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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},
}