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Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases

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Abstract
The standardized added metabolic activity (SAM) is a new marker of total lesion glycolysis that avoids partial volume effect (PVE) and thresholding. SAM is calculated by drawing a volume of interest (VOI1) around the tumour and a larger VOI (VOI2) around VOI1. Subtracting the background activity in VOI2-VOI1 from VOI1 yields SAM. If VOI1 is set at a reasonable distance from the tumour, PVE are avoided. Phantom and initial clinical validation data are presented. Spheres of a Jaszczak phantom were filled with a 5.4, 3.64 and 2.0 times higher concentration relative to background activity and positron emission tomography (PET) data were acquired during 10 min. SAM of all spheres was expressed as a percentage of the expected value (the actual activity ratio minus 1). In 15 patients a 10-min list-mode acquisition PET study centred on their primary squamous cell carcinoma (PSCC) was performed and images of 1-10 min reconstructed. SAM1-9min values of PSCC were expressed as a percentage of SAM10min. Nineteen patients suffering from liver metastases treated with chemotherapy underwent PET/CT prior to (scan 1) and after 3-6 cycles of chemotherapy (scan 2). SAM and maximum standardized uptake values (SUVmax) of the liver lesions on scan 1 (SAM1 and SUV(max)1) and the percentage reduction between both Delta SAM and Delta SUVmax were related to Response Evaluation Criteria in Solid Tumors (RECIST) response. For the phantom acquisitions, the mean normalized SAM/sphere volume calculated was 94.9 % (SD 5.9 %) of the expected value. In the PSCC patients, the mean difference between SAM1min and SAM10min was only 4 % (SD 5 %). SUV(max)1min and SUV(max)10min proved to be not significantly different, but the variability was slightly larger than that of SAM (SD 6.4 %). SAM1 and Delta SAM values for responders versus non-responders were, respectively, 57 (SD 119) versus 297 (SD 625) for SAM1 (p = 0.2) and 99 % (SD 3 %) versus 32 % (SD 44 %) for Delta SAM (p = 0.001). SUV(max)1 and Delta SUVmax values in responders versus non-responders were, respectively, 3.9 (SD 2.4) versus 6.3 (SD 3.1) for SUV(max)1 (p = 0.08) and 94 % (SD 17) versus 7 % (SD 40 %) for Delta SUVmax (p = 0.0001). The AUC of Delta SAM and Delta SUVmax were not significantly different on receiver-operating characteristic (ROC) analysis (AUC 1.0 and 0.99, respectively, p = 0.6). SAM is a promising parameter for tumour response assessment of liver metastases by means of F-18-fluorodeoxyglucose PET.
Keywords
CRITERIA, F-18-FDG, F-18-FDG PET, POSITRON-EMISSION-TOMOGRAPHY, TUMOR VOLUME, SOLID TUMORS, NECK-CANCER, FDG-PET, ADVANCED HEAD, THERAPY, RADIOTHERAPY, Total lesion glycolysis, Therapy monitoring, Partial volume effect, Standardized added metabolic activity

