Cited by 3,777Medical Imaging Techniques and ApplicationsRadiomics and Machine Learning in Medical ImagingLung Cancer Diagnosis and Treatment

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From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors

Open access

Wahl, Richard L., Jacene, Heather, Kasamon, Yvette, Lodge, Martin A.·2009·Journal of Nuclear Medicine

DOI 10.2967/jnumed.108.057307PMC PMC2755245

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Abstract

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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New Guidelines to Evaluate the Response to Treatment in Solid Tumors
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“…criteria, such as the Response Evaluation Criteria in Solid Tumors (RECIST) or Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST), where changes higher than 20% or 30% in size or metabolism, form the basis of determining tumor progression, response, or stable disease (30,32).”
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“, a sphere), VOIs can be drawn using threshold or edge-based methods (49), using a peak VOI for more heterogeneous lesions (50), or mapping to an atlas of regions of interest for neurologic applications (51,52).”
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“Both the morphological Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 and the functional PET Response Criteria in Solid Tumors version (PERCIST) 1.0 cannot address pseudo-progression adequately [137–139].”
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“( 19,20 ).”
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“PERCIST (2009) [12] disappearance of all metabolically active lesions SULpeak reduction ≥ 30% in the hottest target lesions neither PMD nor PMR/CMR SULpeak increase ≥ 30% in the hottest target lesion as progressive disease”
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“…criteria (particularly in MBC), EANM-SNMMI guidelines consider [ 18 F]FDG PET/CT should be reported according to PERCIST or to the EORTC PET response criteria [130,131]; in patients on immunotherapy, [ 18 F]FDG PET/CT should be reported according to the respective EANM guidelines [132,133].”
MethodSelf-citation
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“5 + standard deviation of the liver background × 2 [17].”
Background
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“For the purpose of this study, treatment response was reported according to the PERCIST criteria [16].”
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“1 criteria [11] is the cornerstone of imagingbased response in oncology.”
BackgroundMethod
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Background
A Systematic Review about Imaging and Histopathological Findings for Detecting and Evaluating Electroporation Based Treatments Response
Granata, V., Fusco, R., Salati, S., Petrillo, A., Bernardo, E. D., Grassi, R., Palaia, R., Danti, G., Porta, M. L., Cadossi, M., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18115592 · Cited by 29
“Anatomical change in tumor size remains an important factor in the PERCIST criteria and should be measured according to RECIST 1.1 (Figure 2, Table 1).”
BackgroundInfluential
Gallium-68-labeled fibroblast activation protein inhibitor PET in gastrointestinal cancer: insights into diagnosis and management
Qin, C., Song, Y., Gai, Y.-K., Ruan, W.-W., Liu, Q.-Y., Liu, F., Zheng, D.-Z., Zhang, P., Liu, H.-L., Tao, Z., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05847-0 · Cited by 28
Radiomics-guided radiation therapy: opportunities and challenges
Abdollahi, H., Chin, E., Clark, H., Hyde, D. E., Thomas, S., Wu, J., Uribe, C., & Rahmim, A. (2022) · Physics in Medicine and Biology · doi:10.1088/1361-6560/ac6fab · Cited by 32
“…as theworld health organization (WHO) criteria, Response EvaluationCriteria in Solid Tumors (RECIST) (andmore recently, immuneRECIST (iRECIST)), and PET-based RECIST (PERCIST) (andmore recently, iPERCIST) for response evaluation respectively (Wahl et al 2009, JooHyun et al 2016, Beer et al 2019).”
BackgroundMethod
Pre‐treatment total metabolic tumour volumes in lymphoma: Does quantity matter?
El-Galaly, T., Villa, D., Chan, C.-A. Y., & Gormsen, L. (2022) · British Journal of Haematology · doi:10.1111/bjh.18016 · Cited by 28
“The highest SUV in a volume of interest (VOI) is the SUVmax, and the average SUV in an entire VOI is the SUVmean.”
