title: FDG PET/CT for rectal carcinoma radiotherapy treatment planning: comparison of functional volume delineation algorithms and clinical challenges.
abstract: PET/CT imaging could improve delineation of rectal carcinoma gross tumor volume (GTV) and reduce interobserver variability. The objective of this work was to compare various functional volume delineation algorithms. We enrolled 31 consecutive patients with locally advanced rectal carcinoma. The FDG PET/CT and the high dose CT (CTRT) were performed in the radiation treatment position. For each patient, the anatomical GTVRT was delineated based on the CTRT and compared to six different functional/metabolic GTVPET derived from two automatic segmentation approaches (FLAB and a gradient-based method); a relative threshold (45% of the SUVmax) and an absolute threshold (SUV &gt; 2.5), using two different commercially available software (Philips EBW4 and Segami OASIS). The spatial sizes and shapes of all volumes were compared using the conformity index (CI). All the delineated metabolic tumor volumes (MTVs) were significantly different. The MTVs were as follows (mean ± SD): GTVRT (40.6 ± 31.28ml); FLAB (21.36± 16.34 ml); the gradient-based method (18.97± 16.83ml); OASIS 45% (15.89 ± 12.68 ml); Philips 45% (14.52 ± 10.91 ml); OASIS 2.5 (41.6 2 ± 33.26 ml); Philips 2.5 (40 ± 31.27 ml). CI between these various volumes ranged from 0.40 to 0.90. The mean CI between the different MTVs and the GTVCT was &lt; 0.4. Finally, the DICOM transfer of MTVs led to additional volume variations. In conclusion, we observed large and statistically significant variations in tumor volume delineation according to the segmentation algorithms and the software products. The manipulation of PET/CT images and MTVs, such as the DICOM transfer to the Radiation Oncology Department, induced additional volume variations.
authors.affiliation: Division of Nuclear Medicine, CHU Liege. nwithofs@chu.ulg.ac.be.
authors.forename: Nadia
authors.initials: N
authors.lastname: Withofs
authors.forename: Claire
authors.initials: C
authors.lastname: Bernard
authors.forename: Catherine
authors.initials: C
authors.lastname: Van der Rest
authors.forename: Philippe
authors.initials: P
authors.lastname: Martinive
authors.forename: Mathieu
authors.initials: M
authors.lastname: Hatt
authors.forename: Sebastien
authors.initials: S
authors.lastname: Jodogne
authors.forename: Dimitris
authors.initials: D
authors.lastname: Visvikis
authors.forename: John A
authors.initials: JA
authors.lastname: Lee
authors.forename: Philippe A
authors.initials: PA
authors.lastname: Coucke
authors.forename: Roland
authors.initials: R
authors.lastname: Hustinx
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D008297:Male; D064847:Multimodal Imaging / Q000379:methods; D015588:Observer Variation; D010363:Pattern Recognition, Automated / Q000379:methods; D049268:Positron-Emission Tomography / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D019788:Fluorodeoxyglucose F18