From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors
Open accessAbstract
UNLABELLED: The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. METHODS: PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. RESULTS: Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. CONCLUSION: Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments.
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SUVmax of normal background tissues, including the liver and mediastinal blood pool, are commonly used as references to define disease and assess tumor response to therapy.
“SUVmax of normal background tissues, including the liver and mediastinal blood pool are commonly used as references to define the disease and assess tumor response to therapy.[7]”
From Intrapatient variability of 18F-FDG uptake in normal tissues (2022) · cites this paper as [7]
In “How Is Response Determined on PET?”, the paper describes liver and mediastinal blood pool as background references, and “Introduction to PERCIST 1.0” uses them to set thresholds for measurable tumor activity. But it does not endorse background-tissue SUVmax for this purpose: the former section says liver or blood-pool SUVmax had higher variance and was not recommended for normalization. The references described are based on mean uptake, principally mean SUL. (LLM, conf=0.88)
Experimental — accuracy not yet measuredInter-rater agreement in response assessment with [18F]FDG-PET in non-small cell lung cancer or metastatic breast cancer can be considerably improved through the use of the target lesion SULpeak (PERCIST 1.0 criteria) in comparison with a subjective assessment.
“However, it has been demonstrated that inter-rater agreement in response assessment with [18F]FDG-PET in non-small cell lung cancer or metastatic breast cancer can be considerably improved through the use of the target lesion SULpeak (PERCIST 1.0 criteria) in comparison with a subjective assessment [194,214,215].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [194]
The Introduction to PERCIST 1.0 identifies SULpeak as a response metric, supporting the citation for the criteria. But the section ‘How Is Response Determined on PET?’ says reader comparisons were limited and calls for more information on reproducibility; it does not demonstrate that SULpeak considerably improves inter-rater agreement over subjective assessment in non-small cell lung or metastatic breast cancer. (LLM, conf=0.87)
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“A background threshold approach has been developed as a tool for defining metabolic tumor volumes for mesotheliomas with good initial success, choosing 3 SDs above background levels for segmentation (111).”
BackgroundMethodGuillem, J., Moore, H., Akhurst, T., Klimstra, D., Ruo, L., Mazumdar, M., Minsky, B., Saltz, L., Wong, W., & Larson, S. (2004) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2004.02.024 · Cited by 205 · cited 2×
“Choosing a threshold based on a single maximal pixel value in the tumor carries with it the variability inherent in determining a single-pixel value and is driven by that value (104,109,112,119,120).”
BackgroundSpaepen, K., Stroobants, S., Dupont, P., Bormans, G., Balzarini, J., Verhoef, G., Mortelmans, L., Vandenberghe, P., & Wolf-Peeters, C. (2003) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-003-1120-6 · Cited by 203 · see citing works
Individual patient data analysis to assess modifications to the RECIST criteria.
Bogaerts, J., Ford, R., Sargent, D., Schwartz, L., Rubinstein, L., Lacombe, D., Eisenhauer, E., Verweij, J., & Therasse, P. (2009) · European Journal of Cancer · doi:10.1016/j.ejca.2008.10.027 · Cited by 201 · cited 1× · see citing works
“If tumors other than these 5 progress unequivocally, progression has occurred (39,40).”
BackgroundNahmias, C., & Wahl, L. M. (2008) · Journal of Nuclear Medicine · doi:10.2967/jnumed.108.054239 · Cited by 199 · cited 9× · see citing works
“Concordantly, Nahmias and Wahl (115) showed in test–retest studies that absolute differences in mean SUV obtained from a large ROI did not exceed 0.5 SUV unit and that the absolute differences in mean SUV decreased as mean SUV increased.”
BackgroundMethodInfluentialMeasuring response in a post-RECIST world: from black and white to shades of grey
Michaelis, L., & Ratain, M. (2006) · Nature Reviews. Cancer · doi:10.1038/nrc1883 · Cited by 197 · cited 3× · see citing works
“With such reductionism, potential valuable information that may be important is lost (1,2,4,10).”
BackgroundRandomized discontinuation design: application to cytostatic antineoplastic agents.
Rosner, G., Stadler, W., & Ratain, M. (2002) · Journal of Clinical Oncology · doi:10.1200/jco.2002.11.126 · Cited by 195 · cited 1× · see citing works
“With such newer treatments, lack of progression may be associated with a good improvement in outcome, even in the absence of major shrinkage of tumors as evidenced by partial response or complete response (2,3).”
BackgroundCerfolio, R. J., Bryant, A. S., Winokur, T. S., Ohja, B., & Bartolucci, A. A. (2004) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2004.06.102 · Cited by 194 · see citing works
Karrison, T., Maitland, M., Stadler, W., & Ratain, M. (2007) · Journal of the National Cancer Institute · doi:10.1093/jnci/djm158 · Cited by 184 · cited 4× · see citing works
“PET/CT images obtained before (1) and after (2) treatment of pancreatic carcinoma with experimental therapy targeting mammalian target of rapamycin.”
BackgroundInfluentialLevine, E., Farmer, M., Clark, P. B., Mishra, G., Ho, C., Geisinger, K., Melin, S., Lovato, J., Oaks, T., & Blackstock, A. (2006) · Annals of Surgery · doi:10.1097/01.sla.0000208430.07050.61 · Cited by 181
Hicks, R., Manus, M. M., Matthews, J., Hogg, A., Binns, D., Rischin, D., Ball, D., & Peters, L. (2004) · International Journal of Radiation Oncology, Biology, Physics · doi:10.1016/j.ijrobp.2004.03.036 · Cited by 175
Akhurst, T., Downey, R., Ginsberg, M., Gonen, M., Bains, M., Korst, R., Ginsberg, R., Rusch, V., & Larson, S. (2002) · Annals of Thoracic Surgery · doi:10.1016/s0003-4975(01)03257-x · Cited by 174 · see citing works
Armitage, J., Weisenburger, D., Hutchins, M., Moravec, D., Dowling, M., Sorensen, S., Mailliard, J., Okerbloom, J., Johnson, P. S., & Howe, D. (1986) · Journal of Clinical Oncology · doi:10.1200/jco.1986.4.2.160 · Cited by 172 · cited 1× · see citing works
“For example, in lymphomas, patients whose tumors shrink the most rapidly are most likely to do well, and they may need less treatment (55).”
BackgroundKaplan, W. D., Jochelson, M., Herman, T., Nadler, L., Stomper, P., Takvorian, T., Andersen, J. W., & Canellos, G. (1990) · Journal of Clinical Oncology · doi:10.1200/jco.1990.8.12.1966 · Cited by 170 · cited 1× · see citing works
“showed that a positive 67Ga scan midway through or at the end of treatment of patients with diffuse large cell lymphoma predicted a poor outcome in comparison to patients whose scans had normalized, even if residual masses were over 10 cm in size (11).”
ResultComparison of simplified quantitative analyses of FDG uptake
Graham, M. M., Peterson, L. M., & Hayward, R. M. (2000) · Nuclear Medicine and Biology · doi:10.1016/s0969-8051(00)00143-8 · Cited by 169 · cited 1× · see citing works
“More than 30 different ways to monitor tumor response have been discussed, but the SUV appears to be the most widely applied, generally correlating well with more complex analytic approaches (100,101).”
BackgroundThe paradox of response and survival in cancer therapeutics.
Huff, C., Matsui, W., Smith, B., & Jones, R. J. (2006) · Blood · doi:10.1182/blood-2005-06-2517 · Cited by 166 · see citing works
DeVita, V. T. (1981) · Cancer · doi:10.1002/1097-0142(19810101)47:1 · Cited by 164 · see citing works
Manus, M. M., Hicks, R., Matthews, J., Wirth, A., Rischin, D., & Ball, D. (2005) · Lung Cancer · doi:10.1016/j.lungcan.2004.11.024 · Cited by 164 · cited 1×
“In the Hicks qualitative PET criteria (Table 5), multiple lesions are assessed (76,84,92,141).”
BackgroundVansteenkiste, J., Stroobants, S. G., Leyn, P. R. D., Dupont, P. J., & Verbeken, E. K. (1998) · Annals of Oncology · doi:10.1023/a:1008437915860 · Cited by 155 · see citing works
Bryant, A., Cerfolio, R., Klemm, K., & Ojha, B. C. (2006) · Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2005.12.047 · Cited by 154 · see citing works
Ott, K., Herrmann, K., Lordick, F., Wieder, H., Weber, W., Becker, K., Buck, A., Dobritz, M., Fink, U., Ulm, K., et al. (2008) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-07-0934 · Cited by 151 · cited 1×
“Similarly, in sarcoma and gastric and ovarian carcinoma responses, a drop in SUV of more than 25% is associated with the best outcomes (43,87,137,138).”
