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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BackgroundInfluential

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BackgroundMethod
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Method
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Background
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Huang, Z., Guo, Y., Zhang, N., Huang, X., Decazes, P., Becker, S., & Ruan, S. (2022) · Comput. Biol. Medicine · doi:10.1016/j.compbiomed.2022.106230 · Cited by 16
A pilot study of 68 Ga-PSMA-617 PET/CT imaging and 177Lu-EB-PSMA-617 radioligand therapy in patients with adenoid cystic carcinoma
Wang, G., Zhou, M., Zang, J., Jiang, Y., Chen, X., Zhu, Z., & Chen, X. S. (2022) · EJNMMI Research · doi:10.1186/s13550-022-00922-x · Cited by 21
Super enhancer‐LncRNA SENCR promoted cisplatin resistance and growth of NSCLC through upregulating FLI1
Shen, Q., Zhou, H., Zhang, M., Wu, R., Wang, L., Wang, Y., & Chen, J. (2022) · Journal of Clinical Laboratory Analysis · doi:10.1002/jcla.24460 · Cited by 18
Predictive Value of 18F-FDG PET/CT Using Machine Learning for Pathological Response to Neoadjuvant Concurrent Chemoradiotherapy in Patients with Stage III Non-Small Cell Lung Cancer
Yoo, J., Lee, J., Cheon, M., Woo, S., Ahn, M., Pyo, H., Choi, Y., Han, J., & Choi, J. Y. (2022) · Cancers · doi:10.3390/cancers14081987 · Cited by 16
“0) as an evaluation for 18F-FDG PET/CT has been performed to enhance the limitation of anatomic tumor response metrics [15,16].”
Method
LncRNA RP3-326I13.1 promotes cisplatin resistance in lung adenocarcinoma by binding to HSP90B and upregulating MMP13
Zhou, H.-X., Huang, X.-L., Shi, W.-J., Xu, S., Chen, J., Huang, K., & Wang, Y. (2022) · Cell Cycle · doi:10.1080/15384101.2022.2051971 · Cited by 16
“Patients were divided into a “DDP-sensitive group” (relief) and a “DDP-resistant group” (progression) based on medical imaging tests, as computed tomography (CT), magnetic resonance imaging (MRI), serum tumor markers, and Response Evaluation Criteria in Solid Tumors (RECIST) criteria [36].”
Method
Imaging Glioblastoma With 18F-Fluciclovine Amino Acid Positron Emission Tomography
Scarpelli, M., Healey, D., Mehta, S., & Quarles, C. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.829050 · Cited by 16
Development and validation of a longitudinal soft-tissue metastatic lesion matching algorithm
Santoro-Fernandes, V., Huff, D. T., Scarpelli, M., Perk, T., Albertini, M., Perlman, S., Yip, S., & Jeraj, R. (2021) · Physics in Medicine and Biology · doi:10.1088/1361-6560/ac1457 · Cited by 16
Impacts of time interval on 18F-FDG uptake for PET/CT in normal organs: A systematic review
Wang, R., Chen, H., & Fan, C. (2018) · Medicine · doi:10.1097/md.0000000000013122 · Cited by 15
Standardization of PET/CT Performance Requirements for Whole-Body Quantitative Imaging: An International Proposal
Sunderland, J. J., Boellaard, R., Dickson, J. C., Graves, S. A., & Bailey, D. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.269349 · Cited by 15
“Alternatively, a 1-cm 3 spheric VOI can be moved around within a spheric VOI to identify the highest 1-cm 3 average concentration (the peak concentration for each sized sphere) ( 11 ).”
Efficacy and Safety of 225Ac-DOTATATE in the Treatment of Neuroendocrine Neoplasms With High SSTR Expression
Yang, H., Zhang, Y., Li, H., Feng, Y., Yang, X.-Q., & Chen, Y. (2024) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000005149 · Cited by 15
Change in total lesion PSMA (TLP) during [177Lu]Lu-PSMA-617 radioligand therapy predicts overall survival in patients with mCRPC: monocentric evaluation of a prospective registry
Burgard, C., Hein, C., Blickle, A., Bartholomä, M. D., Maus, S., Petto, S., Schaefer-Schuler, A., Ezziddin, S., & Rosar, F. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06476-x · Cited by 17
“The proposed −30%/+30% thresholds are consistent with the recommendations of the widely used PERCIST 1.0 framework, which refers to [ 18 F]FDG PET/CT and the corresponding parameter TLG [32].”
