FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0

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Abstract

The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the physician and physicist to assist to carrying out, interpret, and document quantitative FDG PET/CT examinations, but will concentrate on the optimisation of diagnostic quality and quantitative information.

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Most cited references 35

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From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors.

Richard L. Wahl, Heather Jacene, Yvette Kasamon … (2009)

The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments.

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Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group.

H. Young, R. Baum, U Cremerius … (1999)

[18F]-fluorodeoxyglucose ([18F]-FDG) uptake is enhanced in most malignant tumours which in turn can be measured using positron emission tomography (PET). A number of small clinical trials have indicated that quantification of the change in tumour [18F]-FDG uptake may provide an early, sensitive, pharmacodynamic marker of the tumoricidal effect of anticancer drugs. This may allow for the introduction of subclinical response for anticancer drug evaluation in early clinical trials and improvements in patient management. For comparison of results from smaller clinical trials and larger-scale multicentre trials a consensus is desirable for: (i) common measurement criteria; and (ii) reporting of alterations in [18F]-FDG uptake with treatment. This paper summarises the current status of the technique and recommendations on the measurement of [18F]-FDG uptake for tumour response monitoring from a consensus meeting of the European Organization for Research and Treatment of Cancer (EORTC) PET study group held in Brussels in February 1998 and confirmed at a subsequent meeting in March 1999.

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Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma.

Malik Juweid, Sigrid S. Stroobants, Otto Hoekstra … (2007)

To develop guidelines for performing and interpreting positron emission tomography (PET) imaging for treatment assessment in patients with lymphoma both in clinical practice and in clinical trials. An International Harmonization Project (IHP) was convened to discuss standardization of clinical trial parameters in lymphoma. An imaging subcommittee developed consensus recommendations based on published PET literature and the collective expertise of its members in the use of PET in lymphoma. Only recommendations subsequently endorsed by all IHP subcommittees were adopted. PET after completion of therapy should be performed at least 3 weeks, and preferably at 6 to 8 weeks, after chemotherapy or chemoimmunotherapy, and 8 to 12 weeks after radiation or chemoradiotherapy. Visual assessment alone is adequate for interpreting PET findings as positive or negative when assessing response after completion of therapy. Mediastinal blood pool activity is recommended as the reference background activity to define PET positivity for a residual mass > or = 2 cm in greatest transverse diameter, regardless of its location. A smaller residual mass or a normal sized lymph node (ie, < or = 1 x 1 cm in diameter) should be considered positive if its activity is above that of the surrounding background. Specific criteria for defining PET positivity in the liver, spleen, lung, and bone marrow are also proposed. Use of attenuation-corrected PET is strongly encouraged. Use of PET for treatment monitoring during a course of therapy should only be done in a clinical trial or as part of a prospective registry.

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Author and article information

Contributors

: +31-20-4449638 , +31-20-4443090 , r.boellaard@vumc.nl

Journal

Journal ID (nlm-ta): Eur J Nucl Med Mol Imaging

Title: European Journal of Nuclear Medicine and Molecular Imaging

Publisher: Springer-Verlag (Berlin/Heidelberg )

ISSN (Print): 1619-7070

ISSN (Electronic): 1619-7089

Publication date (Electronic): 14 November 2009

Publication date (Print): January 2010

Volume: 37

Issue: 1

Pages: 181-200

Affiliations

[1 ]Department of Nuclear Medicine and PET Research, VU University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands

[2 ]PET Imaging Centre, Division of Imaging Sciences, King’s College London and Guys and St Thomas’ NHS Foundation Trust, London, UK

[3 ]Department of Nuclear Medicine, University Hospital Freiburg, Freiburg, Germany

[4 ]Department of Nuclear Medicine, University Hospital RWTH Aachen, Aachen, Germany

[5 ]Department of Clinical Physiology and Nuclear Medicine, Bispebjerg Hospital, Copenhagen, Denmark

[6 ]Department of Nuclear Medicine, University Hospital Antwerpen, Antwerpen, Belgium

[7 ]Department of Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

[8 ]Clinic and Outpatient Clinic for Nuclear Medicine, University Hospital Dresden, Dresden, Germany

[9 ]Department of Nuclear Medicine and Molecular Imaging, University Medical Centre Groningen, Groningen, The Netherlands

[10 ]EANM Research Ltd. (EARL), Vienna, Austria

[11 ]Department of Nuclear Medicine, Jeroen Bosch Hospital, ‘s-Hertogenbosch, The Netherlands

[12 ]Department of Clinical Physics, Catharina Hospital, Eindhoven, The Netherlands

[13 ]Department of Nuclear Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands

[14 ]Department of Haematology, VU University Medical Centre, Amsterdam, The Netherlands

[15 ]cmi-experts GmbH, Zurich, Switzerland

[16 ]Clinic for Nuclear Medicine, University Hospital Essen, Essen, Germany

[17 ]Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands

[18 ]Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN USA

[19 ]Department of Nuclear Medicine, Center for PET/CT, Zentralklinik Bad Berka, Germany

[20 ]Nuclear Medicine, Istituto Clinico Humanitas, Rozzano, MI Italy

[21 ]Department of Nuclear Medicine, Technische Universität München, Munich, Germany

Article

Publisher ID: 1297

DOI: 10.1007/s00259-009-1297-4

PMC ID: 2791475

PubMed ID: 19915839

SO-VID: 26dc148e-e548-4e19-8b6f-4d2b1b9d1b38

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ScienceOpen disciplines: Radiology & Imaging

Keywords: qa,qc,guideline,pet/ct,oncology,tumour,pet,quantification,fdg

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ScienceOpen disciplines: Radiology & Imaging

Keywords: qa, qc, guideline, pet/ct, oncology, tumour, pet, quantification, fdg

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FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0

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Most cited references 35

From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors.

Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. European Organization for Research and Treatment of Cancer (EORTC) PET Study Group.

Use of positron emission tomography for response assessment of lymphoma: consensus of the Imaging Subcommittee of International Harmonization Project in Lymphoma.

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Cited by 313

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