Background
Melanoma brain metastases that progress on BRAF-MEK inhibitors demonstrate resistance to ipilimumab-nivolumab that is associated with the Innate PD-1 Resistance Signature (IPRES)
Lau, P. K. H., Feran, B., Smith, L. K., Lasocki, A., Molania, R., Smith, K. M., Weppler, A. M., Angel, C. M., Kee, D., Bhave, P., et al. (2021) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2021-002995 · Cited by 30
Quantitative accuracy in total-body imaging using the uEXPLORER PET/CT scanner
Leung, E. K., Berg, E., Omidvari, N., Spencer, B. A., Li, E., Abdelhafez, Y., Schmall, J., Liu, W., He, L., Tang, S., et al. (2021) · Physics in Medicine and Biology · doi:10.1088/1361-6560/ac287c · Cited by 28
In Vivo Cell Tracking Using PET: Opportunities and Challenges for Clinical Translation in Oncology
Lechermann, L. M., Lau, D., Attili, B. N. N. R., Aloj, L., & Gallagher, F. A. (2021) · Cancers · doi:10.3390/cancers13164042 · Cited by 27
“PET/CT is widely available in most large hospitals and by far the most frequently used tracer is the glucose analogue [18F]-2-fluoro-2-deoxy-D-glucose ([18F]FDG), used to probe increased tumour metabolism for image-based treatment response assessment [14,15].”
Method
Ultralow-dose [18F]FDG PET/CT imaging: demonstration of feasibility in dynamic and static images
Tan, H., Qi, C., Cao, Y., Cai, D., Mao, W., Yu, H., Sui, X., Liu, G., & Shi, H. (2023) · European Radiology · doi:10.1007/s00330-023-09389-3 · Cited by 27
“In PET solid tumor response evaluation criteria, the use of SUL instead of SUV to reduce the effect of body weight is the main quantitative indicator of treatment response [24, 27].”
Method
Clinical phenotypes and long-term outcome of kidney involvement in Erdheim-Chester histiocytosis.
Chazal, T., Pegoraro, F., Manari, G., Bettiol, A., Maniscalco, V., Gelain, E., Charlotte, F., Mazor, R., Renard-Penna, R., Amoura, Z., et al. (2022) · Kidney International · doi:10.1016/j.kint.2022.09.027 · Cited by 27
Parametric Imaging With Dynamic PET for Oncological Applications: Protocols, Interpretation, Current Applications and Limitations for Clinical Use.
Dimitrakopoulou-Strauss, A., Pan, L., & Sachpekidis, C. (2021) · Seminars in nuclear medicine · doi:10.1053/j.semnuclmed.2021.10.002 · Cited by 27
Response Assessment and Prediction of Progression-Free Survival by 68Ga-PSMA-11 PET/CT Based on Tumor-to-Liver Ratio (TLR) in Patients with mCRPC Undergoing 177Lu-PSMA-617 Radioligand Therapy
Khreish, F., Wiessner, M., Rosar, F., Ghazal, Z., Sabet, A., Maus, S., Linxweiler, J., Bartholomä, M. D., & Ezziddin, S. (2021) · Biomolecules · doi:10.3390/biom11081099 · Cited by 32
“0 were slightly modified [25] and then used to interpret post treatment changes.”
Method
The Prognostic Value of the Novel Global Immune-Nutrition-Inflammation Index (GINI) in Stage IIIC Non-Small Cell Lung Cancer Patients Treated with Concurrent Chemoradiotherapy
Topkan, E., Selek, U., Pehlivan, B., Kucuk, A., Ozturk, D., Ozdemir, B. S., Besen, A., & Mertsoylu, H. (2023) · Cancers · doi:10.3390/cancers15184512 · Cited by 26
“Second, it assured uniformity by employing PET-CT staging consistently across all participants.”