MethodInfluential
Quantitative Assessment of Treatment Response in Metastatic Breast Cancer Patients by SPECT-CT Bone Imaging—Getting Closer to PET-CT
Gherghe, M., Mutuleanu, M.-D., Stanciu, A., Irimescu, I., Lazăr, A., Toma, R., Trifănescu, O., & Anghel, R. (2023) · Cancers · doi:10.3390/cancers15030696 · Cited by 15
“0 criteria for quantitative data interpretation, thus categorizing treatment response as follows: Complete Response (CR), Partial Response (PR), Stable Disease (SD) and Progressive disease (PD), with a minimum of 1 and a maximum of 5 lesions being compared following S1 and S2 of the same patient [32].”
Background
Development of Radiomic-Based Model to Predict Clinical Outcomes in Non-Small Cell Lung Cancer Patients Treated with Immunotherapy
Tankyevych, O., Trousset, F., Latappy, C., Berraho, M., Dutilh, J., Tasu, J., Lamour, C., & Rest, C. C. L. (2022) · Cancers · doi:10.3390/cancers14235931 · Cited by 15
“Metabolic response was assessed using PERCIST criteria on follow-up PET/CT performed 6 to 8 weeks (PET/CT1) after treatment initiation [26].”
Method
Novel applications of molecular imaging to guide breast cancer therapy
Edmonds, C. E., O’Brien, S. R., Mankoff, D. A., & Pantel, A. R. (2022) · Cancer Imaging · doi:10.1186/s40644-022-00468-0 · Cited by 20
“While anatomic imaging, usually CT, has traditionally been the primary means of measuring treatment response, metabolic tumor changes on FDG-PET/CT likely offer a better, and earlier, response assessment compared to CT [48].”
BackgroundResult
Phase Ib trial of camrelizumab combined with chemotherapy and apatinib for neoadjuvant treatment of locally advanced thoracic esophageal squamous cell carcinoma
Wang, Z., Chen, X.-K., Li, Y., Qin, J., Fang, Y., Yang, Z.-Y., Fang, Y., Qu, D., Zhang, R.-X., Zheng, Q., et al. (2022) · Journal of the National Cancer Center · doi:10.1016/j.jncc.2022.04.002 · Cited by 15
“28,29 Unlike solid organ tumors, primary esophageal tumors are usually deﬁned as “non-measurable lesions ” according to the RECIST criteria.”
Prognostic value of total tumour volume, adding necrosis to metabolic tumour volume, in advanced or metastatic non-small cell lung cancer treated with first-line pembrolizumab
Eude, F., Guisier, F., Salaün, M., Thiberville, L., Pressat-Laffouilhere, T., Véra, P., & Decazes, P. (2022) · Annals of Nuclear Medicine · doi:10.1007/s12149-021-01694-5 · Cited by 16
“Besides, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) has proven its interest for diagnosing, staging, evaluating tumour response [17, 18] and has shown its potential as a prognostic imaging biomarker in lung cancer [19].”
Background
Clinical Experience with Targeted Alpha-Emitter Peptide Receptor Radionuclide Therapy (α-PRRT) for Somatostatin Receptor-Positive Neuroendocrine Tumors
Leupe, H., Cauwenbergh, M., Cleeren, F., Dekervel, J., Verslype, C., & Deroose, C. M. (2025) · Pharmaceuticals · doi:10.3390/ph18111608 · Cited by 14
“They received a median of 3 cycles (range: 2–6) at 100 kBq/kg with a mean cumulative activity of 22.9 ± 9 MBq. Notably, response evaluation was performed according to PERCIST 1.0 criteria (slightly modified for SST PET) at a median follow-up time of 14 months (range: 7–22) [45].”
