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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“While RECIST 1.1 response is the standard for assessing treatment response in a variety of clinical contexts [30,31] , its limitations are increasingly recognized, particularly its inability to detect early metabolic changes within tumors that precede size reduction after cytotoxic therapies [32] .”
Influential
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Method
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“These can be detected, for example, using PET measurements of uptake of the glucose analog [18F]fluoro-D-deoxyglucose (18F-FDG) and guidelines for its use in assessing treatment response have been published (PET Response Evaluation Criteria in Solid Tumors (PERCIST) [3]).”
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“[28] Therefore, SUVpeak has been recommended as an alternative to SUVmax.”
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Background
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“93]).(27,28) Beyond week 3 PET response status as a single binary variable, we restricted prognostic evaluation of week 3 PET biomarkers to total lesion glycolysis (TLGmidtx [g]), representing metabolic disease burden and the product of MTV (mL) with SUVmean (g/mL).”
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Precision theranostics in oncology: integrating antibody-drug conjugates, radioimmunotherapy, and immuno‑PET for adaptive cancer care
Wang, J., Zhang, Q., Cao, Y., 王春波, & Hamzeh, S. (2026) · Discover Oncology · doi:10.1007/s12672-026-05151-5 · Cited by 2
“…change ≥ 30% decline from baseline as the provisional threshold to continue ADC; lack of ≥ 30% decline (or a ≥ 30% increase) at the pre-specified early timepoint (for example 2–4 weeks depending on agent) should trigger lesion-level review and consideration of sequencing/escalation to RIT [115].”
Influential
Prognostic Impact of PET/CT-Derived Sarcopenia in Metastatic Breast Cancer Treated with CDK4/6 Inhibitors
Cebeci, S., Birsin, Z., Jeral, S., Abbasov, H., Aliyev, V., Çerme, E., Çiçek, E., Atak, S., Günaltılı, M., Guliyev, M., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15103736 · Cited by 2
“Treatment response was evaluated using FDG-PET/CT imaging every three months according to the Positron Emission Tomography Response Criteria in Solid Tumors (PER-CIST) [13].”
Radiothérapie interne vectorisée et théranostique en France : recommandations de bonnes pratiques par la Société Française de Médecine Nucléaire
Bailly, C., Giraudet, A., Turpin, L., Claudin, M., Tonnelet, D., Habouzit, V., Merlin, C., Deshayes, E., Lussey, C., Robin, P., et al. (2026) · Médecine Nucléaire · doi:10.1016/j.mednuc.2026.02.001 · Cited by 2
Complementary prognostic value of hotspot-to-centroid distance (NHOCpeak) to SUVpeak in high-grade glioma.
Bosque, J. J., Molina-García, D., Pérez-Beteta, J., Vicente, A. G., & Pérez-García, V. M. (2026) · Annals of Nuclear Medicine · doi:10.1007/s12149-025-02138-0 · Cited by 2
Phase 1 Trial of Withania somnifera Leaf Extract (RH324) in Advanced Non-Small Cell Lung Cancer Including [18F]FDG PET/CT as a Short-Term Metabolic Biomarker to Assess Efficacy: A Novel Model for Assessment of Complimentary Therapies in Early Phase Human Clinical Trials
Heo, J., Rao, S., Newton, H., Dowlati, A., Muzic, R., & Kardan, A. (2026) · Integrative Cancer Therapies · doi:10.1177/15347354251410182 · Cited by 2
“…anatomic imaging, governed by World Health Organization (WHO), RECIST, and RECIST 1.1 criteria, exhibits inherent limitations in accurately gauging the efficacy of contemporary cancer treatments, especially those that achieve disease stabilization rather than reduction in tumor size 15 .”
Influential
68Ga-FAPI and 18F-FDG PET/CT for predicting pathologic response and progression-free survival in locally advanced esophageal squamous cell carcinoma treated with neoadjuvant chemoradiotherapy.
Dai, J.-N., Zou, Y., Wang, H., Huang, H.-X., Yang, L.-X., Zou, B.-W., & Tian, R. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07684-3 · Cited by 2
EANM insights on PET-based response assessment in neuro-oncology: things are moving forward!
