Abstract
Investigation of differences in derived [18F]FDG PET metabolic and volumetric parameters among three different software programs in lung cancer. A retrospective analysis was performed on a group of 98 lung cancer patients who underwent a baseline [18F]FDG PET/CT study. To assess appropriate delineation methods, the NEMA phantom study was first performed using the following software: Philips EBW (Extended Brilliance Workstation), MIM Software and Rover. Based on this study, the best cut-off methods (dependent on tumour size) were selected, extracted and applied for lung cancer delineation. Several semiquantitative [18F]FDG parameters (SUVmax, SUVmean, TLG and MTV) were assessed and compared among the three software programs. The parameters were assessed based on body weight (BW), lean body mass (LBM) and Bq/mL. Statistically significant differences were found in SUVmean (LBM) between MIM Software and Rover (4.62 ± 2.15 vs 4.84 ± 1.20; p < 0.005), in SUVmean (Bq/mL) between Rover and Philips EBW (21,852.30 ± 21,821.23 vs 19,274.81 ± 13,340.28; p < 0.005) and Rover and MIM Software (21,852.30 ± 21,821.23 vs 19,399.40 ± 10,051.30; p < 0.005), and in MTV between MIM Software and Philips EBW (19.87 ± 25.83 vs 78.82 ± 228.00; p = 0.0489). This study showed statistically significant differences in the estimation of semiquantitative parameters using three independent image analysis tools. These findings are important for performing further diagnostic and treatment procedures in lung cancer patients.
Highlights
Lung cancer in general is one of the most commonly diagnosed (11.6%) types of cancer and is the leading cause of cancer-related death (18.4%) worldwide in both sex groups[1], while non-small cell lung cancer (NSCLC) in particular is the most commonly (85%) newly diagnosed histopathological lung cancer type[2]
In the whole group of patients, a very strong correlation was found in S UVmax values in body weight (BW), Becquerel’s per millilitre (Bq/mL) and lean body mass (LBM) among all three software programs and in SUVmean BW and LBM, while a moderate correlation was found in SUVmean values in Bq/mL among all three software programs (Tables 1 and 2)
Another strong correlation was found between Rover and MIM Software in total lesion glycolysis (TLG) (Bq/mL) value (r = 0.9863) and in metabolic tumour volume (MTV) (BW) value (r = 0.9830) (Tables 3 and 4)
Summary
Lung cancer in general is one of the most commonly diagnosed (11.6%) types of cancer and is the leading cause of cancer-related death (18.4%) worldwide in both sex groups[1], while non-small cell lung cancer (NSCLC) in particular is the most commonly (85%) newly diagnosed histopathological lung cancer type[2]. SUV is a normalized concentration of a radiopharmaceutical in a lesion of interest Since both the patient’s body weight (BW) and lean body mass (LBM) can be used for normalization, both options should be examined alongside the nonnormalized uptake value (Bq/mL). Three different software programs in only two patients were each analysed, and the results showed that the distribution of SUV differs among packages. Different approaches were shown by Arain et al, who compared four software packages and assessed the differences in various SUV values in 100 p atients[6]. Their study concluded that different software programs should not be used interchangeably in clinical practice, the differences in SUV values among them were small. Wilson et al reviewed PET/CT images among four different FDA-approved software packages and found significant differences in S UVmax values among t hem[7]. In 2017, Breault et al used this software in the analysis of [ 18F]florbetapir PET standard uptake value ratios (SUVr) in patients suspected of having Alzheimer’s d isease[11]
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