Oncologic PET/CT interpretation and reporting approaches

D. Karantanis; D. Kalkanis; M. S. Allen-Auerbach; K. Herrmann; K. L. Pomykala; T. V. Bogsrud; V. J. Lowe; J. Czernin

doi:10.3413/Nukmed-0613-13-07

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2014; 53(02): 19-25
DOI: 10.3413/Nukmed-0613-13-07

Original article

Schattauer GmbH

Oncologic PET/CT interpretation and reporting approaches

Survey in clinical practiceOnkologische PET/CT-Interpretation und Erstellung der BefundberichteUmfrage im klinischen Bereich

Authors

D. Karantanis

¹Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

²Department of Nuclear Medicine, Greek Air Force Hospital, Athens, Greece
D. Kalkanis

²Department of Nuclear Medicine, Greek Air Force Hospital, Athens, Greece
M. S. Allen-Auerbach

¹Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
K. Herrmann

¹Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
K. L. Pomykala

¹Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
T. V. Bogsrud

³Division of Nuclear Medicine, Department of Diagnostic Imaging and Intervention, Oslo University Hospital, Norway
V. J. Lowe

⁴Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
J. Czernin

¹Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

Abstract

Summary

Aim: To elucidate techniques most commonly used for interpreting oncologic PET/CT studies. This survey forms a basis to work on standardization of reporting and highlight the most important issues to be addressed. Methods: A web-based survey of 329 PET/CT imaging specialists was designed with the intent to determine image interpretation patterns. The questionnaire consisted of 19 questions. Of the 329 participants, 230 were nuclear medicine specialists, 46 were radiologists, and 53 had dual-board certification. Results: Report of standardized uptake values (SUV) is not consistent; only 50.2% of respondents always report SUVs, while 45.2% report only if needed or requested. 80.9% of respondents indicated that reporting of SUV is only appropriate when its limitations are understood whereby a large majority prefer to report SUVmax. Maximum intensity projection (MIP) images are almost always reviewed by 91.1% of the respondents. An accurate and detailed clinical history is considered an essential element for reading PET/ CT studies by 84.0%, but only 20.7% report that this is always available. The most common self-reported average time for reviewing and reporting of whole body PET/CT (with no prior comparison scan) was 15-20 min (27.5%). Conclusion: PET readers have considerable reservations regarding the use and reporting of SUVs. SUVmax is more frequently used than SUVmean. Evaluation of MIP images is considered an important element of PET/CT interpretation. Although availability of sufficient patient’s history is considered essential, this is rarely available.

Zusammenfassung

Ziel: Darstellung der häufigsten Interpretationstechniken onkologischer PET/CT-Untersu- chungen. Diese Umfrage bildet die Grundlage für die Standardisierung von Befundberichten und beleuchtet die wichtigsten zu berücksichtigenden Aspekte. Methoden: Bei 329 Spezialisten für PET/CT-Aufnahmen wurde eine Webbasierte Umfrage durchgeführt, um Bildinterpretationsmuster identifizieren. Der Fragebogen enthielt 19 Fragen. Unter den 329 Teilneh mern waren 230 Fachärzte für Nuklearmedizin, 46 Radiologen und 53 für beide Fachgebiete. Ergebnisse: Angaben zu standardisierten Aufnahmewerten (SUV) sind uneinheitlich; nur 50,2% der Teilnehmer geben SUVs immer an, während dies bei 45,2% nur bei Bedarf oder auf Anfrage der Fall ist. 80,9% der Befragten meinen, dass SUVs nur angegeben werden sollten, wenn deren Grenzen bekannt sind; hingegen bevorzugt eine große Mehrheit die Nennung von SUVmax. Maximumintensitätsprojektion (MIP)-Aufnahmen werden von 91,1% der Teilnehmer fast immer besprochen. Eine genaue, detaillierte klinische Anamnese wird von 84,0% als wesentlich für die Interpretation von PET/CT-Un- tersuchungen erachtet, aber nur bei 20,7% liegt diese immer vor. Nach subjektiver Einschätzung werden für Beurteilung und Beschreibung eines Ganzkörper-PET/CT (ohne frühere Vergleichsaufnahme) durchschnittlich 15-20 Minuten (27,5%) benötigt. Schlussfolgerung: Bei der Befundung von PET/CT-Auf- nahmen bestehen erhebliche Vorbehalte gegenüber der Angabe von SUVs. SUVmax wird häufiger verwendet als SUVmean. Die Bewertung von MIP-Aufnahmen erscheint wichtig für die Interpretation der PET/CT. Zwar gilt eine ausreichende Anamnese des Patienten als wesentlich, diese ist aber nur selten verfügbar