Verger, A., Albert, N., Brendel, M., Cecchin, D., Aguiar-Fernández, P., Fraioli, F., Guedj, E., Traub-Weidinger, T., Yakushev, I., Weehaeghe, D. V., et al. (2025) · The EANM Journal · doi:10.1016/j.eanmj.2025.100008 · Cited by 2
Phase II trial of neoadjuvant camrelizumab and apatinib in resectable NSCLC: 3-year survival outcomes and dynamic circulating tumor DNA analyses
Guo, W. J., Zhao, L., Chen, X., Wang, S., Tao, X., Li, L., Sun, Q., Gao, Y. S., Mao, Y., Shao, K., et al. (2025) · European Journal of Cancer · doi:10.1016/j.ejca.2025.116198 · Cited by 3
Novel Molecular Imaging Approaches: Towards a Better Estimation of Response in Breast Cancer.
Sharkey, A. R., & Cook, G. J. R. (2025) · British journal of hospital medicine · doi:10.12968/hmed.2024.0959 · Cited by 2
Emerging biomarkers for early detection of lung cancer
Khangar, P. K., Daniel, V., Vengurlekar, S., Daniel, K., & Jain, S. K. (2025) · Clinical Cancer Bulletin · doi:10.1007/s44272-025-00046-y · Cited by 2
“For example, PET scan is useful in imaging metabolic activity, while the CT scans are used to image the structure of the body [228, 229].”
Mapping systemic inter-organ metabolic networks across glycemic continuum using whole-body [18F]FDG PET/CT and machine learning
Tao, X., Guan, Z., Qu, J., Sun, Q., Xiao, Y., Li, Z., Ma, N., Lin, X., Wen, G., Zheng, H., et al. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07582-8 · Cited by 2
“The use of SUL is recommended by both the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and the European Association of Nuclear Medicine (EANM) in their procedural guidelines for FDG PET/CT imaging, particularly in multi-center and quantitative research settings [22, 23 ].”
Effect of reconstruction settings on radiomics feature robustness in positron emission tomography images: a clinical study
Liu, Y.-N., Wang, G.-L., Yan, X.-F., Wang, H.-T., Li, T.-C., Yang, S.-Y., Liu, Z.-F., Zhang, S., & Su, X.-H. (2025) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-2025-958 · Cited by 2
“For clinical 18F-fluorodeoxyglucose ( 18 F-FDG) PET/CT oncology imaging, standardized uptake value (SUV) metrics including maximum SUV (SUVmax), mean SUV (SUVmean), and peak SUV (SUVpeak) are now routinely utilized in single-time-point images for quantifying glucose metabolic activity (1).”
Real-World Endpoints in Stereotactic Body Radiation Therapy Trials for Oligoprogression: Beyond Progression-Free Survival and Overall Survival.
David, S., White, M., Siva, S., Tan, J., Connolly, E., & Bressel, M. (2025) · International Journal of Radiation Oncology, Biology, Physics · doi:10.1016/j.ijrobp.2025.08.009 · Cited by 2
Real world outcomes of high dose hypo-fractionated radiation therapy for mucosal head and neck cancer in patients unsuitable for curative treatment
Lawless, A., Mohan, R., Ragavan, A., Venkatesha, V., Brown, C., Macleod, P., Stevens, M., Eade, T., Jayamanne, D., & Bergamin, S. (2025) · Reports of Practical Oncology & Radiotherapy · doi:10.5603/rpor.108006 · Cited by 2
“Response to treatment was defined as per Response Evaluation Criteria in Solid Tumors (RECIST) or PET Response Criteria in Sol-id Tumors (PERCIST) criteria in those undergoing CT or FDG PET-CT, respectively [5, 6].”
Prechemoradiotherapy number of natural teeth as a prognostic factor in patients with locally advanced nasopharyngeal cancer: A retrospective observational study
Topkan, E., Somay, E., Başçıl, S., Ozturk, D., & Selek, U. (2025) · Journal of International Medical Research · doi:10.1177/03000605251379977 · Cited by 2
Relationship Between [18F]FDG PET/CT Texture Analysis and Progression-Free Survival in Patients Diagnosed With Invasive Breast Carcinoma
Bülbül, O., Bülbül, H. M., & Göksel, S. (2025) · European Journal of Breast Health · doi:10.4274/ejbh.galenos.2025.2025-5-3 · Cited by 2
“PET/ CT images were evaluated according to the PERCIST criteria, while CT and MRI findings were assessed according to the RECIST 1.1 criteria (14).”
