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. 2010 Sep 2:5:76.
doi: 10.1186/1748-717X-5-76.

18F-FDG PET/CT-based gross tumor volume definition for radiotherapy in head and neck cancer: a correlation study between suitable uptake value threshold and tumor parameters

Chia-Hung Kao  1 , Te-Chun Hsieh, Chun-Yen Yu, Kuo-Yang Yen, Shih-Neng Yang, Yao-Ching Wang, Ji-An Liang, Chun-Ru Chien, Shang-Wen Chen
Affiliations

18F-FDG PET/CT-based gross tumor volume definition for radiotherapy in head and neck cancer: a correlation study between suitable uptake value threshold and tumor parameters

Chia-Hung Kao et al. Radiat Oncol. .

Abstract

Background: To define a suitable threshold setting for gross tumor volume (GTV) when using 18Fluoro-deoxyglucose positron emission tomography and computed tomogram (PET/CT) for radiotherapy planning in head and neck cancer (HNC).

Methods: Fifteen HNC patients prospectively received PET/CT simulation for their radiation treatment planning. Biological target volume (BTV) was derived from PET/CT-based GTV of the primary tumor. The BTVs were defined as the isodensity volumes when adjusting different percentage of the maximal standardized uptake value (SUVmax), excluding any artifact from surrounding normal tissues. CT-based primary GTV (C-pGTV) that had been previously defined by radiation oncologists was compared with the BTV. Suitable threshold level (sTL) could be determined when BTV value and its morphology using a certain threshold level was observed to be the best fitness of the C-pGTV. Suitable standardized uptake value (sSUV) was calculated as the sTL multiplied by the SUVmax.

Results: Our result demonstrated no single sTL or sSUV method could achieve an optimized volumetric match with the C-pGTV. The sTL was 13% to 27% (mean, 19%), whereas the sSUV was 1.64 to 3.98 (mean, 2.46). The sTL was inversely correlated with the SUVmax [sTL = -0.1004 Ln (SUVmax) + 0.4464; R2 = 0.81]. The sSUV showed a linear correlation with the SUVmax (sSUV = 0.0842 SUVmax + 1.248; R2 = 0.89). The sTL was not associated with the value of C-pGTVs.

Conclusion: In PET/CT-based BTV for HNC, a suitable threshold or SUV level can be established by correlating with SUVmax rather than using a fixed threshold.

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Figures

Figure 1
Figure 1
The biological target volume (BTV) of the primary tumor was determined when using 10% isodensity volumes (yellow line). CT-based GTV was outlined by red line.
Figure 2
Figure 2
The BTV of the primary tumor was determined when using 15% isodensity volumes (green line). CT-based GTV was outlined by red line.
Figure 3
Figure 3
The BTV of the primary tumor was determined when using 20% isodensity volumes (pink line). CT-based GTV was outlined by red line.
Figure 4
Figure 4
The association between the SUVmax and the CT-based pGTV.
Figure 5
Figure 5
The correlation curve between the suitable threshold level and the SUVmax.
Figure 6
Figure 6
The association between the suitable threshold level and the CT-based GTV.
Figure 7
Figure 7
The correlation curve between the suitable SUV and the SUVmax.
See this image and copyright information in PMC

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