Evidence map›Paper›PMID 31879795›Full record

ArticleEJNMMI physics2019

Quantitative implications of the updated EARL 2019 PET-CT performance standards.

Andres Kaalep, Coreline N Burggraaff, Simone Pieplenbosch, Eline E Verwer, Terez Sera, Josee Zijlstra, Otto S Hoekstra, Daniela E Oprea-Lager, Ronald Boellaard

Abstract read
In one paragraph

Article in EJNMMI physics, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
43citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

43 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Guideline
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  3. Whole-body CD8Nature communications · 2025
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  8. SUV normalisation and reference tissue selection for [European journal of nuclear medicine and molecular imaging · 2025
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  16. Mitigating SUV uncertainties using total body PET imaging.European journal of nuclear medicine and molecular imaging · 2024
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  20. Sensitivity of an AI method for [EJNMMI research · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

9 authors.

Andres KaalepDepartment of Medical Technology, North Estonia Medical Centre Foundation, J. Sutiste Str 19, Tallinn, 13419, Republic of Estonia. kaalep@gmail.com.
Coreline N BurggraaffDepartment of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Simone PieplenboschDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands.
Eline E VerwerDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands.
Terez SeraDepartment of Nuclear Medicine, University of Szeged, Szeged, Hungary.
Josee ZijlstraDepartment of Hematology, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Otto S HoekstraDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands.
Daniela E Oprea-LagerDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands.
Ronald BoellaardDepartment of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Cancer Center Amsterdam, De Boelelaan 1117, Amsterdam, 1081HV, the Netherlands. r.boellaard@umcg.nl.ORCID http://orcid.org/0000-0002-0313-5686

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeRecently, updated EARL specifications (EARL2) have been developed and announced. This study aims at investigating the impact of the EARL2 specifications on the quantitative reads of clinical PET-CT studies and testing a method to enable the use of the EARL2 standards whilst still generating quantitative reads compliant with current EARL standards (EARL1).

methodsThirteen non-small cell lung cancer (NSCLC) and seventeen lymphoma PET-CT studies were used to derive four image datasets-the first dataset complying with EARL1 specifications and the second reconstructed using parameters as described in EARL2. For the third (EARL2F6) and fourth (EARL2F7) dataset in EARL2, respectively, 6 mm and 7 mm Gaussian post-filtering was applied. We compared the results of quantitative metrics (MATV, SUVmax, SUVpeak, SUVmean, TLG, and tumor-to-liver and tumor-to-blood pool ratios) obtained with these 4 datasets in 55 suspected malignant lesions using three commonly used segmentation/volume of interest (VOI) methods (MAX41, A50P, SUV4).

resultsWe found that with EARL2 MAX41 VOI method, MATV decreases by 22%, TLG remains unchanged and SUV values increase by 23-30% depending on the specific metric used. The EARL2F7 dataset produced quantitative metrics best aligning with EARL1, with no significant differences between most of the datasets (p>0.05). Different VOI methods performed similarly with regard to SUV metrics but differences in MATV as well as TLG were observed. No significant difference between NSCLC and lymphoma cancer types was observed.

conclusionsApplication of EARL2 standards can result in higher SUVs, reduced MATV and slightly changed TLG values relative to EARL1. Applying a Gaussian filter to PET images reconstructed using EARL2 parameters successfully yielded EARL1 compliant data.

Indexed as

CTEARL accreditationHarmonisationPerformancePETQuantificationStandards

Identifiers

PMID31879795
PMCPMC6933045

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.