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Assessment of various strategies for 18F-FET PET-guided delineation of target volumes in high-grade glioma patients

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The purpose of the study is to assess the contribution of 18F-fluoro-ethyl-tyrosine (18F-FET) positron emission tomography (PET) in the delineation of gross tumor volume (GTV) in patients with high-grade gliomas compared with magnetic resonance imaging (MRI) alone.

Materials and methods

The study population consisted of 18 patients with high-grade gliomas. Seven image segmentation techniques were used to delineate 18F-FET PET GTVs, and the results were compared to the manual MRI-derived GTV (GTVMRI). PET image segmentation techniques included manual delineation of contours (GTVman), a 2.5 standardized uptake value (SUV) cutoff (GTV2.5), a fixed threshold of 40% and 50% of the maximum signal intensity (GTV40% and GTV50%), signal-to-background ratio (SBR)-based adaptive thresholding (GTVSBR), gradient find (GTVGF), and region growing (GTVRG). Overlap analysis was also conducted to assess geographic mismatch between the GTVs delineated using the different techniques.

Results

Contours defined using GTV2.5 failed to provide successful delineation technically in three patients (18% of cases) as SUVmax < 2.5 and clinically in 14 patients (78% of cases). Overall, the majority of GTVs defined on PET-based techniques were usually smaller than GTVMRI (67% of cases). Yet, PET detected frequently tumors that are not visible on MRI and added substantially tumor extension outside the GTVMRI in six patients (33% of cases).

Conclusions

The selection of the most appropriate 18F-FET PET-based segmentation algorithm is crucial, since it impacts both the volume and shape of the resulting GTV. The 2.5 SUV isocontour and GF segmentation techniques performed poorly and should not be used for GTV delineation. With adequate setting, the SBR-based PET technique may add considerably to conventional MRI-guided GTV delineation.

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Acknowledgments

This work was supported by the Swiss National Science Foundation under grant No. 3152A0-102143, the Indo Swiss Bilateral Research Initiative (ISBRI) supported by the Swiss State Secretariat for Education and Research under grant No. AP24, and the foundation Cellex International. This paper is dedicated to the memory of Prof. Bruce Hasegawa (Department of Radiology, UCSF), a brilliant scientist and true friend who sadly passed away last summer.

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Authors and Affiliations

  1. Service of Nuclear Medicine, Geneva University Hospital, CH-1211, Geneva, Switzerland

    Hansjörg Vees, Srinivasan Senthamizhchelvan, Osman Ratib & Habib Zaidi

  2. Service of Radiation Oncology, Geneva University Hospital, CH-1211, Geneva, Switzerland

    Hansjörg Vees, Raymond Miralbell & Damien C. Weber

  3. Division of Nuclear Medicine, Geneva University Hospital, CH-1211, Geneva 4, Switzerland

    Habib Zaidi

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  1. Hansjörg Vees
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  2. Srinivasan Senthamizhchelvan
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Correspondence to Habib Zaidi.

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Vees, H., Senthamizhchelvan, S., Miralbell, R. et al. Assessment of various strategies for 18F-FET PET-guided delineation of target volumes in high-grade glioma patients. Eur J Nucl Med Mol Imaging 36, 182–193 (2009). https://doi.org/10.1007/s00259-008-0943-6

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  • DOI: https://doi.org/10.1007/s00259-008-0943-6

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