MethodInfluential
FDG PET/CT Prognostic Markers in Patients with Advanced Melanoma Treated with Ipilimumab and Nivolumab
Iravani, A., Wallace, R., Lo, S., Galligan, A., Weppler, A. M., Hicks, R. J., & Sandhu, S. K. (2023) · Radiology · doi:10.1148/radiol.221180 · Cited by 26
Quantitative classification and radiomics of [18F]FDG-PET/CT in indeterminate thyroid nodules
de Koster, E. J., Noortman, W. A., Mostert, J. M., Booij, J., Brouwer, C. B., de Keizer, B., de Klerk, J. M. H., Oyen, W. J. G., van Velden, F. H. P., de Geus‐Oei, L., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05712-0 · Cited by 33
Results of a single-arm pilot study of 32P microparticles in unresectable locally advanced pancreatic adenocarcinoma with gemcitabine/nab-paclitaxel or FOLFIRINOX chemotherapy
Ross, P., Wasan, H., Croagh, D., Nikfarjam, M., Nguyen, N., Aghmesheh, M., Nagrial, A., Bartholomeusz, D., Hendlisz, A., Ajithkumar, T., et al. (2021) · ESMO Open · doi:10.1016/j.esmoop.2021.100356 · Cited by 26
“Between March 2017 and June 2018, 50 patients were enrolled (ITT population), 50 patients received any study treatment (safety population), and 42 patients subsequently received (32)P microparticle implantation (PP population; Figure 1) at a median (range) of 31 (21-77) days from commencing chemotherapy.”
Method
Assessing the Value of 68Ga-FAPI PET/CT in Gastric Mucinous Adenocarcinoma or Signet Ring Cell Carcinoma.
Sun, Y.-Y., Xu, J.-Y., Qiao, Y., Zhang, J., Pan, H., Xu, X.-P., & Song, S.-L. (2024) · Radiology: Imaging Cancer · doi:10.1148/rycan.230195 · Cited by 25
Dose Reduction in Pediatric Oncology Patients with Delayed Total-Body [18F]FDG PET/CT
Mingels, C., Spencer, B. A., Nalbant, H., Omidvari, N., Rokni, M., Rominger, A., Sen, F., Cherry, S. R., Badawi, R., Abdelhafez, Y., et al. (2024) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.267521 · Cited by 25
“The background activity concentration was measured by placing a 30-mm-diameter spheric volume of interest in the right lobe of healthy liver tissue ( 27 ).”
Method
A Review on the Use of Imaging Biomarkers in Oncology Clinical Trials: Quality Assurance Strategies for Technical Validation
Chauvie, S., Mazzoni, L., & O'Doherty, J. (2023) · Tomography · doi:10.3390/tomography9050149 · Cited by 25
“…concentration of activity in the tissue to the injected activity normalized to the patient’s body weight (SUV corrected for lean body mass (SUL) has been introduced recently [27] but has not been yet used extensively in clinical practice [3,34]) has been proposed to override this problem [31].”
BackgroundMethod
Long Versus Short Axial Field of View Immuno-PET/CT: Semiquantitative Evaluation for 89 Zr-Trastuzumab
Mohr, P., van Sluis, J., Providência, L., van Snick, J. H., Hooge, M. N. L., Willemsen, A. T. M., Glaudemans, A. W. J. M., Boellaard, R., Lammertsma, A. A., Brouwers, A. H., et al. (2023) · Journal of Nuclear Medicine · doi:10.2967/jnumed.123.265621 · Cited by 28
Radiomics of Tumor Heterogeneity in 18F-FDG-PET-CT for Predicting Response to Immune Checkpoint Inhibition in Therapy-Naïve Patients with Advanced Non-Small-Cell Lung Cancer
Ventura, D., Schindler, P., Masthoff, M., Görlich, D., Dittmann, M., Heindel, W. L., Schäfers, M. A., Lenz, G., Wardelmann, E., Möhr, M., et al. (2023) · Cancers · doi:10.3390/cancers15082297 · Cited by 24
“5 × mean liver “standardized uptake value” (SUV) + 2 standard deviations to define FDG-positive tumor volume [28,29].”