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MLA
Mertens, Jeroen, André Dobbeleir, Hamphrey Ham, et al. “Standardized Added Metabolic Activity (SAM): a Partial Volume Independent Marker of Total Lesion Glycolysis in Liver Metastases.” EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING 39.9 (2012): 1441–1448. Print.
APA
Mertens, Jeroen, Dobbeleir, A., Ham, H., D’Asseler, Y., Goethals, I., & Van De Wiele, C. (2012). Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases. EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, 39(9), 1441–1448.
Chicago author-date
Mertens, Jeroen, André Dobbeleir, Hamphrey Ham, Yves D’Asseler, Ingeborg Goethals, and Christophe Van De Wiele. 2012. “Standardized Added Metabolic Activity (SAM): a Partial Volume Independent Marker of Total Lesion Glycolysis in Liver Metastases.” European Journal of Nuclear Medicine and Molecular Imaging 39 (9): 1441–1448.
Chicago author-date (all authors)
Mertens, Jeroen, André Dobbeleir, Hamphrey Ham, Yves D’Asseler, Ingeborg Goethals, and Christophe Van De Wiele. 2012. “Standardized Added Metabolic Activity (SAM): a Partial Volume Independent Marker of Total Lesion Glycolysis in Liver Metastases.” European Journal of Nuclear Medicine and Molecular Imaging 39 (9): 1441–1448.
Vancouver
1.
Mertens J, Dobbeleir A, Ham H, D’Asseler Y, Goethals I, Van De Wiele C. Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases. EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING. 2012;39(9):1441–8.
IEEE
[1]
J. Mertens, A. Dobbeleir, H. Ham, Y. D’Asseler, I. Goethals, and C. Van De Wiele, “Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases,” EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING, vol. 39, no. 9, pp. 1441–1448, 2012.
@article{3141984,
  abstract     = {The standardized added metabolic activity (SAM) is a new marker of total lesion glycolysis that avoids partial volume effect (PVE) and thresholding. SAM is calculated by drawing a volume of interest (VOI1) around the tumour and a larger VOI (VOI2) around VOI1. Subtracting the background activity in VOI2-VOI1 from VOI1 yields SAM. If VOI1 is set at a reasonable distance from the tumour, PVE are avoided. Phantom and initial clinical validation data are presented. 
Spheres of a Jaszczak phantom were filled with a 5.4, 3.64 and 2.0 times higher concentration relative to background activity and positron emission tomography (PET) data were acquired during 10 min. SAM of all spheres was expressed as a percentage of the expected value (the actual activity ratio minus 1). In 15 patients a 10-min list-mode acquisition PET study centred on their primary squamous cell carcinoma (PSCC) was performed and images of 1-10 min reconstructed. SAM1-9min values of PSCC were expressed as a percentage of SAM10min. Nineteen patients suffering from liver metastases treated with chemotherapy underwent PET/CT prior to (scan 1) and after 3-6 cycles of chemotherapy (scan 2). SAM and maximum standardized uptake values (SUVmax) of the liver lesions on scan 1 (SAM1 and SUV(max)1) and the percentage reduction between both Delta SAM and Delta SUVmax were related to Response Evaluation Criteria in Solid Tumors (RECIST) response. 
For the phantom acquisitions, the mean normalized SAM/sphere volume calculated was 94.9 % (SD 5.9 %) of the expected value. In the PSCC patients, the mean difference between SAM1min and SAM10min was only 4 % (SD 5 %). SUV(max)1min and SUV(max)10min proved to be not significantly different, but the variability was slightly larger than that of SAM (SD 6.4 %). SAM1 and Delta SAM values for responders versus non-responders were, respectively, 57 (SD 119) versus 297 (SD 625) for SAM1 (p = 0.2) and 99 % (SD 3 %) versus 32 % (SD 44 %) for Delta SAM (p = 0.001). SUV(max)1 and Delta SUVmax values in responders versus non-responders were, respectively, 3.9 (SD 2.4) versus 6.3 (SD 3.1) for SUV(max)1 (p = 0.08) and 94 % (SD 17) versus 7 % (SD 40 %) for Delta SUVmax (p = 0.0001). The AUC of Delta SAM and Delta SUVmax were not significantly different on receiver-operating characteristic (ROC) analysis (AUC 1.0 and 0.99, respectively, p = 0.6). 
SAM is a promising parameter for tumour response assessment of liver metastases by means of F-18-fluorodeoxyglucose PET.},
  author       = {Mertens, Jeroen and Dobbeleir, André and Ham, Hamphrey and D'Asseler, Yves and Goethals, Ingeborg and Van De Wiele, Christophe},
  issn         = {1619-7070},
  journal      = {EUROPEAN JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING},
  keywords     = {CRITERIA,F-18-FDG,F-18-FDG PET,POSITRON-EMISSION-TOMOGRAPHY,TUMOR VOLUME,SOLID TUMORS,NECK-CANCER,FDG-PET,ADVANCED HEAD,THERAPY,RADIOTHERAPY,Total lesion glycolysis,Therapy monitoring,Partial volume effect,Standardized added metabolic activity},
  language     = {eng},
  number       = {9},
  pages        = {1441--1448},
  title        = {Standardized added metabolic activity (SAM): a partial volume independent marker of total lesion glycolysis in liver metastases},
  url          = {http://dx.doi.org/10.1007/s00259-012-2166-0},
  volume       = {39},
  year         = {2012},
}

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