# PERCIST — PERCIST 1.0 metabolic response criteria for solid tumors

> Patient-level FDG PET response using protocol-comparable SULpeak measurements of the hottest evaluable tumor plus whole-study review for new or unequivocally progressive disease.

**Situação:** vigente · **Órgão:** Oncologia · **Órgão emissor:** Wahl et al. / nuclear medicine consensus · **Versão:** 1.0 (2009; practical clarification 2016) · **Ano:** 2009

> ⚠️ Uma versão mais nova pode existir (em revisão).

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: PET, CT
- Fonte primária: Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria (2009) — https://doi.org/10.2967/jnumed.108.057307
- Última verificação: 2026-07-24
- Última checagem: 2026-08-12

## Lógica de decisão
Run the technical gate before the response thresholds. Keep pretreatment-baseline PERCIST 1.0 separate from nadir, immune and multi-lesion variants, and always pair the hottest-lesion calculation with whole-study review.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| CMR | Complete metabolic response | Complete metabolic response: abnormal FDG uptake resolves in every known tumor focus to a level below mean liver activity and indistinguishable from surrounding background blood-pool activity, with no new cancer-typical FDG-avid lesion. SULpeak need not become zero, and a residual anatomic mass can remain; the whole examination, not only the hottest focus, must support complete response. | Report CMR with the baseline and follow-up dates, acquisition comparability, residual morphology and any uncertainty, then defer treatment continuation, cessation and surveillance to the disease-specific multidisciplinary team. CMR is an imaging response state, not proof of pathologic eradication or an instruction to stop therapy. | CMR is the most favorable PERCIST metabolic category but supplies no individualized probability of cure, recurrence or survival. Small-volume viable disease may remain below PET resolution, and inflammation, glucose, uptake time or reconstruction differences can alter apparent activity. | Wahl et al. 2009, J Nucl Med 50 Suppl 1:122S-150S, DOI 10.2967/jnumed.108.057307, PMC2755245, proposed PERCIST 1.0 response definitions; O et al. 2016, Radiology 280:576-584, DOI 10.1148/radiol.2016142043, PMC4976461, Response Assessment and Practical PERCIST framework clarify background-level resolution, whole-study review and residual-mass interpretation. | ✓ |
| PMR | Partial metabolic response | Partial metabolic response: on technically comparable studies, the SULpeak of the single hottest evaluable malignant focus decreases by at least 30% and by at least 0.8 SUL units relative to the declared pretreatment baseline, with no credible new lesion, no unequivocal progression elsewhere and no disqualifying target-size increase. Both quantitative thresholds are required; the hottest focus at follow-up may be a different lesion. | Return the baseline and follow-up hottest-lesion identities, SULpeak values, relative and absolute changes, interval from treatment and full-study progression review. Use the result as one response input; the API must not infer a drug choice, treatment duration, dose change or operation from PMR alone. | PMR denotes a qualifying fall in FDG avidity but is not a calibrated patient-specific prognosis and does not exclude resistant or discordantly progressing clones. A result can be falsely favorable when the wrong reference scan, SUVmax, a noncomparable acquisition or only one lesion is reviewed. | Wahl et al. 2009, PMC2755245, PERCIST 1.0 quantitative response proposal; O et al. 2016, PMC4976461, Response Assessment, Measurement of Tumor SULpeak and Summary specify at least 30% plus 0.8-SUL decline, the hottest-lesion method, pretreatment reference and progression exclusions. | ✓ |
| SMD | Stable metabolic disease | Stable metabolic disease: the examination is quantitatively assessable and, after review of target, nontarget and new-lesion findings, meets none of CMR, PMR or PMD. Do not reduce SMD to a less-than-30% change shortcut: a new lesion, unequivocal discordant progression, complete resolution or a failed technical gate changes the result. | Report the continuous SULpeak change and technical quality rather than only the word stable, and distinguish biological stability from an indeterminate or noncomparable study. Clinical management remains dependent on tumor type, therapy, symptoms, toxicity, other imaging and protocol-defined endpoints. | SMD does not mean absence of viable tumor, lack of therapeutic benefit or inevitable failure, and it carries no universal survival estimate. Near-threshold measurement variability and mixed lesion behavior can be clinically important despite an unchanged category. | Wahl et al. 2009, PMC2755245, proposed four-category PERCIST synthesis; O et al. 2016, PMC4976461, Response Assessment and Summary define SMD residually after excluding complete response, partial response and progression and emphasize whole-body review and technical comparability. | ✓ |
| PMD | Progressive metabolic disease | Progressive metabolic disease: on comparable studies, the hottest malignant SULpeak increases by at least 30% and by at least 0.8 SUL units, or there is a credible new cancer-typical FDG-avid lesion, unequivocal increase in metabolic extent or qualifying discordant progression. Confirm a small or atypical new focus when inflammation, treatment effect or physiologic uptake is plausible, and record the mechanism that established PMD. | Flag technically supported PMD promptly with the responsible lesion, quantitative change, comparison date and confidence for oncology review. The response code must not autonomously stop or switch treatment; an equivocal new focus should retain an explicit confirmation plan rather than be forced into progression. | PMD indicates imaging evidence of progression but does not quantify survival, resistance mechanism or treatment benefit for an individual. Infection, granulomatous inflammation, immune effects, altered uptake time and partial-volume noise can mimic progression, whereas single-focus measurement can miss heterogeneous response. | Wahl et al. 2009, PMC2755245, PERCIST 1.0 PMD definition and whole-body disease assessment; O et al. 2016, PMC4976461, Response Assessment and Practical PERCIST framework specify the relative and absolute SULpeak increase, new-lesion and extent branches, and careful adjudication of equivocal foci. | ✓ |