Background
FDG-PET/CT in the Monitoring of Lymphoma Immunotherapy Response: Current Status and Future Prospects
Al‐Ibraheem, A., Abdlkadir, A. S., Juweid, M. E., Al-Rabi, K. H., Ma’koseh, M., Abdel‐Razeq, H., & Mansour, A. H. (2023) · Cancers · doi:10.3390/cancers15041063 · Cited by 30
Durability of response to immune checkpoint inhibitors in metastatic Merkel cell carcinoma after treatment cessation
Weppler, A. M., Meda, L. D., da Silva, I. P., Xu, W., Grignani, G., Menzies, A. M., Carlino, M. S., Long, G. V., Lo, S., Nordman, I. I. C., et al. (2023) · European Journal of Cancer · doi:10.1016/j.ejca.2023.01.016 · Cited by 26
Baseline Imaging Derived Predictive Factors of Response Following [177Lu]Lu-PSMA-617 Therapy in Salvage Metastatic Castration-Resistant Prostate Cancer: A Lesion- and Patient-Based Analysis
van der Sar, E. C. A., Kühr, A. J. S., Ebbers, S. C., Henderson, A., de Keizer, B., Lam, M. G. E. H., & Braat, A. J. A. T. (2022) · Biomedicines · doi:10.3390/biomedicines10071575 · Cited by 26
“Manual adoption was needed if single tumor lesions and organs were not automatically divided based on the set PERCIST criteria.”
BackgroundMethodInfluential
Multivariate analysis of various factors affecting background liver and mediastinal standardized uptake values
Mittal, B., Kuruva, M., Abrar, M., Kashyap, R., & Bhattacharya, A. (2012) · Indian Journal of Nuclear Medicine · doi:10.4103/0972-3919.108835 · Cited by 24
Dual FDG/PSMA PET imaging to predict lesion-based progression of mCRPC during PSMA-RLT
Rosar, F., Burgard, C., David, S., Marlowe, R. J., Bartholomä, M. D., Maus, S., Petto, S., Khreish, F., Schaefer-Schuler, A., & Ezziddin, S. (2024) · Scientific Reports · doi:10.1038/s41598-024-61961-z · Cited by 24
Clinical feasibility and impact of data-driven respiratory motion compensation studied in 200 whole-body 18F-FDG PET/CT scans
Dias, A. H., Schleyer, P., Vendelbo, M., Hjorthaug, K., Gormsen, L., & Munk, O. (2022) · EJNMMI Research · doi:10.1186/s13550-022-00887-x · Cited by 24
“0 [19]), these criteria have not gained widespread use.”
Background
Exploration of the total-body PET/CT reconstruction protocol with ultra-low 18F-FDG activity over a wide range of patient body mass indices
Sui, X., Tan, H., Yu, H., Xiao, J., Qi, C., Cao, Y., Chen, S., Zhang, Y., Hu, P., & Shi, H. (2022) · EJNMMI Physics · doi:10.1186/s40658-022-00445-3 · Cited by 28
Stereotactic body radiotherapy in oligometastatic cervical cancer (MITO-RT2/RAD study): a collaboration of MITO, AIRO GYN, and MaNGO groups
Macchia, G., Nardangeli, A., Laliscia, C., Fodor, A., Draghini, L., Gentile, P., D'Agostino, G., Balcet, V., Bonome, P., Ferioli, M., et al. (2022) · International Journal of Gynecological Cancer · doi:10.1136/ijgc-2021-003237 · Cited by 24
Long-term outcome and prognosis of mixed histiocytosis (Erdheim-Chester disease and Langerhans Cell Histiocytosis)
Pegoraro, F., Papo, M., Cohen-Aubart, F., Peyronel, F., Lugli, G., Trambusti, I., Baulier, G., de Menthon, M., Scornet, T. L., Oziol, É., et al. (2024) · EClinicalMedicine · doi:10.1016/j.eclinm.2024.102658 · Cited by 23
Differences and Common Ground in 177 Lu-PSMA Radioligand Therapy Practice Patterns: International Survey of 95 Theranostic Centers
Farolfi, A., Armstrong, W. R., Djaileb, L., Gafita, A., Hotta, M., Allen-Auerbach, M., Unterrainer, L. M., Fendler, W. P., Rettig, M. B., Eiber, M., et al. (2024) · Journal of Nuclear Medicine · doi:10.2967/jnumed.123.266391 · Cited by 25
Immune checkpoint inhibitor therapy for advanced cutaneous squamous cell carcinoma in Australia: a retrospective real world cohort study
McLean, L. S., Lim, A., Bressel, M., Lee, J. H., Ladwa, R., Guminski, A., Hughes, B., Bowyer, S. E., Briscoe, K., Harris, S., et al. (2024) · Medical Journal of Australia · doi:10.5694/mja2.52199 · Cited by 23
A phase 1 trial to determine the maximum tolerated dose and patient-specific dosimetry of [177Lu]Lu-LNC1003 in patients with metastatic castration-resistant prostate cancer
Zang, J., Wang, G., Zhao, T., Liu, H., Lin, X., Yang, Y., Shao, Z., Wang, C., Chen, H., Chen, Y., et al. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06470-3 · Cited by 30
Predictive value of 18F-FDG PET/CT-based radiomics model for neoadjuvant chemotherapy efficacy in breast cancer: a multi-scanner/center study with external validation
Chen, K., Wang, J., Li, S., Zhou, W., & Xu, W.-G. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06150-2 · Cited by 23
“Currently, many PET/CT-related breast cancer studies are also using TLR as an indicator [16, 17].”
