title: Harmonizing SUVs in multicentre trials when using different generation PET systems: prospective validation in non-small cell lung cancer patients.
abstract: OBJECTIVE
  We prospectively evaluated whether a strategy using point spread function (PSF) reconstruction for both diagnostic and quantitative analysis in non-small cell lung cancer (NSCLC) patients meets the European Association of Nuclear Medicine (EANM) guidelines for harmonization of quantitative values.
  
  
  METHODS
  The NEMA NU-2 phantom was used to determine the optimal filter to apply to PSF-reconstructed images in order to obtain recovery coefficients (RCs) fulfilling the EANM guidelines for tumour positron emission tomography (PET) imaging (PSF(EANM)). PET data of 52 consecutive NSCLC patients were reconstructed with unfiltered PSF reconstruction (PSF(allpass)), PSF(EANM) and with a conventional ordered subset expectation maximization (OSEM) algorithm known to meet EANM guidelines. To mimic a situation in which a patient would undergo pre- and post-therapy PET scans on different generation PET systems, standardized uptake values (SUVs) for OSEM reconstruction were compared to SUVs for PSF(EANM) and PSF(allpass) reconstruction.
  
  
  RESULTS
  Overall, in 195 lesions, Bland-Altman analysis demonstrated that the mean ratio between PSF(EANM) and OSEM data was 1.03 [95% confidence interval (CI) 0.94-1.12] and 1.02 (95% CI 0.90-1.14) for SUV(max) and SUV(mean), respectively. No difference was noticed when analysing lesions based on their size and location or on patient body habitus and image noise. Ten patients (84 lesions) underwent two PET scans for response monitoring. Using the European Organization for Research and Treatment of Cancer (EORTC) criteria, there was an almost perfect agreement between OSEM(PET1)/OSEM(PET2) (current standard) and OSEM(PET1)/PSF(EANM-PET2) or PSF(EANM-PET1)/OSEM(PET2) with kappa values of 0.95 (95% CI 0.91-1.00) and 0.99 (95% CI 0.96-1.00), respectively. The use of PSF(allpass) either for pre- or post-treatment (i.e. OSEM(PET1)/PSF(allpass-PET2) or PSF(allpass-PET1)/OSEM(PET2)) showed considerably less agreement with kappa values of 0.75 (95% CI 0.67-0.83) and 0.86 (95% CI 0.78-0.94), respectively.
  
  
  CONCLUSIONS
  Protocol-optimized images and compliance with EANM guidelines allowed for a reliable pre- and post-therapy evaluation when using different generation PET systems. These data obtained in NSCLC patients could be extrapolated to other solid tumours.
authors.affiliation: Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France.
authors.forename: Charline
authors.initials: C
authors.lastname: Lasnon
authors.forename: Cédric
authors.initials: C
authors.lastname: Desmonts
authors.forename: Elske
authors.initials: E
authors.lastname: Quak
authors.forename: Radj
authors.initials: R
authors.lastname: Gervais
authors.forename: Pascal
authors.initials: P
authors.lastname: Do
authors.forename: Catherine
authors.initials: C
authors.lastname: Dubos-Arvis
authors.forename: Nicolas
authors.initials: N
authors.lastname: Aide
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001692:Biological Transport; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000628:therapy; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D049268:Positron-Emission Tomography / Q000592:standards*; D011446:Prospective Studies; D012015:Reference Standards; D015203:Reproducibility of Results; D016896:Treatment Outcome
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