BackgroundMinn, H. R. I., & Soini, I. (1989) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/bf00702620 · Cited by 143 · cited 1× · see citing works
“Planar imaging and SPECT with 18F-FDG showed that breast cancers and lymphomas had qualitative declines in tracer uptake with effective treatment (18,19).”
MethodUse of PET to monitor the response of lung cancer to radiation treatment
Erdi, Y., Macapinlac, H., Rosenzweig, K., Humm, J., Larson, S., Erdi, A. K., & Yorke, E. (2000) · European Journal of Nuclear Medicine · doi:10.1007/s002590000258 · Cited by 141 · cited 2×
“Choosing a threshold based on a single maximal pixel value in the tumor carries with it the variability inherent in determining a single-pixel value and is driven by that value (104,109,112,119,120).”
BackgroundThe significance of the residual mediastinal mass in treated Hodgkin's disease.
Jochelson, M., Mauch, P., Balikian, J., Rosenthal, D. N., & Canellos, G. (1985) · Journal of Clinical Oncology · doi:10.1200/jco.1985.3.5.637 · Cited by 141 · cited 1×
“Briefly, residual or even bulky masses after therapy completion are frequent in both Hodgkin disease and non-Hodgkin lymphoma but correlate poorly with survival (58).”
BackgroundOptimising the design of phase II oncology trials: the importance of randomisation.
Ratain, M., & Sargent, D. (2009) · European Journal of Cancer · doi:10.1016/j.ejca.2008.10.029 · Cited by 139 · cited 2× · see citing works
“With such reductionism, potential valuable information that may be important is lost (1,2,4,10).”
BackgroundDirect Comparison of FDG PET and CT Findings in Patients with Lymphoma: Initial Experience
Tatsumi, M., Cohade, C., Nakamoto, Y., Fishman, E. K., & Wahl, R. L. (2005) · Radiology · doi:10.1148/radiol.2373040555 · Cited by 138 · cited 1× · see citing works
“0-cm diameter (67,68), which translates into a tumor size roughly of 0.”
BackgroundSelf-citationKim, M. K., Ryu, J., Kim, S.-B., Ahn, J., Kim, S., Park, S.-I., Kim, Y. H., Song, H., Shin, J., Jung, H.-Y., et al. (2007) · European Journal of Cancer · doi:10.1016/j.ejca.2007.04.001 · Cited by 127 · cited 1×
“Because a growing body of data suggests that patients whose scans rapidly normalize are those most likely to have a favorable outcome, a disease-assessment scan performed soon after the beginning of treatment provides much information predictive of subsequent outcomes (85).”
BackgroundMonitoring chemotherapy and radiotherapy of solid tumors
Weber, W., & Wieder, H. (2006) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-006-0133-3 · Cited by 126 · cited 1× · see citing works
“Since that report, there have been many others in a wide range of tumors (21,22).”
Backgroundvan Klaveren, R. V., Aerts, J., de Bruin, H. D., Giaccone, G., Manegold, C., & van Meerbeeck, J. V. (2004) · Lung Cancer · doi:10.1016/s0169-5002(03)00292-7 · Cited by 126 · see citing works
Hellwig, D., Graeter, T., Ukena, D., Georg, T., Kirsch, C., & Schäfers, H. (2004) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2004.07.031 · Cited by 121 · cited 2×
“However, several papers have shown that in lung cancer, for example, a decline in a tumor SUV to below 4–6 after treatment separates groups of patients with longer and shorter survival reasonably well (72,127).”
BackgroundSugawara, Y., Zasadny, K. R., Grossman, H. B., Francis, I. R., Clarke, M. F., & Wahl, R. L. (1999) · Radiology · doi:10.1148/radiology.211.1.r99ap16249 · Cited by 119 · cited 1× · see citing works
“Ki is an attractive parameter and may be helpful when the SUV after treatment is low (117).”
BackgroundSelf-citationDooms, C., Verbeken, E., Stroobants, S., Nackaerts, K., Leyn, P. D., & Vansteenkiste, J. (2008) · Journal of Clinical Oncology · doi:10.1200/jco.2007.13.9550 · Cited by 118 · cited 1× · see citing works
“have shown that metastatic-tumor-involved mediastinal nodal pathology and clinical behavior are well predicted by changes in SUV and absolute SUV in the primary lung cancer and by qualitative visual assessments of nodal status (66,142).”
BackgroundLessons learned from independent central review.
Ford, R., Schwartz, L., Dancey, J., Dodd, L. E., Eisenhauer, E., Gwyther, S., Rubinstein, L., Sargent, D., Shankar, L., Therasse, P., et al. (2009) · European Journal of Cancer · doi:10.1016/j.ejca.2008.10.031 · Cited by 117 · see citing works
Benz, M., Allen-Auerbach, M., Eilber, F., Chen, H. J. J., Dry, S., Phelps, M., Czernin, J., & Weber, W. (2008) · Journal of Nuclear Medicine · doi:10.2967/jnumed.108.053694 · Cited by 116 · cited 8× · see citing works
“Measuring tumor or node size with CT from PET/CT is feasible, but slight errors in those mea- RECIST TO PERCIST: PET TUMOR RESPONSE • Wahl et al. 139S T A B L E 7 .”
BackgroundInfluentialNakamoto, Y., Zasadny, K., Minn, H., & Wahl, R. (2002) · Molecular Imaging and Biology · doi:10.1016/s1536-1632(01)00004-x · Cited by 115 · cited 6× · see citing works
“Absolute and rigorous standardization of the protocol for PET is required to achieve reproducible SUVs.”
BackgroundInfluentialSelf-citationPort, J., Kent, M., Korst, R., Keresztes, R., Levin, M., & Altorki, N. (2004) · Annals of Thoracic Surgery · doi:10.1016/s0003-4975(03)01457-7 · Cited by 112
Assessment of tumor response on MR imaging after locoregional therapy.
Vossen, J., Buijs, M., & Kamel, I. (2006) · Techniques in Vascular and Interventional Radiology · doi:10.1053/j.tvir.2007.02.004 · Cited by 104 · cited 1×
“In hepatomas, alternative criteria to RECIST have been developed, referred to as the EASL (European Association for the Study of the Liver) criteria (44,50).”
MethodCachin, F., Prince, H., Hogg, A., Ware, R., & Hicks, R. (2006) · Journal of Clinical Oncology · doi:10.1200/jco.2005.04.6326 · Cited by 99 · see citing works
Measuring [18F]FDG uptake in breast cancer during chemotherapy: comparison of analytical methods
Krak, N. C., van der Hoeven, J. J. M., Hoekstra, O. S., Twisk, J. W. R., van der Wall, E., & Lammertsma, A. A. (2003) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-003-1127-z · Cited by 94 · cited 3× · see citing works
“More than 30 different ways to monitor tumor response have been discussed, but the SUV appears to be the most widely applied, generally correlating well with more complex analytic approaches (100,101).”
BackgroundMethodOverview of early response assessment in lymphoma with FDG-PET
MacManus, M., Seymour, J., & Hicks, R. (2007) · Cancer Imaging · doi:10.1102/1470-7330.2007.0004 · Cited by 86 · see citing works
Aggressive non-Hodgkin lymphoma: early prediction of outcome with 67Ga scintigraphy.
Front, D., Bar-Shalom, R., Mor, M., Haim, N., Epelbaum, R., Frenkel, A., Gaitini, D., Kolodny, G., & Israel, O. (2000) · Radiology · doi:10.1148/radiology.214.1.r00ja03253 · Cited by 84 · cited 1× · see citing works
“67Ga results, qualitatively reported as positive or negative, were significantly predictive of outcome, with a negative 67Ga scan predicting a favorable outcome (12,14,15).”
BackgroundSelection of response criteria for clinical trials of sarcoma treatment.
Schuetze, S., Baker, L., Benjamin, R., & Canetta, R. (2008) · The Oncologist · doi:10.1634/theoncologist.13-s2-32 · Cited by 83 · cited 2× · see citing works
“There is great interest in surrogate metrics for survival after investigational cancer treatments, such as response rate, time to tumor progression, or progression-free survival (5).”
