Correlation of PET standard uptake value and CT window-level thresholds for target delineation in CT-based radiation treatment planning

Hong, Robert; Halama, J; Bova, Davide; Sethi, Anil; Emami, Bahman

doi:10.1016/j.ijrobp.2006.09.039

Cited by 131 publications

(96 citation statements)

References 29 publications

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“…Therefore, with 18 F-FDG PET, the target volume can either be enlarged, incorporating additional tumor tissue not identified by CT, or reduced, excluding nontumor structures and leading to a reduction of the irradiated normal tissue and, thus, permitting an escalation of the irradiation dose (36). There is no reliable correlation of CT window and level settings to PET SUV, although Hong et al (37) developed a method of correlating SUV to window and level thresholds. The use of variable CT-threshold settings (18,36,38) can undoubtedly affect the GTV.…”

Section: Discussionmentioning

confidence: 99%

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using ¹⁸F-FDG PET/CT in Non–Small Cell Lung Cancer?

Ung

Hwang

et al. 2010

J Nucl Med

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Previously, we showed that a CT window and level setting of 1,600 and -300 Hounsfield units, respectively, and autocontouring using an 18 F-FDG PET 50% intensity level correlated best with pathologic results. The aim of this study was to compare this autocontouring with manual contouring, to determine which method is better. Methods: Seventeen patients with non-small cell lung cancer underwent 18 F-FDG PET/CT before surgery. The maximum diameter on pathologic examination was determined. Seven sets of gross tumor volumes (GTVs) were defined. The first set (GTV CT ) was contoured manually using only CT information. The second set (GTV Auto ) was autocontoured using a 50% intensity level for 18 F-FDG PET images. The third set (GTV Manual ) was manually contoured using a visual method on PET images. The other 4 sets combined CT and 18 F-FDG PET images fused to one another to become composite volumes: GTV CT1Auto , GTV CT1Manual , GTV CT2Auto , and GTV CT-Manual . To quantitate the degree to which CT and 18 F-FDG PET defined the same region of interest, a matching index was calculated for each case. The maximum diameter of GTV was compared with the maximum diameter on pathologic examination. Results: The median GTV CT , GTV Auto , GTV Manual , GTV CT1Auto , GTV CT1Manual , GTV CT-Auto , and GTV CT-Manual were 6. 96, 2.42, 4.37, 7.46, 10.17, 2.21, and 3.38 cm 3 , respectively. The median matching indexes of GTV CT versus GTV CT1Auto , GTV Auto versus GTV CT1Auto , GTV CT versus GTV CT1Manual , and GTV Manual versus GTV CT1Manual were 0.86, 0.65, 0.88, and 0.81, respectively. Compared with the maximum diameter on pathologic examination, the correlations of GTV CT , GTV Auto , GTV Manual , GTV CT1Auto , and GTV CT1Manual were 0.87, 0.83, 0.93, 0.86, and 0.94, respectively. Conclusion: The matching index was higher for manual contouring than for autocontouring using a 50% intensity level on 18 F-FDG PET images. When using a 50% intensity level to contour the target of non-small cell lung cancer, one should also consider using manual contouring of 18 F-FDG PET to check for any missed disease. It is well established that 18 F-FDG PET plays an important role in the staging of non-small cell lung cancer (NSCLC). Multiple studies have demonstrated the utility of PET for improving staging accuracy. In an overview of the available literature, 18 F-FDG PET was found to have a 79%-100% sensitivity and a 40%-90% specificity in diagnosing primary lung cancer (1).The conventional imaging modality for therapy planning in NSCLC is CT. Targeting of the gross tumor has been facilitated by the use of CT simulation, which allows for more accurate delineation of the tumor. Multimodality imaging combining functional and anatomic information such as PET has allowed for further refinement in the therapy planning process and has a significant impact on the planning target volume. However, much uncertainty exists regarding the most appropriate threshold cutoff that should be used to define a PET target volume in NSCLC therapy planning. There ar...

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Section: Discussionmentioning

confidence: 99%

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using ¹⁸F-FDG PET/CT in Non–Small Cell Lung Cancer?

Ung

Hwang

et al. 2010

J Nucl Med

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“…The retention index (RI) represented the percent change of 18 F-FDG uptake and was calculated as follows: RI = ΔSUVmax/SUVmax initial x100%, ΔSUVmax = SUVmax delayed -SUVmax initial and RI >10% was considered as a criterion for the diagnosis of malignancy, a threshold that has been widely used in previous studies (2)(3)(4)(5). In this study, we limited metabolic tumor volume (MTV) by a fixed SUV of 2.5, a threshold that has been widely used for diagnosis in previous studies (6)(7)(8). All the measurements were performed on the combined PET-CT images.…”

