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

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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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Diagnostic Performance of Response Assessment FDG-PET/CECT in HNSCC Treated With Definitive Radio(chemo)therapy Using NI-RADS.
Paul, S., Gupta, T., Purandare, N., Joshi, K., Ghosh-Laskar, S., Budrukkar, A., Swain, M., Sinha, S., Kumar, A., Joshi, A., et al. (2023) · Otolaryngology Head & Neck Surgery · doi:10.1002/ohn.305 · Cited by 7
Prostate-specific Membrane Antigen Positron Emission Tomography as a Biomarker to Assess Treatment Response in Patients with Advanced Prostate Cancer
Esen, B., Herrmann, K., Bavbek, S. E., Kordan, Y., Derya Tilki, A., & Esen, T. (2023) · European Urology Focus · doi:10.1016/j.euf.2023.02.001 · Cited by 7
Hybrid Attention Fusion Segmentation Network for Diffuse Large B-cell Lymphoma in PET-CT
Chen, S.-L., Li, A., Chen, J., Zhang, X.-G., Jiang, C., & Xu, J.-Y. (2022) · International Conference on Wireless Communications and Signal Processing · doi:10.1109/wcsp55476.2022.10039141 · Cited by 7
“Secondly, due to the characteristics of PET technology, PET image resolution is low and image artifacts are serious [3].”
Background
Comparing [18F]FDG PET/CT response criteria in melanoma and lung cancer patients treated with immunotherapy: a systematic review
Saadani, H., Aalbersberg, E. A., Schats, W., Hoekstra, O. S., Stokkel, M. P. M., & de Vet, H. C. W. (2022) · Clinical and Translational Imaging · doi:10.1007/s40336-022-00522-8 · Cited by 7
A Scoring System for Predicting Neoadjuvant Chemotherapy Response in Primary High‐Grade Bone Sarcomas: A Multicenter Study
He, F., Xie, L., Sun, X., Xu, J., Li, Y., Liu, R., Sun, K., Shen, D.-H., Gu, J., Ji, T., et al. (2022) · Orthopaedic Surgery · doi:10.1111/os.13469 · Cited by 7
“In recent years, some studies have revealed that decreased fluorine-18-fluorodeoxyglucose (18F-FDG) uptake after chemotherapy or radiotherapy is associated with a good pathological response.(10,11) In positron emission tomography (PET), the response criteria in solid tumors (PERCIST 1.”
Background
The impact of serum albumin-to-alkaline phosphatase ratio in cervical cancer patients treated with definitive chemoradiotherapy
Onal, C., Gultekin, M., Yavas, G., Oymak, E., Sari, S. Y., Guler, O., Yigit, E., & Yildiz, F. (2022) · Journal of Obstetrics and Gynaecology Research · doi:10.1080/01443615.2022.2069484 · Cited by 7
“A treatment response evaluation was performed according to RECIST/ PERCIST criteria (Wahl et al. 2009).”
Method
A spectral CT-based nomogram for predicting the response to induction chemotherapy in nasopharyngeal carcinoma.
Liao, H., Pei, W., Wei, Y., Liu, Y., Liang, X., Bao, H., Wang, C., & Su, D. (2022) · Clinical Radiology · doi:10.1016/j.crad.2022.03.024 · Cited by 7
F18-FDG PET/CT imaging early predicts pathologic complete response to induction chemoimmunotherapy of locally advanced head and neck cancer: preliminary single-center analysis of the checkrad-cd8 trial
Beck, M., Hartwich, J., Eckstein, M., Schmidt, D., Gostian, A., Müller, S., Rutzner, S., Gaipl, U., von der Grün, J., Illmer, T., et al. (2022) · Annals of Nuclear Medicine · doi:10.1007/s12149-022-01744-6 · Cited by 7
18F-FDG PET/CT During Neoadjuvant Targeted Therapy in Prior Unresectable Stage III Melanoma Patients
van der Hiel, B., Blankenstein, S. A., Aalbersberg, E. A., Wondergem, M., Stokkel, M. P. M., van de Wiel, B. A., Klop, W. M. C., van Akkooi, A. C. J., & Haanen, J. B. A. G. (2022) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000004217 · Cited by 11
An evaluation of the response to neoadjuvant chemotherapy for osteosarcoma of extremities: PERCIST versus RECIST 1.1 criteria after long-term follow-up
Xu, J., Li, Y., Xie, L., Sun, X., Cai, Z., Wang, S.-D., Wang, Q., Sun, K., & Guo, W. (2022) · Annals of Nuclear Medicine · doi:10.1007/s12149-022-01737-5 · Cited by 7
“However, the tumor size increased, thus leading to an increase in the MTV and an 86% increase in TLG; this patient was finally classified as PMD.”
