Reference range for intrapatient variability in blood-pool and liver SUV for 18F-FDG PET

(18)F-FDG PET qualitative tumor response assessment or tumor-to-background ratios compare targets against blood-pool or liver activity; standardized uptake value (SUV) semiquantitation has artifacts and is validated by a stable normal-tissue baseline. The aim of this study was to document the normal intrapatient range of scan-to-scan variation in blood-pool SUV and liver SUV and to identify factors that may adversely affect it (increase its spread).

Between July 2009 and June 2010, 132 oncology patients had 2 PET/CT scans. Patient preparation, acquisition, and reconstruction protocols were held stable, uniform, and reproducible. Mean SUV (body weight) values were obtained from 2-dimensional regions of interest in the aortic arch blood pool and in the right lobe of the liver.

Of the 132 patients, 65 had lymphoma. Their mean age was 62.5 y. The group's mean serum glucose level was 6.0 mmol/L at the first visit and 5.9 mmol/L at the second visit. The mean (18)F-FDG dose was 4.1 MBq/kg at the first visit and 4.0 at the second. At the first visit, the group's mean blood-pool SUV was 1.55 (SD, 0.38); at the second, 1.58 (SD, 0.37)-not statistically different. The group's mean liver SUV was 2.17 (SD, 0.44) at the first visit and 2.29 (SD, 0.44) at the second (P = 0.005). Visit-to-visit intrapatient variation in blood-pool and liver SUVs had gaussian distributions. The variation in blood-pool SUV had a mean of 0.03 and SD of 0.42. The variation in liver SUV had a mean of 0.12 and SD of 0.50. Using 95th percentiles, the reference range in our patient population for intrapatient variation was -0.8 to 0.9 for blood pool SUV and -0.9 to 1.1 for liver SUV. Subanalysis by cancer type and chemotherapy suggested that the rise in liver SUV between the 2 visits was largely due to the commencement of chemotherapy, but no factors were identified as systematically affecting intrapatient variation, and no factors were identified as increasing its spread.

In our patient cohort, the reference range for intrapatient variation in blood-pool and liver SUVs is -0.8 to 0.9 and -0.9 to 1.1, respectively.