Section: F-fdg Pet-ctmentioning

confidence: 99%

Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer

Xue

Zheng

Guo

et al. 2014

Molecular and Clinical Oncology

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Abstract. This study was conducted to investigate the predictive value of 18 F-fluorodeoxyglucose positron emission tomography-computed tomography ( 18 F-FDG PET-CT) in patients with non-small-cell lung cancer (NSCLC), compared to that of postoperative pathological findings, for T and N staging and the associations of the metabolic parameters of the primary tumor with histological type and differentiation. The preoperative contrast-enhanced CT and 18 F-FDG PET-CT and postoperative pathological findings of 112 NSCLC patients treated with lobectomy or pneumonectomy combined with systematic mediastinal lymphadenectomy were retrospectively reviewed. Compared to the postoperative pathological findings, the effect of contrast-enhanced CT and 18 F-FDG PET-CT on T and N staging were evaluated. The metabolic tumor volume (MTV) and maximum standardized uptake value (SUVmax) of the primary tumor were measured. The associations between these metabolic parameters and histological type and differentiation were also evaluated. The differences in the accuracy in overall staging and T staging between PET-CT and contrast-enhanced CT were significant (91.1 vs. 69.6%, P=0.000; and 92.9 vs. 76.8%, P=0.000, respectively). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of regional lymph node metastasis detection were 91.7, 93.0, 86.5, 95.8 and 92.6%, respectively, with PET-CT; and 71.3, 77.2, 60.6, 84.5 and 75.2%, respectively, with contrast-enhanced CT. The SUVmax , t=4.48, P=0.000) were significantly higher for squamous cell carcinoma (SCC) compared to those for adenocarcinoma (AC). There was a positive correlation between the MTV and SUVmax of the primary tumor (Pearson's r=0.838, P=0.000). Significant differences were observed among differentiation subgroups in the SUVmax and MTV of the primary tumor for both SCC and AC. In conclusion, compared to the postoperative pathological findings, the predictive value of 18 F-FDG PET-CT for T and N staging in NSCLC was higher compared to that of contrast-enhanced CT. The FDG uptake of the primary tumor was associated with histological type and differentiation and the difference was statistically significant. Therefore, the SUVmax and MTV of the primary tumor may be valuable indices to partly predict the histological type and grade of differentiation of NSCLC.

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“…The primary tumor was delineated on a lung window setting (window 1000 HU, level 2600 HU) and the lymph nodes on mediastinal setting (window 40 HU, level 400 HU) and central necrosis within the tumor was not excluded from GTV. Lymph nodes were defined to be involved if the short axis was larger than 10 mm on CT, or if they had high FDG-avidity in PET images, and the edge of the lesion was established by an the standard uptake value (SUV) contour of 2.5 (12). Gross tumor volumes (GTVs) for primary tumors and involved lymph nodes were delineated and agreed upon by two radiation oncologists who were well trained in PET/CT diagnosis.…”

Section: F-fdg Pet/ct Image and Target Delineationmentioning

confidence: 99%

A Clinical Study of Shrinking Field Radiation Therapy Based on ¹⁸F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer

Ding

Wang

et al. 2013

Technol Cancer Res Treat

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The aim is to investigate the feasibility of shrinking field technique after 40 Gy for stage III nonsmall cell lung cancer (NSCLC) during radiation therapy. Eighty-seven consecutive patients treated with intensity-modulated radiation therapy or three-dimensional conformal radiation therapy were enrolled in this study. months, ranging from 5 to 46 months, and the 1-and 2-year overall survival rates in our study were 74.7% and 34.6%. The response rate was 79.5%, and radiation toxicity was acceptable. Tumor progression occurred in 67.8% (59/87) patients. Numbers of patients who had outfield, infield and both infield and outfield recurrences were 3 (3.4%), 26 (29.5%), and 3 (3.4%), respectively. In conclusion, significant tumor regression was observed after 40 Gy, and radiation dose escalated after shrinking field with acceptable toxicity and outfield relapse. Shrinking field radiotherapy based on 18 F-FDG PET/CT after 40 Gy was safe and feasible for stage III NSCLC.

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Correlation of PET standard uptake value and CT window-level thresholds for target delineation in CT-based radiation treatment planning

Cited by 131 publications

References 29 publications

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using ¹⁸F-FDG PET/CT in Non–Small Cell Lung Cancer?

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using ¹⁸F-FDG PET/CT in Non–Small Cell Lung Cancer?

Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer

A Clinical Study of Shrinking Field Radiation Therapy Based on ¹⁸F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer

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Correlation of PET standard uptake value and CT window-level thresholds for target delineation in CT-based radiation treatment planning

Cited by 131 publications

References 29 publications

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using 18F-FDG PET/CT in Non–Small Cell Lung Cancer?

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using 18F-FDG PET/CT in Non–Small Cell Lung Cancer?

Predictive value of 18F-fluorodeoxyglucose positron emission tomography - computed tomography compared to postoperative pathological findings for patients with non-small-cell lung cancer

A Clinical Study of Shrinking Field Radiation Therapy Based on 18F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer

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Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using ¹⁸F-FDG PET/CT in Non–Small Cell Lung Cancer?

Autocontouring and Manual Contouring: Which Is the Better Method for Target Delineation Using ¹⁸F-FDG PET/CT in Non–Small Cell Lung Cancer?

A Clinical Study of Shrinking Field Radiation Therapy Based on ¹⁸F-FDG PET/CT for Stage III Non-Small Cell Lung Cancer