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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Background
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“Among the patients, four demonstrated a response to treatment, with either a partial or complete response as the best response according to the Response Evaluation Criteria In Solid Tumors (RECIST) 1.1 [26] or the PET Response Criteria in Solid Tumors (PERCIST) [27].”
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“All HG-NEN patients were included in the ﬁ nal analysis, including cases with a Ki-67 > 55% after re-evaluation.”
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Method
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“PET/ CT has distinct advantages over traditional imaging techniques because it provides information about the tumor’s metabolic and biological aspects characteristics and the patient’s prognosis [12, 13].”
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“According to the RECIST 1.1 criteria [131], a partial response corresponds to a ≥ 30% decrease in the SUV [129,132].”
MethodInfluential
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“0 defines this baseline assessment threshold (19) as:”
BackgroundMethodInfluentialSelf-citation
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“Reporting SUVmean and SUVpeak instead of SUVmax addresses these setbacks, but is rarely performed in clinical practice [76].”
Background
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“These include the PERCIST criteria as well as formal incorporation of FDG PET parameters into traditional anatomically based response criteria, such as RECIST, PERCIST, EORTC, PETCRIT and PERCIMT [19].”
Method
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“For example, target lesions in PERCIST must have uptake greater than a threshold defined by background liver uptake, in large part to ensure the ability to detect a decrease in percentage radiotracer uptake with effective treatment (38).”
Background
18F-FDG-PET-MRI for the assessment of acute intestinal graft-versus-host-disease (GvHD)
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“liver lobe according to established criteria [16].”
Prospective trial of immuno(chemo)therapy before resection, definitive chemoradiotherapy or palliative therapy in patients with locally advanced or oligometastatic non-small cell lung cancer without a primary curative option
Faehling, M., Fallscheer, S., Kramberg, S., Sträter, J., Eschmann, S. M., Sätzler, R., & Heinzelmann, F. (2021) · European Journal of Cancer · doi:10.1016/j.ejca.2021.07.035 · Cited by 13
Role of noninvasive imaging in the evaluation of intrahepatic cholangiocarcinoma: from diagnosis and prognosis to treatment response
Li, Q., Che, F., Wei, Y., Jiang, H.-Y., Zhang, Y., & Song, B. (2021) · Expert Review of Gastroenterology & Hepatology · doi:10.1080/17474124.2021.1974294 · Cited by 11
“theray) as target lesion tumor response, and nonprogression in nontarget lesions plus target lesion tumor response as overall tumors response [146].”
Background
Multimodal functional imaging for early response assessment in patients with gastrointestinal stromal tumor treated with tyrosine kinase inhibitors
Revheim, M., Hole, K., Mo, T., Bruland, Ø., Reitan, E., Julsrud, L., & Seierstad, T. (2021) · Acta Radiologica · doi:10.1177/02841851211027389 · Cited by 11
“FDG uptake was assessed using PERCIST (Table 2) (16).”
Method
Long-term outcomes of cervical cancer patients with complete metabolic response after definitive chemoradiotherapy
Onal, C., Guler, O., Reyhan, M., & Yapar, A. (2021) · Journal of Gynecologic Oncology · doi:10.3802/jgo.2021.32.e74 · Cited by 11
Evaluation of Quantitative Ga-68 PSMA PET/CT Repeatability of Recurrent Prostate Cancer Lesions Using Both OSEM and Bayesian Penalized Likelihood Reconstruction Algorithms
Roef, M., Rijnsdorp, S., Brouwer, C., Wyndaele, D., & Arends, A. (2021) · Diagnostics · doi:10.3390/diagnostics11061100 · Cited by 11
“proposed a minimum of 30% SUVmax decrease for a true response in their PERCIST response criteria [24].”
Background
Upfront metastasis-directed therapy in oligorecurrent prostate cancer does not decrease the time from initiation of androgen deprivation therapy to castration resistance
Triggiani, L., Mazzola, R., Tomasini, D., Bruni, A., Alicino, G., Matrone, F., Bortolus, R., Francolini, G., Detti, B., Magli, A., et al. (2021) · Medical Oncology · doi:10.1007/s12032-021-01518-6 · Cited by 11
“Instrumental tumor response was assessed according to the PET Response Criteria in Solid Tumors [10].”