### Citações por categoria
- **CMR**: Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria (2009) — https://doi.org/10.2967/jnumed.108.057307 · Wahl et al. 2009, J Nucl Med 50 Suppl 1:122S-150S, DOI 10.2967/jnumed.108.057307, PMC2755245, proposed PERCIST 1.0 response definitions; O et al. 2016, Radiology 280:576-584, DOI 10.1148/radiol.2016142043, PMC4976461, Response Assessment and Practical PERCIST framework clarify background-level resolution, whole-study review and residual-mass interpretation.
- **PMR**: Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria (2009) — https://doi.org/10.2967/jnumed.108.057307 · Wahl et al. 2009, PMC2755245, PERCIST 1.0 quantitative response proposal; O et al. 2016, PMC4976461, Response Assessment, Measurement of Tumor SULpeak and Summary specify at least 30% plus 0.8-SUL decline, the hottest-lesion method, pretreatment reference and progression exclusions.
- **SMD**: Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria (2009) — https://doi.org/10.2967/jnumed.108.057307 · Wahl et al. 2009, PMC2755245, proposed four-category PERCIST synthesis; O et al. 2016, PMC4976461, Response Assessment and Summary define SMD residually after excluding complete response, partial response and progression and emphasize whole-body review and technical comparability.
- **PMD**: Wahl RL, Jacene H, Kasamon Y, Lodge MA. From RECIST to PERCIST: evolving considerations for PET response criteria (2009) — https://doi.org/10.2967/jnumed.108.057307 · Wahl et al. 2009, PMC2755245, PERCIST 1.0 PMD definition and whole-body disease assessment; O et al. 2016, PMC4976461, Response Assessment and Practical PERCIST framework specify the relative and absolute SULpeak increase, new-lesion and extent branches, and careful adjudication of equivocal foci.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2026-08-12 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-08-04 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-29 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-28 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-26 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2026-07-25 | revised | Monitored source changed (content_hash). Detected automatically; awaiting reviewer confirmation. | needs_review |
| 2016-08-01 | revised | Practical PERCIST clarified acquisition comparability, target selection, response synthesis and equivocal progression without creating a new numbered version. | confirmed |
| 2009-05-01 | published | PERCIST 1.0 introduced a protocol-controlled SULpeak framework for FDG PET response assessment. | confirmed |


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> Conteúdo de referência reescrito. Confira a publicação primária vigente. Não é dispositivo médico nem substitui o julgamento clínico. O radiologista responsável pelo laudo permanece o autor e o responsável.

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