Influential
Multicollinearity and redundancy of the PET radiomic feature set
Noortman, W. A., Vriens, D., Bussink, J., Meijer, T., Aarntzen, E., Deroose, C. M., Lhommel, R., Aide, N., le Tourneau, C., de Koster, E. J., et al. (2025) · European Radiology · doi:10.1007/s00330-025-11637-7 · Cited by 14
“An adaptive threshold of 41% and 50% of SUV peak was applied, obtained using a sphere of 12 mm diameter [16], corrected for local background, using in-house developed software or using the Accurate tool (Amsterda-mUMC) [17].”
Multicycle Dosimetric Behavior and Dose–Effect Relationships in [177Lu]Lu-DOTATATE Peptide Receptor Radionuclide Therapy
Kayal, G., Roseland, M., Wang, C., Fitzpatrick, K., Mirando, D. M., Suresh, K., Wong, K.-K., & Dewaraja, Y. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.269389 · Cited by 14
“…by partial-volume effects and segmentation accuracy, we also estimated ADs to a small (1 mL) spheric volume-of-interest (VOI) automatically placed on the area of highest mean AD within the tumor contour on the AD map (similar to the VOI placement on tumors for PERCIST-based PET response) ( 25 ).”
Quantification of metabolic activity in the evaluation of cardiac sarcoidosis
Wiefels, C., Boczar, K. E., Birnie, D. H., Beanlands, R. S., & Chareonthaitawee, P. (2024) · Journal of Nuclear Cardiology · doi:10.1016/j.nuclcard.2024.102088 · Cited by 13
Tumor therapeutics in the era of “RECIST”: past, current insights, and future prospects
Xu, Z.-L., Jiang, G.-N., & Dai, J. (2024) · Oncology Reviews · doi:10.3389/or.2024.1435922 · Cited by 14
Efficacy and safety of rechallenge with [177Lu]Lu-PSMA-I&T radioligand therapy in metastatic castration resistant prostate cancer
Santo, G., di Santo, G., Sviridenko, A., Bayerschmidt, S., Wirth, L., Scherbauer, F., Lehmann, P., von Guggenberg, E., Decristoforo, C., Heidegger-Pircher, I., et al. (2024) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-024-06905-5 · Cited by 14
“The imaging response was classified according to the adapted PERCIST 1.0 criteria [33, 34].”
Influential
The Correlation between Plasma Circulating Tumor DNA and Radiographic Tumor Burden
Alexander, E. M., Miller, H. A., Egger, M. E., Smith, M. L., Yaddanapudi, K., & Linder, M. W. (2024) · Journal of Molecular Diagnostics · doi:10.1016/j.jmoldx.2024.07.001 · Cited by 14
Metabolic tumor burden as a prognostic indicator after neoadjuvant chemotherapy in pancreatic cancer
Lee, W., Oh, M., Kim, J. S., Sung, M., Hong, K., Kwak, B., Park, Y., Jun, E., Song, K.-B., Hwang, D., et al. (2024) · International Journal of Surgery · doi:10.1097/js9.0000000000001389 · Cited by 14
“This analysis followed PERCIST (Positron Emission Tomography Response Evaluation Criteria in Solid Tumor) criteria and included all patients who were examined using internal and external scanners both before and after NAT [21] .”
Method
Assessment of perineural spread in advanced cutaneous squamous cell carcinomas treated with immunotherapy
Cavanagh, K., McLean, L. S., Lim, A., Cardin, A., Levy, S. M., & Rischin, D. (2024) · Cancer Imaging · doi:10.1186/s40644-024-00678-8 · Cited by 14
“Additionally, for the subset of patients with Positron Emission Tomography Response Criteria 1.0 (PERCIST 1.0) [25] measurable disease on FDG-PET/ CT, these responses were also recorded.”
