title: Repeatability of metabolically active tumor volume measurements with FDG PET/CT in advanced gastrointestinal malignancies: a multicenter study.
abstract: OBJECTIVE
  To evaluate the feasibility and repeatability of various metabolically active tumor volume ( MATV metabolically active tumor volume ) quantification methods in fluorine 18 fluorodeoxyglucose ( FDG fluorine 18 fluorodeoxyglucose ) positron emission tomography (PET)/computed tomography (CT) in a multicenter setting and propose the optimal MATV metabolically active tumor volume method together with the minimal threshold for future response evaluation studies.
  
  
  METHODS
  The study was approved by the institutional review board of all four participating centers, and patients provided written informed consent. Thirty-four patients with advanced gastrointestinal malignancies underwent two FDG fluorine 18 fluorodeoxyglucose PET/CT examinations within 1 week. MATV metabolically active tumor volume s were defined semiautomatically with 27 variations of tumor delineation methods with different reference values. Feasibility was determined as the percentage of successful tumor segmentations per MATV metabolically active tumor volume method. Repeatability was determined with intraclass correlation coefficients, Bland-Altman plots, and limits of agreement ( LOA limit of agreement s) of the percentage difference between the test and repeat test measurements. In addition, LOA limit of agreement variability per center was investigated.
  
  
  RESULTS
  In total, 136 lesions were identified. Feasibility of tumor segmentation ranged from 54% to 100% (74-136 of 136 lesions); repeatability was evaluated for 19 MATV metabolically active tumor volume methods with feasibility of greater than 95%. The median MATV metabolically active tumor volume derived with 50% threshold of mean standardized uptake value ( SUV standardized uptake value ) of a sphere of 12-mm diameter with highest local intensity ( SUVhp mean SUV of a sphere of 12-mm diameter with highest local intensity ), which may not include the voxel with highest SUV standardized uptake value corrected for local background, was 5.7 and 6.1 mL for test and retest scans, respectively, with a relative LOA limit of agreement of 36.1%. Comparable repeatability was found between centers. A difference in uptake time between scan 1 and 2 of 15 minutes or longer had a minor negative influence on repeatability.
  
  
  CONCLUSIONS
  MATV metabolically active tumor volume measured with 50% of SUVhp mean SUV of a sphere of 12-mm diameter with highest local intensity corrected for local background is recommended in multicenter FDG fluorine 18 fluorodeoxyglucose PET/CT studies on the basis of a high feasibility (96%) and repeatability ( LOA limit of agreement of 36.1%).
authors.affiliation: From the Department of Radiology and Nuclear Medicine (V.F., F.H.P.v.V., O.S.H., R.B.) and Department of Biostatistics and Epidemiology (P.M.v.d.V.), VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, the Netherlands; and Bristol-Myers Squibb, Princeton, NJ (L.M.V., W.H.).
authors.forename: Virginie
authors.initials: V
authors.lastname: Frings
authors.forename: Floris H P
authors.initials: FH
authors.lastname: van Velden
authors.forename: Linda M
authors.initials: LM
authors.lastname: Velasquez
authors.forename: Wendy
authors.initials: W
authors.lastname: Hayes
authors.forename: Peter M
authors.initials: PM
authors.lastname: van de Ven
authors.forename: Otto S
authors.initials: OS
authors.lastname: Hoekstra
authors.forename: Ronald
authors.initials: R
authors.lastname: Boellaard
mesh_terms: D002170:Canada; D005260:Female; D019788:Fluorodeoxyglucose F18; D005770:Gastrointestinal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed; D014481:United States
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18