BackgroundMelton, G. B., Lavely, W. C., Jacene, H. A., Schulick, R. D., Choti, M. A., Wahl, R. L., & Gearhart, S. L. (2007) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-007-0170-7 · Cited by 82 · cited 5× · see citing works
“Tumor histologic status was well associated with changes in tumor volumes in neoadjuvant therapy of colorectal cancer, however (57).”
BackgroundMethodInfluentialSelf-citationCeresoli, G., Chiti, A., Zucali, P., Vincenzo, F. D., Rodari, M., Lutman, R., Salamina, S., Garassino, I., Campagnoli, E., Cavina, R., et al. (2006) · Journal of Clinical Oncology · doi:10.1016/s0169-5002(07)70156-3 · Cited by 75 · cited 1×
“However, SUVmax is also a potent predictor of outcomes in other studies of mesothelioma (52,129) and is quite strong in the data of Francis et al.”
ResultDuong, C., Demitriou, H., Weih, L., Thompson, A., Williams, D., Thomas, R. J. S., & Hicks, R. (2006) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-005-0028-8 · Cited by 74
Hodgkin disease: prediction of outcome with 67Ga scintigraphy after one cycle of chemotherapy.
Front, D., Bar-Shalom, R., Mor, M., Haim, N., Epelbaum, R., Frenkel, A., Gaitini, D., Kolodny, G., & Israel, O. (1999) · Radiology · doi:10.1148/radiology.210.2.r99fe07487 · Cited by 74
Plathow, C., Klopp, M., Thieke, C., Herth, F., Thomas, A., Schmaehl, A., Zuna, I., & Kauczor, H. (2008) · European Radiology · doi:10.1007/s00330-008-0918-9 · Cited by 70 · see citing works
Kasamon, Y. L., Wahl, R., Ziessman, H., Blackford, A., Goodman, S., Fidyk, C., Rogers, K. M., Bolaños-Meade, J., Borowitz, M., Ambinder, R., et al. (2009) · Biology of Blood and Marrow Transplantation · doi:10.1016/j.bbmt.2008.11.026 · Cited by 64 · cited 2× · see citing works
“We have used a 5-point visual assessment scale in our patients with non-Hodgkin lymphoma during therapy, and a 4-point scale in colorectal cancer after treatment, recognizing that response does likely represent a continuum of intensities of uptake (57,90).”
MethodSelf-citationFDG PET and risk-adapted therapy in Hodgkin's and non-Hodgkin's lymphoma
Kasamon, Y. L., & Wahl, R. (2008) · Current Opinion in Oncology · doi:10.1097/cco.0b013e3282f5123d · Cited by 63 · cited 2× · see citing works
“Thus, a dose of therapy that produces a 90% (1 log) reduction in tumor mass will have to be repeated 11 times to eliminate a newly diagnosed cancer comprising 1011 cells (26,27).”
BackgroundSelf-citationDuong, C., Hicks, R., Weih, L., Drummond, E., Leong, T., Michael, M., & Thomas, R. J. S. (2006) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-005-0040-z · Cited by 63 · see citing works
Roedl, J., Halpern, E., Colen, R., Sahani, D., Fischman, A., & Blake, M. (2008) · Molecular Imaging and Biology · doi:10.1007/s11307-008-0169-9 · Cited by 62 · cited 1×
“They could suffer from the variance intrinsic in the metabolic and anatomic methods, potentially reducing the precision of the methods, but initial results are encouraging in esophageal cancer treatment assessment (123).”
ResultReinhardt, M., Herkel, C., Altehoefer, C., Finke, J., & Moser, E. (2005) · Annals of Oncology · doi:10.1093/annonc/mdi271 · Cited by 59 · cited 1×
“It has been demonstrated that adding PET to the posttherapy CT is especially useful in identifying which of these patients have achieved a satisfactory functional remission (60,61).”
BackgroundAssessment of tumor response in malignant pleural mesothelioma.
Ceresoli, G., Chiti, A., Zucali, P., Cappuzzo, F., Vincenzo, F. D., Cavina, R., Rodari, M., Poretti, D., Lutman, F. R., & Santoro, A. (2007) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2007.07.012 · Cited by 58 · cited 1× · see citing works
“However, SUVmax is also a potent predictor of outcomes in other studies of mesothelioma (52,129) and is quite strong in the data of Francis et al.”
ResultFDG-PET Determination of Metabolically Active Tumor Volume and Comparison with CT.
Zasadny, K., Kison, P. V., Francis, I., & Wahl, R. (1998) · Clinical Positron Imaging · doi:10.1016/s1095-0397(98)00007-7 · Cited by 58 · cited 28× · see citing works
“Francis has found total lesion glycolysis to be superior to SUVmax in mesothelioma response RECIST TO PERCIST: PET TUMOR RESPONSE • Wahl et al. 137S assessment.”
BackgroundInfluentialSelf-citationThe role of PET in monitoring therapy
Hicks, R. (2005) · Cancer Imaging · doi:10.1102/1470-7330.2005.0006 · Cited by 57 · see citing works
How to perform a comprehensive search for FDG-PET literature
Mijnhout, G. S., Hooft, L., van Tulder, M. V., Devillé, W., Teule, G. J. J., & Hoekstra, O. (2000) · European Journal of Nuclear Medicine · doi:10.1007/pl00006669 · Cited by 55
Neuroblastomas contain iron-rich ferritin
Iancu, T. C., Shiloh, H., & Kedar, A. (1988) · Cancer · doi:10.1002/1097-0142(19880615)61:12 · Cited by 53 · see citing works
18F-FDG PET/CT for Monitoring the Response of Lymphoma to Radioimmunotherapy
Jacene, H., Filice, R., Kasecamp, W., & Wahl, R. (2008) · Journal of Nuclear Medicine · doi:10.2967/jnumed.108.055376 · Cited by 53 · cited 1× · see citing works
“However, in many studies the degree of SUV reduction associated with a complete metabolic response is less than 100% (139).”
BackgroundSelf-citationOxnard, G., & Schwartz, L. H. (2010) · Cancer · doi:10.1002/cncr.24803 · Cited by 44
FDG PET in lymphoma: The need for standardization of interpretation. An observer variation study
Zijlstra, J., Comans, E., van Lingen, A., Hoekstra, O., Gundy, C., Coebergh, J. W., & Bongers, V. (2007) · Nuclear medicine communications · doi:10.1097/mnm.0b013e3282eff2d5 · Cited by 44 · cited 1× · see citing works
“Indeed, only a 56% concurrence rate was seen between less experienced readers and experts (99) in assessments of nonHodgkin lymphoma disease activity.”
BackgroundAccuracy of the EasyTouch blood glucose self-monitoring system: a study of 516 cases
Dai, K.-S., Tai, D.-Y., Ho, P., Chen, C.-C., Peng, W.-C., Chen, S.-T., Hsu, C.-C., Liu, Y.-P., Hsieh, H.-C., Yang, C.-C., et al. (2004) · Clinica Chimica Acta · doi:10.1016/j.cccn.2004.06.010 · Cited by 41 · cited 1× · see citing works
“SUV should be corrected for lean body mass (SUL) and should not be corrected for serum glucose levels (glucose corrections have been variably useful, and errors in glucometer measurements are well known and may add errors (135)).”
BackgroundBarnacle, A., & McHugh, K. (2006) · Pediatric Blood & Cancer · doi:10.1002/pbc.20344 · Cited by 40
Mabille, M., Vanel, D., Albiter, M., Cesne, A. L., Bonvalot, S., Péchoux, C. L., Terrier, P., Shapeero, L., & Dromain, C. (2009) · European Journal of Radiology · doi:10.1016/j.ejrad.2008.10.009 · Cited by 36 · cited 1×
“Additional anatomic characteristics of GIST, such as the development of mural nodules, but not necessarily with tumor growth because of the predominantly cystic nature of the tumors, are indicative of progression and of a poor outcome (48,49).”
BackgroundCancer clinical trial outcomes: any progress in tumour-size assessment?
Verweij, J., Therasse, P., & Eisenhauer, E. (2009) · European Journal of Cancer · doi:10.1016/j.ejca.2008.10.025 · Cited by 35 · cited 1×
“recently reviewed the use of RECIST in about 60 papers and American Society of Clinical Oncology meeting abstracts (37,38).”
Update of the FDG PET search strategy
Mijnhout, G. S., Riphagen, I., & Hoekstra, O. (2004) · Nuclear medicine communications · doi:10.1097/00006231-200412000-00006 · Cited by 33
Israel, O., Mor, M., Epelbaum, R., Frenkel, A., Haim, N., Dann, E., Gaitini, D., Bar-Shalom, R., Kolodny, G., & Front, D. (2002) · Cancer · doi:10.1002/cncr.10344 · Cited by 31 · cited 1×
“67Ga results, qualitatively reported as positive or negative, were significantly predictive of outcome, with a negative 67Ga scan predicting a favorable outcome (12,14,15).”
