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Impact of Lesion Location On the Repeatability of 18F-NaF PET/CT

C Lin

C Lin*, T Perk , S Harmon , S Perlman , G Liu , R Jeraj , University of Wisconsin, Madison, WI


WE-H-207A-4 (Wednesday, August 3, 2016) 4:30 PM - 6:00 PM Room: 207A

Quantifying the repeatability of imaging biomarkers is critical for assessing therapeutic response. While ¹⁸F-NaF PET/CT has shown to be a repeatable imaging method, research has not shown which factors may influence its repeatability. The purpose of this study was to evaluate whether the location of the lesion impacts the repeatability of quantitative ¹⁸F-NaF PET-derived SUV metrics.

Metastatic castrate-resistant prostate cancer patients with multiple bone lesions received whole-body test-retest NaF PET/CT scans. Malignant bone lesions of PET-defined volume greater than 1.5 cm³ were identified by a nuclear medicine physician and automatically delineated using a SUV>15 threshold. The maximum (SUVmax), average (SUVmean), and total (SUVtotal) SUV were extracted from each lesion. Atlas-based segmentation was used to divide each patient skeleton into 25 skeletal regions. Test-retest repeatability of each SUV metric was assessed with coefficient of variation (CV).

A total of 265 malignant bone lesions from 18 patients were identified by nuclear medicine physician. The largest proportion of bone lesions were localized to the spine (41%), with 41% of those lesions localized to the thoracic spine. One-way ANOVA showed that measurement differences differed significantly for all three metrics across locations (p<0.01 for each metrics). Overall, CV was smallest for SUVmean at 5.3%, followed by SUVmax at 11.5% and SUVtotal at 20.4%. Lesions in the pubis were consistently the most repeatable (CV(SUVmax)= 5.6%, CV(SUVmean)= 0.6%, CV(SUVtotal)= 2.9%). According to SUVmean, repeatability was poorest in the cervical spine (CV = 6.2%), whereas according to SUVmax and SUVtotal, repeatability was poorest in the ribs (CV(SUVmax)= 15.0%, CV(SUVtotal)= 29.8%).

Location of the lesion affects the repeatability of ¹⁸F-NaF PET/CT, with the ribs and cervical spine having the lowest repeatability and the pubis having the highest repeatability. These results can be used to establish location-specific response criteria for NaF PET-based treatment response assessment.

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