Repeatability of18F-FLT PET in a Multicenter Study of Patients with High-Grade Glioma.
Quantitative 3'-deoxy-3'-18F-fluorothymidine (18F-FLT) PET has potential as a noninvasive tumor biomarker for the objective assessment of response to treatment. To guide interpretation of these quantitative data, we evaluated the repeatability of18F-FLT PET as part of a multicenter trial involving patients with high-grade glioma.Methods:18F-FLT PET was performed on 10 patients with recurrent high-grade glioma at 5 different institutions within the Adult Brain Tumor Consortium trial ABTC1101. Data were acquired according to a double baseline protocol in which PET examinations were repeated within 2 d of each other with no intervening treatment. On each of the 2 imaging days, dedicated brain PET was performed at 2 time points, 1 and 3 h after18F-FLT administration. Tumor SUVs and related parameters were measured at a central laboratory using various volumes of interest: isocontour at 30% of the maximum pixel (SUVmean_30%), gradient-based segmentation (SUVmean_gradient), the maximum pixel (SUVmax), and a 1-mL sphere at the region of highest uptake (SUVpeak). Repeatability coefficients (RCs) were calculated from the relative differences between corresponding SUV measurements obtained on the 2 d.Results:RCs for tumor SUVs were 22.5% (SUVmean_30%), 23.8% (SUVmean_gradient), 23.2% (SUVmax), and 18.5% (SUVpeak) at 1 h after injection. Corresponding data at 3 h were 22.4%, 25.0%, 27.3%, and 23.6%. Normalizing the tumor SUV data with reference to a background region improved repeatability, and the most stable parameter was the tumor-to-background ratio derived using SUVpeak(RC, 16.5%).Conclusion:SUV quantification of18F-FLT uptake in glioma had an RC in the range of 18%-24% when imaging began 1 h after18F-FLT administration. The volume-of-interest methodology had a small but not negligible influence on repeatability, with the best performance obtained using SUVpeakAlthough changes in18F-FLT SUV after treatment cannot be directly interpreted as a change in tumor proliferation, we have established ranges beyond which SUV differences are likely due to legitimate biologic effects.
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland mlodge1@jhmi.edu.
Martin A
MA
Lodge
Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Matthias
M
Holdhoff
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Jeffrey P
JP
Leal
University of Alabama, Birmingham, Alabama.
Asim K
AK
Bag
University of Alabama, Birmingham, Alabama.
L Burt
LB
Nabors
Wake Forest University School of Medicine, Winston Salem, North Carolina.
Akiva
A
Mintz
Wake Forest University School of Medicine, Winston Salem, North Carolina.
Glenn J
GJ
Lesser
University of Pennsylvania, Philadelphia, Pennsylvania.
David A
DA
Mankoff
University of Pennsylvania, Philadelphia, Pennsylvania.
Arati S
AS
Desai
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
James M
JM
Mountz
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; and.
Frank S
FS
Lieberman
Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Joy D
JD
Fisher
Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Serena
S
Desideri
Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Xiaobu
X
Ye
Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Stuart A
SA
Grossman
University of Virginia, Charlottesville, Virginia.
David
D
Schiff
The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland.|Brain Cancer Program, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, Maryland.
Richard L
RL
Wahl
D000328:Adult; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D015224:Dideoxynucleosides; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D015588:Observer Variation; D049268:Positron-Emission Tomography / Q000379:methods*; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States
D015224:Dideoxynucleosides; D019275:Radiopharmaceuticals; C002854:alovudine
FLT; PET; SUV; glioma; repeatability; reproducibility
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