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Impact of rigid and nonrigid registration on the determination of 18F-FDG PET-based tumour volume and standardized uptake value in patients with lung cancer

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Assessment of the metabolically active tumour tissue by FDG PET is evolving for use in the diagnosis of non-small-cell lung cancer (NSCLC), in the planning of radiotherapy, and in follow-up and response evaluation. For exact evaluation accurate registration of PET and CT data is required. The registration process is usually based on rigid algorithms; however, nonrigid algorithms are increasingly being used. The influence of the registration method on FDG PET-based standardized uptake value (SUVmax) and metabolic tumour volume (MTV) definition has not yet been evaluated. We compared intra- and interindividual differences in SUV and MTV between rigid- and nonrigid-registered PET and CT acquired during different breathing manoeuvres.

Methods

The study group comprised 28 radiotherapy candidates with histologically proven NSCLC who underwent FDG PET acquisition and three CT acquisitions (expiration – EXP, inspiration – INS, mid-breath-hold – MID). All scans were registered with both a rigid (R) and a nonrigid (NR) procedure resulting in six fused datasets: R-INS, R-EXP, R-MID, NR-INS, NR-EXP and NR-MID. For the delineation of MTVs a contrast-oriented contouring algorithm developed in-house was used. To accelerate the delineation a semiautomatic software prototype was utilized.

Results

Tumour mean SUVmax did not differ for R and NR registration (R 17.5 ± 7, NR 17.4 ± 7; p=0.2). The mean MTV was higher by 3 ± 12 ml (p=0.02) in the NR group than in the R group, as was the mean tumour diameter (by 0.1 ± 0.2 cm; p<0.01). With respect to the three different breathing manoeuvres, there were no differences in MTV in the R group (p > 0.7). In intraindividual comparison there were no significant differences in MTVs concerning the registration pairs R-EXP (68 ± 88 ml) vs. NR-EXP (69 ± 85 ml) und R-MID (68 ± 86 ml) vs. NR-MID (69 ± 83 ml) (both p > 0.4). However, the MTVs were larger after NR registration during inspiration (R-INS 68 ± 82 vs. NR-INS 78 ± 93 ml; p=0.02).

Conclusion

The use of nonrigid algorithms may lead to a change in MTV, whose extent is influenced by the breathing manoeuvre on CT. Nonrigid registration methods cannot be recommended for the definition of MTV if the CT scan is performed during inspiration. The choice of registration algorithm has no significant impact on SUVmax.

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Authors and Affiliations

  1. Saarland University Medical Center, Department of Nuclear Medicine, Geb. 50, 66421, Homburg/Saar, Germany

    Aleksandar Grgic, Elena Ballek, Norbert Moca, Andrea Schaefer, Carl-Martin Kirsch & Dirk Hellwig

  2. Department of Radio-Oncology, Saarland University Medical Center, Homburg/Saar, Germany

    Jochen Fleckenstein, Stephanie Kremp & Christian Rübe

  3. Fraunhofer, MEVIS, Bremen, Germany

    Jan-Martin Kuhnigk

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  1. Aleksandar Grgic
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Correspondence to Aleksandar Grgic.

Electronic supplementary material

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Supplementary Figure 1

a Correlation (r = 0.99, p < 0.001) between the tumour volumes (millilitres) in all patients measured in the rigid group (R-VOLUME) and the nonrigid group (NR-VOLUME), logarithmic scale. b Correlation (r = 0.99, p < 0.001) between the tumour diameters (centimetres) in all patients measured in the rigid group (R-DIAMETER) and nonrigid group (NR-DIAMETER), logarithmic scale. c Correlation (r = 0.99, p < 0.001) between the tumour SUVs in all patients measured in the rigid group (R-SUV) and nonrigid group (NR-SUV), logarithmic scale. Solid lines indicate the best fit. Dashed lines indicate lines of identity (DOC 2205 kb)

Supplementary Figure 2

a Correlation (r = 0.98, p < 0.001) between the tumour volumes (millilitres) during inspiration measured in the rigid group (R-INSP-VOLUME) and the nonrigid group (NR-INSP-VOLUME), logarithmic scale. Note the systematic overestimation of volumes after nonrigid registration. b Correlation (r = 0.99, p < 0.001) between the tumour volumes during expiration measured in the rigid group (R-EXP-VOLUME) and nonrigid group (NR-EXP-VOLUME), logarithmic scale. c Correlation (r = 0.99, p < 0.001) between the tumour volumes (millilitres) during mid-breath-hold measured in the rigid group (R-MID-VOLUME) and nonrigid group (NR-MID-VOLUME), logarithmic scale. Solid lines indicate the best fit. Dashed lines indicate lines of identity [(DOC 2198 kb)

Supplementary Figure 3

a Correlation (r = 0.98, p < 0.001) between SUVmax of the tumour lesions during inspiration measured in the rigid group (R -INSP-SUV) and nonrigid group (NR -INSP-SUV), logarithmic scale. b Correlation (r = 0.99, p < 0.001) between SUVmax of the tumour lesions during expiration measured in the rigid group (R -EXP-SUV) and nonrigid group (NR -EXP-SUV), logarithmic scale. c Correlation (r = 0.99, p < 0.001) between SUVmax of the tumour lesions during mid-breath-hold measured in the rigid group (R -MID-SUV) and nonrigid group (NR -MID-SUV), logarithmic scale. Solid lines indicate the best fit. Dashed lines indicate lines of identity (DOC 1480 kb)

Supplementary Table

SUVmean values in relation to breathing protocol used (DOC 28 kb)

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Grgic, A., Ballek, E., Fleckenstein, J. et al. Impact of rigid and nonrigid registration on the determination of 18F-FDG PET-based tumour volume and standardized uptake value in patients with lung cancer. Eur J Nucl Med Mol Imaging 38, 856–864 (2011). https://doi.org/10.1007/s00259-010-1719-3

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  • DOI: https://doi.org/10.1007/s00259-010-1719-3

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