Delineation and agreement of FET PET biological volumes in glioblastoma: results of the nuclear medicine credentialing program from the prospective, multi-centre trial evaluating FET PET In Glioblastoma (FIG) study-TROG 18.06
Details
Publication Year 2023,Volume 50,Issue #13,Page 3970-3981
Journal Title
European Journal of Nuclear Medicine and Molecular Imaging
Publication Type
Research article
Abstract
PURPOSE: The O-(2-[(18)F]-fluoroethyl)-L-tyrosine (FET) PET in Glioblastoma (FIG) trial is an Australian prospective, multi-centre study evaluating FET PET for glioblastoma patient management. FET PET imaging timepoints are pre-chemoradiotherapy (FET1), 1-month post-chemoradiotherapy (FET2), and at suspected progression (FET3). Before participant recruitment, site nuclear medicine physicians (NMPs) underwent credentialing of FET PET delineation and image interpretation. METHODS: Sites were required to complete contouring and dynamic analysis by >/= 2 NMPs on benchmarking cases (n = 6) assessing biological tumour volume (BTV) delineation (3 x FET1) and image interpretation (3 x FET3). Data was reviewed by experts and violations noted. BTV definition includes tumour-to-background ratio (TBR) threshold of 1.6 with crescent-shaped background contour in the contralateral normal brain. Recurrence/pseudoprogression interpretation (FET3) required assessment of maximum TBR (TBR(max)), dynamic analysis (time activity curve [TAC] type, time to peak), and qualitative assessment. Intraclass correlation coefficient (ICC) assessed volume agreement, coefficient of variation (CoV) compared maximum/mean TBR (TBR(max)/TBR(mean)) across cases, and pairwise analysis assessed spatial (Dice similarity coefficient [DSC]) and boundary agreement (Hausdorff distance [HD], mean absolute surface distance [MASD]). RESULTS: Data was accrued from 21 NMPs (10 centres, n >/= 2 each) and 20 underwent review. The initial pass rate was 93/119 (78.2%) and 27/30 requested resubmissions were completed. Violations were found in 25/72 (34.7%; 13/12 minor/major) of FET1 and 22/74 (29.7%; 14/8 minor/major) of FET3 reports. The primary reasons for resubmission were as follows: BTV over-contour (15/30, 50.0%), background placement (8/30, 26.7%), TAC classification (9/30, 30.0%), and image interpretation (7/30, 23.3%). CoV median and range for BTV, TBR(max), and TBR(mean) were 21.53% (12.00-30.10%), 5.89% (5.01-6.68%), and 5.01% (3.37-6.34%), respectively. BTV agreement was moderate to excellent (ICC = 0.82; 95% CI, 0.63-0.97) with good spatial (DSC = 0.84 +/- 0.09) and boundary (HD = 15.78 +/- 8.30 mm; MASD = 1.47 +/- 1.36 mm) agreement. CONCLUSION: The FIG study credentialing program has increased expertise across study sites. TBR(max) and TBR(mean) were robust, with considerable variability in BTV delineation and image interpretation observed.
Publisher
Springer Nature
Keywords
Humans; *Glioblastoma/diagnostic imaging/pathology; *Ficus; *Brain Neoplasms/diagnostic imaging/pathology; *Nuclear Medicine; Prospective Studies; Australia; Positron-Emission Tomography/methods; Tyrosine; Magnetic Resonance Imaging
Department(s)
Cancer Imaging
PubMed ID
37563351
Open Access at Publisher's Site
https://doi.org/10.1007/s00259-023-06371-5
Terms of Use/Rights Notice
Refer to copyright notice on published article.


Creation Date: 2023-12-11 11:35:13
Last Modified: 2023-12-11 11:37:04

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