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01.07.2012 | Original article

Respiratory gated [¹⁸F]FDG PET/CT for target volume delineation in stereotactic radiation treatment of liver metastases

verfasst von: R.A. Bundschuh, N. Andratschke, J. Dinges, M.N. Duma, S.T. Astner, M. Brügel, S.I. Ziegler, M. Molls, M. Schwaiger, M. Essler

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 7/2012

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Abstract

Purpose

The use of 4D-[¹⁸F]fluorodeoxyglucose (FDG) PET/CT in combination with respiratory gated magnet resonance imaging (MRI) in target volume definition for stereotactic radiation of liver metastases was investigated.

Methods and materials

A total of 18 patients received respiration gated FDG-PET/CT and MRI. Data were fused using a rigid co-registration algorithm. The quality of the co-registration was rated on a scale from 1 (excellent) to 5 (poor) for co-registration of MRI with gated PET and ungated PET. Gross tumor volume (GTV) was delineated in CT (GTV _CT), MRI (GTV_MRI), and PET (GTV_PET). MRI- and PET-based GTVs were defined by three observers each. Interobserver variability was calculated for all patients as well as for subgroups with and without previous treatment of liver metastases. All GTVs were compared for all patients and separately for patients with previous local therapy. In addition, a semiautomatic segmentation algorithm was applied on the PET images.

Results

Co-registration between MR and PET images was rated with 3.3 in average when non-gated PET was used and improved significantly (p < 0.01) to 2.1 using gated PET. The average GTV_CT was 51.5 ml, GTV_MRI 51.8 ml, and the average GTV_PET 48.1 ml. Volumes delineated in MRI were 9.9% larger compared to those delineated in CT. Volumes delineated in PET were 13.8% larger than in MRI. The differences between the GTVs were more pronounced in patients with previous treatment. The GTVs defined in MRI showed an interobserver variability of 47.9% (84.1% with previous treatment and 26.2% without previous treatment). The PET-defined GTVs showed an interobserver variability of 21% regardless of previous treatment. Semiautomatic segmentation did not provide satisfying results.

Conclusion

FDG-PET can distinguish vital tumor tissue and scar tissue, and therefore alters the GTV especially in patients with previous local treatment. In addition, it reduces the interobserver variability significantly compared to MRI. However, respiratory gated PET is necessary for good co-registration of PET and MRI.

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Titel: Respiratory gated [18F]FDG PET/CT for target volume delineation in stereotactic radiation treatment of liver metastases
verfasst von: R.A. Bundschuh
N. Andratschke
J. Dinges
M.N. Duma
S.T. Astner
M. Brügel
S.I. Ziegler
M. Molls
M. Schwaiger
M. Essler
Publikationsdatum: 01.07.2012
Verlag: Springer-Verlag
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 7/2012
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-012-0094-3

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Respiratory gated [¹⁸F]FDG PET/CT for target volume delineation in stereotactic radiation treatment of liver metastases

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Purpose

Methods and materials

Results

Conclusion

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