BackgroundTumor Burden Assessment with Positron Emission Tomography with
Akhurst, T., Ng, Larson, S. M., O'Donoghue, J., O'Neel, J., Erdi, Y., & Divgi, C. (2000) · Clinical Positron Imaging · doi:10.1016/s1095-0397(00)00041-8 · Cited by 30 · cited 2×
“Choosing a threshold based on a single maximal pixel value in the tumor carries with it the variability inherent in determining a single-pixel value and is driven by that value (104,109,112,119,120).”
BackgroundNg, A. P., Wirth, A., Seymour, J., Lee, M. E., Hogg, A., Januszewicz, H., Wolf, M., Prince, H., MacManus, M., & Hicks, R. (2007) · Leukemia and Lymphoma · doi:10.1080/10428190601099965 · Cited by 29
Hoekstra, O., van Lingen, A., Ossenkoppele, G., Golding, R., & Teule, G. (1993) · European Journal of Nuclear Medicine · doi:10.1007/bf00171020 · Cited by 27 · cited 1× · see citing works
“Planar imaging and SPECT with 18F-FDG showed that breast cancers and lymphomas had qualitative declines in tracer uptake with effective treatment (18,19).”
Methodvan der Putten, L., Hoekstra, O., de Bree, R., Kuik, D., Comans, E., Langendijk, J., & Leemans, C. (2008) · Molecular Imaging and Biology · doi:10.1007/s11307-008-0154-3 · Cited by 25 · cited 1× · see citing works
“, neither positive nor negative), indicating the difficulty of dichotomizing the inherently continuously variable PET uptake patterns (97).”
Background[Gastrointestinal stromal tumors: role of computed tomography before and after treatment].
Bensimhon, D., Soyer, P., Brouland, J., Boudiaf, M., Fargeaudou, Y., & Rymer, R. (2008) · Gastroentérologie Clinique et Biologique · doi:10.1016/j.gcb.2007.12.015 · Cited by 20 · cited 1×
“Additional anatomic characteristics of GIST, such as the development of mural nodules, but not necessarily with tumor growth because of the predominantly cystic nature of the tumors, are indicative of progression and of a poor outcome (48,49).”
BackgroundFDG PET and high-dose therapy for aggressive lymphomas: toward a risk-adapted strategy
Kasamon, Y. L., Wahl, R., & Swinnen, L. (2004) · Current Opinion in Oncology · doi:10.1097/00001622-200403000-00003 · Cited by 19 · cited 1× · see citing works
“Use of these socalled response-adaptive or risk-adaptive treatment approaches is expected to grow (28).”
BackgroundSelf-citationSmulders, S., Gundy, C., van Lingen, A., Comans, E., Smeenk, F., & Hoekstra, O. (2007) · Molecular Imaging and Biology · doi:10.1007/s11307-007-0108-1 · Cited by 16 · see citing works
Discordant Response to Chemotherapy Detected by PET Scanning: Unveiling of a Second Primary Cancer
Blum, R., Prince, H., Hicks, R., Patrikeos, A., & Seymour, J. (2002) · American Journal of Clinical Oncology · doi:10.1097/00000421-200208000-00010 · Cited by 10 · cited 1×
“This is in part because ‘‘child’’ metastases biologically resemble their ‘‘parents’’ (143,144).”
Time and Again, Children Resemble Their Parents
Hicks, R. (2008) · Journal of Nuclear Medicine · doi:10.2967/jnumed.108.052142 · Cited by 3 · cited 1×
“This is in part because ‘‘child’’ metastases biologically resemble their ‘‘parents’’ (143,144).”
Flagged first, then by citations
25 of the 157 references couldn’t be matched to a known paper.
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Zwanenburg, A., Vallières, M., Abdalah, M. A., Aerts, H. J. W. L., Andrearczyk, V., Apte, A., Ashrafinia, S., Bakas, S., Beukinga, R. J., Boellaard, R., et al. (2020) · Radiology · doi:10.1148/radiol.2020191145 · Cited by 4,177 · see citing works
FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0
Boellaard, R., Delgado-Bolton, R., Oyen, W. J. G., Giammarile, F., Tatsch, K., Eschner, W., Verzijlbergen, F. J., Barrington, S. F., Pike, L. C., Weber, W. A., et al. (2015) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-014-2961-x · Cited by 3,303 · see citing works
HER kinase inhibition in patients with HER2- and HER3-mutant cancers
Hyman, D. M., Piha-Paul, S. A., Won, H., Rodon, J., Saura, C., Shapiro, G. I., Juric, D., Quinn, D. I., Moreno, V., Doger, B., et al. (2018) · Nature · doi:10.1038/nature25475 · Cited by 780 · see citing works
A Systematic Review of the Factors Affecting Accuracy of SUV Measurements
Adams, M. C., Turkington, T. G., Wilson, J. M., & Wong, T. Z. (2010) · American Journal of Roentgenology · doi:10.2214/ajr.10.4923 · Cited by 662 · see citing works
Kinahan, P. E., & Fletcher, J. W. (2010) · Seminars in Ultrasound, CT and MRI · doi:10.1053/j.sult.2010.10.001 · Cited by 631 · see citing works
Mapping of human brown adipose tissue in lean and obese young men
Leitner, B. P., Huang, S., Brychta, R. J., Duckworth, C. J., Baskin, A. S., McGehee, S., Tal, I., Dieckmann, W., Gupta, G., Kolodny, G. M., et al. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1705287114 · Cited by 530 · see citing works
Guidelines for the Diagnosis and Treatment of Primary Liver Cancer (2022 Edition)
Zhou, J., Sun, H., Wang, Z., Cong, W., Zeng, M., Zhou, W., Bie, P., Liu, L., Wen, T., Kuang, M., et al. (2023) · Liver Cancer · doi:10.1159/000530495 · Cited by 505 · see citing works
“…(evidence level 2, recommendation B); more sensitive and accurate evaluation of the ef fi cacy of targeted drugs that inhibit tumor activity [40, 41] (evidence level 2, recommendation A); guiding biologic target volume delineation for radiation therapy and determination of puncture biopsy sites…”
BackgroundMetabolic positron emission tomography imaging in cancer detection and therapy response
Zhu, A., Lee, D., & Shim, H. (2011) · Seminars in Oncology · doi:10.1053/j.seminoncol.2010.11.012 · Cited by 368 · see citing works
Grignani, G., Palmerini, E., Dileo, P., Asaftei, S. D., D’Ambrosio, L., Pignochino, Y., Mercuri, M., Picci, P., Fagioli, F., Casali, P. G., et al. (2012) · Annals of Oncology · doi:10.1093/annonc/mdr151 · Cited by 359 · see citing works
Aide, N., Lasnon, C., Veit-Haibach, P., Sera, T., Sattler, B., & Boellaard, R. (2017) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-017-3740-2 · Cited by 344 · see citing works
Italiano, A., Mir, O., Mathoulin-Pelissier, S., Penel, N., Piperno-Neumann, S., Bompas, E., Chevreau, C., Duffaud, F., Entz-Werlé, N., Saada, E., et al. (2020) · The Lancet Oncology · doi:10.1016/s1470-2045(19)30825-3 · Cited by 326 · see citing works
Violet, J., Sandhu, S., Iravani, A., Ferdinandus, J., Thang, S.-P., Kong, G., Kumar, A. R., Akhurst, T., Pattison, D., Beaulieu, A., et al. (2020) · Journal of Nuclear Medicine · doi:10.2967/jnumed.119.236414 · Cited by 292 · see citing works
PET/CT imaging in cancer: current applications and future directions
Farwell, M. D., Pryma, D. A., & Mankoff, D. A. (2014) · Cancer · doi:10.1002/cncr.28860 · Cited by 230 · see citing works
Ballal, S., Yadav, M. P., Bal, C., Sahoo, R. K., & Tripathi, M. (2020) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-019-04567-2 · Cited by 215 · see citing works
Repeatability of SUV in Oncologic <sup>18</sup>F-FDG PET
Lodge, M. A. (2017) · Journal of Nuclear Medicine · doi:10.2967/jnumed.116.186353 · Cited by 214 · see citing works
Self-citationKaira, K., Higuchi, T., Naruse, I., Arisaka, Y., Tokue, A., Altan, B., Suda, S., Mogi, A., Shimizu, K., Sunaga, N., et al. (2018) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-017-3806-1 · Cited by 195 · see citing works
