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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New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)
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Background
New Guidelines to Evaluate the Response to Treatment in Solid Tumors
Therasse, P., Arbuck, S. G., Eisenhauer, E. A., Wanders, J., Kaplan, R. S., Rubinstein, L., Verweij, J., Van Glabbeke, M., van Oosterom, A. T., Christian, M. C., et al. (2000) · JNCI: Journal of the National Cancer Institute · doi:10.1093/jnci/92.3.205 · Cited by 15,660
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Background
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BackgroundInfluential

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Background
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Background
18F-FDG PET/CT for assessing heterogeneous metabolic response between primary tumor and metastases and prognosis in non-small cell lung cancer.
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BackgroundMethod
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“Metabolic response using FDG-PET is commonly based on change in maximum or peak SUV, as in PERCIST [8].”
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Method
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Patterns of treatment and outcomes of patients with metastatic HER2-low breast cancer treated with CDK4/6 inhibitors and hormone therapy
Sottotetti, F., Tagliaferri, B., Rizzo, G., Palumbo, R., Chessa, G., Raso, C., Perrone, L., Malovini, A., Tibollo, V., Locati, L., et al. (2025) · Drugs in Context · doi:10.7573/dic.2024-12-1 · Cited by 4
“Response was assessed using the revised RECIST criteria (version 1.1) in the case of CT evaluation 12 or using PERCIST criteria 13 in the case of PET-CT imaging according to the physician’s choice.”
Influential
PSMA-targeted radioligand therapy with [177Lu]Lu-LNC1011 for metastatic castration-resistant prostate cancer: a pilot study
Hou, L., Wang, Y.-J., Fu, H., Chen, L.-P., Yu, C.-J., Chen, X.-Y., & Zhang, J.-J. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07245-8 · Cited by 4
“Molecular imaging responses were classified according to adapt PERCIST 1.0 [18 , 19].”
Influential
A mini-review: Application of the radiopharmaceutical [18F]DPA-714 in neuroinflammation research in post-SARS-CoV-2 patients
Boniek, D., & Malamut, C. (2025) · Journal of the Neurological Sciences · doi:10.1016/j.jns.2025.123518 · Cited by 4
The value of combined assessment of tumor cellularity and metabolism by PET/MRI in predicting pathological complete response after neoadjuvant treatment in breast cancer
Ateş, Y. Ü., Aydos, U., Balcı, E., Ateş, S. G., & Atay, L. (2025) · Clinical and translational imaging · doi:10.1007/s40336-025-00690-3 · Cited by 4
“The patients were divided into two groups according to PERCIST (Positron Emission Tomography Response Criteria in Solid Tumors): those with CMR and those without CMR [31].”
"Current Status of Staging and Restaging Malignant Pleural Mesothelioma".
Lopci, E. (2025) · Seminars in nuclear medicine · doi:10.1053/j.semnuclmed.2025.01.003 · Cited by 4
Baseline Imaging Derived Factors of Response Following [225Ac]Ac‐J591 Therapy in Metastatic Castration‐Resistant Prostate Cancer: A Lesion Level Analysis
Stangl‐Kremser, J., Ricaurte‐Fajardo, A., Castellanos, S. H., Martinez‐Fundichely, A., Sun, M., Osborne, J. R., Nauseef, J. T., Tagawa, S. T., & Bander, N. H. (2025) · The Prostate · doi:10.1002/pros.24853 · Cited by 4
“…measured in follow ‐ up PSMA PET relative to baseline PSMA PET measured in each lesion was used to assess response based on PERCIST version 1.0 (e.g., complete response [PERCIST ‐ CR], partial response [PERCIST ‐ PR], stable disease [PERCIST ‐ SD], or progressive disease [PERCIST ‐ PD]) [39].”
Influential
Clinical Outcomes of CDK4/6 Inhibitor Therapy in HR+/HER2− Metastatic Breast Cancer: A Multicenter Comparison of HER2-Low and HER2-Zero Subgroups
Ozcan, E., Gokmen, I., Akgul, F., Kahvecioglu, F., Çelebi, A., Kostek, O., Hacıbekiroglu, I., & Erdoğan, B. (2025) · The Breast Journal · doi:10.1155/tbj/5577345 · Cited by 4
“Response evaluation was performed according to RECIST Version 1.1 for CT and PERCIST criteria for PET-CT [17, 18].”
