Standards for PET Image Acquisition and Quantitative Data Analysis

Abstract

Quantitative 18 F-FDG PET is increasingly being recognized as an important tool for diagnosis, determination of prognosis, and response monitoring in oncology. However, PET quantification with, for example, standardized uptake values (SUVs) is affected by many technical and physiologic factors. As a result, some of the variations in the literature on SUV-based patient outcomes are explained by differences in 18 F-FDG PET study methods. Various technical and clinical studies have been performed to understand the factors affecting PET quantification. On the basis of the results of those studies, several recommendations and guidelines have been proposed with the aims of improving the image quality and the quantitative accuracy of 18 F-FDG PET studies. In this contribution, an overview of recommendations and guidelines for quantitative 18 F-FDG PET studies in oncology is provided. Special attention is given to the rationale underlying certain recommendations and to some of the differences in various guidelines.

Reply to comments by Laffon et al.: Liver SUV versus stage in Hodgkin’s lymphoma: the total amount of uptake may play a role in the inverse relationship

“…1) [2]. In agreement with Laffon et al, we can conclude that when a tissue shows an intense tracer uptake, the amount of tracer available to another tissue is reduced (to be specific, the circulating 18 F-FDG in the blood as detectable by means of mediastinum SUV max ) [4]. We would like to thank Laffon et al for their detailed comments and suggestions that have greatly improved the results of our study.…”

Associations Between Somatic Mutations and Metabolic Imaging Phenotypes in Non–Small Cell Lung Cancer

“…First, because of the retrospective nature of the study, the imaging protocols were not standardized for all the patients, resulting in different acquisition and reconstruction parameters (Table 1). Although these differences may lead to variability in quantification of SUV (46)(47)(48), the distributions of scanners used for PET/CT image acquisition were similar for all patient groups (Table 1). Second, partial-volume effects resulting from limited PET spatial resolution may lead to an underestimation of the metabolic tumor region and SUV measures (49).…”

Comparison of SUVs Normalized by Lean Body Mass Determined by CT with Those Normalized by Lean Body Mass Estimated by Predictive Equations in Normal Tissues

“…Many investigators have extensively studied biological and physical factors affecting numerators of the SUV equation such as region of interest (ROI) size, definition of ROI, image resolution and reconstruction algorithm, and uptake period [2]. Several studies have concerned denominator factors (i.e., normalization factors) such as body weight (BW), body surface area, lean body mass (LBM), and blood glucose level [3][4][5][6][7][8][9], in which LBM was estimated by various predictive equations (PEs).…”