Influential
Addressing Partial Volume Effects in Clinical PET Quantification: Modern Correction Strategies and Challenges.
Marquis, H., Erlandsson, K., & Buvat, I. (2025) · PET Clinics · doi:10.1016/j.cpet.2025.07.001 · Cited by 2
The Importance of PET Quantification for Prognosis and Treatment Response Monitoring.
Abgral, R., Bailly, C., Boellaard, R., Bourhis, D., & Carlier, T. (2025) · PET Clinics · doi:10.1016/j.cpet.2025.07.007 · Cited by 2
L-5-[11C]-glutamine PET of breast cancer: Preclinical studies in mouse models
Hensley, C., Padakanti, P. K., Damani, R., Dulal, C., Choi, H., Li, S.-H., Cao, J., Lee, H.-J. S., Pantel, A., Li, E. J., et al. (2025) · Nuclear Medicine and Biology · doi:10.1016/j.nucmedbio.2025.109092 · Cited by 2
Comparison of standardized uptake value and standardized uptake lean body mass metrics in 18F-fluorodeoxyglucose positron emission tomography for assessing transformation in chronic lymphocytic leukemia and follicular lymphoma
Oldan, J., Jensen, C. E., Stephens, D. M., Grover, N., Beaven, A., Dittus, C., Lodge, M. A., Benefield, T., & Rowe, S. P. (2025) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-2024-2740 · Cited by 2
“SUL is used in some response assessment methodologies such as Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) (1).”
Self-citation
18F-FDG PET-based liver segmentation using deep-learning
Kaneko, Y., Miwa, K., Yamao, T., Miyaji, N., Nishii, R., Yamazaki, K., Nishikawa, N., Yusa, M., & Higashi, T. (2025) · Physical and Engineering Sciences in Medicine · doi:10.1007/s13246-025-01595-1 · Cited by 2
“SUV is defined as tissue radioactivity concentration (kBq/mL) divided by injected dose (MBq) per body weight (kg) [8].”
Characterization of Pulmonary Sclerosing Pneumocytoma Assessed by 18F‐FDG PET/CT
Xu, J., Wan, X., Zhai, S., Yuan, S., Li, S.-Y., Xu, W.-G., Fan, M., & Zhu, L. (2025) · Thoracic Cancer · doi:10.1111/1759-7714.70124 · Cited by 2
“It has been suggested that SUV mean may not be as reproducible as SUV peak because it relies on the delineation of VOIs [28, 29].”
Prognostic Value of 18F-FDG PET/CT in Neoadjuvant PD-1 Inhibitor-treated NSCLC
Tao, X., Zhang, Q., Li, N., Wang, S.-H., Guo, W., Yuan, P., Ying, J.-M., Li, J., Guo, L., Tang, W., et al. (2025) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000005910 · Cited by 2
New FDG-PET/CT interpretation criteria (Huaxi criteria) for response assessment in patients with nasal-type extranodal NK/T-cell lymphoma: development and validation
Li, L., Cui, F., Tian, R., Jiang, M., Zou, L., Li, X., & Su, M. (2025) · Annals of Hematology · doi:10.1007/s00277-025-06420-z · Cited by 1
“The liver SUV max was obtained by measuring the SUV max of a 3-cm-diameter spherical volume of interest (VOI) in the center of the normal right lobe of the liver [15].”
Influential
Regorafenib plus modified gemcitabine-oxaliplatin in patients with advanced biliary tract cancer. The randomized phase Ib/II BREGO study
Blanc, J., Bouattour, M., Gauthier, L., Deshayes, E., Guillemard, S., Touchefeu, Y., Portales, F., Borg, C., Harguem, L., Guimbaud, R., et al. (2025) · The Oncologist · doi:10.1093/oncolo/oyaf080 · Cited by 1
The Biochemical–Imaging Connection: Urinary Noradrenaline and Fluorodeoxyglucose-Positron Emission Tomography in Unresectable or Metastatic Pheochromocytomas and Paragangliomas
Takenaka, J., Watanabe, S., Abe, T., Takeuchi, S., Hirata, K., Kimura, R., Ishii, H., Wakabayashi, N., Majigsuren, M., & Kudo, K. (2025) · Diagnostics · doi:10.3390/diagnostics15111305 · Cited by 2
“The criteria for FDG avidity were established using a threshold of the mean + 3 SD to ensure consistency [40].”