Influential
A deep learning pipeline to simulate fluorodeoxyglucose (FDG) uptake in head and neck cancers using non-contrast CT images without the administration of radioactive tracer
Chandrashekar, A., Handa, A., Ward, J., Grau, V., & Lee, R. (2022) · Insights into Imaging · doi:10.1186/s13244-022-01161-3 · Cited by 7
“Technical accuracy of the generated SUV maps was assessed by extracting criteria supported by the PET Response Criteria in Solid Tumours (PERCIST, version 1), which is used to monitor tumour progression and response to treatment [16].”
Method
Prognostic value of textural features obtained from F-fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) in patients with locally advanced cervical cancer undergoing concurrent chemoradiotherapy
Cho, H.-W., Lee, E. S., Lee, J. K., Eo, J., Kim, S., & Hong, J. (2022) · Annals of Nuclear Medicine · doi:10.1007/s12149-022-01802-z · Cited by 7
Design and evaluation of a modular multimodality imaging phantom to simulate heterogeneous uptake and enhancement patterns for radiomic quantification in hybrid imaging: A feasibility study
Kalisvaart, G., van Velden, F. V., Hernández-Girón, I., Meijer, K., Ghesquière-Diérickx, L., Brink, W., Webb, A., de Geus-Oei, L. D., Slump, C., Kuznetsov, D., et al. (2022) · Medical Physics (Lancaster) · doi:10.1002/mp.15537 · Cited by 7
Characterising 18F-fluciclovine uptake in breast cancer through the use of dynamic PET/CT imaging
Scott, N., Teoh, E., Flight, H., Jones, B., Niederer, J., Mustață, L., Maclean, G., Roy, P., Remoundos, D., Snell, C., et al. (2021) · British Journal of Cancer · doi:10.1038/s41416-021-01623-3 · Cited by 7
“The location of the SUVpeak volume was independently found for each time interval [19].”
Background
The diagnostic value of [18F]FDG-PET/CT in detecting septic thrombosis in patients with central venous catheter-related Staphylococcus aureus bacteremia.
Gompelman, M., Tuinte, R., Aarntzen, E., Kouijzer, I., van Leerdam, E. J., Berrevoets, M., ten Oever, J., Bleeker-Rovers, C., & Wanten, G. (2021) · Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie · doi:10.1016/j.biopha.2021.112296 · Cited by 7
Metabolic positron emission tomography/CT response after induction chemotherapy and chemo(re)irradiation is associated with higher negative resection margin rate in patients with locally recurrent rectal cancer
van Zoggel, D., Voogt, E., van Lijnschoten, G., Cnossen, J., Creemers, G., Nederend, J., Bloemen, J., Nieuwenhuijzen, G., Burger, J., Lardenoije, S., et al. (2021) · Colorectal Disease · doi:10.1111/codi.15934 · Cited by 7
“The response on PET/CT can be scored visually, according to accepted guidelines, and/or quantitatively using full metabolic analysis [10,11].”
BackgroundMethod
A prognostic index integrating deep learning baseline PET/CT biomarkers and multi-omics profiling in diffuse large B cell lymphoma
Wang, Y., Wang, X., Huang, X.-Y., Jing, H., Jiang, S., Li, H., Mu, R.-J., Shi, Q., Fu, D., Li, Z., et al. (2025) · Cell Reports Medicine · doi:10.1016/j.xcrm.2025.102452 · Cited by 6
[68Ga]Ga-PSMA-11 PET Tumor Volume Predicts Overall Survival of Patients with Metastatic Prostate Cancer Undergoing Taxane-Based Chemotherapy
Beintner-Skawran, S., Gafita, A., Lorenzini, T., Tauber, R., Hoberück, S., Mattana, F., Giorgio, A. D., Miederer, M., Paller, C., Djaileb, L., et al. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.125.269584 · Cited by 6
“Considering PSMA PET parameters as prognostic biomarkers, several studies have applied the thresholds from the PERCIST framework ( 13 ), originally developed for response assessment of solid tumors in patients undergoing [ 18 F]FDG PET imaging, to PSMA PET, de ﬁ ning a clinically relevant metabolic…”
5-year survival and safety of stereotactic ablative radiotherapy in unresectable locally advanced non-small cell lung cancer patients unfit for concurrent radio-chemotherapy:focus on patterns of local recurrence from the START-NEW-ERA non-randomized phase II trial.