Method
The Role of PET Molecular Imaging in Immune Checkpoint Inhibitor Therapy in Lung Cancer: Precision Medicine and Visual Monitoring
Yao, Y., Zhou, X., Zhang, A., Ma, X., Zhu, H., Yang, Z., & Li, N. (2022) · European Journal of Radiology · doi:10.1016/j.ejrad.2022.110200 · Cited by 10
Two-Time-Point FDG PET/CT: Liver SULmean Repeatability
Tahari, A. K., Paidpally, V., Chirindel, A., Wahl, R. L., & Subramaniam, R. M. (2015) · American Journal of Roentgenology · doi:10.2214/ajr.14.12719 · Cited by 10
Self-citation
Interrater Agreement and Reliability of PERCIST and Visual Assessment When Using 18F-FDG-PET/CT for Response Monitoring of Metastatic Breast Cancer
Sørensen, J. S., Vilstrup, M. H., Holm, J., Vogsen, M., Bülow, J. L., Ljungstrøm, L., Braad, P.-E., Gerke, O., & Hildebrandt, M. G. (2020) · Diagnostics · doi:10.3390/diagnostics10121001 · Cited by 10
Automatic Lugano staging for risk stratification in lymphoma: a multicenter PET radiomics and machine learning study with survival analysis
Hasanabadi, S., Aghamiri, S. R., Abin, A. A., Cheraghi, M., Karam, M. B., Vosoughi, H., Emami, F., & Arabi, H. (2025) · Nuclear medicine communications · doi:10.1097/mnm.0000000000002046 · Cited by 10
“Following lesion delineation, a three-dimensional region of interest with three diameters was defined in the liver’s right lobe, making sure it was lesion-free, in compliance with the PERCIST criteria [38], to compute tumor-to-liver ratio (TLR) radiomics.”
Molecular Imaging for Response Assessment of Neuroendocrine Tumors (NET).
Franco, M. D., Lamberti, G., Campana, D., & Ambrosini, V. (2025) · Seminars in nuclear medicine · doi:10.1053/j.semnuclmed.2025.04.005 · Cited by 10
Prognostic Value of 18F-FDG PET/CT Metabolic Parameters in Resectable Non–small Cell Lung Cancer Treated With Neoadjuvant Immunotherapy Plus Chemotherapy
Cheng, Y., Jiang, Z.-P., Chen, X., Lu, K.-Y., Liu, Z., & Shao, D. (2025) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000005863 · Cited by 16
Kinetics of PSMA PET signal after radiotherapy in prostate cancer lesions: A single-center retrospective study
Hotta, M., Nguyen, K., Thin, P., Armstrong, W. R., Sonni, I., Farolfi, A., Steinberg, M. L., Czernin, J. G., Nickols, N. G., Kishan, A. U., et al. (2025) · Radiotherapy and Oncology · doi:10.1016/j.radonc.2025.110869 · Cited by 10
Radiolabelled anti-PD-L1 peptide PET/CT in predicting the efficacy of neoadjuvant immunotherapy combined with chemotherapy in resectable non-small cell lung cancer
Zhou, X., Yan, S., Li, D., Zhu, H., Liu, B., Liu, S., Zhao, W., Yang, Z., Wu, N., & Li, N. (2024) · Annals of Nuclear Medicine · doi:10.1007/s12149-024-02009-0 · Cited by 10
“The values of SUV max of the lesions and the SUV mean of the blood pool (BP) in 1-cm-diameter region in descending thoracic aorta extended over 2-cm z-axis [21], were recorded, and the ratio of tumour-to-BP (TBR) was calculated as tumour SUV max /BP SUV mean .”
Safety, pharmacokinetics, and dosimetry of 177Lu-AB-3PRGD2 in patients with advanced integrin αvβ3-positive tumors: A first-in-human study
Sui, H., Guo, F., Liu, H., Wang, R., Li, L., Wang, J., Jia, C., Xiang, J., Liang, Y., Chen, X., et al. (2024) · Acta Pharmaceutica Sinica B · doi:10.1016/j.apsb.2024.10.012 · Cited by 12
Psychometric performance of EQ-5D-5L and SF-6Dv2 in patients with lymphoma in China
Zhang, A., Li, J., Mao, Z., Wang, Z., Wu, J. H., Luo, N., Liu, P., & Wang, P. (2024) · The European Journal of Health Economics · doi:10.1007/s10198-024-01672-4 · Cited by 11
Real-World Experience of Immune-Checkpoint Inhibitors in Older Patients with Advanced Cutaneous Squamous Cell Carcinoma
McLean, L. S., Lim, A., Bressel, M., Thai, A., & Rischin, D. (2024) · Drugs & Aging · doi:10.1007/s40266-024-01095-z · Cited by 10
“0) [20] on fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT).”