Test-retest repeatability of quantitative organ and tissue uptake using 20-minute dynamic multiparametric whole-body [18F]FDG PET/CT in patients with type 2 diabetes
Baier, J., Funck, K., Dons-Jensen, A., Munk, O. L., Tolbod, L., Laugesen, E., Poulsen, P. L., Gormsen, L., & Dias, A. H. (2025) · EJNMMI Research · doi:10.1186/s13550-025-01249-z · Cited by 2
“…by Langen et al. [29] suggested that a 25% variation in SUV mean variation in studies performed within 30 days of each other might be used as a threshold for significant changes in lesions between studies, while the PERCIST criteria established a 30% variation of SUV-peak as significant [30].”
Quantitative 177Lu-DOTATATE SPECT/CT is predictive of 6-month PRRT morphological response in midgut neuroendocrine tumors: a pilot study
Megherbi, I., Hoog, C., Perrier, M., Brixi, H., Cadiot, G., Hoeffel-Fornes, C., & Morland, D. (2025) · EJNMMI Research · doi:10.1186/s13550-025-01250-6 · Cited by 2
“PET with 68Ga-DOTATATE has been studied in the evaluation of response, however 68Ga-DOTATATE SUV lacks validation before it can be used as reliably as FDG PET [31].”
Fast 4D-PET parametric imaging computation at the whole field of view level: Reliability under simulated conditions of PET KinetiX, a dedicated software solution
Faure, S., Paillet, A., Comtat, C., & Besson, F. L. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07285-0 · Cited by 2
“To meet the growing demands of precision medicine, numerous diagnostic and prognostic PET imaging biomarkers have been proposed over the past 15 years [11–16].”
Evaluation of early chemotherapy response by combining static- and dynamic [18F]FDG-PET with diffusion-weighted MRI in subcutaneous patient-derived endometrial cancer mouse models
Espedal, H., Lyngstad, J. M., Berg, H., Hjelmeland, M., Fasmer, K., Krakstad, C., & Haldorsen, I. (2025) · EJNMMI Research · doi:10.1186/s13550-025-01235-5 · Cited by 2
“…to a decrease in tumor size (measured by CT or calipers), similar to our findings (MR FDG ) in Model A. Reduction in metabolic activity may precede reduction in tumor size [23, 35, 36], and encourages the use of [ 18 F]FDG-PET imaging for evaluation of treatment response following chemotherapy.”
A new therapeutic paradigm: radioiodine combined with lenvatinib for radioiodine-avid metastatic well-differentiated thyroid cancer
Sharma, S., Nazar, A. H., Mishra, P., Ora, M., Arya, A., Barai, S., Pradhan, P., & Gambhir, S. (2025) · Nuclear medicine communications · doi:10.1097/mnm.0000000000001980 · Cited by 2
Development and Validation of an 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography–Based Imaging Score to Predict 12-Week Life Expectancy in Advanced Chemorefractory Colorectal Cancer
Paquier, Z., Dhont, J., Guiot, T., Levillain, H., Critchi, G., Saúde-Conde, R., Sclafani, F., Flamen, P., Reynaert, N., Woff, E., et al. (2025) · JCO Clinical Cancer Informatics · doi:10.1200/cci-24-00207 · Cited by 2
“41 Furthermore, ensuring consistent and reliable results of our Imaging Score in other centers would require the standardization or harmonization of PET image acquisition.”
RECIP 1.0: A Roadmap for Clinical Implementation
Gafita, A., Djaileb, L., Calais, J., Eiber, M., & Fendler, W. (2025) · Journal of Nuclear Medicine · doi:10.2967/jnumed.124.268730 · Cited by 2
18F-Labeled Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography in Staging and Restaging Patients With Breast Cancer.
