Abstract
Respiratory motion causes uncertainties in tumor edges on either computed tomography (CT) or positron emission tomography (PET) images and causes misalignment when registering PET and CT images. This phenomenon may cause radiation oncologists to delineate tumor volume inaccurately in radiotherapy treatment planning. The purpose of this study was to analyze radiology applications using interpolated average CT (IACT) as attenuation correction (AC) to diminish the occurrence of this scenario. Thirteen non-small cell lung cancer patients were recruited for the present comparison study. Each patient had full-inspiration, full-expiration CT images and free breathing PET images by an integrated PET/CT scan. IACT for AC in PETIACT was used to reduce the PET/CT misalignment. The standardized uptake value (SUV) correction with a low radiation dose was applied, and its tumor volume delineation was compared to those from HCT/PETHCT. The misalignment between the PETIACT and IACT was reduced when compared to the difference between PETHCT and HCT. The range of tumor motion was from 4 to 17 mm in the patient cohort. For HCT and PETHCT, correction was from 72% to 91%, while for IACT and PETIACT, correction was from 73% to 93% (*p<0.0001). The maximum and minimum differences in SUVmax were 0.18% and 27.27% for PETHCT and PETIACT, respectively. The largest percentage differences in the tumor volumes between HCT/PET and IACT/PET were observed in tumors located in the lowest lobe of the lung. Internal tumor volume defined by functional information using IACT/PETIACT fusion images for lung cancer would reduce the inaccuracy of tumor delineation in radiation therapy planning.
Highlights
PET/CT combines F18-FDG positron emission tomography (PET), and computed tomography (CT) images with both functional and anatomic information provide a more precise diagnostic reference for tumor volume, tumor locations and tumor staging
For helical CTs (HCT) and PETHCT, correction was from 72% to 91%, while for interpolated average CT (IACT) and PETIACT, correction was from 73% to 93% (*p,0.0001)
The arrows indicate the mismatch observed in PETHCT/HCT fusion between PETHCT and HCT showing in the (A) transverse (B) coronal and (C) sagittal views
Summary
PET/CT combines F18-FDG positron emission tomography (PET), and computed tomography (CT) images with both functional and anatomic information provide a more precise diagnostic reference for tumor volume, tumor locations and tumor staging. PET/CT has been increasingly used for target volume delineation in radiotherapy treatment planning (RTP) to deliver the optimal radiation dose to tumors and to decrease the radiation dose to surrounding normal tissues [1,2,3]. The reduction of intra- and inter-observer variability in target volume delineation by contouring with PET/CT has been reported in previous studies [4,5]. PET is a useful imaging tool to differentiate between inflammation and malignance, such as lung atelectasis, mediastinal lymphadenopathy, and distant metastases [6]. The incorporation of PET information in RTP along with the CT-based gross tumor volume can improve the definition of tumor volume and has been extensively used in radiotherapy.
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