Arcidiacono, F., Anselmo, P., Casale, M., Zannori, C., Loreti, F., Enrico, B., Tassi, V., di Marzo, A., Italiani, M., Viani, G., et al. (2025) · International Journal of Radiation Oncology, Biology, Physics · doi:10.1016/j.ijrobp.2025.08.060 · Cited by 6
AI lesion tracking in PET/CT imaging: a proposal for a Siamese-based CNN pipeline applied to PSMA PET/CT scans
Hein, S. P., Schultheiss, M., Gafita, A., Zaum, R., Yagubbayli, F., Tauber, R., Rauscher, I., Eiber, M., Pfeiffer, F., & Weber, W. A. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07426-5 · Cited by 6
“Since detailed manual lesion tracking is laborious and error-prone, routinely, only a small subset of index lesions out of multiple lesions is analyzed [ 3 ].”
Uncertainty quantification for deep learning-based metastatic lesion segmentation on whole body PET/CT
Schott, B., Santoro-Fernandes, V., Klaneček, Ž., Perlman, S. B., & Jeraj, R. (2025) · Physics in Medicine and Biology · doi:10.1088/1361-6560/add9df · Cited by 5
“This was primarily because clinical PET assessments generally rely on either region-wise or image-wise metrics (Wahl et al 2009), rendering voxel-wise assessments less interpretable and impactful.”
Prediction of pathological response to neoadjuvant immunochemotherapy with baseline and post-treatment 18F-FDG PET imaging biomarkers in patients with locally advanced gastric cancer
Xu, M.-M., Zhang, Y.-F., Zhao, K., Jiang, H.-P., Wang, G.-F., Wu, Y., Wang, Y., Liu, N., & Su, X.-H. (2025) · BMC Cancer · doi:10.1186/s12885-025-13765-1 · Cited by 6
“These limitations arise because CT and MRI assess responses based solely on structural changes in the tumor [9–12].”
[18F]FDG PET/CT for predicting neoadjuvant PD-L1 blockade monotherapy treatment response in patients with locally advanced esophageal squamous cell carcinoma: a preliminary study
Yang, R., Tang, H., Xie, Y., Cai, D.-J., He, Y.-B., Zheng, Z., Lin, Y., Gao, H., Tang, W., Yan, Y.-H., et al. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-024-07051-8 · Cited by 6
“[ 18 F]FDG PET–based responses were evaluated using European Organization for Research and Treatment of Cancer (EORTC) criteria [24], Positron Emission tomography Response Criteria in Solid Tumors (PERCIST) criteria [25] and ROC analysis of PET-derived metabolic parameters.”
Metabolic tumor volume from baseline [18 F]FDG PET/CT at diagnosis improves the IPI stratification in patients with diffuse large B-cell lymphoma
Zhang, H.-Z., Xu, Z., Zhou, W.-L., Chen, J.-J., Wei, Y.-Q., Wu, H.-B., Wei, X.-L., & Feng, R. (2024) · Annals of Hematology · doi:10.1007/s00277-024-05717-9 · Cited by 6
“There are several methods for measuring MTV: SUV ≥ 2.5, SUV ≥ 4.0, SUV relative to liver or mediasti - num as a reference, or percentage SUVmax thresholds of 41% [30–32].”
Influential
Multimodal Imaging Approach for Tumor Treatment Response Evaluation in the Era of Immunotherapy.
Lee, G., Moon, S., Kim, J. H., Jeong, D. Y., Choi, J., Choi, J. Y., & Lee, H.-Y. (2024) · Investigative Radiology · doi:10.1097/rli.0000000000001096 · Cited by 6
Assessing the Heterogeneity of Response of [68Ga] Ga-PSMA-11 PET/CT Lesions in Patients With Biochemical Recurrence of Prostate Cancer.
