Comparison of simplified quantitative analyses of FDG uptake

Quantitative analysis of [F-18]-fluoro-deoxyglucose (FDG) uptake is importa nt in oncologic positron emission tomography (PET) studies to be able to se t an objective threshold in determining if a tissue is malignant or benign, in assessing response to therapy, and in attempting to predict the aggress iveness of an individual tumor. The most common method used today for simpl e, clinical quantitation is standardized uptake value (SUV). SUV is normali zed for body weight. Other potential normalization factors are lean body ma ss (LBM) or body surface area (BSA). More complex quantitation schemes incl ude simplified kinetic analysis (SKA), Patlak graphical analysis (PGA), and parameter optimization of the complete kinetic model to determine FDG meta bolic rate (FDGMR), These various methods were compared in a group of 40 pa tients with colon cancer metastatic to the liver. The methods were assessed by (1) correlation with FDGMR, (2) ability to predict survival using Kapla n-Meier plots, and (3) area under receiver operating characteristic (ROC) c urves for distinguishing between tumor and normal liver, The best normaliza tion scheme appears to be BSA with minor differences depending: on the spec ific formula used to calculate BSA, Overall, PGA is the best predictor of o utcome and best discriminator between normal tissue and tumor. SKA is almos t as good. In conventional PET imaging it is worthwhile to normalize SUV us ing BSA. If a single blood sample is available, it is possible to use the S KA method, which is distinctly better, If more than one image is available, along with at least one blood sample, PGA is feasible and should produce t he most accurate results. NUCL MED BIOL 27 7:647-655 2000. (C) 2000 Elsevie r Science Inc. All rights reserved.