MethodInfluential
Deep learning model for automatic image quality assessment in PET
Zhang, H., Liu, Y., Wang, Y., Ma, Y., Niu, N., Jing, H., & Huo, L. (2023) · BMC Medical Imaging · doi:10.1186/s12880-023-01017-2 · Cited by 14
MSRA-Net: Tumor segmentation network based on Multi-scale Residual Attention
Wu, Y., Jiang, H.-Y., & Pang, W. (2023) · Comput. Biol. Medicine · doi:10.1016/j.compbiomed.2023.106818 · Cited by 14
177Lu-DOTATATE Theranostics
Peterson, A. B., Wang, C.-S., Wong, K.-K., Frey, K., Muzik, O., Schipper, M., & Dewaraja, Y. (2023) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000004599 · Cited by 14
Perspectives on joint EANM/SNMMI/ANZSNM practice guidelines/procedure standards for [18F]FDG PET/CT imaging during immunomodulatory treatments in patients with solid tumors
Lopci, E., Aide, N., Dimitrakopoulou-Strauss, A., Dercle, L., Iravani, A., Seban, R., Sachpekidis, C., Humbert, O., Gheysens, O., Glaudemans, A., et al. (2022) · Cancer Imaging · doi:10.1186/s40644-022-00512-z · Cited by 14
Self-citation
A Decision Support System for the Identification of Metastases of Metastatic Melanoma Using Whole-Body FDG PET/CT Images
Vagenas, T. P., Economopoulos, T. L., Sachpekidis, C., Dimitrakopoulou‐Strauss, A., Pan, L., Provata, A., & Matsopoulos, G. K. (2022) · IEEE Journal of Biomedical and Health Informatics · doi:10.1109/jbhi.2022.3230060 · Cited by 21
“Liver’s mean is estimated from a spherical VOI of 3 cm(2) placed in the liver as suggested in [42].”
Method
Regorafenib Induces Senescence and Epithelial-Mesenchymal Transition in Colorectal Cancer to Promote Drug Resistance
Kehagias, P., Kindt, N., Krayem, M., Najem, A., Agostini, G., Reina, E. A., Bregni, G., Sclafani, F., Journé, F., Awada, A. H., et al. (2022) · Cells · doi:10.3390/cells11223663 · Cited by 13
[18F]FDG-PET/CT radiomics for the identification of genetic clusters in pheochromocytomas and paragangliomas
Noortman, W. A., Vriens, D., de Geus‐Oei, L., Slump, C. H., Aarntzen, E. H. J. G., van Berkel, A., Timmers, H. J. L. M., & van Velden, F. H. P. (2022) · European Radiology · doi:10.1007/s00330-022-09034-5 · Cited by 22
Evaluation of Amide Proton Transfer‐Weighted Imaging for Lung Cancer Subtype and Epidermal Growth Factor Receptor: A Comparative Study With Diffusion and Metabolic Parameters
Meng, N., Fu, F.-F., Feng, P., Li, Z.-Q., Gao, H., Wu, Y.-P., Zhang, J.-W., Wei, W., Yuan, J.-M., Yang, Y., et al. (2022) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.28135 · Cited by 14
“However, the difference in SUVmax between the two groups was not significant, which may be related to the weakness of SUVmax in terms of representing only one dimension of the tumor or a single-pixel point of metabolic information.(30) Results obtained from the comparison of EGFR mutation-type and wild-type NSCLC show…”
Result
General Concepts in Theranostics.
Nunes, R. F., Zuppani, R. M. F., Coutinho, A., Barbosa, F. G., Sapienza, M., Marin, J. F., & Buchpiguel, C. (2021) · PET Clinics · doi:10.1016/j.cpet.2021.03.010 · Cited by 14
Response Prediction and Evaluation Using PET in Patients with Solid Tumors Treated with Immunotherapy
Borm, F. J., Smit, J., Oprea-Lager, D., Wondergem, M., Haanen, J., Smit, E., & de Langen, A. D. (2021) · Cancers · doi:10.3390/cancers13123083 · Cited by 14
“The RECIST 1.1, imRECIST, EORTC, PERCIST, imPERCIST, and PERCIMT criteria were all applied in a cohort of 52 NSCLC patients treated with nivolumab or pembrolizumab.”
BackgroundInfluential
Peptide Receptor Radionuclide Therapy in Patients with Advanced, Recurrent or Progressive Meningioma: An Updated Systematic Review and Meta-Analysis
Muoio, B., Iacovitti, C., Bosetti, D., Sansovini, M., Cuzzocrea, M., Paone, G., & Treglia, G. (2025) · Cancers · doi:10.3390/cancers17122039 · Cited by 13
“Other criteria that were less frequently used were volumetric criteria [37,38], Response Evaluation Criteria In Solid Tumors 1.1 (RECIST 1.1) [39], PET Response Criteria in Solid Tumors (PERCIST) [40], Southwest Oncology Group (SWOG) criteria [41] and modified Macdonald criteria [42].”
