Arturo Chiti

Bernd J. Krause

H Zaidi

M Soret

Mike J O’Doherty

R Boellaard

Ronald Boellaard

PubMed

Boellaard, R.

O'Doherty, M.J.

Chiti, A.

Krause, B.J.

DSpace at VU

LETTER TO THE EDITOR
Reply to: FDG PET and PET/CT: EANM procedure
guideline for tumour PET imaging
Ronald Boellaard & Mike J O’Doherty & Arturo Chiti &
Bernd J. Krause &
on behalf of the authors of the guideline “FDG PET and
PET/CT: EANM procedure guidelines for tumour PET
imaging”
Published online: 26 May 2010
# The Author(s) 2010
Dear Sir,
In the letter to the editor regarding the EANM guideline
for FDG PET and PET/CT tumour imaging [1] the
authors raise two issues, i.e. partial volume effects (PVE)
and use of total lesion glycolysis (TLG) as a quantitative
parameter, which might not have been addressed in the
guideline. PVE does indeed affect quantification of
tumour uptake causing an increasing negative bias in
smaller tumours. PVE has, however, been addressed in the
guideline. Rather than promoting the use of PVC methods,
the guideline aims at matching SUV contrast recoveries
between different PET/CT systems and institutes, thereby
matching partial volume effects, as a combined effect of
scanner resolution, image reconstruction algorithms and
settings (zoom, voxel size and filters). To this end a
specific multi-centre image quality QC is suggested. This
strategy is proposed as, unlike the authors of the letter
state, there are not yet validated, accepted and widely
available PVC methods for use in oncology FDG PET
studies. Although there is much experience in using PVC
in oncology and for PET brain studies, there is still large
variability regarding methodology being used or explored
[2]. For example, most frequently used methods for PVC
of brain studies depend e.g. on a coregistered MRI image
and grey and white matter segmentations, for which again
many different algorithms exist. The quality of the
acquired MRI data as well as the algorithms being used
for coregistration of PET and MRI images, grey and white
matter segmentations and PVC can have a large effect on
the quantitative results of these studies, as was also
observed by Zaidi et al. [3]. Likewise, use of PVC in
oncology FDG PET studies is still in an exploratory phase.
Yet, it should be noted that further development of PVC
methods both for brain as well as for oncology studies is
highly supported by the authors of the EANM guideline
and, in fact, many are involved in the development and
evaluation of these methods [2]. The EANM guideline
does not discourage improvement of PET technology or
(correction) algorithms, but aims at defining minimal
standards to allow for multi-centre quantitative PET
studies that should be feasible to be carried out in a
clinical setting. Future guidelines will probably recom-
mend use of PVC provided that these methods are
validated, accepted and are widely available, i.e. can be
routinely applied in a multi-centre setting.
As indicated in the letter to the editor, apart from
SUV, other parameters such as TLG and/or metabolic
This reply refers to the letter to the editor at http://dx.doi.org/10.1007/
s00259-010-1458-5
R. Boellaard (*)
Department of Nuclear Medicine & PET Research,
VU University Medical Centre,
Amsterdam, The Netherlands
e-mail: r.boellaard@vumc.nl
M. J. O’Doherty
PET Imaging Centre, Division of Imaging Sciences,
King’s College London and Guys and St Thomas’ NHS
Foundation Trust,
London, UK
A. Chiti
Nuclear Medicine, Istituto Clinico Humanitas,
Rozzano, MI, Italy
B. J. Krause
Department of Nuclear Medicine,
Technische Universität München,
Munich, Germany
Eur J Nucl Med Mol Imaging (2010) 37:1432–1433
DOI 10.1007/s00259-010-1459-4
volume can be derived from quantitative FDG PET
studies. The EANM guideline does indeed not mention
or address these parameters explicitly. Yet, admittedly,
these biomarkers provide additional valuable quantitative
information on FDG tumour uptake. The EANM
guideline, however, does allow for the use of any 3-D
volume of interest, in addition to ‘max’ and ‘peak’, and
thereby allows for parameters such as TLG and meta-
bolic volume to be further explored. The primary aim of
the EANM guideline is to provide a firm basis for
quantitative FDG PET studies in general and it should be
realized that reliable and reproducible assessment of any
quantitative parameter from FDG PET studies requires
strict standardisation of imaging protocols and a common
QC/QA procedure.
We therefore believe that the EANM guideline sets
the standards and is a prerequisite for any quantitative
assessment of FDG uptake.
References
1. Boellaard R, O’Doherty MJ, Weber WA, Mottaghy FM,
Lonsdale MN, Stroobants SG, 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.
2. Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET
tumor imaging. J Nucl Med 2007;48(6):932–45.
3. Zaidi H, Ruest T, Schoenahl F, Montandon ML. Comparative
assessment of statistical brain MR image segmentation algorithms
and their impact on partial volume correction in PET. Neuroimage
2006;32:1591–607.
Eur J Nucl Med Mol Imaging (2010) 37:1432–1433 1433


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