In 18 F-FDG PET, tumors are often characterized by their metabolically active volume and standardized uptake value (SUV). However, many approaches have been proposed to estimate tumor volume and SUV from 18 F-FDG PET images, none of them being widely agreed upon. We assessed the accuracy and robustness of 5 methods for tumor volume estimates and of 10 methods for SUV estimates in a large variety of configurations. Methods: PET acquisitions of an anthropomorphic phantom containing 17 spheres (volumes between 0.43 and 97 mL, sphere-to-surrounding-activity concentration ratios between 2 and 68) were used. Forty-one nonspheric tumors (volumes between 0.6 and 92 mL, SUV of 2, 4, and 8) were also simulated and inserted in a real patient 18 F-FDG PET scan. Four threshold-based methods (including one, T bgd , accounting for background activity) and a model-based method (Fit) described in the literature were used for tumor volume measurements. The mean SUV in the resulting volumes were calculated, without and with partial-volume effect (PVE) correction, as well as the maximum SUV (SUV max ). The parameters involved in the tumor segmentation and SUV estimation methods were optimized using 3 approaches, corresponding to getting the best of each method or testing each method in more realistic situations in which the parameters cannot be perfectly optimized. Results: In the phantom and simulated data, the T bgd and Fit methods yielded the most accurate volume estimates, with mean errors of 2% 6 11% and 28% 6 21% in the most realistic situations. Considering the simulated data, all SUV not corrected for PVE had a mean bias between 231% and 246%, much larger than the bias observed with SUV max (211% 6 23%) or with the PVE-corrected SUV based on T bgd and Fit (22% 6 10% and 3% 6 24%). Conclusion: The method used to estimate tumor volume and SUV greatly affects the reliability of the estimates. The T bgd and Fit methods yielded low errors in volume estimates in a broad range of situations. The PVE-corrected SUV based on T bgd and Fit were more accurate and reproducible than SUV max .

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Our preliminary results showed that a high uptake of (18)F-FETNIM was associated with a worse progression-free and overall survival.