Dell'Oro, M., Huff, D. T., Lokre, O., Kendrick, J., Munian-Govindan, R., Ong, J., Ebert, M., Perk, T., & Francis, R. (2024) · Clinical Genitourinary Cancer · doi:10.1016/j.clgc.2024.102155 · Cited by 6
Plasmatic Inactive IL-18 Predicts a Worse Overall Survival for Advanced Non-Small-Cell Lung Cancer with Early Metabolic Progression after Immunotherapy Initiation
Hreich, S. J. D., Humbert, O., Pacé-Loscos, T., Schiappa, R., Juhel, T., Ilié, M., Ferrari, V., Benzaquen, J., Hofman, P. M., & Vouret‐Craviari, V. (2024) · Cancers · doi:10.3390/cancers16122226 · Cited by 6
“Treatment efficacy can be measured thanks to Positon Emission Tomography/Computed Tomography (PET/CT), where the standard criteria to evaluate response are the “Positron Emission Tomography Response Criteria in Solid Tumors” (PERCIST) defined by Wahl et al. in 2009 [12].”
Method
Response Evaluation Criteria in Gastrointestinal and Abdominal Cancers: Which to Use and How to Measure
Castagnoli, F., Mencel, J., Dafydd, D. A., Gough, J., Drake, B., Mcaddy, N. C., Withey, S. J., Riddell, A. M., Koh, D., & Shur, J. D. (2024) · Radiographics · doi:10.1148/rg.230047 · Cited by 6
Prognostic role of quantitative [18F]FDG PET/CT parameters in adrenocortical carcinoma
Schlötelburg, W., Hartrampf, P. E., Kosmala, A., Fuß, C. T., Serfling, S. E., Buck, A. K., Schirbel, A., Kircher, S., Hahner, S., Werner, R. A., et al. (2024) · Endocrine · doi:10.1007/s12020-024-03695-6 · Cited by 8
“…(MTV in cm 3 ) of the primary adrenal tumor was also assessed, while tumor lesion glycolysis (TLG) was calculated using the following equation [21]: Tumor-to-background ratios (TBR) were determined to quantify the image contrast and de ﬁ ned as follows: As previously used in several studies,…”
MethodResult
Cancer immunotherapy efficacy and machine learning
Fang, Y., Chen, X., & Cao, C. (2024) · Expert Review of Anticancer Therapy · doi:10.1080/14737140.2024.2311684 · Cited by 7
“PET response criteria for solid tumors (PERCIST), immunotherapy-modified PET response criteria for solid tumors (imPERCIST), and PET response evaluation criteria for immunotherapy (PERCIMT) have also been proposed [16–18].”
BackgroundInfluential
Comprehensive framework for evaluation of deep neural networks in detection and quantification of lymphoma from PET/CT images: Clinical insights, pitfalls, and observer agreement analyses
Ahamed, S., Xu, Y., Kurkowska, S., Gowdy, C., Joo Hyun, O., Bloise, I., Wilson, D., Martineau, P., Bénard, F., Yousefirizi, F., et al. (2026) · Physica Medica · doi:10.1016/j.ejmp.2026.105832 · Cited by 10
From RECIST to PERCIST: navigating the landscape of tumor response assessment
Leong, W. L. (2023) · European Radiology · doi:10.1007/s00330-023-10435-3 · Cited by 6
“…node size (lesions ≥ 15 mm in the short axis are considered measurable and assess-able as target lesions) and new definition of disease progression (a 5-mm increase in the sum of diameter is now required in addition to the progression in target disease of 20% increase in sum of diameters) [5].”
Quantitative [68Ga]Ga-PSMA-11 PET biomarkers for the analysis of lesion-level progression in biochemically recurrent prostate cancer: a multicentre study
Kendrick, J., Francis, R., Hassan, G. M., Rowshanfarzad, P., Ong, J., Barry, N., Rusanov, B., & Ebert, M. (2023) · Scientific Reports · doi:10.1038/s41598-023-45106-2 · Cited by 6
Sub-minute acquisition with deep learning-based image filter in the diagnosis of colorectal cancers using total-body 18F-FDG PET/CT
Liu, E.-T., Lyu, Z., Yang, Y.-L., Lv, Y., Zhao, Y.-M., Zhang, X.-C., Sun, T.-T., Jiang, L., & Liu, Z.-Y. (2023) · EJNMMI Research · doi:10.1186/s13550-023-01015-z · Cited by 6
“According to the recommendations of PERCIST, hepatic 18F-FDG activity was assessed using a fixed 3-cm-diameter spherical VOI on the right lobe of the liver [18, 19].”