Keywords

Survey - FDG - standard uptake value - SUV - maximum intensity projection - limitations

Schlüsselwörter

Umfrage - FDG - SUV - Maximumintensitäts-projektion - Limitationen

Volltext

Referenzen

References
1 Agress Jr H, Wong TZ, Shreve P. Interpretation and reporting of positron emission tomography-computed tomographic scans. Semin Ultrasound CT MR 2008; 29: 283-290.
2 Beyer T, Czernin J, Freudenberg LS. Variations in clinical PET/CT operations: results of an international survey of active PET/CT users. J Nucl Med 2011; 52: 303-310.
3 BNMS. Oncology FDG PET/CT scan referral criteria.. UK PET/CT Advisory Board; 2009
4 Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med 2004; 45: 1519-1527.
5 Boellaard R, O’Doherty MJ, Weber WA. et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 2010; 37: 181-200.
6 Carson RE. Precision and accuracy considerations of physiological quantitation in PET. J Cereb Blood Flow Metab 1991; 11: A45-A50.
7 Coleman RE, Hillner BE, Shields AF. et al. PET and PET/CT reports: observations from the National Oncologic PET Registry. J Nucl Med 2010; 51: 158-163.
8 Delbeke D, Coleman RE, Guiberteau MJ. et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med 2006; 47: 885-895.
9 Fletcher JW, Djulbegovic B, Soares HP. et al. Recommendations on the use of ¹⁸F-FDG PET in oncology. J Nucl Med 2008; 49: 480-508.
10 Graham MM. The PET/CT report: the most important part of the study. J Nucl Med 2010; 51: 5-6.
11 Hansen RA, Henley AC, Brouwer ES. et al. Geographic Information System mapping as a tool to assess nonresponse bias in survey research. Res Social Adm Pharm 2007; 3: 249-264.
12 Herrmann K, Benz MR, Krause BJ. et al. ¹⁸F-FDGPET/CT in evaluating response to therapy in solid tumors: where we are and where we can go. Q J Nucl Med Mol Imaging 2011; 55: 620-632.
13 Karantanis D, Kalkanis D, Allen-Auerbach M. et al. Oncologic ¹⁸F-FDG PET/CT: referring physicians’ point of view. J Nucl Med 2012; 53: 1499-1505.
14 Keyes Jr. JW. SUV: standard uptake or silly useless value?. J Nucl Med 1995; 36: 1836-1839.
15 Kim CK, Gupta NC. Dependency of standardized uptake values of fluorine-18 fluorodeoxyglucose on body size: comparison of body surface area correction and lean body mass correction. Nucl Med Commun 1996; 17: 890-894.
16 Kumar R, Halanaik D, Malhotra A. Clinical applications of positron emission tomography-computed tomography in oncology. Indian J Cancer 2010; 47: 100-119.
17 Podoloff DA, Ball DW, Ben-Josef E. et al. NCCN task force: clinical utility of PET in a variety of tumor types. J Natl Compr Canc Netw 2009; 7 (Suppl. 02) S1-S26.
18 RCR. Indications for PET-CT: Guidance from the Royal College of Radiologists.. Royal College of Radiologists; 2010
19 Smith B, Smith TC, Gray GC, Ryan MA. When epidemiology meets the Internet: Web-based surveys in the Millennium Cohort Study. Am J Epidemiol 2007; 166: 1345-1354.
20 SNM. Elements of PET/CT Reporting. PET Professional Resources and Outreach Source. http://interactive.snm.org/docs/PET_PROS/Elementsof-PETCTReporting.pdf (accessed February 3, 2013).
21 Sugawara Y, Zasadny KR, Neuhoff AW, Wahl RL. Reevaluation of the standardized uptake value for FDG: variations with body weight and methods for correction. Radiology 1999; 213: 521-525.
22 Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med 2004; 45: 1431-1434.
23 Van Gelder MM, Bretveld RW, Roeleveld N. Webbased questionnaires: the future in epidemiology?. Am J Epidemiol 2010; 172: 1292-1298.