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. 2022 Aug 16;8(4):2030-2041.
doi: 10.3390/tomography8040170.

Radiotherapy Target Volume Definition in Newly Diagnosed High-Grade Glioma Using 18F-FET PET Imaging and Multiparametric MRI: An Inter Observer Agreement Study

Brieg Dissaux  1   2   3 , Doria Mazouz Fatmi  1 , Julien Ognard  1   3   4 , Bastien Allard  5 , Nathalie Keromnes  5 , Amina Latreche  6 , Amandine Lepeuve  3 , Ulrike Schick  3   4   6 , Vincent Bourbonne  3   4   6 , Douraied Ben Salem  1   3   4 , Gurvan Dissaux  3   4   6 , Solène Querellou  2   3   5
Affiliations

Radiotherapy Target Volume Definition in Newly Diagnosed High-Grade Glioma Using 18F-FET PET Imaging and Multiparametric MRI: An Inter Observer Agreement Study

Brieg Dissaux et al. Tomography. .

Abstract

Background: The aim of this prospective monocentric study was to assess the inter-observer agreement for tumor volume delineations by multiparametric MRI and 18-F-FET-PET/CT in newly diagnosed, untreated high-grade glioma (HGG) patients. Methods: Thirty patients HGG underwent O-(2-[18F]-fluoroethyl)-l-tyrosine(18F-FET) positron emission tomography (PET), and multiparametric MRI with computation of rCBV map and K2 map. Three nuclear physicians and three radiologists with different levels of experience delineated the 18-F-FET-PET/CT and 6 MRI sequences, respectively. Spatial similarity (Dice and Jaccard: DSC and JSC) and overlap (Overlap: OV) coefficients were calculated between the readers for each sequence. Results: DSC, JSC, and OV were high for 18F-FET PET/CT, T1-GD, and T2-FLAIR (>0.67). The Spearman correlation coefficient between readers was ≥0.6 for these sequences. Cross-comparison of similarity and overlap parameters showed significant differences for DSC and JSC between 18F-FET PET/CT and T2-FLAIR and for JSC between 18F-FET PET/CT and T1-GD with higher values for 18F-FET PET/CT. No significant difference was found between T1-GD and T2-FLAIR. rCBV, K2, b1000, and ADC showed correlation coefficients between readers <0.6. Conclusion: The interobserver agreements for tumor volume delineations were high for 18-F-FET-PET/CT, T1-GD, and T2-FLAIR. The DWI (b1000, ADC), rCBV, and K2-based sequences, as performed, did not seem sufficiently reproducible to be used in daily practice.

Trial registration: ClinicalTrials.gov NCT03370926.

Keywords: 18-F-FET-PET/CT; high-grade glioma; inter-observer agreement study; multiparametric MRI; tumor volume delineation.

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Conflict of interest statement

The authors of this manuscript declare no relevant conflict of interest.

Figures

Figure 1
Figure 1
Bland−Altman plot of volumes delineated with 18F-FET PET/CT, T1-GD, and FLAIR sequences. T1-GD and 18F-FET PET/CT volumes are the most similar. T2-FLAIR and T1-GD and T2-FLAIR and 18F-FET volumes PET/CT are the most similar for small volumes, but show higher differences for high volumes.
Figure 2
Figure 2
Example of sequences with good agreement for tumor volume delineation in high-grade glioma between readers: (A) CE T1-weighted imaging (T1-GD) (B) T2-weighted fluid-attenuated inversion recovery (T2-FLAIR), which appears in hypersignal. (C) 18F-FET PET/CT.
Figure 3
Figure 3
Example of sequences with poor agreement for tumor volume delineation in high-grade glioma between readers: (A) Relative cerebral blood volume (rCVB) corrected for contrast leakage shows. (B) Permeability estimation map (k2). (C) Diffusion-weighted imaging (DWI b1000). (D) Apparent diffusion coefficient (ADC) map. In this case, only two readers delineated tumor volume with an ADC map.
See this image and copyright information in PMC

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