TY - JOUR
T1 - Repeatability of quantitative 18F-FLT uptake measurements in solid tumors
T2 - an individual patient data multi-center meta-analysis
AU - on behalf of the QuIC-ConCePT Consortium
AU - Kramer, G. M.
AU - Liu, Y.
AU - de Langen, A. J.
AU - Jansma, E. P.
AU - Trigonis, I.
AU - Asselin, M. C.
AU - Jackson, A.
AU - Kenny, L.
AU - Aboagye, E. O.
AU - Hoekstra, O. S.
AU - Boellaard, R.
PY - 2018/6/1
Y1 - 2018/6/1
N2 - Introduction: 3′-deoxy-3′-[18F]fluorothymidine (18F–FLT) positron emission tomography (PET) provides a non-invasive method to assess cellular proliferation and response to antitumor therapy. Quantitative 18F–FLT uptake metrics are being used for evaluation of proliferative response in investigational setting, however multi-center repeatability needs to be established. The aim of this study was to determine the repeatability of 18F–FLT tumor uptake metrics by re-analyzing individual patient data from previously published reports using the same tumor segmentation method and repeatability metrics across cohorts. Methods: A systematic search in PubMed, EMBASE.com and the Cochrane Library from inception-October 2016 yielded five 18F–FLT repeatability cohorts in solid tumors. 18F–FLT avid lesions were delineated using a 50% isocontour adapted for local background on test and retest scans. SUVmax, SUVmean, SUVpeak, proliferative volume and total lesion uptake (TLU) were calculated. Repeatability was assessed using the repeatability coefficient (RC = 1.96 × SD of test–retest differences), linear regression analysis, and the intra-class correlation coefficient (ICC). The impact of different lesion selection criteria was also evaluated. Results: Images from four cohorts containing 30 patients with 52 lesions were obtained and analyzed (ten in breast cancer, nine in head and neck squamous cell carcinoma, and 33 in non-small cell lung cancer patients). A good correlation was found between test–retest data for all 18F–FLT uptake metrics (R2 ≥ 0.93; ICC ≥ 0.96). Best repeatability was found for SUVpeak (RC: 23.1%), without significant differences in RC between different SUV metrics. Repeatability of proliferative volume (RC: 36.0%) and TLU (RC: 36.4%) was worse than SUV. Lesion selection methods based on SUVmax ≥ 4.0 improved the repeatability of volumetric metrics (RC: 26–28%), but did not affect the repeatability of SUV metrics. Conclusions: In multi-center studies, differences ≥ 25% in 18F–FLT SUV metrics likely represent a true change in tumor uptake. Larger differences are required for FLT metrics comprising volume estimates when no lesion selection criteria are applied.
AB - Introduction: 3′-deoxy-3′-[18F]fluorothymidine (18F–FLT) positron emission tomography (PET) provides a non-invasive method to assess cellular proliferation and response to antitumor therapy. Quantitative 18F–FLT uptake metrics are being used for evaluation of proliferative response in investigational setting, however multi-center repeatability needs to be established. The aim of this study was to determine the repeatability of 18F–FLT tumor uptake metrics by re-analyzing individual patient data from previously published reports using the same tumor segmentation method and repeatability metrics across cohorts. Methods: A systematic search in PubMed, EMBASE.com and the Cochrane Library from inception-October 2016 yielded five 18F–FLT repeatability cohorts in solid tumors. 18F–FLT avid lesions were delineated using a 50% isocontour adapted for local background on test and retest scans. SUVmax, SUVmean, SUVpeak, proliferative volume and total lesion uptake (TLU) were calculated. Repeatability was assessed using the repeatability coefficient (RC = 1.96 × SD of test–retest differences), linear regression analysis, and the intra-class correlation coefficient (ICC). The impact of different lesion selection criteria was also evaluated. Results: Images from four cohorts containing 30 patients with 52 lesions were obtained and analyzed (ten in breast cancer, nine in head and neck squamous cell carcinoma, and 33 in non-small cell lung cancer patients). A good correlation was found between test–retest data for all 18F–FLT uptake metrics (R2 ≥ 0.93; ICC ≥ 0.96). Best repeatability was found for SUVpeak (RC: 23.1%), without significant differences in RC between different SUV metrics. Repeatability of proliferative volume (RC: 36.0%) and TLU (RC: 36.4%) was worse than SUV. Lesion selection methods based on SUVmax ≥ 4.0 improved the repeatability of volumetric metrics (RC: 26–28%), but did not affect the repeatability of SUV metrics. Conclusions: In multi-center studies, differences ≥ 25% in 18F–FLT SUV metrics likely represent a true change in tumor uptake. Larger differences are required for FLT metrics comprising volume estimates when no lesion selection criteria are applied.
KW - Flt
KW - Oncology
KW - PET
KW - Repeatability
UR - http://www.scopus.com/inward/record.url?scp=85040861305&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s00259-017-3923-x
DO - https://doi.org/10.1007/s00259-017-3923-x
M3 - Article
C2 - 29362858
SN - 1619-7070
VL - 45
SP - 951
EP - 961
JO - European journal of nuclear medicine and molecular imaging
JF - European journal of nuclear medicine and molecular imaging
IS - 6
ER -