Influential
Integration of Circulating Tumor DNA and Metabolic Parameters on 18F‐Fludeoxyglucose Positron Emission Tomography for Outcome Prediction in Unresectable Locally Advanced Non‐Small Cell Lung Cancer
Wu, L., Zhang, Z.-S., Jiang, C., Li, L., Sun, X.-J., Bai, M., Liu, M., Xiong, K., Shang, J., Yu, J.-M., et al. (2025) · Advancement of science · doi:10.1002/advs.202413125 · Cited by 13
PET/CT imaging of differentiated and medullary thyroid carcinoma using the novel SSTR-targeting peptide [18F]SiTATE – first clinical experiences
Kunte, S. C., Wenter, V., Toms, J., Lindner, S., Unterrainer, M., Eilsberger, F., Jurkschat, K., Wängler, C., Wängler, B., Schirrmacher, R., et al. (2024) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-024-06944-y · Cited by 16
Advancements and Challenges in the Application of Metal-Organic Framework (MOF) Nanocomposites for Tumor Diagnosis and Treatment
Hou, Y., Zhu, C., Ban, G., Shen, Z.-A., Liang, Y., Chen, K., Wang, C., & Shi, H. (2024) · International Journal of Nanomedicine · doi:10.2147/ijn.s463144 · Cited by 13
“96 PET is distinguished by its superior detection sensitivity and deep signal penetration when compared to other imaging techniques.”
Longitudinal Image Data for Outcome Modeling.
van Timmeren, J. E., Bussink, J., Koopmans, P. J., Smeenk, R., & Monshouwer, R. (2024) · Clinics in oncology · doi:10.1016/j.clon.2024.06.053 · Cited by 13
“For evaluating metabolic activity in tumors to detect treatment response even in absence of major tumor shrinkage, PET RCIST (PERCIST) has been developed [27,28].”
Posttreatment Surveillance Imaging After Radiation for Head and Neck Cancer
Chen, A. M., Harris, J. P., Gan, M., Nabar, R., Tjoa, T., Haidar, Y., Truong, A., Chow, D. S., & Armstrong, W. B. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.42825 · Cited by 13
Prognostic value of [18F]-FDG PET/CT in patients with meta-static breast cancer treated with cyclin-dependent inhibitors
Annovazzi, A., Rea, S., Maccora, D., Pizzuti, L., Ferretti, G., Vici, P., Cappuzzo, F., & Sciuto, R. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1193174 · Cited by 13
“Metabolic response was evaluated according to EORTC (14), PERCIST1 (analyzing SUVpeak of the hottest lesion) (15) and PERCIST5 (analyzing the SUVpeak of 1 or up to 5 lesions) (20), classifying the patients into 4 response groups: complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic dis…”
Method
[18F]FDG PET/CT criteria for treatment response assessment: EORTC and beyond
Miceli, A., Jonghi-Lavarini, L., Santo, G., Cassarino, G., Linguanti, F., Gazzilli, M., Cimino, A., Buschiazzo, A., Sorbello, S., Abenavoli, E., et al. (2023) · Clinical and translational imaging · doi:10.1007/s40336-023-00578-0 · Cited by 13
“This criterion was based on several studies with different cancer types, including small cell lung cancer (SCC), colorectal cancer, non-Hodgkin lymphoma (NHL), esophageal cancer, and the Ewing sarcoma family of tumors [3, 11].”
