ motion and increases lesion SUV, detectability, and delineation, thus potentially affecting patient management by improving diagnosis, prognostication, monitoring, and external-radiation therapy planning.

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Comparative evaluation of CT-based and respiratory-gated PET/CT-based planning target volume (PTV) in the definition of radiation treatment planning in lung cancer: preliminary results

Cited by 31 publications

References 33 publications

Classification and evaluation strategies of auto-segmentation approaches for PET: Report of AAPM task group No. 211

Classification and evaluation strategies of auto-segmentation approaches for PET: Report of AAPM task group No. 211

Present and future roles of FDG-PET/CT imaging in the management of lung cancer

Reduction of Respiratory Motion During PET/CT by Pulsatile-Flow Ventilation: A First Clinical Evaluation

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