Repeatability of the Maximum Standard Uptake Value (SUVmax) in FDG PET

Objective: SUV(max) is often calculated at FDG PET examinations in systematic studies as well as at clinical examinations. Since SUV(max) represents a very small portion of a lesion it may be questioned how statistically reliable the figure is. This was studied by assessing the repeatability of SUV(max) between two FDG acquisitions acquired immediately upon each other in patients with chest lesions. Methods: In 100 clinical patients with a known chest lesion, two identical 3 min PET registrations (PET1 and PET2, respectively) were initiated within 224±31 sec of each other. The difference in SUV(max) between the lesion for the two PET scans (ΔSUVmax) was calculated and the uncertainty expressed as the coefficient of variation, CV (%). The correlation between ΔSUV(max) and the lowest SUV(max) from PET1 or PET2, the approximate metabolic lesion volume, the time from FDG injection to PET1 and the time between PET1 and PET2, respectively, was also assessed. Results: In 56 patients SUV(max) increased at the second acquisition and in 44 patients it decreased. Mean of SUV(max) was 7.8±6.1 and 7.8±6.2 for PET1 and PET2, respectively. The mean percentage difference was 0.9±7.8. The difference was not significant (p=0.20). CV gave an uncertainty of 4.3% between the two measurements which is a strong indicator of equivalence. There was no correlation between ΔSUV(max) and any of the assessed four parameters. The difference between the acquisitions, 0.9%, was much lower compared to the 3 previous published similar, but more restricted studies where the difference was 2.5-8.2%. Conclusion: From camera and computational perspectives, SUV(max) is a stable parameter Conflict of interest:None declared.