Method
The significance of metabolic response to neoadjuvant androgen deprivation therapy detected with [68Ga]Ga-PSMA-11-PET/CT in high-risk prostate cancer patients treated with definitive radiotherapy
Onal, C., Guler, O., Torun, N., Oymak, E., & Reyhan, M. (2023) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-023-06321-1 · Cited by 6
“Therefore, we utilized the PERCIST criteria for PSMA-PET as a result [19].”
Method
Estrogen Receptor-Targeted and Progesterone Receptor-Targeted PET for Patients with Breast Cancer.
Ulaner, G., Fowler, A., Clark, A., & Linden, H. (2023) · PET Clinics · doi:10.1016/j.cpet.2023.04.008 · Cited by 6
Impact of patient's habitus on image quality and quantitative metrics in 18F-FDG PET/CT images.
Zorz, A., D'Alessio, A., Guida, F., Ramadan, R. M., Richetta, E., Cuppari, L., Pellerito, R., Sacchetti, G., Brambilla, M., Paiusco, M., et al. (2023) · Physica medica (Testo stampato) · doi:10.1016/j.ejmp.2023.102584 · Cited by 6
“This consideration is particularly important when comparing PET studies of a patient whose weight may have significantly changed during follow up and indicates SUL as a better alternative to SUV, as already recommended by international guidelines on tumour imaging [17,23].”
Background
A Comparative Evaluation of Mediastinal Nodal SUVmax and Derived Ratios from 18F-FDG PET/CT Imaging to Predict Nodal Metastases in Non-Small Cell Lung Cancer
Alrasheedi, M., Han, S., Thygesen, H., Neilson, M., Hendry, F., Alkarn, A., Maclay, J., & Leung, H. (2023) · Diagnostics · doi:10.3390/diagnostics13071209 · Cited by 6
“In this study, we analysed multiple normalisation ratios in the same patient cohort, thus extending published research on the limited number of normalised LN SUVmax ratios [28–31].”
PET Imaging of Hepatocellular Carcinoma Using ZD2-(68Ga-NOTA)
Sergeeva, O., Zhang, Y., Gao, S., Chan, E., Sergeev, M. E., Iyer, R., Sexton, S., Avril, N., Lu, Z.-R., & Lee, Z. (2023) · Journal of Hepatocellular Carcinoma · doi:10.2147/jhc.s390939 · Cited by 6
Multisystem Imaging Recommendations/Guidelines: In the Pursuit of Precision Oncology
Mahajan, A., Chakrabarty, N., Majithia, J., Ahuja, A., Agarwal, U., Suryavanshi, S., Biradar, M., Sharma, P., Raghavan, B., Arafath, R., et al. (2023) · Indian Journal of Medical and Paediatric Oncology · doi:10.1055/s-0043-1761266 · Cited by 6
Immunotherapy Assessment: A New Paradigm for Radiologists
Granata, V., Fusco, R., Setola, S. V., Simonetti, I., Picone, C., Simeone, E., Festino, L., Vanella, V., Vitale, M. G., Montanino, A., et al. (2023) · Diagnostics · doi:10.3390/diagnostics13020302 · Cited by 7
Reliability of gradient-based segmentation for measuring metabolic parameters influenced by uptake time on 18F-PSMA-1007 PET/CT for prostate cancer
Lau, Y.-C., Chen, S.-R., Ho, C., & Cai, J. (2022) · Frontiers in Oncology · doi:10.3389/fonc.2022.897700 · Cited by 6
“Standardization of PET imaging protocol has been proposed (17, 18).”
