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Background  This study explores various volume of interest (VOI) delineation techniques for fluorine-18-fluorodeoxyglucose positron emission tomography with computed tomography ( 18 F-FDG PET-CT) scans during neoadjuvant extremity soft tissue sarcoma (ESTS) treatment.    Results  During neoadjuvant treatment, hyperthermic isolated limb perfusion (HILP) and preoperative external beam radiotherapy (EBRT), 11 patients underwent three  18 F-FDG PET-CT scans. The first scan was made prior to the HILP, the second after the HILP but prior to the start of the EBRT, and the third prior to surgical resection. An automatically drawn VOI auto , a manually drawn VOI man , and two gradient-based semi-automatically drawn VOIs (VOI grad  and VOI grad+ ) were obtained. Maximum standardized uptake value (SUV max ), SUV peak , SUV mean , metabolically active tumor volume (MATV), and total lesion glycolysis (TLG) were calculated from each VOI. The correlation and level of agreement between VOI delineation techniques was explored. Lastly, the changes in metabolic tumor activity were related to the histopathologic response. The strongest correlation and an acceptable level of agreement was found between the VOI man  and the VOI grad+  delineation techniques. A decline (VOI man ) in SUVmax, SUVpeak, SUVmean, TLG, and MATV (all  p  < 0.05) was found between the three scans. A > 75% decline in TLG between scan 1 and scan 3 possibly identifies histopathologic response.    Conclusions  The VOI grad+  delineation technique was identified as most reliable considering reproducibility when compared with the other VOI delineation techniques during the multimodality neoadjuvant treatment of locally advanced ESTS. A significant decline in metabolic tumor activity during the treatment was found. TLG deserves further exploration as predictor for histopathologic response after multimodality ESTS treatment.    Electronic supplementary material  The online version of this article (10.1186/s13550-018-0397-1) contains supplementary material, which is available to authorized users.

ejnmmi research

Volume of interest delineation techniques for 18F-FDG PET-CT scans during neoadjuvant extremity soft tissue sarcoma treatment in adults: a feasibility study