Groheux, D., Vaz, S. C., de Geus-Oei, L. D., Dibble, E. H., Ulaner, G., Cook, G. J. R., Hindié, E., Poortmans, P., Mann, R. M., Jacene, H., et al. (2025) · Journal of Clinical Oncology · doi:10.1200/jco-24-01945 · Cited by 2
Self-citation
Exploring currently available fibroblast activation protein targeting molecules in adrenocortical carcinoma: Navigating theranostic pathways
Chopra, S., Shukla, J., Purohit, P., Adhikari, U., Roesch, F., Moon, E., Rathore, Y., Rana, N., Bhadada, S., Mittal, B., et al. (2025) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-025-07203-4 · Cited by 2
“The tumor-to-background ratios (TBR) for both tracers were also determined using blood pool (BP) as reference background [25].”
MHC class II: a predictor of outcome in melanoma treated with immune checkpoint inhibitors
Amrane, K., Noac'h, P. L., Hemon, P., Abgral, R., le Meur, C., Pradier, O., Misery, L., Legoupil, D., Berthou, C., & Uguen, A. (2025) · Melanoma research · doi:10.1097/cmr.0000000000001022 · Cited by 2
“Disease control rate (DCR), defined as the proportion of patients who have a partial or complete response or stable disease to ICI (according to PERCIST criteria [29]); 1-year OS, defined as the time from diagnosis to death or date of last follow-up during the first year of treatment.”
Prognostic Values of Pre- and Post-Therapeutic FDG-PET in Anal Canal Cancer: Analysis of a Prospective Study.
Zwarthoed, C., Jaraudias, C., Evesque, L., Baron, D., François, E., Chardin, D., Marie, L., Mitrea, D., Château, Y., Gal, J., et al. (2025) · Clinical colorectal cancer · doi:10.1016/j.clcc.2025.01.006 · Cited by 2
Current and Future Perspective of PET/CT in Response Assessment of Malignant Pleural Mesothelioma.
Badarna, M., Keidar, Z., & Arnon-Sheleg, E. (2025) · Seminars in nuclear medicine · doi:10.1053/j.semnuclmed.2025.02.001 · Cited by 2
Pembrolizumab versus sintilimab in patients with advanced NSCLC: a retrospective multicenter study with propensity-score matching analysis
Xia, Z., Hong, J., Yu, X.-Y., Ran, Y.-H., Xie, H.-L., Zhou, Z., Zuo, J., Chen, T., Meng, J., & Yang, J. (2024) · Frontiers in Oncology · doi:10.3389/fonc.2024.1422039 · Cited by 2
The Objective Response and Disease Control Rates in Patients with Liver Metastastic Breast Cancer Receiving Transarterial Radioembolization: A Meta-Analysis
Quartuccio, N., Militano, V., Pappalardo, M., Filippi, L., Bagni, O., Moreci, A. M., & Ialuna, S. (2024) · Current Oncology · doi:10.3390/curroncol31110508 · Cited by 2
“…article, the number of patients with complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) was extracted, as defined according to response evaluation criteria in solid tumors (RECIST version 1.1) or PET response criteria in solid tumors (PERCIST) [12,13].”
Influential
Postradiotherapy Response Assessment Using 18F-FDG PET/CT in Salivary Gland Carcinoma—A Multicenter Study
Chen, P.-Y., Cheng, N.-M., Lin, C.-Y., Chang, K.-P., Lu, Y.-A., Tsai, T.-Y., Chen, M.-F., Fang, F.-M., Hsu, C.-L., & Hsieh, R. C.-E. (2024) · Clinical Nuclear Medicine · doi:10.1097/rlu.0000000000005538 · Cited by 2
Analysis of Molecular Imaging Biomarkers Derived from [18F]FDG PET/CT in mCRPC: Whole-Body Total Lesion Glycolysis (TLG) Predicts Overall Survival in Patients Undergoing [225Ac]Ac-PSMA-617-Augmented [177Lu]Lu-PSMA-617 Radioligand Therapy
Burgard, C., Khreish, F., Dahlmanns, L., Blickle, A., Bastian, M. B., Speicher, T., Maus, S., Schaefer-Schuler, A., Bartholomä, M. D., Petto, S., et al. (2024) · Cancers · doi:10.3390/cancers16203532 · Cited by 2
“In accordance with the current imaging guidelines [33], the interval between tracer injection and imaging was 60 min.”