Bai, J., Qiu, S.-Q., & Zhang, G. (2023) · Signal Transduction and Targeted Therapy · doi:10.1038/s41392-023-01366-y · Cited by 217 · see citing works
“Besides staging, it is used increasingly frequently to categorize the metabolic response to antineoplastic therapy, called PET Response Criteria in Solid Tumors (PERCIST).(193) Several studies have confirmed that (18)F-FDG PET or PET/CT can predict the response to EGFR-TKI treatment in 1–2 weeks, while conventional CT…”
MethodImpact of the Definition of Peak Standardized Uptake Value on Quantification of Treatment Response
Vanderhoek, M., Perlman, S. B., & Jeraj, R. (2012) · Journal of Nuclear Medicine · doi:10.2967/jnumed.111.093443 · Cited by 188 · see citing works
Head and neck tumor segmentation in PET/CT: The HECKTOR challenge
Oreiller, V., Andrearczyk, V., Jreige, M., Boughdad, S., Elhalawani, H., Castelli, J., Vallières, M., Zhu, S.-M., Xie, J.-Y., Peng, Y.-J., et al. (2021) · Medical Image Anal. · doi:10.1016/j.media.2021.102336 · Cited by 183 · see citing works
Gafita, A., Rauscher, I., Weber, M., Hadaschik, B. A., Wang, H., Armstrong, W. R., Tauber, R., Grogan, T., Czernin, J. G., Rettig, M. B., et al. (2022) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.263072 · Cited by 156 · see citing works
“Criteria for monitoring tumor response in PET imaging were described previously for (18)F-FDG PET (PERCIST (23)), but PSMA PET and (18)F-FDG PET image fundamentally different properties of the tumor tissue (PSMA expression and glucose”
MethodRepeatability of <sup>18</sup>F-FDG Uptake Measurements in Tumors: A Metaanalysis
de Langen, A. J., Vincent, A., Velasquez, L. M., van Tinteren, H., Boellaard, R., Shankar, L. K., Boers, M., Smit, E. F., Stroobants, S., Weber, W. A., et al. (2012) · Journal of Nuclear Medicine · doi:10.2967/jnumed.111.095299 · Cited by 157 · see citing works
Ilyas, H., Mikhaeel, N. G., Dunn, J. T., Rahman, F., Møller, H., Smith, D., & Barrington, S. F. (2018) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-018-3953-z · Cited by 150 · see citing works
Ferdinandus, J., Costa, P. F., Kessler, L., Weber, M., Hirmas, N., Kostbade, K., Bauer, S., Schuler, M., Ahrens, M., Schildhaus, H., et al. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.262468 · Cited by 148 · see citing works
“Clinical, laboratory, and imaging followup was performed as per clinical routine, with laboratory and clinical visits every 2–4 wk and imaging within 1–2 mo. Imaging response was defined as per RECIST (version 1.1) for CT and PERCIST for 18F-FDG PET/CT (17,18).”
BackgroundInfluentialImaging biomarkers for evaluating tumor response: RECIST and beyond
Ko, C., Yeh, L., Kuo, Y., & Chen, J. (2021) · Biomarker Research · doi:10.1186/s40364-021-00306-8 · Cited by 145 · see citing works
“(2009) [24] PERCIST • PET Response Criteria in Solid Tumors (PERCIST).”
BackgroundMethodFendler, W. P., Pabst, K. M., Kessler, L., Costa, P. F., Ferdinandus, J., Weber, M., Lippert, M., Lückerath, K., Umutlu, L., Kostbade, K., et al. (2022) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-22-1432 · Cited by 165 · see citing works
Wu, C., Lorenzo, G., Hormuth, D. A., Lima, E. A. B. F., Slavkova, K. P., DiCarlo, J. C., Virostko, J. M., Phillips, C. M., Patt, D. A., Chung, C. D., et al. (2022) · Biophysics Reviews · doi:10.1063/5.0086789 · Cited by 138 · see citing works
High-throughput proteomics and AI for cancer biomarker discovery
Xiao, Q., Zhang, F., Xu, L., Yue, L., Kon, O. L., Zhu, Y., & Guo, T. (2021) · Advanced Drug Delivery Reviews · doi:10.1016/j.addr.2021.113844 · Cited by 150 · see citing works
Albert, N., Galldiks, N., Ellingson, B., van den Bent, M. J., Chang, S. M., Cicone, F., de Groot, J. D., Koh, E., Law, I., Rhun, É. L., et al. (2024) · The Lancet Oncology · doi:10.1016/s1470-2045(23)00525-9 · Cited by 126 · see citing works
Sher, A., Lacoeuille, F., Fosse, P., Vervueren, L., Cahouet-Vannier, A., Dabli, D., Bouchet, F., & Couturier, O. (2016) · EJNMMI Research · doi:10.1186/s13550-016-0177-8 · Cited by 111 · see citing works
Zhou, X. M., Jiang, J., Yang, X., Liu, T., Ding, J., Nimmagadda, S., Pomper, M. G., Zhu, H., Zhao, J., Yang, Z., et al. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.262045 · Cited by 134 · see citing works
“SUVlean (SUL) was obtained by standardizing SUV to the body mass, which is less dependent on body habitus (24).”
MethodInfluentialDamsky, W., Wang, A., Kim, D. J., Young, B. D., Singh, K., Murphy, M. J., Daccache, J., Clark, A., Ayasun, R., Ryu, C., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-30615-x · Cited by 109 · see citing works
Ballal, S., Yadav, M., Moon, E., Roesch, F., Kumari, S., Agarwal, S., Tripathi, M., Sahoo, R., Mangu, B. S., Tupalli, A., et al. (2021) · Thyroid · doi:10.1089/thy.2021.0412 · Cited by 108
“Quantitative analysis and comparison were conducted according to the region of interest (ROI) methods prescribed by PERCIST 1 criteria (22).”
Quak, E., Le Roux, P.-Y., Hofman, M. S., Robin, P., Bourhis, D., Callahan, J., Binns, D., Desmonts, C., Salaun, P.-Y., Hicks, R. J., et al. (2015) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-015-3128-0 · Cited by 107 · see citing works
EANM practice guideline for quantitative SPECT-CT
Dickson, J., Armstrong, I., Gabiña, P. M., Denis-Bacelar, A., Krizsan, A., Gear, J., den Wyngaert, T. V., de Geus-Oei, L. D., & Herrmann, K. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-06028-9 · Cited by 106 · see citing works
“SUVpeak is an alternative measure for quantitative SPECT, capturing the status of metabolically active features while mitigating image noise [14, 15].”
BackgroundLopci, E., Hicks, R. J., Dimitrakopoulou‐Strauss, A., Dercle, L., Iravani, A., Seban, R., Sachpekidis, C., Humbert, O., Gheysens, O. S., Glaudemans, A. W. J. M., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05780-2 · Cited by 116 · see citing works
“Hence, several metabolic response criteria have been proposed as an alternative to PERCIST criteria [68].”
BackgroundMethodSelf-citationJoint EANM-SNMMI guideline on the role of 2-[18F]FDG PET/CT in no special type breast cancer
Vaz, S. C., Woll, J. P. P., Cardoso, F., Groheux, D., Cook, G. J. R., Ulaner, G., Jacene, H., Rubio, I. T., Schoones, J., Peeters, M.-J. V., et al. (2024) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-024-06696-9 · Cited by 102 · see citing works
“Metabolic therapy response assessment should be performed according to either the European Organisation for Research and Treatment in Cancer (EORTC) PET response criteria or PET Response Criteria in Solid Tumors (PERCIST) [69–71 , 73].”
MethodSelf-citationTriggiani, L., Mazzola, R., Magrini, S. M., Ingrosso, G., Borghetti, P., Trippa, F., Lancia, A., Detti, B., Francolini, G., Matrone, F., et al. (2019) · World Journal of Urology · doi:10.1007/s00345-019-02717-7 · Cited by 96 · see citing works
Ballal, S., Yadav, M., Tripathi, M., Sahoo, R., & Bal, C. (2022) · Journal of Nuclear Medicine · doi:10.2967/jnumed.122.264043 · Cited by 91 · see citing works
“…secondary endpoint was PFS (de fi ned as the fi rst observation of documented morphologic disease progression on diagnostic CT according to the assessment by RECIST 1.1 ( 19 ) or the development of pleural/pericardial effusion/ malignant ascites or disease-speci fi c death, whichever occurred fi rst.”