Background
68Ga-DOTA.SA.FAPi as a Versatile Diagnostic Probe for Various Epithelial Malignancies: A Head-to-Head Comparison with 18F-FDG.
Chopra, S., Mathur, Y., Roesch, F., Moon, E., Rana, N., Irrinki, S., Walia, R., Duseja, A., Singh, H., Kumar, R., et al. (2024) · Academic Radiology · doi:10.1016/j.acra.2023.12.002 · Cited by 10
How to Report PSMA PET
Swiha, M. M., Ayati, N., Oprea‐Lager, D. E., Ceci, F., & Emmett, L. (2023) · Seminars in Nuclear Medicine · doi:10.1053/j.semnuclmed.2023.07.007 · Cited by 12
Diagnosis, Management and Theragnostic Approach of Gastro-Entero-Pancreatic Neuroendocrine Neoplasms
Piscopo, L., Zampella, E., Pellegrino, S., Volpe, F., Nappi, C., Gaudieri, V., Fonti, R., Vecchio, S. D., Cuocolo, A., & Klain, M. (2023) · Cancers · doi:10.3390/cancers15133483 · Cited by 13
“The PET Response Criteria in Solid Tumors (PERCIST) were further introduced based on several quantitative parameters, such as metabolic tumor volume (MTV), a measurement of tumor volume burden and total lesion glycolysis (TLG), that is the product of MTV and the SUV mean parameter [100].”
Method
Can STEreotactic Body Radiation Therapy (SBRT) Improve the Prognosis of Unresectable Locally Advanced Pancreatic Cancer? Long-Term Clinical Outcomes, Toxicity and Prognostic Factors on 142 Patients (STEP Study)
Comito, T., Massaro, M., Teriaca, M., Franzese, C., Franceschini, D., Navarria, P., Clerici, E., di Cristina, L., Bertolini, A., Tomatis, S., et al. (2023) · Current Oncology · doi:10.3390/curroncol30070513 · Cited by 10
“1 (RECIST) [29], and PET Response Criteria in Solid Tumors (PERCIST) [30].”
Background
Development and External Validation of a PET Radiomic Model for Prognostication of Head and Neck Cancer
Noortman, W. A., Aide, N., Vriens, D., Arkes, L. S., Slump, C., Boellaard, R., Goeman, J., Deroose, C., Machiels, J., Licitra, L., et al. (2023) · Cancers · doi:10.3390/cancers15102681 · Cited by 10
“Volumes of interest (VOI) delineation was performed using the Accurate tool (AmsterdamUMC, Amsterdam, The Netherlands) [13] on both the baseline and evaluation [18F]FDG PET scans using an isocontour that applies an adaptive threshold of 50% of the peak standardised uptake value (SUVpeak), obtained using a sphere 12 mm…”
Method
Outcomes and prognostic predictors of Lu‐177 PSMA radioligand therapy in metastatic castration‐resistant prostate cancer (Asian Population Study)
Chua, W. M., Lam, W. W.-C., Tong, A. K. T., Sultana, R., Kua, S. M. Y., Kanesvaran, R., Wong, A. S. C., Tay, K. J., Cheng, T. J. L., Ng, D. C. E., et al. (2023) · Asia-Pacific Journal of Clinical Oncology · doi:10.1111/ajco.13944 · Cited by 10
Metabolic tumour and nodal response to neoadjuvant chemotherapy on FDG PET-CT as a predictor of pathological response and survival in patients with oesophageal adenocarcinoma
Moore, J., Subesinghe, M., Santaolalla, A., Green, M., Deere, H., van Hemelrijck, M., Lagergren, J., Chicklore, S., Maisey, N., Gossage, J., et al. (2023) · European Radiology · doi:10.1007/s00330-023-09482-7 · Cited by 10
Molecular imaging as biomarker for treatment response and outcome in breast cancer
van Geel, J. V., de Vries, E. D., van Kruchten, M., Hospers, G., Glaudemans, A., & Schröder, C. (2023) · Therapeutic Advances in Medical Oncology · doi:10.1177/17588359231170738 · Cited by 10
Does 18F-FDG PET/CT add value to conventional imaging in clinical assessment of chronic disseminated candidiasis?