A Pilot Study of 68Ga-PSMA11 and 68Ga-RM2 PET/MRI for Biopsy Guidance in Patients with Suspected Prostate Cancer
Duan, H.-Y., Ghanouni, P., Daniel, B., Rosenberg, J., Thong, A., Kunder, C. A., Aparici, C., Davidzon, G., Moradi, F., Sonn, G., et al. (2022) · Journal of Nuclear Medicine · doi:10.2967/jnumed.122.264448 · Cited by 23
“SUVpeak is defined as the average SUV within a small, fixed-size region of interest (1 cm(3)) (23).”
Background
The Potential of Photoacoustic Imaging in Radiation Oncology
Lefebvre, T. L., Brown, E. L., Hacker, L., Else, T. R., Oraiopoulou, M., Tomaszewski, M. R., Jena, R., & Bohndiek, S. E. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.803777 · Cited by 28
“In recent decades, the paradigm of response assessment in EBRT has been slowly redefined (10, 13) by the use of molecular imaging in addition to widely used anatomical imaging (14, 15).”
Method
New standards for phantom image quality and SUV harmonization range for multicenter oncology PET studies
Akamatsu, G., Shimada, N., Matsumoto, K., Daisaki, H., Suzuki, K., Watabe, H., Oda, K., Senda, M., Terauchi, T., & Tateishi, U. (2022) · Annals of Nuclear Medicine · doi:10.1007/s12149-021-01709-1 · Cited by 27
“SUVmax has been most commonly used to measure lesion uptakes in FDG PET, because its measurement is easy and observer-independent [8, 13].”
MethodInfluential
Clonal dynamics of BRAF-driven drug resistance in EGFR-mutant lung cancer
Schaufler, D., Ast, D., Tumbrink, H. L., Abedpour, N., Maas, L., Schwäbe, A. E., Spille, I., Lennartz, S., Fassunke, J., Aldea, M. D., et al. (2021) · npj Precision Oncology · doi:10.1038/s41698-021-00241-9 · Cited by 29
The metabolic parameters based on volume in PET/CT are associated with clinicopathological N stage of colorectal cancer and can predict prognosis
Kido, H., Kato, S., Funahashi, K., Shibuya, K., Sasaki, Y., Urita, Y., Hori, M., & Mizumura, S. (2021) · EJNMMI Research · doi:10.1186/s13550-021-00831-5 · Cited by 23
Response-Adapted Surgical and Radiotherapy De-Escalation in Resectable Cutaneous Squamous Cell Cancer Using Pembrolizumab: The De-Squamate Study
Ladwa, R., Lee, J., McGrath, M. E., Cooper, C. L., Liu, H. Y.-H., Bowman, J., Gupta, R., Cuscaden, C., Nottage, M. K., Clark, J. R., et al. (2025) · Journal of Clinical Oncology · doi:10.1200/jco-25-00387 · Cited by 30
Neoadjuvant Therapy for Mucosal Head and Neck Squamous Cell Carcinoma
Contrera, K. J., Kansara, S., Goyal, N., Mady, L. J., Puram, S. V., Young, G. D., Zandberg, D. P., Uppaluri, R., Ferrarotto, R., Holsinger, F. C., et al. (2025) · JAMA Otolaryngology–Head & Neck Surgery · doi:10.1001/jamaoto.2025.0410 · Cited by 22
Four-dimensional quantitative analysis using FDG-PET in clinical oncology
Tamaki, N., Hirata, K., Kotani, T., Nakai, Y., Matsushima, S., & Yamada, K. (2023) · Japanese Journal of Radiology · doi:10.1007/s11604-023-01411-4 · Cited by 22
“In this example, 7206 voxels were extracted from the VOI.”