Influential
Deep Radiomics Detection of Clinically Significant Prostate Cancer on Multicenter MRI: Initial Comparison to PI-RADS Assessment
Nketiah, G., Sunoqrot, M. R. S., Sandsmark, E., Langørgen, S., Selnæs, K., Bertilsson, H., Elschot, M., & Bathen, T. (2024) · arXiv.org · doi:10.48550/arxiv.2410.16238 · Cited by 4
“For each candidate lesion, the local peak intensity [31] was then calculated using 10 mm diameter spherical kernel, representing the cancer probability of that lesion. csPCa probability threshold of 0.76. which resulted in the highest average of area under receiver-operating characteristic curve…”
MethodInfluential
A Multidimensional Framework Incorporating 2D U-Net and 3D Attention U-Net for the Segmentation of Organs from 3D Fluorodeoxyglucose-Positron Emission Tomography Images
Vezakis, A., Vezakis, I., Vagenas, T. P., Kakkos, I., & Matsopoulos, G. K. (2024) · Electronics · doi:10.3390/electronics13173526 · Cited by 6
[18F]FDG PET/CT Integration in Evaluating Immunotherapy for Lung Cancer: A Clinician’s Practical Approach
Brezun, J., Aide, N., Peroux, E., Lamboley, J.-L., Gutman, F., Lussato, D., & Helissey, C. (2024) · Diagnostics · doi:10.3390/diagnostics14182104 · Cited by 4
The impact of introducing deep learning based [18F]FDG PET denoising on EORTC and PERCIST therapeutic response assessments in digital PET/CT
Weyts, K., Lequesne, J., Johnson, A., Curcio, H., Parzy, A., Coquan, E., & Lasnon, C. (2024) · EJNMMI Research · doi:10.1186/s13550-024-01128-z · Cited by 4
“Metabolic treatment response evaluation (as in [ 18 F] FDG PET imaging) compared to anatomical assessments has been shown to be of higher and more rapid predictive value of (pathologic) response and survival outcomes in many solid cancers [9, 11–15].”
BackgroundMethodInfluential
Liquid Biopsy and 18F-FDG PET/CT Derived Parameters as Predictive Factors of Osimertinib Treatment in Advanced EGFR-Mutated NSCLC.
Leonetti, A., Cervati, V., Minari, R., Scarlattei, M., Verzè, M., Peroni, M., Pluchino, M., Bonatti, F., Perrone, F., Mazzaschi, G., et al. (2024) · Clinical Lung Cancer · doi:10.1016/j.cllc.2024.07.016 · Cited by 4
A Retrospective Review and Comprehensive Tumour Profiling of Advanced Non-Melanomatous Cutaneous Spindle Cell Neoplasms Treated with Immune-Checkpoint Inhibitors
McLean, L. S., Lim, A., Angel, C., Young, R., Pizzolla, A., Archer, S., Solomon, B., Thai, A., Lewin, J., & Rischin, D. (2024) · Cancers · doi:10.3390/cancers16081452 · Cited by 4
“0) [ 21] if followed by ﬂuorodeoxyglucose positron emission tomography (FDG-PET/CT).”
Background
Treatment Response Imaging in Prostate Cancer.
Swiha, M. M., Gafita, A., Nguyen, A., & Emmett, L. (2024) · PET Clinics · doi:10.1016/j.cpet.2024.03.009 · Cited by 4
Total lesion glycolysis by 18F‐fluorodeoxyglucose positron emission tomography predicts tumor aggressiveness in patients with extrahepatic bile duct carcinoma
Fukushima, R., Harimoto, N., Kawai, S., Ishii, N., Tsukagoshi, M., Igarashi, T., Araki, K., Tomonaga, H., Higuchi, T., & Shirabe, K. (2024) · Journal of hepato-biliary-pancreatic sciences · doi:10.1002/jhbp.1421 · Cited by 4
“19 In this context, tumor MTV and TLG have recently been used as more accurate metabolic parameters of the whole tumor 18 F-FDG uptake.”
