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European Journal of Nuclear Medicine and Molecular Imaging

Erschienen in:

06.10.2020 | Original Article

Optimal ⁶⁸Ga-PSMA and ¹⁸F-PSMA PET window levelling for gross tumour volume delineation in primary prostate cancer

verfasst von: Cédric Draulans, Robin De Roover, Uulke A. van der Heide, Linda Kerkmeijer, Robert J. Smeenk, Floris Pos, Wouter V. Vogel, James Nagarajah, Marcel Janssen, Sofie Isebaert, Frederik Maes, Cindy Mai, Raymond Oyen, Steven Joniau, Martina Kunze-Busch, Karolien Goffin, Karin Haustermans

Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging | Ausgabe 4/2021

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Abstract

Purpose

This study proposes optimal tracer-specific threshold-based window levels for PSMA PET–based intraprostatic gross tumour volume (GTV) contouring to reduce interobserver delineation variability.

Methods

Nine ⁶⁸Ga-PSMA-11 and nine ¹⁸F-PSMA-1007 PET scans including GTV delineations of four expert teams (GTV_manual) and a majority-voted GTV (GTV_majority) were assessed with respect to a registered histopathological GTV (GTV_histo) as the gold standard reference. The standard uptake values (SUVs) per voxel were converted to a percentage (SUV%) relative to the SUV_max. The statistically optimised SUV% threshold (SOST) was defined as those that maximises accuracy for threshold-based contouring. A leave-one-out cross-validation receiver operating characteristic (ROC) curve analysis was performed to determine the SOST for each tracer. The SOST analysis was performed twice, first using the GTV_histo contour as training structure (GTV_SOST-H) and second using the GTV_majority contour as training structure (GTV_SOST-MA) to correct for any limited misregistration. The accuracy of both GTV_SOST-H and GTV_SOST-MA was calculated relative to GTV_histo in the ‘leave-one-out’ patient of each fold and compared with the accuracy of GTV_manual.

Results

ROC curve analysis for ⁶⁸Ga-PSMA-11 PET revealed a median threshold of 25 SUV% (range, 22–27 SUV%) and 41 SUV% (40–43 SUV%) for GTV_SOST-H and GTV_SOST-MA, respectively. For ¹⁸F-PSMA-1007 PET, a median threshold of 42 SUV% (39–45 SUV%) for GTV_SOST-H and 44 SUV% (42–45 SUV%) for GTV_SOST-MA was found. A significant pairwise difference was observed when comparing the accuracy of the GTV_SOST-H contours with the median accuracy of the GTV_manual contours (median, − 2.5%; IQR, − 26.5–0.2%; p = 0.020), whereas no significant pairwise difference was found for the GTV_SOST-MA contours (median, − 0.3%; IQR, − 4.4–0.6%; p = 0.199).

Conclusions

Threshold-based contouring using GTV_majority-trained SOSTs achieves an accuracy comparable with manual contours in delineating GTV_histo. The median SOSTs of 41 SUV% for ⁶⁸Ga-PSMA-11 PET and 44 SUV% for ¹⁸F-PSMA-1007 PET form a base for tracer-specific window levelling.

Trial registration

Clinicaltrials.gov; NCT03327675; 31-10-2017

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Titel: Optimal 68Ga-PSMA and 18F-PSMA PET window levelling for gross tumour volume delineation in primary prostate cancer
verfasst von: Cédric Draulans
Robin De Roover
Uulke A. van der Heide
Linda Kerkmeijer
Robert J. Smeenk
Floris Pos
Wouter V. Vogel
James Nagarajah
Marcel Janssen
Sofie Isebaert
Frederik Maes
Cindy Mai
Raymond Oyen
Steven Joniau
Martina Kunze-Busch
Karolien Goffin
Karin Haustermans
Publikationsdatum: 06.10.2020
Verlag: Springer Berlin Heidelberg
Erschienen in: European Journal of Nuclear Medicine and Molecular Imaging / Ausgabe 4/2021
Print ISSN: 1619-7070
Elektronische ISSN: 1619-7089
DOI: https://doi.org/10.1007/s00259-020-05059-4

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

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