Hoekstra Corneline J, Hoekstra Otto S, Stroobants Sigrid G, Vansteenkiste Johan, Nuyts Johan, Smit Egbert F, Boers Maarten, Twisk Jos W R, Lammertsma Adriaan A
Clinical PET Centre, VU University Medical Centre, Amsterdam, The Netherlands.
J Nucl Med. 2002 Oct;43(10):1304-9.
PET using 18F-FDG is a promising technique to monitor response in oncology. Unfortunately, a multitude of analytic methods is in use. To date, it is not clear whether simplified methods could replace complex quantitative methods in routine clinical practice. The aim of this study was to select those methods that would qualify for further assessment in a future prospective response-monitoring study by comparing results with patient outcome.
Dynamic 18F-FDG PET scans were obtained on 2 groups of patients. First, 10 patients with advanced non-small cell lung cancer (NSCLC) were scanned on consecutive days before treatment to assess test-retest variability. Second, 30 scans were obtained on 19 patients with locally advanced NSCLC as part of an ongoing response-monitoring study. These scans were analyzed by 2 observers to assess observer variability. In addition, these studies were used to compare various methods with the gold standard, full kinetic analysis (nonlinear regression [NLR]).
Using an image-derived input function, NLR showed excellent test-retest and observer agreement confirming that it could be used as a gold standard method. From a total of 34 analytic methods, 10 showed good correlation with NLR. Taking into account the degree of complexity of the methods, 4 remain for further evaluation.
The optimal method for analysis of 18F-FDG PET data was determined for several levels of complexity. Four methods need to be evaluated further to determine the optimal trade-off between simplicity and accuracy for routine clinical practice.
使用18F-FDG的PET是监测肿瘤学中反应的一种有前景的技术。不幸的是，目前使用着多种分析方法。迄今为止，尚不清楚在常规临床实践中简化方法是否能够取代复杂的定量方法。本研究的目的是通过将结果与患者预后进行比较，选择那些有资格在未来前瞻性反应监测研究中进行进一步评估的方法。
对两组患者进行了动态18F-FDG PET扫描。首先，对10例晚期非小细胞肺癌（NSCLC）患者在治疗前连续几天进行扫描，以评估重测变异性。其次，作为正在进行的反应监测研究的一部分，对19例局部晚期NSCLC患者进行了30次扫描。这两名观察者对这些扫描进行分析，以评估观察者间的变异性。此外，这些研究还用于将各种方法与金标准——全动力学分析（非线性回归[NLR]）进行比较。
使用图像衍生输入函数时，NLR显示出极好的重测一致性和观察者间一致性，证实其可作为金标准方法。在总共34种分析方法中，有10种与NLR显示出良好的相关性。考虑到这些方法的复杂程度，有4种方法有待进一步评估。
针对几种复杂程度确定了分析18F-FDG PET数据的最佳方法。有4种方法需要进一步评估，以确定在常规临床实践中简单性和准确性之间的最佳权衡。
