FDG-PET/CT-based Gross Tumor Volume Contouring for Radiation Therapy Planning: An Experimental Phantom Study

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  • TOYA Ryo
    Departments of Radiation Oncology, Faculty of Life Sciences, Kumamoto University
  • MURAKAMI Ryuji
    Departments of Medical Imaging, Faculty of Life Sciences, Kumamoto University
  • TASHIRO Kuniyuki
    Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
  • YOSHIDA Morikatsu
    Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
  • SAKAMOTO Fumi
    Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
  • KAWANAKA Koichi
    Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
  • SHIRAISHI Shinya
    Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University
  • NAKAGUCHI Yuji
    Department of Radiological Technology, Kumamoto University Hospital
  • TSUJITA Naoko
    Departments of Medical Imaging, Faculty of Life Sciences, Kumamoto University
  • OYA Natsuo
    Departments of Radiation Oncology, Faculty of Life Sciences, Kumamoto University
  • TOMIGUCHI Seiji
    Departments of Medical Imaging, Faculty of Life Sciences, Kumamoto University
  • YAMASHITA Yasuyuki
    Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto University

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As there is continuing controversy over the role of F-18-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT-fused imaging in radiation therapy (RT) planning, we performed a phantom study to assess the feasibility of FDG-PET/CT-based gross tumor volume (GTV) contouring. The phantom set, consisting of an elliptical bowl and 6 spheres measuring from 10–37 mm in diameter, were filled with FDG to obtain 3 source-to-background ratios (SBRs) of 4, 8, and 16. The ratio to maximum intensity at 5% intervals was applied as the threshold for contouring. The ratio between contoured- and actual volumes (volume ratio) was calculated, and the threshold ratio was selected to provide a volume ratio close to 100%. To consider the clinical application, we applied the threshold value (maximum intensity × threshold ratio) for the largest 37-mm sphere to the 6 spheres. The threshold ratio and the volume ratio in 6 spheres with 3 SBRs were compared using the Friedman test. Threshold ratios ranged from 25–80%; they were higher for smaller spheres (p = 0.003) and lower SBRs (p < 0.001). The volume ratios with the threshold value for the largest 37-mm sphere were lower in smaller spheres (p = 0.010). These results suggest that smaller lesions and higher background activities require a higher threshold ratio and smaller lesions a lower threshold value. FDG-PET/CT-fused imaging should not be used as a single modality but rather to obtain supplemental information in RT planning. The contoured GTV should be adjusted based on clinical data including conventional images.

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