SUV(fdg): A standard-uptake-value (SUV) body habitus normalizer specific to fluorodeoxyglucose (FDG) in humans

PURPOSE: To devise a new body-habitus normalizer to be used in the calculation of an SUV that is specific to the PET tracer (18)F-FDG. METHODS: A cohort of 481-patients was selected for analysis of (18)F-FDG uptake into tissues unaffected by their disease. Among these, 65-patients had only brain concentrations measured and the remaining 416 were randomly divided into an 86-patient test set and a 330-patient training set. Within the test set, normal liver, spleen and blood measures were made. In the training set, only normal liver concentrations were measured. Using data from the training set, a simple polynomial function of height and weight was selected and optimized in a fitting procedure to predict each patient’s mean liver %ID/ml. This function, when used as a normalizer, defines a new SUV metric (SUV(fdg)) which we compared to SUV metrics normalized by body weight (SUV(bw)), lean-body mass (SUV(lbm)) and body surface-area (SUV(bsa)) in a five-fold cross-validation. SUV(fdg) was also evaluated in the independent brain-only and whole-body test sets. RESULTS: For patients of all sizes including pediatric patients, the normal range of liver (18)F-FDG uptake at 60 minutes post injection in units of SUV(fdg) is 1.0 ± 0.16. Liver, blood, and spleen SUV(fdg) in all comparisons had lower coefficients of variation compared to SUV(bw) SUV(lbm) and SUV(bsa). Blood had a mean SUV(fdg) of 0.8 ± 0.11 and showed no correlation with age, height, or weight. Brain SUV(fdg) measures were significantly higher (P<0.01) in pediatric patients (4.7 ± 0.9) compared to adults (3.1 ± 0.6). CONCLUSION: A new SUV metric, SUV(fdg), is proposed. It is hoped that SUV(fdg) will prove to be better at classifying tumor lesions compared to SUV metrics in current use. Other tracers may benefit from similarly tracer-specific body habitus normalizers.