BackgroundMethodInfluential
Interim FDG-PET/CT for Response Assessment of Lymphoma.
Zeman, M. N., Akin, E., Merryman, R., & Jacene, H. (2022) · Seminars in nuclear medicine · doi:10.1053/j.semnuclmed.2022.10.004 · Cited by 22
Self-citation
Prognostic value of baseline metabolic tumor volume in children and adolescents with intermediate-risk Hodgkin lymphoma treated with chemo-radiation therapy: FDG PET parameter analysis in a subgroup from COG AHOD0031
Milgrom, S., Kim, J., Chirindel, A., Kim, J.-H., Pei, Q., Chen, L., Buxton, A., Kessel, S., Leal, J., McCarten, K., et al. (2021) · Pediatric Blood & Cancer · doi:10.1002/pbc.29212 · Cited by 22
Improving the response to lenvatinib in partial responders using a Constrained-Disorder-Principle-based second-generation artificial intelligence-therapeutic regimen: a proof-of-concept open-labeled clinical trial
Sigawi, T., Gelman, R., Maimon, O., Yossef, A., Hemed, N., Agus, S., Berg, M., Ilan, Y., & Popovtzer, A. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1426426 · Cited by 21
“1) (24) and PET Response Criteria in Solid Tumors (PERCIST) (25, 26) to determine complete response, partial response, stable disease, or progressing disease.”
Background
Role of serial 18FDG-PET in determining the therapeutic efficacy of immunosuppression and clinical outcome in patients with cardiac sarcoidosis.
Okafor, J., Khattar, R., Kouranos, V., Ohri, S., Diana, D. P., Ebeke, E., Azzu, A., Ahmed, R., Wells, A., Baksi, A., et al. (2024) · Journal of Nuclear Cardiology · doi:10.1016/j.nuclcard.2024.101842 · Cited by 21
Intra-arterial peptide-receptor radionuclide therapy for neuro-endocrine tumour liver metastases: an in-patient randomised controlled trial (LUTIA)
Ebbers, S. C., Barentsz, M. W., de Vries–Huizing, D. M. V., Versleijen, M. W. J., Klompenhouwer, E. G., Tesselaar, M. E. T., Stokkel, M. P. M., Brabander, T., Hofland, J., Moelker, A. D., et al. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06467-y · Cited by 26
“Uptake was calculated as counts per voxel on SPECT/CT. Peak uptake was defined as the mean counts per voxel in a sphere-shaped VOI with a diameter of 1 cm around the voxel with the highest voxel value [17].”
Method
The effect of low HER2 expression on treatment outcomes in metastatic hormone receptor positive breast cancer patients treated with a combination of a CDK4/6 inhibitor and endocrine therapy: A multicentric retrospective study
Yıldırım, E. Ç., Atağ, E., Çoban, E., Ünal, O. Ü., Çelebi, A., Keser, M., Uzun, M., Keskinkılıç, M., Şimşek, E. T., Sarı, M., et al. (2023) · The Breast · doi:10.1016/j.breast.2023.06.006 · Cited by 22
“On the other hand, for patients who underwent PET-CT imaging, response evaluation was conducted using PERCIST criteria [22].”
Method
Tumor Sink Effect with Prostate-Specific Membrane Antigen-Targeted Theranostics in Patients with Metastatic Castration-Resistant Prostate Cancer: Intra-Individual Evaluations
Burgard, C., Rosar, F., Marlowe, R. J., Bartholomä, M. D., Dewes, S., Schaefer-Schuler, A., Linxweiler, J., Khreish, F., & Ezziddin, S. (2023) · Cancers · doi:10.3390/cancers15092592 · Cited by 23
“TLP, and deﬁned according to the modiﬁed PET Response in Solid Tumor Criteria (PERCIST) 1.0 [30].”
