Repeatability of quantitative18F-FLT uptake measurements in solid tumors: an individual patient data multi-center meta-analysis

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Title: Repeatability of quantitative18F-FLT uptake measurements in solid tumors: an individual patient data multi-center meta-analysis
Authors: Kramer, GM
Liu, Y
De Langen, AJ
Jansma, EP
Trigonis, I
Asselin, M-C
Jackson, A
Kenny, L
Aboagye, EO
Hoekstra, OS
Boellaard, R
QuIC-ConCePT consortium
Item Type: Journal Article
Abstract: 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. Quantitative18F-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 of18F-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 five18F-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 all18F-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% in18F-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.
Issue Date: 1-Jun-2018
Date of Acceptance: 26-Dec-2017
URI: http://hdl.handle.net/10044/1/57964
DOI: https://dx.doi.org/10.1007/s00259-017-3923-x
ISSN: 1619-7070
Publisher: Springer Verlag
Start Page: 951
End Page: 961
Journal / Book Title: European Journal of Nuclear Medicine and Molecular Imaging
Volume: 45
Issue: 6
Copyright Statement: © The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: National Institute for Health Research
Commission of the European Communities
Funder's Grant Number: NIHR/CS/009/009
115151
Keywords: Science & Technology
Life Sciences & Biomedicine
Radiology, Nuclear Medicine & Medical Imaging
Flt
Repeatability
PET
Oncology
CELL LUNG-CANCER
POSITRON-EMISSION-TOMOGRAPHY
VOLUME MEASUREMENTS
FDG-PET/CT
REPRODUCIBILITY
PROLIFERATION
CHEMOTHERAPY
PERCIST
QuIC-ConCePT consortium
1103 Clinical Sciences
0299 Other Physical Sciences
Nuclear Medicine & Medical Imaging
Publication Status: Published
Conference Place: Germany
Online Publication Date: 2018-01-23
Appears in Collections:Division of Surgery
Division of Cancer
Faculty of Medicine



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