Rammaert, B., Maunoury, C., Rabeony, T., Corréas, J.-M., Elie, C., Alfandari, S., Berger, P., Rubio, M., Braun, T., Bakouboula, P., et al. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.1026067 · Cited by 8
“Since there was no gold standard for PET/CT criteria to assess infectious complications, a complete response to PET/CT was defined by the visual disappearance of all target hypermetabolic lesions, according to PET Response Criteria in Solid Tumors (PERCIST) (26) (for more details see Supplementary Table 1).”
Method
Enhancement of 18F-Fluorodeoxyglucose PET Image Quality by Deep-Learning-Based Image Reconstruction Using Advanced Intelligent Clear-IQ Engine in Semiconductor-Based PET/CT Scanners
Yamagiwa, K., Tsuchiya, J., Yokoyama, K., Watanabe, R., Kimura, K., Kishino, M., & Tateishi, U. (2022) · Diagnostics · doi:10.3390/diagnostics12102500 · Cited by 10
“SUVmean is the average SUV and SUVmax is pixel with largest SUV SUVpeak is calculated by defining a 1 cm3 spherical volume at every pixel within the selected VOI, measuring the average SUV in each sphere and then calculating the maximum of all the average SUVs across all these spheres [27].”
Method
[68Ga]FAPI-PET/CT for radiation therapy planning in biliary tract, pancreatic ductal adeno-, and adenoidcystic carcinomas
Guberina, N., Kessler, L., Pöttgen, C., Guberina, M., Metzenmacher, M., Herrmann, K., Mucha, M., Rischpler, C., Indenkämpen, F., Siveke, J., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-20447-6 · Cited by 10
Prospective assessment using 18F-FDG PET/CT as a novel predictor for early response to PD-1 blockade in non-small-cell lung cancer
Yamaguchi, O., Kaira, K., Naruse, I., Umeda, Y., Honda, T., Watanabe, S., Ichikawa, K., Tateishi, K., Kasahara, N., Higuchi, T., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-15964-3 · Cited by 10
Prognostic value of complete metabolic response on 18F-FDG-PET/CT after three cycles of neoadjuvant chemotherapy in advanced high-grade serous ovarian cancer
Chung, Y. S., Kim, Y., Kim, H., Lee, J.-Y., Kang, W., Kim, S., & Kim, S. W. (2022) · Journal of Gynecologic Oncology · doi:10.3802/jgo.2022.33.e28 · Cited by 10
“Considering the kinetics of tumor cell killing and its relationship to PET/CT, increasing the number of chemotherapy cycles reduces the number of cancer cells that can be detected by PET/ CT [10].”
BackgroundInfluential
18F-FDG PET/CT for early response assessment of jaw osteoradionecrosis after the PENTOCLO protocol: a promising imaging modality.
Dinnoo, A., Benmoussa, N., Bidault, F., Brau, J., Tissot, H., Temam, S., Janot, F., & Henry, T. (2021) · Journal of Stomatology Oral and Maxillofacial Surgery · doi:10.1016/j.jormas.2021.11.005 · Cited by 10
The Influence of the Exclusion of Central Necrosis on [18F]FDG PET Radiomic Analysis
Noortman, W. A., Vriens, D., Mooij, C. D. Y., Slump, C., Aarntzen, E., van Berkel, A., Timmers, H., Bussink, J., Meijer, T., de Geus-Oei, L. D., et al. (2021) · Diagnostics · doi:10.3390/diagnostics11071296 · Cited by 10
“A threshold of 41% of the peak standardised uptake value (SUVpeak) that was obtained using a sphere of 12 mm diameter [21] was selected, since the delineated tumour sizes of this method agreed best with pathological tumour sizes [22].”
Method
Dedifferentiation and Redifferentiation of Follicular-Cell-Derived Thyroid Carcinoma: Mechanisms and Therapeutic Implications
He, Y., Tang, Z.-M., Xu, M., & Huang, T. (2025) · Biomedicines · doi:10.3390/biomedicines13122982 · Cited by 9
“Imaging with [18F] FDG-PET/CT is conducted 3 to 12 months post-131 I treatment, evaluated according to RECIST 1.1 [93] and PERCIST 1.0 criteria [94].”
