Repeatability of quantitative (18)F-NaF PET: A multicenter study Journal Article


Authors: Lin, C.; Bradshaw, T.; Perk, T.; Harmon, S.; Eickhoff, J.; Jallow, N.; Choyke, P. L.; Dahut, W. L.; Larson, S.; Humm, J. L.; Perlman, S.; Apolo, A. B.; Morris, M. J.; Liu, G.; Jeraj, R.
Article Title: Repeatability of quantitative (18)F-NaF PET: A multicenter study
Abstract: 18F-NaF, a PET radiotracer of bone turnover, has shown potential as an imaging biomarker for assessing the response of bone metastases to therapy. This study aimed to evaluate the repeatability of 18F-NaF PET-derived SUV imaging metrics in individual bone lesions from patients in a multicenter study. Methods: Thirty-five castration-resistant prostate cancer patients with multiple metastases underwent 2 whole-body (test-retest) 18F-NaF PET/CT scans 3 ± 2 d apart from 1 of 3 imaging sites. A total of 411 bone lesions larger than 1.5 cm3 were automatically segmented using an SUV threshold of 15 g/mL. Two levels of analysis were performed: lesion-level, in which measures were extracted from individual-lesion regions of interest (ROI), and patient-level, in which all lesions within a patient were grouped into a patient ROI for analysis. Uptake was quantified with SUVmax, SUVmean, and SUVtotal. Test-retest repeatability was assessed using Bland-Altman analysis, intraclass correlation coefficient (ICC), coefficient of variation, critical percentage difference, and repeatability coefficient. The 95% limit of agreement (LOA) of the ratio between test and retest measurements was calculated. Results: At the lesion level, the coefficient of variation for SUVmax, SUVmean, and SUVtotal was 14.1%, 6.6%, and 25.5%, respectively. At the patient level, it was slightly smaller: 12.0%, 5.3%, and 18.5%, respectively. ICC was excellent (.0.95) for all SUV metrics. Lesion-level 95% LOA for SUVmax, SUVmean, and SUVtotal was (0.76, 1.32), (0.88, 1.14), and (0.63, 1.71), respectively. Patient-level 95% LOA was slightly narrower, at (0.79, 1.26), (0.89, 1.10), and (0.70, 1.44), respectively. We observed significant differences in the variance and sample mean of lesion-level and patient-level measurements between imaging sites. Conclusion: The repeatability of SUVmax, SUVmean, and SUVtotal for 18F-NaF PET/CT was similar between lesion- and patient-level ROIs. We found significant differences in lesion-level and patient-level distributions between sites. These results can be used to establish 18F-NaF PET-based criteria for assessing treatment response at the lesion and patient levels. 18F-NaF PET demonstrates repeatability levels useful for clinically quantifying the response of bone lesions to therapy. COPYRIGHT © 2016 by the Society of Nuclear Medicine and Molecular Imaging, Inc.
Keywords: pet; repeatability; metastatic prostate cancer; multicenter clinical trial; sodium fluoride
Journal Title: Journal of Nuclear Medicine
Volume: 57
Issue: 12
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2016-12-01
Start Page: 1872
End Page: 1879
Language: English
DOI: 10.2967/jnumed.116.177295
PROVIDER: scopus
PUBMED: 27445292
PMCID: PMC6952054
DOI/URL:
Notes: Article -- Export Date: 3 January 2017 -- Source: Scopus
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MSK Authors
  1. Michael Morris
    353 Morris
  2. John Laurence Humm
    366 Humm
  3. Steven M Larson
    878 Larson