Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting

Sven van den Bosch; Tim Dijkema; Marielle E P Philippens; Chris H J Terhaard; Frank J P Hoebers; Johannes H A M Kaanders; Wim J G Oyen

doi:10.1016/j.radonc.2018.06.037

Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting

Sven van den Bosch, Tim Dijkema, Marielle E P Philippens, Chris H J Terhaard, Frank J P Hoebers, Johannes H A M Kaanders, Wim J G Oyen

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: In quantitative FDG-PET data analysis, normalization of the standardized uptake value (SUV) with an internal image-derived standard improves its reproducibility. In this study, the cervical spinal cord is proposed as an internal standard that is within the field of view of the radiotherapy planning PET/CT-scan in head and neck cancer. The aim is to evaluate if the tumor to cervical spinal cord standardized uptake ratio (SUR) can improve the reproducibility of a model to determine the metabolic tumor volume (MTV) on FDG-PET/CT in a multicenter setting.

MATERIALS AND METHODS: Ninety-five radiotherapy planning FDG-PET/CT-scans of patients with head and neck cancer were analyzed using the Bland-Altman method to evaluate differences in FDG-uptake in the cervical spinal cord and the mediastinal blood pool. Non-linear regression analysis was used to determine the optimal MTV using the gross tumor volume (GTV) as ground truth and a spatial overlap-index as statistical validation metric. Reproducibility was evaluated using the Bland-Altman method and external validation was performed in an independent dataset consisting of 62 patients.

RESULTS: Bland-Altman's analyses demonstrated equivalence of FDG-uptake in the mediastinal blood pool and the cervical spinal cord. Reproducibility of the models improved when using SUR instead of SUV. These results were confirmed in the validation cohort.

CONCLUSION: The use of the tumor to cervical spinal cord SUR instead of SUV improves the reproducibility of a model to determine the MTV on FDG-PET/CT in a multicenter setting. This study indicates that SUR may be preferred over SUV based approaches.

Original language	English
Pages (from-to)	39-45
Number of pages	7
Journal	Radiotherapy & Oncology
Volume	130
DOIs	https://doi.org/10.1016/j.radonc.2018.06.037
Publication status	Published - Jan 2019

Keywords

Adult
Aged
Cervical Cord/diagnostic imaging
Cohort Studies
Female
Fluorodeoxyglucose F18/pharmacokinetics
Head and Neck Neoplasms/diagnostic imaging
Humans
Male
Middle Aged
Positron Emission Tomography Computed Tomography/methods
Radiopharmaceuticals/pharmacokinetics
Radiotherapy Planning, Computer-Assisted/methods
Regression Analysis
Reproducibility of Results
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck/diagnostic imaging
Tumor Burden

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10.1016/j.radonc.2018.06.037

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van den Bosch, S., Dijkema, T., Philippens, M. E. P., Terhaard, C. H. J., Hoebers, F. J. P., Kaanders, J. H. A. M., & Oyen, W. J. G. (2019). Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting. Radiotherapy & Oncology, 130, 39-45. https://doi.org/10.1016/j.radonc.2018.06.037

@article{af0ea142b9bf4f72a8fa4c94299ac639,

title = "Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting",

abstract = "BACKGROUND: In quantitative FDG-PET data analysis, normalization of the standardized uptake value (SUV) with an internal image-derived standard improves its reproducibility. In this study, the cervical spinal cord is proposed as an internal standard that is within the field of view of the radiotherapy planning PET/CT-scan in head and neck cancer. The aim is to evaluate if the tumor to cervical spinal cord standardized uptake ratio (SUR) can improve the reproducibility of a model to determine the metabolic tumor volume (MTV) on FDG-PET/CT in a multicenter setting.MATERIALS AND METHODS: Ninety-five radiotherapy planning FDG-PET/CT-scans of patients with head and neck cancer were analyzed using the Bland-Altman method to evaluate differences in FDG-uptake in the cervical spinal cord and the mediastinal blood pool. Non-linear regression analysis was used to determine the optimal MTV using the gross tumor volume (GTV) as ground truth and a spatial overlap-index as statistical validation metric. Reproducibility was evaluated using the Bland-Altman method and external validation was performed in an independent dataset consisting of 62 patients.RESULTS: Bland-Altman's analyses demonstrated equivalence of FDG-uptake in the mediastinal blood pool and the cervical spinal cord. Reproducibility of the models improved when using SUR instead of SUV. These results were confirmed in the validation cohort.CONCLUSION: The use of the tumor to cervical spinal cord SUR instead of SUV improves the reproducibility of a model to determine the MTV on FDG-PET/CT in a multicenter setting. This study indicates that SUR may be preferred over SUV based approaches.",

keywords = "Adult, Aged, Cervical Cord/diagnostic imaging, Cohort Studies, Female, Fluorodeoxyglucose F18/pharmacokinetics, Head and Neck Neoplasms/diagnostic imaging, Humans, Male, Middle Aged, Positron Emission Tomography Computed Tomography/methods, Radiopharmaceuticals/pharmacokinetics, Radiotherapy Planning, Computer-Assisted/methods, Regression Analysis, Reproducibility of Results, Retrospective Studies, Squamous Cell Carcinoma of Head and Neck/diagnostic imaging, Tumor Burden",

author = "{van den Bosch}, Sven and Tim Dijkema and Philippens, {Marielle E P} and Terhaard, {Chris H J} and Hoebers, {Frank J P} and Kaanders, {Johannes H A M} and Oyen, {Wim J G}",

year = "2019",

month = jan,

doi = "10.1016/j.radonc.2018.06.037",

language = "English",

volume = "130",

pages = "39--45",

journal = "Radiotherapy & Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

}

van den Bosch, S, Dijkema, T, Philippens, MEP , Terhaard, CHJ, Hoebers, FJP, Kaanders, JHAM & Oyen, WJG 2019, 'Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting', Radiotherapy & Oncology, vol. 130, pp. 39-45. https://doi.org/10.1016/j.radonc.2018.06.037

Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting. / van den Bosch, Sven; Dijkema, Tim; Philippens, Marielle E P et al.
In: Radiotherapy & Oncology, Vol. 130, 01.2019, p. 39-45.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting

AU - van den Bosch, Sven

AU - Dijkema, Tim

AU - Philippens, Marielle E P

AU - Terhaard, Chris H J

AU - Hoebers, Frank J P

AU - Kaanders, Johannes H A M

AU - Oyen, Wim J G

PY - 2019/1

Y1 - 2019/1

N2 - BACKGROUND: In quantitative FDG-PET data analysis, normalization of the standardized uptake value (SUV) with an internal image-derived standard improves its reproducibility. In this study, the cervical spinal cord is proposed as an internal standard that is within the field of view of the radiotherapy planning PET/CT-scan in head and neck cancer. The aim is to evaluate if the tumor to cervical spinal cord standardized uptake ratio (SUR) can improve the reproducibility of a model to determine the metabolic tumor volume (MTV) on FDG-PET/CT in a multicenter setting.MATERIALS AND METHODS: Ninety-five radiotherapy planning FDG-PET/CT-scans of patients with head and neck cancer were analyzed using the Bland-Altman method to evaluate differences in FDG-uptake in the cervical spinal cord and the mediastinal blood pool. Non-linear regression analysis was used to determine the optimal MTV using the gross tumor volume (GTV) as ground truth and a spatial overlap-index as statistical validation metric. Reproducibility was evaluated using the Bland-Altman method and external validation was performed in an independent dataset consisting of 62 patients.RESULTS: Bland-Altman's analyses demonstrated equivalence of FDG-uptake in the mediastinal blood pool and the cervical spinal cord. Reproducibility of the models improved when using SUR instead of SUV. These results were confirmed in the validation cohort.CONCLUSION: The use of the tumor to cervical spinal cord SUR instead of SUV improves the reproducibility of a model to determine the MTV on FDG-PET/CT in a multicenter setting. This study indicates that SUR may be preferred over SUV based approaches.

AB - BACKGROUND: In quantitative FDG-PET data analysis, normalization of the standardized uptake value (SUV) with an internal image-derived standard improves its reproducibility. In this study, the cervical spinal cord is proposed as an internal standard that is within the field of view of the radiotherapy planning PET/CT-scan in head and neck cancer. The aim is to evaluate if the tumor to cervical spinal cord standardized uptake ratio (SUR) can improve the reproducibility of a model to determine the metabolic tumor volume (MTV) on FDG-PET/CT in a multicenter setting.MATERIALS AND METHODS: Ninety-five radiotherapy planning FDG-PET/CT-scans of patients with head and neck cancer were analyzed using the Bland-Altman method to evaluate differences in FDG-uptake in the cervical spinal cord and the mediastinal blood pool. Non-linear regression analysis was used to determine the optimal MTV using the gross tumor volume (GTV) as ground truth and a spatial overlap-index as statistical validation metric. Reproducibility was evaluated using the Bland-Altman method and external validation was performed in an independent dataset consisting of 62 patients.RESULTS: Bland-Altman's analyses demonstrated equivalence of FDG-uptake in the mediastinal blood pool and the cervical spinal cord. Reproducibility of the models improved when using SUR instead of SUV. These results were confirmed in the validation cohort.CONCLUSION: The use of the tumor to cervical spinal cord SUR instead of SUV improves the reproducibility of a model to determine the MTV on FDG-PET/CT in a multicenter setting. This study indicates that SUR may be preferred over SUV based approaches.

KW - Adult

KW - Aged

KW - Cervical Cord/diagnostic imaging

KW - Cohort Studies

KW - Female

KW - Fluorodeoxyglucose F18/pharmacokinetics

KW - Head and Neck Neoplasms/diagnostic imaging

KW - Humans

KW - Male

KW - Middle Aged

KW - Positron Emission Tomography Computed Tomography/methods

KW - Radiopharmaceuticals/pharmacokinetics

KW - Radiotherapy Planning, Computer-Assisted/methods

KW - Regression Analysis

KW - Reproducibility of Results

KW - Retrospective Studies

KW - Squamous Cell Carcinoma of Head and Neck/diagnostic imaging

KW - Tumor Burden

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U2 - 10.1016/j.radonc.2018.06.037

DO - 10.1016/j.radonc.2018.06.037

M3 - Article

C2 - 30005954

SN - 0167-8140

VL - 130

SP - 39

EP - 45

JO - Radiotherapy & Oncology

JF - Radiotherapy & Oncology

ER -

Tumor to cervical spinal cord standardized uptake ratio (SUR) improves the reproducibility of F-18-FDG-PET based tumor segmentation in head and neck squamous cell carcinoma in a multicenter setting

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Keywords

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