Method
Exploration of tumor size measurement methods in preoperative breast cancer assessment using whole-body silicon photomultiplier PET: feasibility and first results
Kuroda, H., Yoshizako, T., Yada, N., Kamimura, T., Yamamoto, N., Maruyama, M., Yoshida, R., Fukuda, M., Kataoka, Y., Itakura, M., et al. (2024) · Japanese Journal of Radiology · doi:10.1007/s11604-024-01533-3 · Cited by 4
Quarter-Century Transformation of Oncology: Positron Emission Tomography for Patients with Breast Cancer.
Ulaner, G., Vaz, S. C., & Groheux, D. (2024) · PET Clinics · doi:10.1016/j.cpet.2023.12.002 · Cited by 4
Associations of quantitative whole-body PSMA-PET metrics with PSA progression status under long-term androgen deprivation therapy in prostate cancer patients: a retrospective single-center study
Murthy, V., Appiah-Kubi, E., Nguyen, K., Thin, P., Hotta, M., Shen, J., Drakaki, A., Rettig, M. B., Gafita, A., Calais, J., et al. (2023) · European Journal of Hybrid Imaging · doi:10.1186/s41824-023-00178-1 · Cited by 4
“We used a 20% cutoff for changes in WB-PSMA-VOL and a 30% cutoff for changes in WB-PSMA-SUV mean to be consistent with RECIP 1.0 and PERCIST, respectively (Gafita et al. 2022a; Wahl et al. 2009).”
MethodInfluential
A novel [89Zr]-anti-PD-1-PET-CT to assess response to PD-1/PD-L1 blockade in lung cancer
Puyalto, A., Rodríguez-Remírez, M., López, I., Iribarren, F., Simón, J. A., Ecay, M., Collantes, M., Vilalta-Lacarra, A., Francisco-Cruz, A., Solórzano, J. L., et al. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1272570 · Cited by 4
“These patterns, however, are not re ﬂ ected in the Response Evaluation Criteria in Solid Tumors version 1.1 (RECIST 1.1), which is standard for response assessment in oncology.”
MethodInfluential
Discontinuation of anti‑programmed cell death protein 1 immune checkpoint inhibition after complete remission in head and neck squamous cell carcinoma: A case report and literature review
Stöth, M., Meyer, T., Gehrke, T., Hagen, R., Scheich, M., Hackenberg, S., & Scherzad, A. (2023) · Oncology Letters · doi:10.3892/ol.2023.14076 · Cited by 4
“In cases of persistent stable disease under ICI a metabolic response evaluation by FDG‐PET‐CT might help to improve response evaluation by determine whether vital tumor tissue is still present or whether there is a complete metabolic response (CMR), defined as complete resolution of FDG uptake within the target lesion…”
Background
Predictive Factors of Early 18F-Fluorodeoxyglucose-Positron Emission Tomography Response to [131I] Metaiodobenzylguanidine Treatment for Unresectable or Metastatic Pheochromocytomas and Paragangliomas
Takenaka, J., Watanabe, S., Abe, T., Tsuchikawa, T., Takeuchi, S., Hirata, K., Kimura, R., Wakabayashi, N., Shinohara, N., & Kudo, K. (2023) · Neuroendocrinology · doi:10.1159/000534175 · Cited by 4
“The semi-quantitative FDG-PET parameters for determining the treatment response were de ﬁ ned as complete response (CR), partial remission (PR), stable disease (SD), and PD as described [15, 16].”
Identification of 18F-FDG PET/CT Parameters Associated with Weight Loss in Patients with Esophageal Cancer
Galvez, T., Berkane, I., Thézénas, S., Éberlé, M., Flori, N., Guillemard, S., Ilonca, A.-D., Santoro, L., Kotzki, P., Senesse, P., et al. (2023) · Nutrients · doi:10.3390/nu15133042 · Cited by 4
Predictive power of deep-learning segmentation based prognostication model in non-small cell lung cancer
Gainey, J. C., He, Y., Zhu, R., Baek, S., Wu, X., Buatti, J., Allen, B., Smith, B. J., & Kim, Y. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.868471 · Cited by 4
Case report and literature review: PET/CT in the evaluation of response to treatment of liver metastasis from colorectal cancer with DEBIRI-TACE
Jin, L., Hu, W., Li, T., Sun, H., Kang, D., & Piao, L.-Z. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2023.1015976 · Cited by 4
“PET Response Criteria in Solid Tumors (PERCIST) (Table 1) can help in the evaluation of treatment effects on solid tumors based on fluorodeoxyglucose-positron emission tomography/computed tomography (FDG PET/CT) (6).”