Background
Monitoring of Current Cancer Therapy by Positron Emission Tomography and Possible Role of Radiomics Assessment
Oriuchi, N., Endoh, H., & Kaira, K. (2022) · International Journal of Molecular Sciences · doi:10.3390/ijms23169394 · Cited by 8
“8 SULpeak, or appearance of new lesions [32]”
BackgroundMethod
The Role of 18F-FDG PET/CT in Predicting the Neoadjuvant Treatment Response in Patients with Locally Advanced Breast Cancer
Aydın, S. G., Bilici, A., Olmez, O. F., Oven, B., Acıkgoz, O., Cakir, T., Basım, P., Çakır, A., Kutlu, Y., & Hamdard, J. (2022) · Breast Care · doi:10.1159/000524446 · Cited by 6
Retracted
Reduced Segmentation of Lesions Is Comparable to Whole-Body Segmentation for Response Assessment by PSMA PET/CT: Initial Experience with the Keyhole Approach
Hartrampf, P. E., Krebs, M., Peter, L., Heinrich, M., Ruffing, J., Kalogirou, C., Weinke, M., Brumberg, J., Kübler, H. R., Buck, A. K., et al. (2022) · Biology · doi:10.3390/biology11050660 · Cited by 6
“0 [14] and the consensus guidelines [6].”
BackgroundInfluential
18F-Fluorodeoxyglucose PET/CT for Early Prediction of Outcomes in Patients with Advanced Lung Adenocarcinomas and EGFR Mutations Treated with First-Line EGFR-TKIs
Huang, Y.-E., Tsai, Y.-H., Huang, Y.-J., Lung, J., Ho, K.-W., Yen, T., Chan, S.-C., Chen, S.-T., Tsai, M., & Hung, M.-S. (2022) · Cancers · doi:10.3390/cancers14061507 · Cited by 6
“SULmax measures single-voxel SUL, whereas SULpeak assesses SUL in a sphere with a diameter of approximately 1.2 cm. SULmax is commonly used but reportedly less reproducible than SULpeak [32].”
MethodInfluential
Positron Emission Tomography–Derived Metrics Predict the Probability of Local Relapse After Oligometastasis-Directed Ablative Radiation Therapy
Greco, C., Parés, O., Pimentel, N., Louro, V., Morales, J., Nunes, B., Antunes, I., Vasconcelos, A. L., Kociołek, J., Castanheira, J., et al. (2021) · Advances in Radiation Oncology · doi:10.1016/j.adro.2021.100864 · Cited by 6
“Local response to treatment was scored as complete response, partial response, stable disease, or failure based on modified PERCIST criteria (ie, any increase of SUVmax >30% above nadir level within the irradiated volume).(14) If posttreatment PET showed no residual abnormal uptake with SUVmax decline >90% the lesion…”
Method
Paradigm shift for defining the resectability of pancreatic cancer
Kang, M., & Kim, S.-W. (2021) · Annals of Hepato-Biliary-Pancreatic Surgery · doi:10.14701/ahbps.2021.25.4.451 · Cited by 6
Intermediate-dose cytarabine is an effective therapy for adults with non-Langerhans cell histiocytosis
Liu, T., Cai, H.-C., Cai, H., Chen, M., Zhang, W., Li, J., Zhou, D.-B., & Cao, X.-X. (2021) · Orphanet Journal of Rare Diseases · doi:10.1186/s13023-022-02193-0 · Cited by 6
“Abbreviations CNS: Central nervous system; CMR: Complete metabolic response; CR: Complete response; CT: Computed tomography; CTCAE: Common Terminol‑ ogy Criteria for Adverse Events; ECD: Erdheim–Chester disease; FDG‑PET: 18Ffluorodeoxyglucose positron emission tomography; ICH: Indeterminate cell histiocytosis; IFN‑α:…”
Method
Prospective comparison of early interim 18F-FDG-PET with 18F-FLT-PET for predicting treatment response and survival in metastatic breast cancer
Su, T.-P., Huang, J.-S., Chang, P.-H., Lui, K., Hsieh, J. C.-H., Ng, S., & Chan, S.-C. (2021) · BMC Cancer · doi:10.1186/s12885-021-08649-z · Cited by 6
“In accordance with the PERCIST criteria [19], we measured the mean SUL and standard deviation of the SUL in a 3-cm diameter spherical volume of interest (VOI) in the right hepatic lobe for background activity.”