MethodInfluential
Response Evaluation in Patients with Peritoneal Metastasis Treated with Pressurized IntraPeritoneal Aerosol Chemotherapy (PIPAC)
Roensholdt, S., Detlefsen, S., Mortensen, M., & Graversen, M. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12041289 · Cited by 21
“1) after two PIPACs, in patients with different primary tumors [18,31].”
Background
Phase II Trial of Imatinib Plus Binimetinib in Patients With Treatment-Naive Advanced Gastrointestinal Stromal Tumor
Chi, P., Qin, L., Nguyen, B., Kelly, C., D'Angelo, S., Dickson, M., Gounder, M., Keohan, M., Movva, S., Nacev, B., et al. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.21.02029 · Cited by 21
“Patient Characteristics Characteristic All Patients (n 5 42) Age, years, median (range) 60 (25-78) Sex, No.”
Automatic Segmentation of Metastatic Breast Cancer Lesions on 18F-FDG PET/CT Longitudinal Acquisitions for Treatment Response Assessment
Moreau, N., Rousseau, C., Fourcade, C., Santini, G., Brennan, A., Ferrer, L., Lacombe, M., Guillerminet, C., Colombié, M., Jézéquel, P., et al. (2021) · Cancers · doi:10.3390/cancers14010101 · Cited by 21
“For example, 18F-FDG positron emission tomography combined with computed tomography (PET/CT) evaluated according to PET Response Evaluation Criteria in Solid Tumors (PERCIST) [6] shows better prediction of overall survival (OS) and progression-free survival (PFS) compared to RECIST 1.1.”
MethodInfluential
Prognostic Value of Urokinase-Type Plasminogen Activator Receptor PET/CT in Head and Neck Squamous Cell Carcinomas and Comparison with 18F-FDG PET/CT: A Single-Center Prospective Study
Risør, L. M., Clausen, M., Ujmajuridze, Z., Farhadi, M., Andersen, K., Loft, A., Friborg, J., & Kjaer, A. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.262866 · Cited by 21
“The PET parameter SUVmax is simple to obtain and is the most frequently reported and most reproducible PET uptake metric in the literature (20).”
Background
Combined 177Lu‐PSMA‐617 PRLT and abiraterone acetate versus 177Lu‐PSMA‐617 PRLT monotherapy in metastatic castration‐resistant prostate cancer: An observational study comparing the response and durability
Suman, S., Parghane, R., Joshi, A., Prabhash, K., Talole, S., & Basu, S. (2021) · The Prostate · doi:10.1002/pros.24219 · Cited by 21
“Complete disappearance of abnormal uptake in previously avid lesions defined as CR, ≥30% reduction in tracer uptake (SUVmax) as PR, >30% increase in tracer uptake or appearance newly avid lesions as PD and neither PR nor PD as SD on (68)Ga‐PSMA‐11 and (18)F‐FDG PET/CT imaging according to the Hicks criteria as detaile…”
MethodInfluential
Treatment Response Evaluation in Prostate Cancer Using PSMA PET/CT
Gafita, A., Schroeder, J. A., Ceci, F., Oldan, J. D., Khandani, A. H., Lecouvet, F. E., Sólnes, L. B., & Rowe, S. P. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.268071 · Cited by 13
“PERCIST is a response framework introduced in 2009 ( 52 ) using FDG PET/CT in different cancers.”