MethodInfluentialSchüler, M., Cuppens, K., Plönes, T., Wiesweg, M., Pont, B. D., Hegedűs, B., Köster, J., Mairinger, F. D., Darwiche, K., Paschen, A., et al. (2024) · Nature Medicine · doi:10.1038/s41591-024-02965-0 · Cited by 90 · see citing works
Gafita, A., Rauscher, I., Fendler, W. P., Murthy, V., Wang, H., Armstrong, W. R., Herrmann, K., Weber, W., Calais, J., Eiber, M., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05882-x · Cited by 101 · see citing works
“0 [2] are two frameworks intended to be applied across many oncological diseases.”
BackgroundMethod[131I]Iodometomidate for targeted radionuclide therapy of advanced adrenocortical carcinoma
Hahner, S., Kreissl, M. C., Fassnacht, M., Haenscheid, H., Knoedler, P., Lang, K., Buck, A. K., Reiners, C., Allolio, B., & Schirbel, A. (2012) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-2765 · Cited by 87 · see citing works
Instrumentation factors affecting variance and bias of quantifying tracer uptake with PET/CT
Doot, R. K., Scheuermann, J. S., Christian, P. E., Karp, J. S., & Kinahan, P. E. (2010) · Medical Physics · doi:10.1118/1.3499298 · Cited by 82 · see citing works
Low-count whole-body PET with deep learning in a multicenter and externally validated study
Chaudhari, A. S., Mittra, E., Davidzon, G. A., Gulaka, P., Gandhi, H., Brown, A., Zhang, T., Srinivas, S., Gong, E., Zaharchuk, G., et al. (2021) · npj Digital Medicine · doi:10.1038/s41746-021-00497-2 · Cited by 83 · see citing works
Quantitative implications of the updated EARL 2019 PET–CT performance standards
Kaalep, A., Burggraaff, C. N., Pieplenbosch, S., Verwer, E. E., Sera, T., Zijlstra, J., Hoekstra, O. S., Oprea-Lager, D. E., & Boellaard, R. (2019) · EJNMMI Physics · doi:10.1186/s40658-019-0257-8 · Cited by 79 · see citing works
Gastrointestinal stromal tumors: a comprehensive radiological review
Inoue, A., Ota, S., Yamasaki, M., Batsaikhan, B., Furukawa, A., & Watanabe, Y. (2022) · Japanese Journal of Radiology · doi:10.1007/s11604-022-01305-x · Cited by 79
“Two major response criteria, the European Organization for Research and Treatment of Cancer criteria using the maximum standardized uptake value [79] and the PET response criteria in solid tumors criteria employing the peak of the standardized uptake value corrected for lean body mass [(Lean body mass) = (Total weight…”
MethodYadav, M., Ballal, S., Sahoo, R., & Bal, C. (2021) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05632-5 · Cited by 79 · see citing works
Variance of SUVs for FDG-PET/CT is Greater in Clinical Practice Than Under Ideal Study Settings
Kumar, V., Nath, K., Berman, C. G., Kim, J., Tanvetyanon, T., Chiappori, A. A., Gatenby, R. A., Gillies, R. J., & Eikman, E. A. (2013) · Clinical Nuclear Medicine · doi:10.1097/rlu.0b013e318279ffdf · Cited by 76 · see citing works
Scirocchi, F., Scagnoli, S., Botticelli, A., Filippo, A. D., Napoletano, C., Zizzari, I. G., Strigari, L., Tomao, F., Cortesi, E., Rughetti, A., et al. (2022) · EBioMedicine · doi:10.1016/j.ebiom.2022.104010 · Cited by 85 · see citing works
Breast cancer resistance to chemotherapy: When should we suspect it and how can we prevent it?
Prihantono, P., & Faruk, M. (2021) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2021.102793 · Cited by 84 · see citing works
“1, the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) is available [30, 46].”
BackgroundWeber, M., Kersting, D., Riemann, B., Brandenburg, T., Führer-Sakel, D., Grünwald, F., Kreissl, M., Dralle, H., Weber, F., Schmid, K., et al. (2022) · Clinical Cancer Research · doi:10.1158/1078-0432.ccr-22-0437 · Cited by 72
“0 (24) criteria was assessed by single-session consensus of two readers.”
BackgroundAlberts, I., Sachpekidis, C., Prenosil, G., Viscione, M., Bohn, K. P., Mingels, C., Shi, K., Ashar-Oromieh, A., & Rominger, A. (2021) · Annals of Nuclear Medicine · doi:10.1007/s12149-021-01588-6 · Cited by 70 · see citing works
Hirota, S., Tateishi, U., Nakamoto, Y., Yamamoto, H., Sakurai, S., Kikuchi, H., Kanda, T., Kurokawa, Y., Cho, H., Nishida, T., et al. (2024) · International Journal of Clinical Oncology · doi:10.1007/s10147-024-02488-1 · Cited by 69
“…that after the start of drug therapy FDG-PET/CT should be performed at least 10 days apart, in consideration of the flare phenomenon (a phenomenon in which FDG accumulation increases after the start of drug therapy due to increased activity of immune cells, etc., regardless of the response) [35].”
BackgroundMethodInfluentialThe lung cancers: staging and response, CT, 18F-FDG PET/CT, MRI, DWI: review and new perspectives
Owens, C., Hindocha, S., Lee, R. W., Millard, T., & Sharma, B. (2023) · British Journal of Radiology · doi:10.1259/bjr.20220339 · Cited by 69 · see citing works
Abdelrahman, A., Goenka, A., Alva-Ruiz, R., Yonkus, J., Leiting, J., Graham, R. P., Merrell, K., Thiels, C., Hallemeier, C., Warner, S., et al. (2022) · The Journal of the National Comprehensive Cancer Network · doi:10.6004/jnccn.2022.7041 · Cited by 68
“Major metabolic (PET) response was defined as FDG uptake of the tumor below hepatic FDG uptake and indistinguishable from background pancreatic tissue as previously described.(23) Minor metabolic response was defined as persistent or higher FDG activity than adjacent background tissues and compared with baseline FDG-P…”
ResultImaging of Pheochromocytomas and Paragangliomas
Timmers, H., Taïeb, D., Pacak, K., & Lenders, J. (2024) · Endocrine reviews · doi:10.1210/endrev/bnae001 · Cited by 67 · see citing works
“Currently, 2 sets of criteria to quantify metabolic response are available: PET Response Criteria in Solid Tumors (PERCIST) 1.0 (122) and the criteria developed by the European Organization for Research and Treatment of Cancer (EORTC) (123).”
InfluentialRoy, S., Whitehead, T., Li, S.-Q., Ademuyiwa, F., Wahl, R., Dehdashti, F., & Shoghi, K. (2021) · bioRxiv · doi:10.1007/s00259-021-05489-8 · Cited by 67 · see citing works
Self-citationKramer, G. M., Frings, V., Hoetjes, N., Hoekstra, O. S., Smit, E. F., de Langen, A. J., & Boellaard, R. (2016) · Journal of Nuclear Medicine · doi:10.2967/jnumed.115.170225 · Cited by 65 · see citing works
Guo, R., Xue, S., Hu, J., Sari, H., Mingels, C., Zeimpekis, K., Prenosil, G., Wang, Y., Zhang, Y., Viscione, M., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-33562-9 · Cited by 65 · see citing works
“Additionally, the proposed method needs further clinical validation in clinical applications, especially clinical quantitative scores (refer to quantitative clinical scores such as the PERCIST 56 or the Deauville-Score 57 , and so on).”
MethodJha, A. K., Myers, K., Obuchowski, N., Liu, Z., Rahman, M. A., Saboury, B., Rahmim, A., & Siegel, B. (2021) · PET Clinics · doi:10.1016/j.cpet.2021.06.013 · Cited by 63 · see citing works
Sprinz, C., Zanon, M., Altmayer, S., Watte, G., Irion, K., Marchiori, E., & Hochhegger, B. (2018) · Scientific Reports · doi:10.1038/s41598-018-20529-4 · Cited by 59 · see citing works
AI-Based Detection, Classification and Prediction/Prognosis in Medical Imaging
Yousefirizi, F., Decazes, P., Amyar, A., Ruan, S., Saboury, B., & Rahmim, A. (2021) · PET Clinics · doi:10.1016/j.cpet.2021.09.010 · Cited by 66 · see citing works
“using liver or surrounding tissue) [109].”