Influential
Recent Advances in PET and Radioligand Therapy for Lung Cancer: FDG and FAP
Lee, E. J., Chung, H. W., So, Y., Kim, I. A., Kim, H. J., & Lee, K. Y. (2025) · Cancers · doi:10.3390/cancers17152549 · Cited by 7
“The PET Response Criteria in Solid Tumors (PERCIST) were introduced in 2009 to assess metabolic tumor response both qualitatively and quantitatively [61].”
Efficacy of radiolabelled PD-L1-targeted nanobody in predicting and evaluating the combined immunotherapy and chemotherapy for resectable non-small cell lung cancer
Zhou, X., Yan, S., Ma, X., Zhu, H., Liu, B., Yang, X., Jia, B., Yang, Z., Wu, N., & Li, N. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07115-3 · Cited by 9
“While in therapy evaluation employing CT, a response was defined as diameter decreased more than 30% (≥ 30%), and non-response was defined as diameter decreased less than 30% [18].”
A Systematic Literature Review of Modelling Approaches to Evaluate the Cost Effectiveness of PET/CT for Therapy Response Monitoring in Oncology
van Mossel, S., Cardet, R. E. D. F., de Geus-Oei, L. D., Vriens, D., Koffijberg, H., & Saing, S. (2024) · PharmacoEconomics (Auckland) · doi:10.1007/s40273-024-01447-y · Cited by 9
Improving diagnostic precision in amyloid brain PET imaging through data-driven motion correction
Park, H. L., Park, S. Y., Kim, M., Paeng, S., Min, E. J., Hong, I., Jones, J. P., & Han, E. J. (2024) · EJNMMI Physics · doi:10.1186/s40658-024-00653-z · Cited by 8
“It shows excellent intra-and interobserver reproducibility and can provide more objective and detailed information than visual analysis [22–24].”
Background
Metabolic Tumor Volume from 18F-FDG PET/CT in Combination with Radiologic Measurements to Predict Long-Term Survival Following Transplantation for Colorectal Liver Metastases
Grut, H., Line, P., Syversveen, T., & Dueland, S. (2023) · Cancers · doi:10.3390/cancers16010019 · Cited by 9
“MTV was registered if the maximum standardized uptake value in the metastasis was higher than the mean liver background uptake × 1.5 + standard deviation of the liver background × 2 [17].”
Influential
Prognostic prediction by 18F-FDG-PET/CT parameters in patients with neuroblastoma: a systematic review and meta-analysis
Hu, R., Zhang, Y., Liu, S., Lee, P., Liu, C.-H., & Liu, A. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1208531 · Cited by 9
“There is a study reporting that an individualized threshold based on the liver background could reduce the impact of different scanning techniques on solid tumor-associated indicators (26).”
Background
Prognostic Value of [18F]FDG PET Radiomics to Detect Peritoneal and Distant Metastases in Locally Advanced Gastric Cancer—A Side Study of the Prospective Multicentre PLASTIC Study
Pullen, L. C. E., Noortman, W. A., Triemstra, L., de Jongh, C., Rademaker, F. J., Spijkerman, R., Kalisvaart, G., Gertsen, E. C., de Geus-Oei, L. D., Tolboom, N., et al. (2023) · Cancers · doi:10.3390/cancers15112874 · Cited by 9
“Tumours were delineated on [18F]FDG PET scans using an isocontour that applies an adaptive threshold of 50% of the peak standardised uptake value (SUVpeak), obtained using a sphere of 12 mm diameter [20], corrected for local background [21].”
Method
PET/CT in Patients with Breast Cancer Treated with Immunotherapy
Vaz, S. C., Graff, S. L., Ferreira, A. R., Debiasi, M., & de Geus‐Oei, L. (2023) · Cancers · doi:10.3390/cancers15092620 · Cited by 9
“0) [54]—at the first 2-[18F]FDG PET/CT evaluation, are classified as having unconfirmed progressive metabolic disease (uPMD).”
Background
Assessment of Response to Immunotherapy in Patients with Hodgkin Lymphoma: Towards Quantifying Changes in Tumor Burden Using FDG-PET/CT
Tutino, F., Giovannini, E., Chiola, S., Giovacchini, G., & Ciarmiello, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12103498 · Cited by 9
“In the same year, 2009, on the heels of RECIST, Wahl et al. published the PET Response Criteria in Solid Tumors (PERCIST) [24].”