BackgroundMethod
Standardized classification schemes in reporting oncologic PET/CT
Murad, V., Kulanthaivelu, R., Ortega, C., Veit‐Haibach, P., & Metser, U. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2022.1051309 · Cited by 4
“Various criteria were proposed in the early years of clinical implementation of immunotherapy, such as the EORTC criteria [European Organization for Research and Treatment of Cancer (36)] and the PERCIST criteria [PET Response Criteria in Solid tumors (37)] for the metabolic response assessment to immunotherapy for pa…”
Method
Standardized Uptake Values on SPECT/CT: A Promising Alternative Tool for Treatment Evaluation and Prognosis of Metastatic Neuroendocrine Tumours
Gherghe, M., Lazăr, A., Simion, L., Irimescu, I., Sterea, M.-C., Mutuleanu, M.-D., & Anghel, R. (2023) · Diagnostics · doi:10.3390/diagnostics13020318 · Cited by 4
“SUVpeak is defined as the average SUV within a small, fixed size region of interest centred on a high uptake part of the tumour [40].”
Background
Determination of diagnostic and predictive parameters for vertical mandibular invasion in patients with lower gingival squamous cell carcinoma: A retrospective study
Shimizu, T., Kim, M., Palangka, C., Seki‐Soda, M., Ogawa, M., Takayama, Y., & Yokoo, S. (2022) · Medicine · doi:10.1097/md.0000000000032206 · Cited by 4
“[29,30] In contrast, SUVpeak is a new parameter that measures the mean value of SUV within a 1 cm3 voxel in the VOI and shows the highest mean value, which is superior to SUVmax in terms of reproducibility and stability.[31] However, SUVpeak also reflects only some of the tumor’s metabolic activity, and problems simil…”
Background
Dynamic alteration in SULmax predicts early pathological tumor response and short-term prognosis in non-small cell lung cancer treated with neoadjuvant immunochemotherapy
Sun, T.-T., Huang, S.-J., Jiang, Y., Yuan, H., Wu, J.-H., Liu, C., Zhang, X.-C., Tang, Y., Ben, X., Tang, J.-M., et al. (2022) · Frontiers in Bioengineering and Biotechnology · doi:10.3389/fbioe.2022.1010672 · Cited by 4
“Compared with SULpeak, a SULmax value, which reflects the most metabolically active portion of a potentially heterogeneous mass, was applicable in most lesions, thus is routinely reported and more clinically feasible (Wahl et al., 2009; Lodge et al., 2012).”
Background
Evaluation of 11C‐choline positron emission tomography/computed tomography for determining treatment response in castration‐resistant prostate cancer patients
Kimura, K., Kitajima, K., Kawanaka, Y., Yokoyama, H., Komoto, H., Fujiwara, M., Furukawa, Y., Kanematsu, A., Yamamoto, S., Miyake, H., et al. (2022) · International journal of urology · doi:10.1111/iju.14992 · Cited by 4
A Decade of Success in Melanoma Immunotherapy and Targeted Therapy: What Every Radiologist Should Know
Chen, M. I.-C., Smith, D. A., Yoon, J. G., Vos, D. J., Kikano, E. G., Tirumani, S. H., & Ramaiya, N. H. (2022) · Journal of Computer Assisted Tomography · doi:10.1097/rct.0000000000001315 · Cited by 5
Decoding circulating tumor DNA to identify durable benefit from immunotherapy in lung cancer.