Weyts, K., Lasnon, C., Ciappuccini, R., Lequesne, J., Corroyer-Dulmont, A., Quak, E., Clarisse, B., Roussel, L., Bardet, S., & Jaudet, C. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05800-1 · Cited by 59 · see citing works
“Greater SUL biases occurred especially in lesions with a moderate size and uptake and mostly “non-target and non-evaluable lesions” according to PERCIST criteria [34, 35].”
Hagen, P. V., Heijl, M. V., van Berge Henegouwen, M. I., Boellaard, R., Bossuyt, P. M. M., Kate, F. J. W. T., Dekken, H. V., Hoekstra, O. S., Sloof, G. W., & Lanschot, J. J. B. V. (2017) · Diseases of the Esophagus · doi:10.1111/dote.12479 · Cited by 58 · see citing works
Mileva, M., Marin, G., Levillain, H., Artigas, C., Bogaert, C. V., Marin, C., Danieli, R., Deleporte, A., Picchia, S., Stathopoulos, K., et al. (2023) · Journal of Nuclear Medicine · doi:10.2967/jnumed.123.265987 · Cited by 57 · see citing works
“18 F-FDG – positive target lesions were delineated on 18 F-FDG PET/CT images using a PERCIST-based threshold ( 17 ) to measure SUV max , SUV mean , meta-bolically active TV, and total lesion glycolysis (SUV mean 3 metabolically active TV).”
MethodTumor response assessment on imaging following immunotherapy
Berz, A. M., Dromain, C., Violi, N. V., Boughdad, S., & Durán, R. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.982983 · Cited by 60 · see citing works
Correction of scan time dependence of standard uptake values in oncological PET
van den Hoff, J., Lougovski, A., Schramm, G., Maus, J., Oehme, L., Petr, J., Beuthien-Baumann, B., Kotzerke, J., & Hofheinz, F. (2014) · EJNMMI Research · doi:10.1186/2191-219x-4-18 · Cited by 55 · see citing works
A method for model-free partial volume correction in oncological PET
Hofheinz, F., Langner, J., Petr, J., Beuthien-Baumann, B., Oehme, L., Steinbach, J., Kotzerke, J., & van den Hoff, J. (2012) · EJNMMI Research · doi:10.1186/2191-219x-2-16 · Cited by 55 · see citing works
A role of FDG-PET/CT for response evaluation in metastatic breast cancer?
Hildebrandt, M. G., Naghavi‐Behzad, M., & Vogsen, M. (2022) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2022.03.004 · Cited by 54 · see citing works
Advances in PET/CT Technology: An Update
Aide, N., Lasnon, C., Desmonts, C., Armstrong, I. S., Walker, M. D., & McGowan, D. R. (2021) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2021.10.005 · Cited by 55 · see citing works
FDG PET/CT-based response assessment in malignancies
Parihar, A. S., Dehdashti, F., & Wahl, R. L. (2023) · RadioGraphics · doi:10.1148/rg.220122 · Cited by 53 · see citing works
“The PERCIST were introduced by Wahl and colleagues (43) in 2009 with the aim of improving response assessment by using FDG PET/CT.”
InfluentialSelf-citationChisholm, J., Mandeville, H., Adams, M., Minard-Collin, V., Rogers, T., Kelsey, A., Shipley, J., van Rijn, R., de Vries, I. S. A., van Ewijk, R., et al. (2024) · Cancers · doi:10.3390/cancers16050998 · Cited by 52 · see citing works
“The primary classification of FDG-PET response is with the use of PERCIST [92,93], including quantitative PET indices (standard uptake values (SUVs)).”
MethodOhri, N., Jolly, S., Cooper, B. T., Kabarriti, R., Bodner, W. R., Klein, J., Guha, C., Shankar, V., Shum, E., Sabari, J. K., et al. (2023) · Journal of Clinical Oncology · doi:10.1200/jco.23.00627 · Cited by 70 · see citing works
“Responses on PET/CT performed after induction pem-brolizumab were assessed using CT measurements (RECIST 1.1 14 ) and on PET (PET Response Criteria in Solid Tumors [PERCIST] 15 ), where partial response is de fi ned as ≥ 30% reduction of maximum standardized uptake value.”
MethodInfluentialMitjavila, M., Jiménez-Fonseca, P., Belló, P., Pubul, V., Percovich, J. C., García-Burillo, A., Hernando, J., Arbizu, J., Rodeño, E., Estorch, M., et al. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06166-8 · Cited by 52 · see citing works
“8), complete response defined as normalization of all SUVs, and progression defined as an increase in intensity > 30% or the appearance of new lesions, verified through morphological criteria during follow-up [23].”
18F FDG PET/CT and Novel Molecular Imaging for Directing Immunotherapy in Cancer
Hughes, D. J., Subesinghe, M., Taylor, B. P., Billè, A., Spicer, J. F., Papa, S., Goh, V., & Cook, G. (2022) · Radiology · doi:10.1148/radiol.212481 · Cited by 58 · see citing works
Vaz, S. C., Adam, J. A., Bolton, R. C. D., Véra, P., van Elmpt, W., Herrmann, K., Hicks, R. J., Lievens, Y. N., Santos, A., Schöder, H. M., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05624-5 · Cited by 58 · see citing works
“Metabolic response criteria, such as the PET Response Evaluation Criteria in Solid Tumours (PERCIST), that assess change in standardized uptake value (SUV) corrected for lean body mass (SUL) have also been used to quantify metabolic response to treatment in clinical trials [71].”
MethodInfluences on PET Quantification and Interpretation
Rogasch, J. M. M., Hofheinz, F., van Heek, L., Voltin, C.-A., Boellaard, R., & Kobe, C. (2022) · Diagnostics · doi:10.3390/diagnostics12020451 · Cited by 50 · see citing works
Genomically matched therapy in advanced solid tumors: the randomized phase 2 ROME trial
Marchetti, P., Curigliano, G., Biffoni, M., Lonardi, S., Scagnoli, S., Fornaro, L., Guarneri, V., de Giorgi, U., Ascierto, P., Blandino, G., et al. (2025) · Nature Medicine · doi:10.1038/s41591-025-03918-x · Cited by 49 · see citing works
Zhou, H., Wang, Y., Xu, H., Shen, X., Zhang, T., Zhou, X. M., Zeng, Y., Li, K., Zhang, L., Zhu, H., et al. (2022) · Journal of Clinical Investigation · doi:10.1172/jci161065 · Cited by 75 · see citing works
“Wahl RL, et al. From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors.”
MethodInfluentialFournier, L., de Geus-Oei, L. D., Regge, D., Oprea-Lager, D., D'Anastasi, M., Bidaut, L., Bäuerle, T., Lopci, E., Cappello, G., Lecouvet, F., et al. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2021.800547 · Cited by 49 · see citing works
“Positron Emission Tomography Response Criteria in Solid Tumours (PERCIST), introduced in 2009 (30, 101), enables response to be measured in 18F-fluorodeoxyglucose (18F-FDG) avid bone metastatic lesions based on their metabolic activity in the absence of any obvious anatomic changes.”
BackgroundInfluentialViglianti, B. L., Wong, K. K., Wimer, S. M., Parameswaran, A., Nan, B., Ky, C., Townsend, D. M., Rubello, D., Frey, K. A., & Gross, M. D. (2017) · Biomedicine & Pharmacotherapy · doi:10.1016/j.biopha.2017.01.166 · Cited by 48 · see citing works
Synthetic PET from CT improves diagnosis and prognosis for lung cancer: Proof of concept
Salehjahromi, M., Karpinets, T. V., Sujit, S., Qayati, M., Chen, P., Aminu, M., Saad, M. B., Bandyopadhyay, R., Hong, L., Sheshadri, A., et al. (2024) · Cell Reports Medicine · doi:10.1016/j.xcrm.2024.101463 · Cited by 48 · see citing works
Mileva, M., de Vries, E. G. E., Guiot, T., Wimana, Z., Deleu, A.-L., Schröder, C. P., Lefebvre, Y., Paesmans, M., Stroobants, S. G., Huizing, M. T., et al. (2024) · npj Breast Cancer · doi:10.1038/s41523-023-00610-6 · Cited by 55 · see citing works
“For the late metabolic response assessment, a cutoff of a minimum 30% decrease in SUVmax was used 30 .”