Method
18F-FDG PET/CT for monitoring anti-PD-1 therapy in patients with non-small cell lung cancer using SUV harmonization of results obtained with various types of PET/CT scanners used at different centers
Ito, K., Kitajima, K., Toriihara, A., Ishibashi, M., Nakahara, T., Daisaki, H., Ohe, Y., Honda, R., Kijima, T., Hasegawa, S., et al. (2021) · Annals of Nuclear Medicine · doi:10.1007/s12149-021-01667-8 · Cited by 6
18F-FDG PET/CT Imaging Biomarkers for Early and Late Evaluation of Response to First-Line Chemotherapy in Patients with Pancreatic Ductal Adenocarcinoma
Benz, M., Armstrong, W., Ceci, F., Polverari, G., Donahue, T., Wainberg, Z., Quon, A., Auerbach, M., Girgis, M. D., Herrmann, K., et al. (2021) · Journal of Nuclear Medicine · doi:10.2967/jnumed.121.261952 · Cited by 6
Correlation of primary tumor metabolic parameters with clinical, histopathological and molecular characteristics in breast cancer patients at pre-operative staging FDG-PET/CT study
Abdelaal, A., Zaher, A., Abdelgawad, M., Mekkawy, M., & Eloteify, L. (2021) · The Egyptian Journal of Radiology and Nuclear Medicine · doi:10.1186/s43055-021-00548-4 · Cited by 6
Intrapatient repeatability of background 18F-FDG uptake on PET/CT.
Wang, R., Fan, Q., Tian, R., & Su, M.-G. (2021) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-20-769 · Cited by 6
“In clinical practice, the standardized uptake value (SUV) of background tissues such as the aortic blood pool (ABP) and liver are often used as references (1-3).”
Background
WGCTA-Net: Wavelet-Guided CNN-Transformer fusion with attention mechanism for PET/CT tumor segmentation
Zheng, Y., Sun, Z.-Q., Chen, S., Fu, H., Wang, C.-L., & Zhu, J. (2026) · Biomedical Signal Processing and Control · doi:10.1016/j.bspc.2025.109210 · Cited by 5
Molecular Imaging Advances in Endometriosis: The Promise of Radiopharmaceuticals
Napolitano, R., Speltri, G., Martini, P., Porto, F., Marvelli, L., Niorettini, A., Uccelli, L., Urso, L., Filippi, L., Uslu, H., et al. (2025) · Molecules · doi:10.3390/molecules31010093 · Cited by 5
“…or evaluated in pilot trials for endometriosis, yielding generally disappointing results. is the most widely used PET tracer in oncology as it exploits the principle of increased glucose metabolism characteristic of malignant tissues, a phenomenon commonly referred to as the Warburg effect [7,8].”
PET/CT-guided management of immune checkpoint blockade and multi-modal profiling following treatment in long-term responders with metastatic lung cancer in the National Network Genomic Medicine Lung Cancer Germany (nNGM)
Frost, N., Joosten, M., Franzen, J., Wiesweg, M., Rasokat, A., Kulhavy, J., Kollmeier, J., Reinmuth, N., Grohé, C., Roeper, J., et al. (2025) · Annals of Oncology · doi:10.1016/j.annonc.2025.12.011 · Cited by 5
Tumor Absorbed Dose Predicts Survival and Local Tumor Control in Colorectal Liver Metastases Treated with 90Y Radioembolization
Dimopoulos, M., Sotirchos, V. S., Dunne-Jaffe, C., Mitchell, A., Petre, E., Alexander, E. S., Gonen, M., Rao, D., Connell, L., Soares, K., et al. (2025) · Cardiovascular and Interventional Radiology · doi:10.1007/s00270-025-04175-8 · Cited by 5
“Response of treated liver by RECIST and PERCIST criteria at 4–8-and 12–16-week is presented in Table 5.”
Influential
Artificial intelligence-assisted assessment of metabolic response to tebentafusp in metastatic uveal melanoma: a long axial field-of-view [18F]FDG PET/CT study
Sachpekidis, C., Machiraju, D., Strauss, D. S., Pan, L., Kopp‐Schneider, A., Edenbrandt, L., Dimitrakopoulou‐Strauss, A., & Hassel, J. C. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07504-8 · Cited by 5
“Automated [ 18 F]FDG PET/CT image analysis, including segmentation, quantification and response evaluation to tebentafusp, was performed according to Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) 1.0 [ 21 ]using the cloud‐based RECOMIA platform ( www. recomia.org ) [ 22 ].”
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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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