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@ARTICLE{Giesel:119331,
      author       = {F. Giesel$^*$ and F. Schneider and C. Kratochwil and D.
                      Rath and J. Moltz and T. Holland-Letz$^*$ and H.-U. Kauczor
                      and L. H. Schwartz and U. Haberkorn$^*$ and P. Flechsig},
      title        = {{C}orrelation {B}etween {SUV}max and {CT} {R}adiomic
                      {A}nalysis {U}sing {L}ymph {N}ode {D}ensity in
                      {PET}/{CT}-{B}ased {L}ymph {N}ode {S}taging.},
      journal      = {Journal of nuclear medicine},
      volume       = {58},
      number       = {2},
      issn         = {2159-662X},
      address      = {New York, NY},
      publisher    = {Soc.},
      reportid     = {DKFZ-2017-00086},
      pages        = {282 - 287},
      year         = {2017},
      abstract     = {In patients with lung cancer (LC), malignant melanoma (MM),
                      gastroenteropancreatic neuroendocrine tumors (GEP NETs), and
                      prostate cancer (PCA), lymph node (LN) staging is often
                      performed by (18)F-FDG PET/CT (LC and MM), (68)Ga-DOTATOC
                      PET/CT (GEP NET), and (68)Ga-labeled prostate-specific
                      membrane antigen PET/CT (PCA) but is sometimes not accurate
                      because of indeterminate PET findings. To better evaluate
                      malignant LN infiltration, additional surrogate parameters,
                      especially in cases with indeterminate PET findings, would
                      be helpful. The purpose of this study was to evaluate
                      whether SUVmax in the PET examination might correlate with
                      semiautomated density measurements of LNs in the CT
                      component of the PET/CT examination.After approval by the
                      institutional review board, 1,022 LNs in the PET/CT
                      examinations of 148 patients were retrospectively analyzed
                      (LC: 327 LNs of 40 patients; MM: 224 LNs of 33 patients; GEP
                      NET: 217 LNs of 35 patients; and PCA: 254 LNs of 40
                      patients). PET/CT was performed before surgery, biopsy,
                      chemotherapy, or internal or external radiation therapy,
                      according to the clinical schedule; patients with prior
                      chemotherapy or radiation therapy were excluded. SUVmax
                      analyses were based on uptake 60 min after tracer injection,
                      and volumetric CT histogram analyses were based on the
                      unenhanced CT images of the PET/CT scan.PET findings were
                      considered positive or negative on the basis of SUVmax in
                      the LN compared with that in the blood pool; histologic
                      confirmation was not available. Of the 1,022 LNs, 331 were
                      PET-positive (3 times the SUVmax of the blood pool), 86 were
                      PET-indeterminate (1-3 times the SUVmax of the blood pool),
                      and 605 were PET-negative (less than the SUVmax of the blood
                      pool). PET-positive LNs had significantly higher CT
                      densities than PET-negative LNs, irrespective of the type of
                      cancer.CT density measurements of LNs in patients with LC,
                      MM, GEP NET, and PCA correlated with(18)F-FDG uptake,
                      (68)Ga-DOTATOC uptake, and (68)Ga-PSMA uptake, respectively,
                      and might therefore serve as an additional surrogate
                      parameter for differentiating between malignant and benign
                      LNs. The use of a 7.5-Hounsfield unit CT density threshold
                      to differentiate between malignant and benign LN
                      infiltration and 20 Hounsfield units to exclude benign LN
                      processes might be possible in clinical routine and would be
                      especially helpful for PET-indeterminate LNs.},
      cin          = {E060 / C060},
      ddc          = {610},
      cid          = {I:(DE-He78)E060-20160331 / I:(DE-He78)C060-20160331},
      pnm          = {315 - Imaging and radiooncology (POF3-315)},
      pid          = {G:(DE-HGF)POF3-315},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:27660141},
      doi          = {10.2967/jnumed.116.179648},
      url          = {https://inrepo02.dkfz.de/record/119331},
}