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FDG PET/CT for rectal carcinoma radiotherapy treatment planning: comparison of functional volume delineation algorithms and clinical challenges.

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Withofs, Nadia Bernard, Claire Van der Rest, Catherine Martinive, Philippe Hatt, Mathieu Jodogne, Sébastien [UCL] Lee, John Aldo [UCL] Hustinx, Roland

PET/CT imaging could improve delineation of rectal carcinoma gross tumor volume (GTV) and reduce interobserver variability. The objective of this work was to compare various functional volume delineation algorithms. We enrolled 31 consecutive patients with locally advanced rectal carcinoma. The FDG PET/CT and the high dose CT (CTRT) were performed in the radiation treatment position. For each patient, the anatomical GTVRT was delineated based on the CTRT and compared to six different functional/metabolic GTVPET derived from two automatic segmentation approaches (FLAB and a gradient-based method); a relative threshold (45% of the SUVmax) and an absolute threshold (SUV > 2.5), using two different commercially available software (Philips EBW4 and Segami OASIS). The spatial sizes and shapes of all volumes were compared using the conformity index (CI). All the delineated metabolic tumor volumes (MTVs) were significantly different. The MTVs were as follows (mean ± SD): GTVRT (40.6 ± 31.28ml); FLAB (21.36± 16.34 ml); the gradient-based method (18.97± 16.83ml); OASIS 45% (15.89 ± 12.68 ml); Philips 45% (14.52 ± 10.91 ml); OASIS 2.5 (41.6 2 ± 33.26 ml); Philips 2.5 (40 ± 31.27 ml). CI between these various volumes ranged from 0.40 to 0.90. The mean CI between the different MTVs and the GTVCT was < 0.4. Finally, the DICOM transfer of MTVs led to additional volume variations. In conclusion, we observed large and statistically significant variations in tumor volume delineation according to the segmentation algorithms and the software products. The manipulation of PET/CT images and MTVs, such as the DICOM transfer to the Radiation Oncology Department, induced additional volume variations.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès restreint
Publication date 2014
Language Anglais
Journal information "Journal of Applied Clinical Medical Physics" - Vol. 15, no.5, p. 4696 (2014)
Peer reviewed yes
Publisher American College of Medical Physics
issn 1526-9914
e-issn 1526-9914
Publication status Publié
Affiliations UCL - SSS/IREC/MIRO - Pôle d'imagerie moléculaire, radiothérapie et oncologie
UCL - SST/ICTM/ELEN - Pôle en ingénierie électrique
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Bibliographic reference Withofs, Nadia ; Bernard, Claire ; Van der Rest, Catherine ; Martinive, Philippe ; Hatt, Mathieu ; et. al. FDG PET/CT for rectal carcinoma radiotherapy treatment planning: comparison of functional volume delineation algorithms and clinical challenges.. In: Journal of Applied Clinical Medical Physics, Vol. 15, no.5, p. 4696 (2014)
Permanent URL http://hdl.handle.net/2078.1/156136