RadioLigand Therapy with [177Lu]Lu-PSMA-617 for Salivary Gland Cancers: Literature Review and First Compassionate Use in France
Terroir-Cassou-Mounat, M., Lamesa, C., Krim, M., Vija, L., Texier, J.-S., Cassou‐Mounat, T., Delord, J., Vallot, D., & Courbon, F. (2023) · Pharmaceuticals · doi:10.3390/ph16050754 · Cited by 9
“Imaging showed stable disease according to PERCIST criteria with no significant variation in SUVmax on the hottest lesion on 18FDG PET-CT before and after RLT [25].”
Method
Imaging Follow-Up of Nonsurgical Therapies for Lung Cancer: AJR Expert Panel Narrative Review
Murphy, D. J., Mayoral, M., Larici, A. R., Ginsberg, M. S., Cicchetti, G., Fintelmann, F. J., Marom, E. M., Truong, M. T., & Gill, R. R. (2023) · American Journal of Roentgenology · doi:10.2214/ajr.23.29104 · Cited by 16
[18F]FDG PET/CT in the Evaluation of Melanoma Patients Treated with Immunotherapy
Losada, M. M., Romero-Robles, L. R., Melero, A. M., García-Megías, I., Torres, A. V., Garrastachu-Zumaran, P., Chollet, X. B., Lopci, E., Lasanta, R. R., & Bolton, R. D. (2023) · Diagnostics · doi:10.3390/diagnostics13050978 · Cited by 9
“The need to standardize the evaluation criteria in order to be able to apply them in clinical practice has fuelled in the last 20 years the development of a harmonized and reproducible approach to response evaluation, with the proposal of several new criteria for evaluation and interpretation issues, such as EORTC (Eu…”
Method
Biology of Cancer and PET Imaging: Pictorial Review
Sarikaya, I. (2022) · Journal of Nuclear Medicine Technology · doi:10.2967/jnmt.121.263534 · Cited by 9
“Various PET response criteria are used to better assess the response to chemotherapy, radiotherapy, and treatment with immune checkpoint inhibitors ( 26 ).”
Background
Elevated tumor markers for monitoring tumor response to immunotherapy
Yang, Y., Jiang, X., Liu, Y., Huang, H., Xiong, Y.-L., Xiao, H., Gong, K., Li, X., Kuang, X.-J., & Yang, X.-Q. (2022) · EClinicalMedicine · doi:10.1016/j.eclinm.2022.101381 · Cited by 9
Comparison of ten predictive equations for estimating lean body mass with dual-energy X-ray absorptiometry in older patients
Puri, T., & Blake, G. M. (2022) · British Journal of Radiology · doi:10.1259/bjr.20210378 · Cited by 9
“31,32 Hence, there is interest in equations using factors such as BW, height, age and sex to predict LBM.”
Background
Dynamic whole-body FDG-PET imaging for oncology studies
Tamaki, N., Kotani, T., Nishimura, M., & Kaji, T. (2022) · Clinical and translational imaging · doi:10.1007/s40336-022-00479-8 · Cited by 9
Gallium-68-somatostatin receptor PET/CT parameters as potential prognosticators for clinical time to progression after peptide receptor radionuclide therapy: a cohort study
Ebbers, S., Heimgartner, M., Barentsz, M. W., van Leeuwaarde, R. V., van Treijen, M. V., Lam, M., & Braat, A. (2021) · European Journal of Hybrid Imaging · doi:10.1186/s41824-021-00116-z · Cited by 9
Combined Metabolically Active Tumor Volume and Early Metabolic Response Improve Outcome Prediction in Metastatic Colorectal Cancer
Woff, E., Salvatore, L., Marmorino, F., Genovesi, D., Critchi, G., Guiot, T., Ameye, L., Sclafani, F., Hendlisz, A., & Flamen, P. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.120.245357 · Cited by 9
“0 3 mean aorta SUL 1 2 3 SD, following PERCIST methodology (13).”
