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Standardized uptake value in pediatric patients: an investigation to determine the optimum measurement parameter
H W Yeung1, A Sanches, O D Squire
1Division of Nuclear Medicine, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York City, NY 10021, USA. yeungh@mskcc.org
Insights
Standardized uptake value (SUV) in pediatric FDG-PET imaging is more reliable when normalized to body surface area (BSA) than to body weight. BSA normalization provides a more uniform parameter for assessing pediatric patients.
Area of Science:
- Nuclear Medicine
- Pediatric Imaging
- Radiopharmaceuticals
Background:
- Standardized uptake value (SUV) is a common metric in fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging.
- Concerns exist regarding the accuracy and clinical relevance of SUV, particularly its dependence on body weight in adults.
- Significant body composition changes in children necessitate evaluating SUV normalization methods for pediatric populations.
Purpose of the Study:
- To compare SUV measurements normalized by body weight, body surface area (BSA), and lean body mass (LBM) in pediatric FDG-PET studies.
- To identify a more reliable and consistent parameter for SUV quantification across different pediatric ages and weights.
- To assess the impact of normalization methods on liver and tumor lesion uptake values.
Main Methods:
- Evaluation of 68 pediatric FDG-PET studies (ages 2-17 years, weights 11-77 kg).
- Regions of interest placed on the liver for physiologic comparison and on FDG-avid malignant lesions.
- Calculation and comparison of SUV normalized to body weight (SUV(bw)), BSA (SUV(bsa)), and LBM (SUV(lbm)).
Main Results:
- SUV(bw) showed significant variation with weight, which was less pronounced with SUV(bsa).
- SUV(lbm) also correlated with weight, but normalization to BSA (SUV(bsa-lbm)) reduced this dependence.
- Liver SUV(bw) was lower in pediatric patients (1.1±0.3) compared to adults (1.9±0.3), while liver SUV(bsa) was 7.3±1.3.
- Tumor SUV(bw) was 4.0±2.7 and SUV(bsa) was 25.9±15.4; 65% of patients had neuroblastoma.
- BSA-based SUVs demonstrated greater constancy across pediatric ages and less dependence on weight than SUV(bw).
Conclusions:
- SUV normalization to body surface area (BSA) offers a more uniform and consistent parameter in pediatric FDG-PET imaging compared to body weight normalization.
- BSA-based SUV is likely the most appropriate method for monitoring pediatric patients undergoing FDG-PET scans.
- This finding has significant implications for accurate interpretation and follow-up of pediatric oncologic and other FDG-avid conditions.
Abstract:
Although the standardized uptake value (SUV) is currently used in fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) imaging, concerns have been raised over its accuracy and clinical relevance. Dependence of the SUV on body weight has been observed in adults and this should be of concern in the pediatric population, since there are significant body changes during childhood. The aim of the present study was to compare SUV measurements based on body weight, body surface area and lean body mass in the pediatric population and to determine a more reliable parameter across all ages. Sixty-eight pediatric FDG-PET studies were evaluated. Age ranged from 2 to 17 years and weight from 11 to 77 kg. Regions of interest were drawn at the liver for physiologic comparison and at FDG-avid malignant lesions. SUV based on body weight (SUV(bw)) varied across different weights, a phenomenon less evident when body surface area (SUV(bsa)) normalization is applied. Lean body mass-based SUV (SUV(lbm)) also showed a positive correlation with weight, which again was less evident when normalized to bsa (SUV(bsa-lbm)). The measured liver SUV(bw) was 1.1+/-0.3, a much lower value than in our adult population (1.9+/-0.3). The liver SUV(bsa) was 7.3+/-1.3. The tumor sites had an SUV(bw) of 4.0+/-2.7 and an SUV(bsa) of 25.9+/-15.4 (65% of the patients had neuroblastoma). The bsa-based SUVs were more constant across the pediatric ages and were less dependent on body weight than the SUV(bw). These results indicate that SUV calculated on the basis of body surface area is a more uniform parameter than SUV based on body weight in pediatric patients and is probably the most appropriate approach for the follow-up of these patients.