Clinical implications of different image reconstruction parameters for interpretation of whole-body PET studies in cancer patients Journal Article


Authors: Schöder, H.; Erdi, Y. E.; Chao, K.; Gonen, M.; Larson, S. M.; Yeung, H. W. D.
Article Title: Clinical implications of different image reconstruction parameters for interpretation of whole-body PET studies in cancer patients
Abstract: The standardized uptake value (SUV) is the most commonly used parameter to quantify the intensity of radiotracer uptake in tumors. Previous studies suggested that measurements of 18F-FDG accumulation in tissue might be affected by the image reconstruction method, but the clinical relevance of these findings has not been assessed. Methods: Phantom studies were performed and clinical whole-body 18F-FDG PET images of 85 cancer patients were analyzed. All images were reconstructed using either filtered backprojection (FBP) with measured attenuation correction (MAC) or iterative reconstruction (IR) with segmented attenuation correction (SAC). In a subset of 15 patients, images were reconstructed using all 4 combinations of IR+SAC, IR+MAC, FBP+SAC, and FBP+MAC. For phantom studies, a sphere containing 18F-FDG was placed in a water-filled cylinder and the activity concentration of that sphere was measured in FBP and IR reconstructed images using all 4 combinations. Clinical studies were displayed simultaneously and identical regions of interest (ROIs, 50 pixels) were placed in liver, urinary bladder, and tumor tissue in both image sets. SUV max (maximal counts per pixel in ROI) and SUV avg (average counts per pixel) were measured. Results: In phantom studies, measurements from FBP images underestimated the true activity concentration to a greater degree than those from IR images (20% vs. 5% underestimation). In patient studies, SUV derived from FBP images were consistently lower than those from IR images in both normal and tumor tissue: Tumor SUV max with IR+SAC was 9.6 ± 4.5, with IR+MAC it was 7.7 ± 3.5, with FBP+MAC it was 6.9 ± 3.0, and with FBP+SAC it was 8.6 ± 4.1 (all P < 0.01 vs. IR+SAC). Compared with IR+SAC, SUV from FBP+MAC images were 25%-30% lower. Similar discrepancies were noted for liver and bladder. Discrepancies between measurements became more apparent with increasing 18F-FDG concentration in tissue. Conclusion: SUV measurements in whole-body PET studies are affected by the applied methods for both image reconstruction and attenuation correction. This should be considered when serial PET studies are done in cancer patients. Moreover, if SUV is used for tissue characterization, different cutoff values should be applied, depending on the chosen method for image reconstruction and attenuation correction.
Keywords: adolescent; adult; controlled study; aged; aged, 80 and over; middle aged; major clinical study; clinical trial; cancer patient; comparative study; positron emission tomography; methodology; diagnostic accuracy; sensitivity and specificity; radiopharmaceuticals; neoplasm; neoplasms; reproducibility; reproducibility of results; image interpretation, computer-assisted; validation study; algorithms; liver; diagnostic agent; drug uptake; algorithm; computer assisted diagnosis; image enhancement; instrumentation; image quality; fluorodeoxyglucose f 18; computer assisted emission tomography; fluorodeoxyglucose f18; radiopharmaceutical agent; scintiscanning; phantoms, imaging; tumor; whole body counting; whole-body counting; pet; bioaccumulation; image reconstruction; tomography, emission-computed; bladder; infrared spectrophotometry; standardized uptake value; 18f-fdg; cancer; humans; human; male; female; priority journal; article
Journal Title: Journal of Nuclear Medicine
Volume: 45
Issue: 4
ISSN: 0161-5505
Publisher: Society of Nuclear Medicine  
Date Published: 2004-04-01
Start Page: 559
End Page: 566
Language: English
PROVIDER: scopus
PUBMED: 15073250
DOI/URL:
Notes: J. Nucl. Med. -- Cited By (since 1996):61 -- Export Date: 16 June 2014 -- CODEN: JNMEA C2 - 15073250 -- Source: Scopus
Citation Impact
MSK Authors
  1. Henry W D Yeung
    126 Yeung
  2. Mithat Gonen
    1034 Gonen
  3. Heiko Schoder
    552 Schoder
  4. Yusuf E Erdi
    118 Erdi
  5. Steven M Larson
    960 Larson