Method
Usefulness of PET/CT with 18F-FDG in Patients with Differentiated Thyroid Carcinoma after Radioiodine Therapy: An Italian Multicenter Study
Filippi, L., Frantellizzi, V., Monari, F., Rizzini, E. L., Tabacchi, E., Pirisino, R., Marongiu, A., Nuvoli, S., Bagni, O., de Vincentis, G., et al. (2021) · Diagnostics · doi:10.3390/diagnostics11071264 · Cited by 9
“The management was considered to be adequate if the Tg serum level declined by more than 50% (compared to the baseline value) following treatment modification, or if the patients showed complete (CMR) or partial metabolic response (PMR), according to PET Response Criteria in Solid Tumors (PERCIST) at the follow-up PET…”
Method
Direct comparison of F-18 FDG PET/CT and MRI to predict pathologic response to neoadjuvant treatment in locally advanced rectal cancer: a meta-analysis
Lee, S., Jeong, S. Y., Keun-young Kim, A., & Kim, S. (2021) · Annals of Nuclear Medicine · doi:10.1007/s12149-021-01639-y · Cited by 9
68Ga-FAPI-04 PET for Detecting Occult Peritoneal Metastasis in Locally Advanced Gastric Cancer: Diagnostic Performance and Cost Analyses in a Single-Center, Prospective Cohort Study
Hu, Q.-C., Zhang, S.-Y., Yang, K., Yin, Y., Chen, X.-L., Wang, M.-J., Zhang, B., Zhuang, W., Liu, M., Shen, C.-Y., et al. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.125.270633 · Cited by 8
Chondrosarcoma: Clinical Behavior, Molecular Mechanisms, and Emerging Therapeutic Strategies.
Agulnik, M., Wilky, B., Facs, S. W. T., & Zuckerman, L. M. (2025) · Critical reviews in oncology/hematology · doi:10.1016/j.critrevonc.2025.105075 · Cited by 8
The legend of the response evaluation criteria in solid tumors: A historical overview
Smesseim, I., Lipman, K. G. G., Lalezari, F., Burgers, J., & Trebeschi, S. (2025) · Cancer · doi:10.1002/cncr.70064 · Cited by 8
“2,3,6,8,13 The authors stated that an increase in tumor 18F - FDG uptake indicates disease progression, whereas a decline indicates disease response.”
Therapeutic Potential of Glutaminase Inhibition Targeting Metabolic Adaptations in Resistant Melanomas to Targeted Therapy
Soumoy, L., Genbauffe, A., Sant’Angelo, D., Everaert, M., Mukeba-Harchies, L., Sarry, J., Declèves, A.-É., & Journé, F. (2025) · International Journal of Molecular Sciences · doi:10.3390/ijms26178241 · Cited by 8
NAVIGATING THE CHALLENGES OF IMMUNOTHERAPY AS A NEOADJUVANT TREATMENT FOR LOCALLY ADVANCED SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK: A REVIEW OF THE EVIDENCE FROM THE LITERATURE.
López, I., Aliaga, A. V., & Sanz-García, E. (2025) · Critical reviews in oncology/hematology · doi:10.1016/j.critrevonc.2025.104841 · Cited by 8
Novel framework for response evaluation criteria in grade 1/2 neuroendocrine tumors (RECIN) following [177Lu]Lu-DOTATATE therapy: post-hoc analysis of the phase 2 LuCAP trial
Satapathy, S., Aggarwal, P., Sood, A., Chandekar, K., Das, C. K., Gupta, R., Khosla, D., Das, N., Kapoor, R., Kumar, R., et al. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07351-7 · Cited by 8
“SULpeak was also advantageous due to its simplicity of use and reproducibility in contrast to the volumetric parameters like SSTR-total tumor volume which require rigorous tumor segmentation, often specialized software, and currently lack standardized methodology for esti - mation [35].”
Efficacy assessment in phase I clinical trials: endpoints and challenges
Gouda, M., Ballesteros, P. A., Garrido-Laguna, I., & Rodon, J. (2025) · Annals of Oncology · doi:10.1016/j.annonc.2025.02.010 · Cited by 8
Challenging the significance of SUV-based parameters in a large-scale retrospective study on lung lesions
Pini, C., Kirienko, M., Gelardi, F., Bossi, P., Rahal, D., Toschi, L., Ninatti, G., Rodari, M., Marulli, G., Antunovic, L., et al. (2024) · Cancer Imaging · doi:10.1186/s40644-024-00807-3 · Cited by 8
“Frequently, SUV values are mentioned in the scan reports and its use is becoming more and more common especially among clinicians [36].”

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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