FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0

Abstract

The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.

Overview of the predictive value of quantitative 18 FDG PET in head and neck cancer treated with chemoradiotherapy

“…Such methodologies and findings highlight the difficulty in identifying a cutoff which may be tested on external dataset of patients. The use of international guidelines, like the European Association of Nuclear Medecine guidelines for tumor imaging (Boellaard et al, 2015), by harmonizing quantitative FDG PET/CT imaging procedures in multicentre studies and quantitative interpretation criteria, may increases the reproducibility of PET studies.…”

Role of Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Imaging in Diagnosis and Staging of Lung Cancer

“…Soliter akciğer nodüllerinin değerlendirilmesinde FDG PET/BT gösterdiği yüksek duyarlılık sayesinde, boyutu 8 mm üzerinde olan nodüller için akciğer kanserinin dışlanması amacıyla kullanılır (7,8,10,11,12). PET pozitifliği nodülde FDG tutulumunun görsel olarak mediastinal kan havuzundan daha yüksek olması biçiminde tanımlanmıştır (8).…”

“…Akciğer kanseri FDG PET/BT görüntülemenin klinikte öncelikli olarak kabul gördüğü alanlardan birisi olmuştur. Akciğer kanserinde gösterdiği yüksek tanısal doğruluk sayesinde günümüzde FDG PET/ BT görüntüleme birçok klinik akciğer kanseri yönergesinde rutin bir tanısal yöntem olarak yer almaktadır (6,7,8,10,11). PET görüntülerine uygulanan yeni sayısal analiz yöntemleri, PET detektörlerinin manyetik rezonans (MR) görüntüleme ile eş zamanlı kullanılabildiği hibrid PET/MR sistemleri ve glikoz metabolizması dışındaki farklı patofizyolojik mekanizmaları hedefleyen yeni PET radyofarmasötiklerinin üretilmesi gibi gelişmeler sayesinde akciğer kanserinde PET görüntüleme endikasyonlarının ve kullanım yaygınlığının artması öngörülmektedir.…”

The promise of multiparametric imaging in oncology: how do we move forward?

“…Besides MRI, other drivers beneficial for multiparametric imaging are the increased number of standardization procedures that are being rolled out. For PET [6] and also MRI [7], standardization (or harmonization) procedures are currently in place or being developed. These procedures should remove some of the uncertainties and difficulties that multicentre trials face in quantitative analysis and allow more robust quantitative imaging-derived parameters [8].…”