MethodEvaluation of pediatric malignancies using total-body PET/CT with half-dose [18F]-FDG
Chen, W.-J., Liu, L., Li, Y.-H., Li, S., Li, Z., Zhang, W.-G., Zhang, X., Wu, R., Hu, D., Sun, H.-Y., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05893-8 · Cited by 48 · see citing works
The future of PSMA PET and WB MRI as next-generation imaging tools in prostate cancer
Wang, Y., Galante, J. R., Haroon, A., Wan, S., Afaq, A., Payne, H. A., Bomanji, J. B., Adeleke, S. M., & Kasivisvanathan, V. (2022) · Nature Reviews Urology · doi:10.1038/s41585-022-00618-w · Cited by 56 · see citing works
Efficacy and Safety of 177Lu-DOTATATE in Lung Neuroendocrine Tumors: A Bicenter study
Zidan, L., Iravani, A., Oleinikov, K., Ben-Haim, S., Gross, D., Meirovitz, A., Maimon, O., Akhurst, T., Michael, M., Hicks, R., et al. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.120.260760 · Cited by 48
“In patients who underwent baseline (18)F-FDG PET/CT, positive lesion was defined as uptake above the liver, and metabolic responses were assessed on the (18)F-FDG PET images qualitatively according to the PMCC criteria (supplemental materials) (15,16).”
MethodVanderhoek, M., Perlman, S. B., & Jeraj, R. (2013) · Journal of Nuclear Medicine · doi:10.2967/jnumed.112.113332 · Cited by 47 · see citing works
Real-world efficacy and safety of tofacitinib treatment in Asian patients with ulcerative colitis
Kojima, K., Watanabe, K., Kawai, M., Yagi, S., Kaku, K., Ikenouchi, M., Sato, T., Kamikozuru, K., Yokoyama, Y., Takagawa, T., et al. (2024) · World Journal of Gastroenterology · doi:10.3748/wjg.v30.i13.1871 · Cited by 45
“Figure 2 displays the flowchart illustrating trial progression.”
Capobianco, N., Sibille, L., Chantadisai, M., Gafita, A., Langbein, T., Platsch, G., Solari, E. L., Shah, V. P., Spottiswoode, B. S., Eiber, M., et al. (2021) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05473-2 · Cited by 46 · see citing works
Vogsen, M., Harbo, F., Jakobsen, N., Nissen, H. J., Dahlsgaard-Wallenius, S. E., Gerke, O., Jensen, J. D., Asmussen, J., Jylling, A., Braad, P., et al. (2022) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.263358 · Cited by 44 · see citing works
Filippi, L., Bianconi, F., Schillaci, O., Spanu, A., & Palumbo, B. (2022) · Diagnostics · doi:10.3390/diagnostics12040929 · Cited by 44 · see citing works
“[47] 2009 PERCIST Complete regression of all 18F-FDG-avid sites SULpeak reduction in at least 30% in the target lesions Increase in SULpeak of at least 30% or new lesions None of the previously mentioned conditions”
Backgroundde Jesus, F. M., Yin, Y., Mantzorou-Kyriaki, E., Kahle, X., de Haas, R. D., Yakar, D., Glaudemans, A., Noordzij, W., Kwee, T., & Nijland, M. (2021) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05626-3 · Cited by 44
“In a first phase, lesions were preselected in line with PERCIST recommendations with a semiau-tomatic segmentation tool on Hermes Hybrid 3D software (Hermes Medical Solutions AB, Stockholm, Sweden) by FMJ and blinded for histopathologic diagnosis (Figure 1) [28].”
Method[18F]FDG PET/CT: EANM procedure guidelines for tumour imaging: version 3.0
Boellaard, R., Herrmann, K., Barrington, S. F., Cranston, I. C., Mottaghy, F. M., Hoekstra, C., Beyer, T., Pike, L., Willemsen, A., Graham, M. M., et al. (2025) · The EANM Journal · doi:10.1016/j.eanmj.2025.100006 · Cited by 43 · see citing works
Ebner, R., Sheikh, G., Brendel, M., Ricke, J., & Cyran, C. (2024) · European Radiology · doi:10.1007/s00330-024-11094-8 · Cited by 43
“…approach not only enhances the evaluation of therapeutic effectiveness, especially in cases where anatomical changes are minimal but also underscores the importance of structured reporting for referring clinicians, ensuring they receive clear and actionable information for patient management [5].”
van Sluis, J., van Snick, J. H., Brouwers, A., Noordzij, W., Dierckx, R., Borra, R., Slart, R., Lammertsma, A., Glaudemans, A., Boellaard, R., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05919-1 · Cited by 43 · see citing works
“, to determine treatment-response, which requires standardised imaging procedures, especially in a multicentre setting [8].”
BackgroundA CGA/EGFR/GATA2 positive feedback circuit confers chemoresistance in gastric cancer
Cao, T., Lu, Y.-Y., Wang, Q., Qin, H.-Q., Li, H.-W., Guo, H., Ge, M., Glass, S. E., Singh, B., Zhang, W.-Y., et al. (2022) · Journal of Clinical Investigation · doi:10.1172/jci154074 · Cited by 43
“Response Evaluation Criteria in Solid Tumors (RECIST, version Chemoresistance is usually monitored through radiological assessment in clinical practice (44).”
Abbreviated scan protocols to capture 18F-FDG kinetics for long axial FOV PET scanners
Viswanath, V., Sari, H., Pantel, A., Conti, M., Daube-Witherspoon, M., Mingels, C., Alberts, I., Eriksson, L., Shi, K., Rominger, A., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05747-3 · Cited by 43 · see citing works
Bone Metastases Are Measurable: The Role of Whole-Body MRI and Positron Emission Tomography
Oprea‐Lager, D. E., Cysouw, M. C. F., Boellaard, R., Deroose, C. M., de Geus‐Oei, L., Lopci, E., Bidaut, L. M., Herrmann, K., Fournier, L. S., Bäuerle, T., et al. (2021) · Frontiers in Oncology · doi:10.3389/fonc.2021.772530 · Cited by 49 · see citing works
“In 2009, the PET Response Criteria in Solid Tumors (PERCIST) were introduced for (18)F-FDG PET (77).”
MethodInfluentialRosar, F., Wenner, F., Khreish, F., Dewes, S., Wagenpfeil, G., Hoffmann, M., Schreckenberger, M., Bartholomä, M. D., & Ezziddin, S. (2021) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05594-8 · Cited by 43 · see citing works
Artificial Intelligence-based Radiomics in the Era of Immuno-oncology
Kang, C., Duarte, S. E., Kim, H. S., Kim, E., Park, J., Lee, A., Kim, Y., Kim, L., Cho, S., Oh, Y., et al. (2022) · The Oncologist · doi:10.1093/oncolo/oyac036 · Cited by 42 · see citing works
A novel analytic approach for outcome prediction in diffuse large B-cell lymphoma by [18F]FDG PET/CT
Zhang, X., Chen, L., Jiang, H., He, X., Feng, L., Ni, M., Ma, M., Wang, J., Zhang, T., Wu, S., et al. (2021) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-021-05572-0 · Cited by 43 · see citing works
- Authors
- Wahl, R. L., Jacene, H., Kasamon, Y., & Lodge, M. A.
- Affiliations
- Johns Hopkins University (US)
- Corresponding author
- Wahl, Richard L.
- Venue
- Journal of Nuclear Medicine
- Publisher
- Society of Nuclear Medicine
- Published
- 2009-04-29
- Volume
- 50
- Issue
- Suppl 1
- Pages
- 122S-150S
- ISSN
- 0161-5505 (ISSN-L)
- 2159-662X
- PMC
- PMC2755245
- OpenAlex
- W2155263737
- Cited by
- 3,777
- References
- 157
- Citations by year
- 2026: 180 · 2025: 200 · 2024: 197 · 2023: 230 · 2022: 248 · 2021: 309 · 2020: 271 · 2019: 259 · 2018: 225 · 2017: 274 · 2016: 246 · 2015: 245 · 2014: 221 · 2013: 230 · 2012: 192
- FWCI
- 21.01
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Nuclear Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (CA006973, P30CA006973)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- RECIST, PERCIST, 18F-FDG PET, tumor response assessment, standardized uptake value, WHO criteria, RECIST 1.1, region of interest, treatment response assessment, solid tumors, lymphoma, sarcoma, hepatocellular carcinoma, mesothelioma, gastrointestinal stromal tumor, test-retest variability
- MeSH terms
- Forecasting, Humans, Neoplasms, Prognosis, World Health Organization, Treatment Outcome, Outcome Assessment, Health Care, Practice Guidelines as Topic, Radiopharmaceuticals, Fluorodeoxyglucose F18, Internationality, Positron-Emission Tomography
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