Method
High concordance of PET‐CT treatment response evaluation according to PERCIST 1.0 when comparing images reconstructed with OSEM vs. BSREM
Skoglund, T., Minarik, D., Edenbrandt, L., & Trägårdh, E. (2024) · Clinical Physiology and Functional Imaging · doi:10.1111/cpf.12907 · Cited by 2
Measures for response assessment in HCC treatment
Yazdanpanah, F., Al‐Daoud, O., Moradpour, M., & Hunt, S. J. (2024) · Hepatoma Research · doi:10.20517/2394-5079.2024.60 · Cited by 1
Prognostic value of pretherapeutic 68 Ga-PSMA-11-PET based imaging parameters in mCRPC patients treated with PSMA radioligands
Nikoukar, L. R., Seifert, R., Ventura, D., Schindler, P., Bögemann, M., Rahbar, K., & Roll, W. (2024) · NuclearMedicine · doi:10.1055/a-2383-2468 · Cited by 2
Patlak Slope versus Standardized Uptake Value Image Quality in an Oncologic PET/CT Population: A Prospective Cross-Sectional Study
Ince, S., Laforest, R., Itani, M., Prasad, V., Ashrafinia, S., Smith, A. M., Wahl, R. L., & Fraum, T. J. (2024) · Diagnostics · doi:10.3390/diagnostics14090883 · Cited by 2
“The standardized uptake value (SUV) is the most widely utilized quantitative metric in positron emission tomography (PET) [1].”
BackgroundMethodSelf-citation
Repeatability of 18F-FDG uptake in metastatic bone lesions of breast cancer patients and implications for accrual to clinical trials
Muzi, M., Peterson, L., Specht, J., Hippe, D., Novakova-Jiresova, A., Lee, J. H., Kurland, B., Mankoff, D., Obuchowski, N. A., Linden, H., et al. (2024) · EJNMMI Research · doi:10.1186/s13550-024-01093-7 · Cited by 2
“The EORTC response criteria were expanded and modified by Wahl and colleagues in 2009 for the Positron Emission Tomography Response Criteria in Solid Tumors, or PERCIST [28].”
Method
A novel approach to evaluation of tumor response for advanced pulmonary adenocarcinoma using the intertumoral heterogeneity response score
Zheng, X.-L., Lu, T., Wu, S., Lin, X.-Y., Bai, J., Chen, X.-H., Miao, Q., Yan, J.-Q., Jiang, K., Zhang, L.-F., et al. (2024) · MedComm · doi:10.1002/mco2.493 · Cited by 2
“16 Although efforts have been made to develop improved versions such as iRECIST 17 and PERCIST 18 to accommodate advancements in immunotherapy and emerging imaging technologies, they still primarily focus on the overall tumor burden but neglect heterogeneity of tumor.”
Background
Role of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography in restaging of adrenocortical carcinoma
Öztürk, H. (2024) · Reports of Practical Oncology & Radiotherapy · doi:10.5603/rpor.98727 · Cited by 2
“However, these criteria do not include a functional component in the evaluation, which led to the proposal of new criteria [PET Response Criteria in Solid Tumors (PERCIST)] that combine functional FDG-PET imaging with cross-sectional body imaging [10].”
Background
PET/Computed Tomography Transformation of Oncology: Immunotherapy Assessment.
Ghodsi, A., Hicks, R. J., & Iravani, A. (2024) · PET Clinics · doi:10.1016/j.cpet.2023.12.012 · Cited by 2
Complete and early response to cemiplimab associated to severe immune toxicity in advanced cervical cancer: a case report
Passarelli, A., Pisano, C., Coppola, E., Ventriglia, J., Cecere, S., Napoli, M. D., Carideo, L., Lastoria, S., & Pignata, S. (2023) · Frontiers in Immunology · doi:10.3389/fimmu.2023.1303893 · Cited by 2
Utility of 18-Flurodeoxyglucose Positron Emission Tomography-Computed Tomography ( 18 FDG PET-CT) in Gallbladder Cancer: Experience from a Tertiary Care Hospital
Bisht, N., Lohia, N., Singh, S., Sarin, A., Mahato, A., Paliwal, D., Sinha, I., & Bhatnagar, S. (2023) · World Journal of Nuclear Medicine · doi:10.1055/s-0043-1777699 · Cited by 2
“20 Also, pooled results of a recent meta-analysis indicate that PET-CT has a good sensitivity (87”
Background
One-tenth-activity total-body positron emission tomography versus full-activity imaging in patients with a complex of hepatic malignant tumors: a retrospective study
Liu, G.-B., Tan, H., Sui, X., Qi, C., Cao, Y., Cai, D.-J., Hu, P.-C., Zhang, Y.-Q., & Shi, H.-C. (2023) · Quantitative Imaging in Medicine and Surgery · doi:10.21037/qims-23-719 · Cited by 2
“According to the PET Response Criteria in Solid Tumors (PERCIST), we defined a positive lesion on PET as follows: SUL peak of lesion >1.5 × SUL mean + 2.0 × SUL SD of the background liver, where SUL denotes SUV normalized by lean body weight (26).”
