Comparative evaluation of SUV, tumor-to-blood standard uptake ratio (SUR), and dual time point measurements for assessment of the metabolic uptake rate in FDG PET

Hofheinz, Frank; Hoff, Jörg van den; Steffen, Ingo G.; Lougovski, Alexandr; Ego, Kilian; Amthauer, Holger; Apostolova, Ivayla

doi:10.1186/s13550-016-0208-5

Cited by 41 publications

(44 citation statements)

References 15 publications

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“…As to why SUR outperforms SUV, it is relevant to note that, contrary to SUV, SUR is (approximately) proportional to the tumors' 18 F-FDG uptake rate, K m , across different investigations, even in the presence of interindividual uptake time and BSUV variability (9,10,17). Assuming glucose metabolism is prognostic of treatment outcome, SUR can be expected to have a higher prognostic value than SUV.…”

Section: Discussionmentioning

confidence: 99%

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Prognostic Value of Standardized Uptake Ratio in Patients with Trimodality Treatment of Locally Advanced Esophageal Carcinoma

et al. 2018

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The prognosis of patients with esophageal carcinoma remains dismal despite ongoing efforts to improve treatment options. For locally advanced tumors, several randomized trials have shown the benefit of neoadjuvant chemoradiation followed by surgery compared to surgery alone. The aim of this exploratory study was to evaluate the prognostic value of different baseline positron emission tomography (PET) parameters and their potentially additional prognostic impact at the end of neoadjuvant radiochemotherapy. Furthermore, the standard uptake ratio (SUR) as a new parameter for quantification of tumor metabolism was compared to the conventional PET parameters metabolic active volume (MTV), total lesion glycolysis (TLG), and standardized uptake value (SUV) taking into account known basic parameters. F-FDG-PET/CT was performed in 76 consecutive patients ((60±10) years, 71 males) with newly diagnosed esophageal cancer before and during the last week of neoadjuvant radiochemotherapy. MTV of the primary tumor was delineated with an adaptive threshold method. The blood SUV was determined by manually delineating the aorta in the low dose CT. SUR values were computed as scan time corrected ratio of tumor SUV and mean blood SUV. Univariate Cox regression and Kaplan-Meier analysis with respect to locoregional control (LRC), freedom from distant metastases (FFDM), and overall survival (OS) was performed. Additionally, independence of PET parameters from standard clinical factors was analyzed with multivariate Cox regression. In multivariate analysis two parameters showed a significant correlation with all endpoints: restaging MTV and restaging SUR. Furthermore, restaging TLG was prognostic for LCR and FFDM. For all endpoints the largest effect size was found for restaging SUR. The only basic factors remaining significantin multivariate analyses were histology for OS and FFDM and age for LRC. PET provides independent prognostic information for OS, LRC, and FFDM in addition to standard clinical parameters in this patient cohort. Our results suggest that the prognostic value of tracer uptake can be improved when characterized by SUR rather than by SUV. Overall, our investigation revealed a higher prognostic value of restaging parameters compared to baseline PET; therapy-adjustments would still be possible at this point of time. Further investigations are required to confirm these hypothesis-generating results.

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Section: Discussionmentioning

confidence: 99%

“…Uptake time correction to T 0 5 75 min after injection was performed as described previously (10). A value of zero for the apparent volume of distribution was assumed (i.e., V r 5 0 was used in the correction formula) for the reasons discussed elsewhere (17). The uptake time-corrected SUR is then given by…”

Section: Pet Data Analysismentioning

confidence: 99%

Prognostic Value of Standardized Uptake Ratio in Patients with Trimodality Treatment of Locally Advanced Esophageal Carcinoma

et al. 2018

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“…This theoretical prediction has in fact been verified in patient data [9,11]. Two causes (beyond the elimination of all calibration related issues that is the principal advantage of any ratio method) are operational here: SUR corrects for the inherent variability of actual arterial tracer supply (present even after SUV normalization of the image data) [9] as well as for the practically unavoidable substantial variability of uptake time prior to scanning [8].…”

Section: Methodological Aspects Of Quantificationmentioning

confidence: 65%

“…So far, in oncological PET, especially the tumour to liver ratio (TLR) has been used (one example of this approach is the work of Huang et al [7]). More recently, we have proposed the imagederived tumour to arterial blood standard uptake ratio (SUR) as a promising alternative [8,9] and investigated its properties and performance compared to SUV [5,10,11]. We also addressed the question to what extent the healthy liver parenchyma might act as a substitute for actual arterial tracer supply [12].…”

Section: Methodological Aspects Of Quantificationmentioning

confidence: 99%

Quantification: there is more to worry about than good scanner hardware and reliable calibration

