Reproducibility and repeatability of same-day two sequential FDG PET/MR and PET/CT

Abstract Background To determine PET/CT and PET/MR reproducibility and PET/MR repeatability of fluorine 18 fluorodeoxyglucose (FDG) uptake measurements in tumors in cancer patients. Methods This IRB approved prospective study was performed between October 2015 and February 2016 in consecutive patients who performed same day PET/CT and two sequential PET/MR. Thirty three patients with visible tumors (N = 63) were included. SUV for body weight (SUV) and lean body mass (SUL) were obtained. Volume of interest (VOI) with a threshold of 40% was used and SUV/L’s, metabolic tumor volume (MTV) and tumor to liver ratio (T/L) were calculated. Measurements were plotted in a scattered diagram to visually identify correlation, a regression line was drawn and the equation of the line was calculated. Bland-Altman plots expressed as percentages were constructed to assess the agreement between measurements. The maximal clinically acceptable limits range was defined as ±30%. Results Lesional SUV’s, SUL’s and MTV corrected to body weight (BW) and lean body mass (LBM) demonstrated strong positive linear correlation between PET/CT and PET/MR and between two sequential PET/MR. The 95% limits of agreement ranged from -27.7 to 17.5 with a mean of -5.1 and -27.6 to 17.9 with a mean of -4.9 for SUVpeak and SULpeak, respectively for sequential PET/MR. Other PET metrics demonstrated limits range that is above ±30% between PET/CT and PET/MR and between two sequential PET/MR. Conclusion PET/MR SUV/L peak has a clinically acceptable repeatability performance and can be used to evaluate the response to treatment.