Donker, H., Schuuring, E., Heitzer, E., & Groen, H. (2022) · Lung Cancer · doi:10.1016/j.lungcan.2022.05.013 · Cited by 4
Role of 18F-FDG PET/CT in the assessment of therapy response and clinical outcome in metastatic renal cell carcinoma treated with tyrosine kinase inhibitors or immunotherapy
Tatar, G., Alçın, G., Samancı, N. Ş., Fenercioğlu, Ö. E., Beyhan, E., & Çermik, T. F. (2022) · Nuclear medicine communications · doi:10.1097/mnm.0000000000001553 · Cited by 4
Predicting pathological response of locally advanced breast cancer to neoadjuvant chemotherapy: comparing the performance of whole body 18F-FDG PETCT versus DCE-MRI of the breast
Sobhi, A., Hamed, S. T., Hussein, E., Lasheen, S., Hussein, M., & Ebrahim, Y. (2022) · The Egyptian Journal of Radiology and Nuclear Medicine · doi:10.1186/s43055-022-00743-x · Cited by 4
Tumor Size Measurements for Predicting Hodgkin’s and Non-Hodgkin’s Lymphoma Response to Treatment
Kallergi, M., Georgakopoulos, A., Lyra, V., & Chatziioannou, S. (2022) · Metabolites · doi:10.3390/metabo12040285 · Cited by 4
“Lymphomas have unique characteristics, different from solid tumors, which have been studied extensively in the last 20 years including the value of metabolic tumor volume (MTV) as a prognostic marker of Hodgkin’s Lymphoma (HL) and Non-Hodgkin’s Lymphoma (NHL) response to treatment [3,4].”
BackgroundMethod
Heterogeneous radiological response to chemotherapy is associated with poor prognosis in advanced non‐small‐cell lung cancer
Ryu, W., Kim, J. S., Park, M., Lee, M.-K., Kim, H.-J., Ryu, J., & Lim, J. (2021) · Thoracic Cancer · doi:10.1111/1759-7714.14207 · Cited by 4
“This incidence is comparable to those of radiological heterogeneity in other kinds of cancer in previous studies.12,13 We defined radiological heterogeneity as more than 20% increase in the size of particular lesion in patients with PR or SD, considering the criteria in RECIST.”
Influential
Effects of New Bayesian Penalized Likelihood Reconstruction Algorithm on Visualization and Quantification of Upper Abdominal Malignant Tumors in Clinical FDG PET/CT Examinations
Tatsumi, M., Soeda, F., Kamiya, T., Ueda, J., Katayama, D., Matsunaga, K., Watabe, T., Kato, H., & Tomiyama, N. (2021) · Frontiers in Oncology · doi:10.3389/fonc.2021.707023 · Cited by 4
“SUVpeak was mean SUV of a 1 cm(3) three-dimensional region-of-interest covering the area with most intense FDG uptake in the same lesion where SUVmax was calculated (11).”
Background
OncoNet: Weakly Supervised Siamese Network to automate cancer treatment response assessment between longitudinal FDG PET/CT examinationsPreprint
Joshi, A., Eyuboglu, S., Huang, S.-C., Dunnmon, J., Soin, A., Davidzon, G., Chaudhari, A. S., & Lungren, M. P. (2021) · arXiv (Cornell University) · doi:10.48550/arxiv.2108.02016 · Cited by 3
FAP-Targeted Theranostics in Advanced Sarcoma: A Pilot Study of ⁶⁸Ga-FAPI-46 Imaging and ¹⁷⁷Lu-FAPI-2286 Therapy
Jokar, N., Juweid, M., Jafari, E., Yazdani, E., Deylami, A. A., Rekabpour, S. J., Shakibazad, N., Peer-Firozjaei, M., Arabi, H., Zaidi, H., et al. (2026) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000006507 · Cited by 2
PD-L1-targeted PET imaging for non-invasive assessment of immunotherapy response in lung cancer
Chen, Y., Liu, X., Hu, Y.-T., Li, A., Zeng, B.-Z., Wang, P., Tang, G.-H., Jiang, B.-Y., Yuan, H., & Jiang, L. (2026) · Journal for ImmunoTherapy of Cancer · doi:10.1136/jitc-2025-013837 · Cited by 3
“9 10 However, during ICIs therapy, immune activation and infiltration within the tumor microenvironment (eg, increased T cell activity) can lead to elevated [ 18 F]FDG uptake, resulting in false-positive findings.”
Metastasis-directed thermal ablation in patients with metastatic breast cancer and visceral oligoprogression or oligopersistence: a cohort study
Bianco, N., Valenza, C., Milano, M., Multinu, R., Battaiotto, E., Cavallone, M., Malvezzi, G., Trapani, D., Vigna, P. D., Bonomo, G., et al. (2025) · Breast · doi:10.1016/j.breast.2025.104667 · Cited by 3
“…oligoprogressive disease were included in cohort A. Oligoprogression was defined as radiologic (at MRI or CT scan) progression per RECIST 1.1, as assessed by the tumor board, in ≤ 5 extracranial metastatic sites, with at least one other metastatic site maintaining the disease control [6,7].”
