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Updated: Sep 17, 2025
Author Spotlight: Enhancing Diagnostic Strategies and Biomarker Development for Comprehensive Lung Function Analysis
Published on: August 9, 2024
Pulmonary uptake value (PUV): a new quantification method for lung PET/CT imaging
Pierre-Yves Le Roux1, Romain Le Pennec2, Vincent Bourbonne3
1Univ Brest, CHU Brest, Médecine Nucléaire, GETBO, INSERM, UMR1304, CHU Cavale Blanche, 29609, Brest Cedex, France. pierre-yves.leroux@chu-brest.fr.
Background:
A current limitation to the use of lung PET/CT is the absence of a tool that reliably and reproducibly quantifies the intensity of tracer uptake. We aim to develop a quantitative approach for lung perfusion PET/CT imaging. Sixty patients who underwent [68Ga]Ga-MAA PET/CT scans before (M0) and 3 months (M3) after completion of radiotherapy were analyzed. The anatomical lung volume (ALV) was delineated on the CT scan. CT and PET images were co-registered, and the ALV was transferred onto the PET images. The measured activity concentration (kBq/L) in each voxel was converted in three metrics: SUV based on normalizing the measured activity to the patient's weight (kg) and the injected dose (kBq); SUVp by normalizing to the ALV (L) and the injected dose (kBq); pulmonary uptake value (PUV) by normalizing to the ALV (L) and the total activity measured in the ALV (kBq). The mean SUV, SUVp and PUV values within the ALV were measured.
Results:
The mean (SD) SUV in the ALV was 9.90 (5.24) with an inconsistently wide range of values from 0.11 to 22.52. The correlation coefficient between the patient's weight and the ALV was 0.14. The mean (SD) SUVp in the ALV was 0.54 (0.09). The mean (SD) percentage of [68Ga]Ga-MAA lung retention was 58.2% (7.7%), with significant variability both between patients and within repeated scans of the same patient. The mean PUV in the ALV used for normalization was equal to 1. Quantitative methods were tested in challenging scenarios for quantification, including patients exhibiting decorrelation between ALV and patient's weight and patients with different percentage of [68Ga]Ga-MAA lung retention between M0 and M3. In contrast to the SUV and SUVp metrics, the PUV method showed coherent results compared to visual analysis.
Conclusion:
The patient's weight and the injected activity are not suitable parameters for normalization in lung perfusion quantification. We proposed a quantitative metric for lung perfusion PET/CT imaging, based on normalizing the measured activity to the ALV computed from a co-registered CT scan and to the total activity measured in the ALV.
Trial Registration:
NCT04942275. Registered 19 June 2021.
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