Kotzerke

Hoff

2017

Eur J Nucl Med Mol Imaging

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Positron emission tomography (PET) is Ban analytical imaging technology developed to use compounds labelled with positron-emitting radioisotopes as molecular probes to image and measure biochemical processes of mammalian biology in vivo^ [1]. One outstanding feature of the PET technology is the ability to perform absolute quantification of regional perfusion, metabolism, and function [2]. There are clinical demands for quantification regarding description of biodistribution, dosimetry, intra-and inter-individual comparisons, and setup of age-and gender-specific (normal) databases. Notably, FDG PET allows diagnosis, differential diagnosis, assessment of prognosis, and patient stratification in malignant disease. Moreover, image guided therapy has been proven to improve tumour delineation and irradiation field definition regarding protection of normal tissue and dose escalation on tumour tissue [3]. After initial assessment, followup investigations describe the effect of therapy and influence therapeutic management regarding continuation or change of modality and intensification or de-escalation of therapy. In addition to qualitative description and quantification of tracer uptake or uptake changes during follow-up, more sophisticated kinetic modelling and analysis may be applied. However, reliability and significance of all derived numbers is influenced by technical factors and biological processes. Methodological aspects of quantificationFormally, the principal goal in quantitative oncological FDG PET is to measure a surrogate of the tumour's metabolic rate of glucose consumption. Ideally, the surrogate parameter should be proportional to the latter quantity but, of course, a more general (linear or nonlinear) monotonic relation between surrogate and target parameter would suffice, too. But in any case, the respective relation has to be universally valid (i.e., invariant) across different scans, scanners, and patients. Otherwise, comparisons between different investigations are affected by spurious variability of the measured surrogate that is unrelated to actual changes in tumour metabolism.Currently, the standardized uptake value (SUV) is accepted as a suitable surrogate parameter derivable from static investigations, although it is widely recognized that its properties are far from ideal. Consequently, much effort has been invested to improve the reliability of SUV measurements by means of addressing the recognized technical issues, e.g., by focusing on strict calibration procedures and SOPs on how to perform measurement and data evaluation [4].Despite the unquestionable value of these efforts, test-retest stability of SUV remains rather unsatisfactory: even under highly controlled study conditions with nearly perfectly observed constant uptake times, test-retest variability is of the order of ±(30-40)% [5,6]. Consequently, SUV is not able to reliably detect (or exclude) moderate changes of the tumours' metabolic rate.In this context it is interesting to observe that there exist assorted reports of superior p...

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“…In this context, it seems worthwhile to note that the recently proposed and evaluated tumor-to-blood standard uptake ratio (SUR) approach [14,15,17] accounts for such true inter-individual BSUV differences. There is increasing evidence that SUR is superior to SUV as a surrogate for tumor metabolism in whole-body FDG-PET [20][21][22]. Naturally, given its definition as an imagederived ratio, changes/differences in scanner calibration are implicitly accounted for as well.…”

Section: Discussionmentioning

confidence: 99%

Monitoring scanner calibration using the image-derived arterial blood SUV in whole-body FDG-PET

et al. 2018

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BackgroundThe current de facto standard for quantification of tumor metabolism in oncological whole-body PET is the standardized uptake value (SUV) approach. SUV determination requires accurate scanner calibration. Residual inaccuracies of the calibration lead to biased SUV values. Especially, this can adversely affect multicenter trials where it is difficult to ensure reliable cross-calibration across participating sites. The goal of the present work was the evaluation of a new method for monitoring scanner calibration utilizing the image-derived arterial blood SUV (BSUV) averaged over a sufficiently large number of whole-body FDG-PET investigations.Data of 681 patients from three sites which underwent routine 18F-FDG PET/CT or PET/MR were retrospectively analyzed. BSUV was determined in the descending aorta using a three-dimensional ROI concentric to the aorta’s centerline. The ROI was delineated in the CT or MRI images and transferred to the PET images. A minimum ROI volume of 5 mL and a concentric safety margin to the aortic wall was observed. Mean BSUV, standard deviation (SD), and standard error of the mean (SE) were computed for three groups of patients at each site, investigated 2 years apart, respectively, with group sizes between 53 and 100 patients. Differences of mean BSUV between the individual groups and sites were determined.ResultsSD (SE) of BSUV in the different groups ranged from 14.3 to 20.7% (1.7 to 2.8%). Differences of mean BSUV between intra-site groups were small (1.1–6.3%). Only one out of nine of these differences reached statistical significance. Inter-site differences were distinctly larger (12.6–25.1%) and highly significant (P<0.001).ConclusionsImage-based determination of the group-averaged blood SUV in modestly large groups of whole-body FDG-PET investigations is a viable approach for ensuring consistent scanner calibration over time and across different sites. We propose this approach as a quality control and cross-calibration tool augmenting established phantom-based procedures.

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Comparative evaluation of SUV, tumor-to-blood standard uptake ratio (SUR), and dual time point measurements for assessment of the metabolic uptake rate in FDG PET

Cited by 41 publications

References 15 publications

Prognostic Value of Standardized Uptake Ratio in Patients with Trimodality Treatment of Locally Advanced Esophageal Carcinoma

Prognostic Value of Standardized Uptake Ratio in Patients with Trimodality Treatment of Locally Advanced Esophageal Carcinoma

Quantification: there is more to worry about than good scanner hardware and reliable calibration

Monitoring scanner calibration using the image-derived arterial blood SUV in whole-body FDG-PET

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