Influential
¹⁸F-FDG PET radiomics and machine learning for virtual biopsy and treatment decisions in lymphoma: a multicenter study
Hasanabadi, S., Aghamiri, S. R., Abin, A. A., Karam, M. B., Vosoughi, H., Emami, F., Askari, E., Seifi, S., Dorudinia, A., Arabi, H., et al. (2025) · Physical and Engineering Sciences in Medicine · doi:10.1007/s13246-025-01675-2 · Cited by 3
“After lesion delineation, a 3-dimensional region of interest (ROI) with three diameters was defined in the right lobe of the liver, ensuring it was free of any lesions, in accordance with the PERCIST criteria [26], to calculate TLR radiomics.”
[18F]FDG-PET/CT’s change in total lesion glycolysis can accurately identify early response upon neoadjuvant immunotherapy prior to curative-intent surgery in cutaneous squamous cell carcinoma; MATISSE trial
Breukers, S. E., Crommelin, R. D., Smit, L., de Boer, J. D., Navran, A., van Houdt, W. V., de Bree, R., Devriese, L., Haanen, J., Wondergem, M., et al. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07518-2 · Cited by 3
“For FDG-PET-based response evaluation, EORTC and PET Response Criteria in Solid Tumours (PERCIST) criteria have previously been formulated for response assessment, using SUV max and the peak region of Standardized Uptake Value normalized to lean body mass (SUL peak ), respectively [26, 27].”
18-FDG-PET Imaging in Head and Neck Cancer: Current Application.
Batchala, P., & Raghavan, P. (2025) · The Radiologic clinics of North America · doi:10.1016/j.rcl.2025.06.003 · Cited by 3
Research on the Precise Differentiation of Pathological Subtypes of Non-Small Cell Lung Cancer Based on 18F-FDG PET/CT Radiomics Features
Li, W., Ju, L.-J., Zhang, S.-X., Chen, Z., Li, Y., Feng, Y., Xiang, Y., Xiang, T.-X., Wu, Z.-J., & Pang, H. (2025) · Cancers · doi:10.3390/cancers17203311 · Cited by 3
“This method is invasive and may result in diagnostic inaccuracies due to sampling errors, with limited applicability for patients with advanced or inoperable disease [11–14].”
Radiologists and treatment response assessment: conventional and functional radiological criteria for predicting therapeutic response in virus-related and non-virus-related cancers
Granata, V., Fusco, R., Pupo, D., Alfieri, A., Caranci, F., Riga, M. G., Feo, M. E. D., Sgariglia, L., Carrafiello, G., Karaboue, M. A., et al. (2025) · Infectious Agents and Cancer · doi:10.1186/s13027-025-00695-7 · Cited by 3
“These include criteria based on viable tumor components only [16], attenuation values reflecting necrosis [17], functional imaging techniques (e.g., perfusion and diffusion imaging), and metabolic imaging approaches like the PERCIST criteria or newer PET-based markers [18–20].”
PD-1 inhibitor combined with TPF induction chemotherapy in locally advanced nasopharyngeal carcinoma: a retrospective study of efficacy and safety
Zhang, W., Meng, Y., Zhang, P., Tian, D., Zeng, X., Dong, M., & He, L. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1654616 · Cited by 1
Early prediction of histopathological response of locally advanced rectal cancer after 1 week of preoperative radiochemotherapy using 18FDG PET-CT imaging: a prospective clinical validation study
Kundel, Y., Cohen, Z., Gordon, N., Sulkes, A., Morgenstern, S., Perl, G., Wasserberg, N., Groshar, D., Bernstine, H., & Brenner, B. (2025) · Radiation Oncology · doi:10.1186/s13014-025-02703-x · Cited by 3
“Indeed, the complex methodology for standardization of PET-CT imaging for comparative studies was published by Wahl et al. [16], but unfortunately without a global impact.”
Image-guided radiofrequency ablation for treatment of stage I non–small cell lung cancer in 111 high-risk patients: Analysis of prognostic variables
Christie, I., Luketich, J., Schuchert, M., Slingerland, A., Gooding, W., Ryan, J., Awais, O., Levy, R. M., Sarkaria, I., Christie, N., et al. (2025) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2025.08.015 · Cited by 3
“25 Assessment of response after RFA is difficult, given the presence of a scar after treatment.”