Influential
Evaluation of a semi-automated approach for FDG PET image analysis for routine clinical application in patients with multiple myeloma
Wellman, T., Mudd, S., Godby, K., Wooten, D. W., Ross, J. A., Bueno, O., Wanik, D., Divgi, C., Comley, R., Costa, L. J., et al. (2023) · Translational Oncology · doi:10.1016/j.tranon.2023.101767 · Cited by 2
“The PERCIST outcome for the follow-up timepoints was determined per patient using published methods [11,12].”
MethodInfluential
Quantitative uptake in 99mTc-EDDA/HYNIC-TOC somatostatin receptor imaging – the effect of long-acting release somatostatin analogue therapy
Gemmell, A., Brown, C., Ray, S., & Small, A. (2023) · Nuclear medicine communications · doi:10.1097/mnm.0000000000001746 · Cited by 2
Diagnostic potential of [18F]FDG PET/MRI in non-small cell lung cancer lymph node metastasis: a meta-analysis
Zhang, M., Yang, W., Yuan, Y., Liu, Z., Yue, X., Cao, X., & Han, B. (2023) · Japanese Journal of Radiology · doi:10.1007/s11604-023-01477-0 · Cited by 2
A Subset of Non-Small Cell Lung Cancer Patients Treated with Pemetrexed Show 18F-Fluorothymidine “Flare” on Positron Emission Tomography
Aravind, P., Popat, S., Barwick, T. D., Soneji, N. D. R., Lythgoe, M. P., Sreter, K. B., Lozano-Kühne, J., Bergqvist, M., Patel, N., Aboagye, E. O., et al. (2023) · Cancers · doi:10.3390/cancers15143718 · Cited by 2
“The repeatability of quantitative uptake measures with the 18F- fluorodeoxyglucose (18F-FDG) PET that has been integrated into the response assessment criteria Positron Emission Tomography Response Criteria in Solid Tumours (PERCIST) [19], as well as that of 18F-FLT, is deemed to be about 20% [20–22].”
Method
Multi-institutional analysis of cervical esophageal carcinoma patients treated with definitive chemoradiotherapy: TROD 01-005 study
Guler, O., Oymak, E., Yazici, G., Akagunduz, O., Çetinayak, O., Erpolat, P., Aksoy, A., Duzova, M., Yıldırım, B., Kurt, M., et al. (2023) · Oncology Research · doi:10.32604/or.2023.028840 · Cited by 2
Optimized 18F-FDG PET-CT Method to Improve Accuracy of Diagnosis of Metastatic Cancer
Black, R., Barentsz, J., Howell, D., Bostwick, D., & Strum, S. (2023) · Diagnostics · doi:10.3390/diagnostics13091580 · Cited by 2
“Fourth, the derived algorithm needs to be prospectively validated for utility in diagnosis of treatment response, including metabolic stability, metabolic progression, or complete or partial metabolic response utilizing EORTC criteria [36] or PERCIST criteria [20,37].”
BackgroundMethod
Assessment of 18F-DCFPyL PSMA PET/CT and PET/MR quantitative parameters for reference standard organs: Inter-reader, inter-modality, and inter-patient variability
Lawrence, E. M., Kieler, M., Cooley, G., Wells, S. A., & Cho, S. Y. (2023) · PLoS ONE · doi:10.1371/journal.pone.0283830 · Cited by 2

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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