BackgroundMethodInfluential
PSMA PET/CT for Response Assessment of 177Lu-PSMA Therapy
Hartrampf, P. E., Serfling, S. E., Michalski, K., Buck, A. K., & Werner, R. A. (2023) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2023.06.003 · Cited by 13
Multimodality liver directed treatment for colorectal liver metastasis: Array of complementary options can improve outcomes - A single centre experience from India
Patkar, S., Chopde, A. N., Shetty, N., Kulkarni, S., Gala, K., Chandra, D., Ramaswamy, A., Ostwal, V., & Goel, M. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1073311 · Cited by 13
PET Criteria by Cancer Type from Imaging Interpretation to Treatment Response Assessment: Beyond FDG PET Score
Dondi, F., Lazzarato, A., Gorica, J., Guglielmo, P., Borgia, F., Filice, R., Vento, A., Pacella, S., Camedda, R., Caracciolo, M., et al. (2023) · Life · doi:10.3390/life13030611 · Cited by 12
“More recently, the same group compared the available response criteria for PCa, both specific (aPCWG3, PPP and RECIP 1.0) and non-specific (RECIST 1.1, aPERCIST), in the response evaluation of patients treated with [177Lu]Lu-PSMA.”
MethodInfluential
Added value of digital FDG-PET/CT in disease staging and restaging in patients with resectable or borderline resectable pancreatic cancer.
de Jong, T. D., Koopman, D., van der Worp, C. A. J., Stevens, H., Vuijk, F., Vahrmeijer, A., Mieog, J., de Groot, J. D., Meijssen, M., Nieuwenhuijs, V., et al. (2023) · Surgical oncology · doi:10.1016/j.suronc.2023.101909 · Cited by 13
Semi-automated 18 F-FDG PET segmentation methods for tumor volume determination in Non-Hodgkin lymphoma patients: a literature review, implementation and multi-threshold evaluation
Keijzer, K., Niezink, A. G. H., de Boer, J., van Doesum, J. A., Noordzij, W., van Meerten, T., & van Dijk, L. V. (2023) · Computational and Structural Biotechnology Journal · doi:10.1016/j.csbj.2023.01.023 · Cited by 16
“2.3 SUV ≥ PERCIST SUV [27] (PERSIST); Based on the same SUV vales in the sphere area described at 2.2., the PERCIST SUV is defined as: 1.5 x average liver SUV + 2 x Standard Deviation.”
BackgroundInfluential
The role of quantitative tumor burden based on [^68 Ga]Ga-DOTA-NOC PET/CT in well-differentiated neuroendocrine tumors: beyond prognosis
Chen, L.-H., Jumai, N., He, Q., Liu, M., Lin, Y., Luo, Y.-J., Wang, Y., Chen, M.-H., Zeng, Z.-R., Zhang, X.-S., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05971-x · Cited by 13
“This method is based on PET Response Criteria in Solid Tumors (PERCIST) criteria; according to PERCIST, if a normal liver is not available, blood values can be used [12].”
Method
Breast PET/MRI hybrid imaging and targeted tracers
Romeo, V., Helbich, T., & Pinker, K. (2022) · Journal of Magnetic Resonance Imaging · doi:10.1002/jmri.28431 · Cited by 13
“In light of this, PET Response Criteria in Solid Tumors (PERCIST) have been proposed for a standardized assessment of FDG Uptake, in which SUV is normalized by lean body mass and abbreviated as SUL.(58) According to such criteria, an uptake decrease by 30% is considered an index of tumor response, with a minimum SUL a…”
Influential
Predictive Biomarkers for Response and Toxicity of Induction Chemotherapy in Head and Neck Cancers
Boguszewicz, Ł. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.900903 · Cited by 13
Prognostic value of immunotherapy-induced organ inflammation assessed on 18FDG PET in patients with metastatic non-small cell lung cancer
Humbert, O., Bauckneht, M., Gal, J., Paquet, M., Chardin, D., Rener, D., Schiazza, A., Genova, C., Schiappa, R., Zullo, L., et al. (2022) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-022-05788-8 · Cited by 14
“– The PERCIST criteria [19] but also the iPERCIST criteria, adapted to the issue of immunotherapy and inspired from previous guidelines and studies [14–16, 18], were used for the interpretation of the interim PET scans (see Supplementary Table S1 for iPERCIST criteria and definitions).”
Method
Current Roles of PET/CT in Thymic Epithelial Tumours: Which Evidences and Which Prospects? A Pictorial Review
Lococo, F., Chiappetta, M., Triumbari, E. K., Evangelista, J., Congedo, M., Pizzuto, D., Brascia, D., Marulli, G., Annunziata, S., & Margaritora, S. (2021) · Cancers · doi:10.3390/cancers13236091 · Cited by 13
“Distant metastases from TETs mostly involved pleural cavity, diaphragm, lung and more rarely extra-thoracic areas, such as intra-ocular region, spleen, liver, pancreas, spinal cord and bone [38].”