Clinical outcomes with combination of stereotactic body radiation therapy in patients with hepatocellular carcinoma.
Sahai, P., Mall, A., Solanky, A. P., Jawahar, V., Bharadwaj, M., Jaleel, J., Jagya, D., Kumar, G., Shasthry, S., & Yadav, H. P. (2025) · Journal of Cancer Research and Therapeutics · doi:10.4103/jcrt.jcrt_2351_24 · Cited by 3
Metabolic parameters on baseline and early [18F]FDG PET/CT as a predictive biomarker for resistance to BRAF/MEK inhibition in advanced cutaneous BRAFV600-mutated melanoma
van der Hiel, B., der Veen, B. J. D. W., van den Eertwegh, A. J. M., Vogel, W. V., Stokkel, M. P. M., López‐Yurda, M., Boellaard, R., Kapiteijn, E., Hospers, G. A. P., Aarts, M. J. B., et al. (2025) · EJNMMI Research · doi:10.1186/s13550-025-01259-x · Cited by 2
Theranostic: A Primer for Radiologists
Mirshahvalad, S. A., Beheshti, M., Metser, U., Jiang, D. M., Wong, R., Alrekhais, I., & Veit-Haibach, P. (2025) · Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes · doi:10.1177/08465371251338032 · Cited by 3
“30 However, anatomical changes can be delayed in comparison to molecular or functional changes.”
Research advances in evaluation methods for neoadjuvant therapy of tumors
Yuan, Z.-Y., Chen, T., Zhang, H., Li, J.-T., Li, J.-T., & Shang, G.-N. (2025) · Frontiers in Oncology · doi:10.3389/fonc.2025.1580360 · Cited by 3
In Vivo Visualization of Tumor Metabolic Activity with a Tetra Glucose-Conjugated Zinc-Phthalocyanine Photoacoustic Contrast
Patkulkar, P., Sv, A., Sharma, A., Panda, S., V., V., Shringi, C., & Sinharay, S. (2025) · JACS Au · doi:10.1021/jacsau.5c00151 · Cited by 3
Long-term Efficacy, Survival, and Toxicity of Peptide Receptor Radionuclide Therapy in Patients With Refractory Meningioma
Zhang, J.-J., Li, D., Shi, M., Jakobsson, V., Jia, W., Kulkarni, H., Schuchardt, C., & Baum, R. P. (2025) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000005845 · Cited by 3
“29 The disease control rate was de ﬁ ned as complete response (CR; complete removal of all CNS target lesions), partial response (PR; a ≥ 50% decrease in overall perpendicular diameters of all target lesions), minor response (MR; a ≥ 25% but < 50% decrease in overall perpendicular diameters of all…”
Comparison of PERCIST5, imPERCIST5, and PERCIMT Criteria for Early Assessment of Pembrolizumab Response with FDG-PET/CT in Metastatic Bladder Cancer Patients
Bertaux, M., Luo, C., Radulescu, C., Beuzeboc, P., Landais, C., Touche, P., Abraham, C., Seban, M. H., Camps, E., Faucheron, A., et al. (2025) · Pharmaceuticals · doi:10.3390/ph18050701 · Cited by 3
“…study was to compare the prognostic values of imPERCIST5, PERCIMT, and the variation with maximum five target lesions of the more traditional response score PERCIST 1.0 (PERCIST5), in the early assessment of treatment response of metastatic bladder cancer patients treated with Pembrolizumab [13].”
Influential
Disease response criteria in Langerhans cell histiocytosis: a global view
Buhtoiarov, I., Minkov, M., Vali, R., & Abla, O. (2025) · International journal of hematology · doi:10.1007/s12185-025-03989-z · Cited by 3
“The PET Response Criteria in Solid Tumors (PERCIST) were created in 2009 to ensure a systematic and structured assessment of treatment response with 18 F-FDG-PET/CT [35].”
Neuroendocrine peritoneal disease and [177Lu]DOTATATE peptide receptor radionuclide therapy: a therapeutic challenge with potential clinical complications
Poterszman, N., Baltzinger, P., Bessac, D. M., Van, F. P., Goichot, B., Mertz, L., Addeo, P., Brigand, C., & Imperiale, A. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07212-3 · Cited by 3
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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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