Dotatate PET/CT and 225 Ac-Dotatate Therapy for Somatostatin Receptor–expressing Metastatic Breast Cancer
Ulaner, G. A., VanderMolen, L. A., Li, G., & Ferreira, D. (2024) · Radiology · doi:10.1148/radiol.233408 · Cited by 20
Stereotactic Body Radiotherapy and Liver Transplant for Liver Cancer
Lee, V., Vardhanabhuti, V., Wong, T. C.-L., Lam, K.-O., Choi, H. C. W., Chiu, K., Ho, P. P., Leung, D. K.-C., Szeto, M. H.-M., Choi, K.-F., et al. (2024) · JAMA Network Open · doi:10.1001/jamanetworkopen.2024.15998 · Cited by 20
Quantitative imaging for 177Lu-PSMA treatment response monitoring and dosimetry
Meyer, C. A. L., Szidonya, L. K., Winters, C., Mench, A. M., Mallak, N., & Mittra, E. (2023) · Frontiers in Nuclear Medicine · doi:10.3389/fnume.2023.1291253 · Cited by 20
“The PERCIST liver-derived SUV threshold was determined by placing a representative 3 cm spherical ROI in the right lobe of normal liver and the threshold was calculated as: 1.5*liver_mean + 2*liver_SD (16).”
MethodInfluential
Prognostic utility of RECIP 1.0 with manual and AI-based segmentations in biochemically recurrent prostate cancer from [68Ga]Ga-PSMA-11 PET images
Kendrick, J., Francis, R., Hassan, G. M., Rowshanfarzad, P., Ong, J., McCarthy, M., Alexander, S., & Ebert, M. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06382-2 · Cited by 20
“There exist several generalised imaging response assessment frameworks that are applied across a range of cancer types, such as the Response Evaluation Criteria in Solid Tumours (RECIST 1.1) and the PET Evaluation Response Criteria in Solid Tumours (PERCIST) [7, 8].”
MethodInfluential
Information fusion for fully automated segmentation of head and neck tumors from PET and CT images
Shiri, I., Amini, M., Yousefirizi, F., Sadr, A. V., Hajianfar, G., Salimi, Y., Mansouri, Z., Jenabi, E., Maghsudi, M., Mainta, I., et al. (2023) · Medical Physics · doi:10.1002/mp.16615 · Cited by 21
A high pan-immune-inflammation value before chemoradiotherapy indicates poor outcomes in patients with small-cell lung cancer
Küçük, A., Topkan, E., Özkan, E. E., Öztürk, D., Pehlivan, B., & Selek, U. (2023) · International Journal of Immunopathology and Pharmacology · doi:10.1177/03946320231187759 · Cited by 16
“5 Gy per fraction, administered over a period of 10 days).(33)”
Background
The prognostic value of [18F]FDG PET/CT based response monitoring in metastatic melanoma patients undergoing immunotherapy: comparison of different metabolic criteria
Sachpekidis, C., Weru, V., Kopp-Schneider, A., Hassel, J., & Dimitrakopoulou-Strauss, A. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06243-y · Cited by 20
Outcome Prediction at Patient Level Derived from Pre-Treatment 18F-FDG PET Due to Machine Learning in Metastatic Melanoma Treated with Anti-PD1 Treatment
Flaus, A., Habouzit, V., de Leiris, N., Vuillez, J., Leccia, M., Simonson, M., Perrot, J., Cachin, F., & Prévôt, N. (2022) · Diagnostics · doi:10.3390/diagnostics12020388 · Cited by 20
“This was consistent with the Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) definition of target lesion [17].”
Result
Predictive Value of Multiparametric MRI for Response to Single-Cycle Induction Chemo-Immunotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma
Hellwig, K., Ellmann, S., Eckstein, M., Wiesmueller, M., Rutzner, S., Semrau, S., Frey, B., Gaipl, U. S., Gostian, A., Hartmann, A., et al. (2021) · Frontiers in Oncology · doi:10.3389/fonc.2021.734872 · Cited by 24
“Response evaluation is performed by measuring the SUV normalized by lean body mass (SUL); an increase in SUL peak > 30% or the appearance of a new lesions is considered progressive disease (25).”
Method

Authors: Wahl, R. L., Jacene, H., Kasamon, Y., & Lodge, M. A.
Affiliations: Johns Hopkins University (US)
Corresponding author: Wahl, Richard L.
ORCID: Wahl, Richard L.
Jacene, Heather
Kasamon, Yvette
Lodge, Martin A.
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
DOI: 10.2967/jnumed.108.057307
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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From RECIST to PERCIST: Evolving Considerations for PET Response Criteria in Solid Tumors

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