BackgroundResult
The role of dosimetry and biological effects in metastatic castration–resistant prostate cancer (mCRPC) patients treated with 223Ra: first in human study
Sciuto, R., Rea, S., Ungania, S., Testa, A., Dini, V., Tabocchini, M. A., Patrono, C., Soriani, A., Palma, V., Marconi, R., et al. (2021) · Journal of Experimental & Clinical Cancer Research · doi:10.1186/s13046-021-02056-9 · Cited by 12
“Lesion based response at 3 months was also evaluated to define TTR on imaging distinguishing between complete (CR), partial (PR), stable (SD) and progressive disease (PD) according to PERCIST criteria [21].”
Method
Impact of 18F-FDG PET/CT on Clinical Management of Suspected Radio-Iodine Refractory Differentiated Thyroid Cancer (RAI-R-DTC)
Rizzini, E. L., Repaci, A., Tabacchi, E., Zanoni, L., Vicennati, V., Cavicchi, O., Pagotto, U., Morganti, A., Fanti, S., & Monari, F. (2021) · Diagnostics · doi:10.3390/diagnostics11081430 · Cited by 13
“Conversely, we found no significant association between SUVmax and 131I/FDG groups, SUVmax and PERCIST response, SUVmax and final outcome.”
MethodInfluential
Standardisation of conventional and advanced iterative reconstruction methods for Gallium-68 multi-centre PET-CT trials
Krokos, G., Pike, L. C., Cook, G., & Marsden, P. K. (2021) · EJNMMI Physics · doi:10.1186/s40658-021-00400-8 · Cited by 15
“For the sphere regions, the RC was measured for the voxel with the maximum reconstructed activity concentration (RCmax), for the mean activity (RCmean) and for a small (1cm (3)) spherical region of interest in the area of the highest reconstructed activity concentration (RCpeak) which was allowed to extend outside the…”
Method
In vivo quantitative assessment of therapeutic response to bortezomib therapy in disseminated animal models of multiple myeloma with [18F]FDG and [64Cu]Cu-LLP2A PET
Ghai, A., Fettig, N., Fontana, F., DiPersio, J. F., Rettig, M. P., O’Neal, J., Achilefu, S., Shoghi, K. I., & Shokeen, M. (2021) · EJNMMI Research · doi:10.1186/s13550-021-00840-4 · Cited by 12
“Standard uptake values (SUV) from PET data provide a reliable semiquantitative measure of the tumor uptake and kinetics in various tissues and help assess therapy response [45, 46].”
Background
Imaging Assessment of Tumor Response in the Era of Immunotherapy
Nakata, J., Isohashi, K., Oka, Y., Nakajima, H., Morimoto, S., Fujiki, F., Oji, Y., Tsuboi, A., Kumanogoh, A., Hashimoto, N., et al. (2021) · Diagnostics · doi:10.3390/diagnostics11061041 · Cited by 13
“1 criteria and metabolic EORTC criteria—were introduced under the name of PET response criteria in solid tumors (PERCIST) in 2009 [14].”
Background
Evaluation of SUVlean consistency in FDG and PSMA PET/MR with Dixon-, James-, and Janma-based lean body mass correction
Zhao, J., Xue, Q., Chen, X., You, Z., Wang, Z., Yuan, J., Liu, H., & Hu, L. (2021) · EJNMMI Physics · doi:10.1186/s40658-021-00363-w · Cited by 12
The Role of PSMA PET Parameters as Biomarkers for Response to PSMA-Targeted Radiopharmaceutical Therapy
Murthy, V., Ludwig, V. B., Gafita, A., Hope, T. A., & Calais, J. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.268818 · Cited by 13
“The National Cancer Institute ’ s radiographic RECIST 1.1 and the metabolic PERCIST 1.0 are currently used to assess therapy response across multiple oncologic diseases ( 37 , 38 ).”
Influential

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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