PET/CT中的SUV计算与正常组织变异性分析

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"这篇文章主要探讨了SUV（标准摄取值）在正电子发射断层扫描/计算机断层扫描（PET/CT）中的计算方法及其在正常组织中的变异性。作者通过研究评估了不同测量SUV的方法对结果的影响，并考虑了体重、身高、血糖水平、注射剂量和摄取时间等因素。实验涉及70例无癌症的患者，在两次平均间隔271天的研究中，他们在肝脏、肺部、纵隔和斜方肌四个区域进行了SUV的测定。研究还讨论了基于体重、瘦体重（LBM）、体表面积（BSA）以及结合血糖水平的SUV标准化方法。结果显示，在肺部和肌肉等组织中，代谢活性存在一定的变异性和方法依赖性。" 文章深入浅出地介绍了SUV的基本概念，它是PET/CT成像中一个关键的量化指标，用于评估体内组织对放射性示踪剂的摄取程度，通常用以诊断和监测肿瘤疾病。SUV的计算公式是：(放射性药物摄取量 / 注射剂量) / (体重或其它生理参数)，这里的生理参数可以是体重、瘦体重、体表面积等，以减少个体差异的影响。在正常组织中，SUV的变异性和稳定性对于临床应用至关重要，因为这直接影响到对异常摄取的判断。文章指出，尽管在两次扫描之间患者的体重、血糖水平等指标保持稳定，但不同组织的SUV仍存在变异，这可能与生理过程、示踪剂分布的不均匀性以及测量方法的差异有关。研究中，作者选择了四个代表性区域进行分析，包括肝脏（作为解剖参照）、肺部（常见于肺癌筛查）、纵隔（可能涉及多种肿瘤）和斜方肌（代表肌肉组织）。通过比较不同的SUV标准化方法，他们发现不同方法可能导致SUV的结果有所不同，特别是在考虑到血糖水平时，因为高血糖可能会影响示踪剂的摄取。该文章强调了SUV计算的复杂性和在实际应用中的注意事项，这对于PET/CT的临床医生和技术人员来说是非常重要的信息。了解并掌握这些知识，能帮助他们更准确地解读PET/CT图像，提高诊断的可靠性和精确度。

Within-Patient Variability of

F-FDG:

Standardized Uptake Values in Normal Tissues

Nancy Paquet, MD

; Adelin Albert, PhD

; Jacqueline Foidart, MD, PhD

; and Roland Hustinx, MD, PhD

Division of Nuclear Medicine, University Hospital of Lie`ge, Lie`ge, Belgium; and

Department of Biostatistics, University Hospital

of Lie`ge, Lie`ge, Belgium

The aim of this study was to evaluate the test–retest variability

of standardized uptake values (SUVs) in normal tissues and the

impact of various methods for measuring the SUV. Methods:

SUVs were determined in 70 cancer-free patients (40 female

and 30 male) on 2 occasions an average of 271 d apart. Mean

values for body weight and height, blood glucose level, injected

dose, and uptake period did not change between the 2 groups

of studies. Four regions of interest (ROIs) were placed— on the

liver, lung, mediastinum, and trapezius muscle. Mean and max-

imum SUVs normalized for body weight were obtained, and

normalizations were then applied for lean body mass (LBM),

LBM and blood glucose level, body surface area (BSA), and

BSA and blood glucose level. Results: In the lungs and muscle,

metabolic activity within the ROIs was signiﬁcantly different in

the 2 studies, no matter which method was used for the SUVs.

The differences ranged from 0.02 to 0.1 for SUV normalized for

body weight and SUV normalized for LBM and from 0.001 to

0.002 for SUV normalized for BSA. In the liver, results were

similar for all SUVs, except for maximum SUV corrected for

LBM and maximum SUV corrected for LBM and blood glucose

level. The metabolic activity measured in the mediastinum was

also comparable in the 2 studies, regardless of the type of SUV.

When investigating whether any normalization method for SUVs

reduces variability and improves test–retest concordance, we

found no signiﬁcant superiority for any. The best intraclass

correlation coefﬁcients were obtained with the SUV normalized

for body weight, in both the liver and the mediastinum, but the

coefﬁcients of variation were similar for all 3 mean SUVs that

were not corrected for glucose level (range, 10.8%–13.4%).

However, normalizing for blood glucose level increased the

variability and decreased the level of concordance between

studies. Conclusion: The SUVs measured in normal liver and

mediastinum in cancer-free patients are stable over time, no

matter which normalization is used. Correcting for blood glu-

cose level increases the variability of the values and should

therefore be avoided. Normalizing for BSA or LBM does not

improve the reproducibility of the measurements.

Key Words: instrumentation; oncology;

F-FDG PET; stan-

dardized uptake value; test–retest variability

J Nucl Med 2004; 45:784 –788

The increased glucose metabolism of cancer cells is used

to detect neoplasms with

F-FDG PET imaging, for either

initial staging, posttreatment follow-up, or detection of sus-

pected recurrence. In clinical routine, images are analyzed

either qualitatively, using visual comparison of the metab-

olism in lesions versus normal tissue, or semiquantitatively,

using standardized uptake values (SUVs). SUV is deﬁned as

the tissue concentration (MBq/mL) divided by activity in-

jected per body weight (MBq/g). Many authors have dis-

cussed the multiple factors affecting the SUV, such as

weight, plasma glucose level, length of uptake period, par-

tial-volume effects, and recovery coefﬁcient (1–5).

To our knowledge, there has been no published report of

the test–retest within-patient variability of SUV in normal

tissues. The purpose of this work was to evaluate this issue

and to verify whether one correction method for SUV is

more reproducible than the others. Both the qualitative and

the quantitative evaluation of

F-FDG PET images could

be affected.

MATERIALS AND METHODS

Patients

The data on 70 patients (40 female and 30 male; mean age ⫾

SD, 50 ⫾ 16 y) who underwent 2

F-FDG PET examinations with

normal ﬁndings (271 ⫾ 118 d apart) were analyzed retrospec-

tively. The patients were referred for follow-up of lymphoma

(41%), melanoma (39%), lung carcinoma (10%), gastrointestinal

carcinoma (5%), renal carcinoma (3%), or ovarian carcinoma

(2%). None of the patients received anticancer treatment within 3

mo before the studies or experienced tumor recurrence between the

2 studies. All studies were reviewed by 2 experienced nuclear

medicine physicians, fully aware of all clinical data, and the results

were found to be rigorously normal.

Average body weight (70 ⫾ 12 kg) and height (168 ⫾ 10 cm)

were stable between the 2 studies. The change in weight was 0.7 ⫾

4.2 kg between studies. Only 9 of 70 patients had changes exceed-

ing 10% of their initial weight (13% of the population sample).

The blood glucose level was measured in all patients before

injection. The average glucose level was 4.8 ⫾ 0.9 mmol/L (3.2–

9.6 mmol/L) for study A (test) and 4.9 ⫾ 0.9 mmol/L (3.6–8.3

mmol/L) for study B (retest) (P ⫽ 0.29).

Received Sep. 23, 2003; revision accepted Dec. 12, 2003.

For correspondence or reprints contact: Roland Hustinx, MD, PhD, Division

of Nuclear Medicine, University Hospital of Lie` ge, Sart-Tilman B35, 4000

Lie` ge 1, Belgium.

E-mail: rhustinx@chu.ulg.ac.be

784 THE JOURNAL OF NUCLEAR MEDICINE • Vol. 45 • No. 5 • May 2004

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