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Hybrid PET/MRI-based delineation of gross tumor volume in head and neck cancer and tumor parameter analysis

Ma, Jie-Taoa,c; Han, Cheng-Boa; Zheng, Jia-Hec; Sun, Hong-Zanb; Zhang, Shao-Minc,d; Xin, Junb; Guo, Qi-Yongc

Nuclear Medicine Communications: July 2017 - Volume 38 - Issue 7 - p 642–649
doi: 10.1097/MNM.0000000000000687

Objectives Accurate target delineation allows an increase in radiation dose to the target tumor while reducing damage to the surrounding normal tissue. However, there is currently no standard for evaluating volumes measured by different imaging modalities. The aim of this study is to evaluate the feasibility of contouring gross tumor volume (GTV) by PET/MRI in head and neck cancer, and to define an adaptive threshold level (aTL) for delineating the biological target volume (BTV).

Patients and methods Eighteen head and neck cancer patients underwent time of flight PET/MRI before chemoradiotherapy. Different GTVs of primary tumors and metastatic lymph nodes were manually contoured on MRI (GTVMRI), PET (GTVVIS), and fused PET/MRI (GTVFUS). An MRI-based GTV contour was substituted for the pathologic GTV. The percentile threshold boundary of the maximum standardized uptake value (SUVmax) for the BTV was determined when the volume of BTV approached that of GTVMRI.

Results All GTVs were highly correlated (all Pearson’s r>0.85, all P<0.001). Tumor diameter strongly correlated with GTVs (r=0.7–0.8 for all lesions and primary tumor; r=0.8–0.9 for lymph node metastases). aTL and SUVmax were moderately correlated for all lesions (r=−0.692, P<0.001) and were strongly correlated for primary tumors (r=−0.866, P<0.001).

Conclusion Delineating GTV on hybrid PET/MRIs is feasible, and aTL, the threshold boundary of BTV, was correlated inversely with the SUVmax.

Department of aRadiation Oncology

bNuclear Medicine

cRadiology, Shengjing Hospital of China Medical University, Shenyang

dDepartment of Software Engineering, School of Computer Science and Engineering, Beifang University of Nationalities, Yinchuan, China

Correspondence to Qi-Yong Guo, PhD, MD, Department of Radiology, Shengjing Hospital of China Medical University, Road 36#, Sanhao Street, Heping District, Shenyang 110004, China Tel: +86 189 402 56026; fax: +86 242 392 9902; e-mail:

Received November 14, 2016

Received in revised form March 27, 2017

Accepted April 12, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.