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Background  In clinical routine, SUV max  and SUV peak  are most often used to determine the glucose metabolism in tumours by  18 F-FDG PET/CT. Both metrics can be further normalised to SUVs in reference regions resulting in a SUV ratio (SUV ratio ). The aim of the study was to directly compare several widely used SUVs/SUV ratios  with regard to differentiation between common tumours in paediatric patients; a special focus was put on characteristics of reference region SUVs.    Methods  The final study population consisted of 61 children and adolescents with diagnoses of non-Hodgkin lymphoma (NHL,  n  = 25), Hodgkin lymphoma (HL,  n  = 14), and sarcoma ( n  = 22). SUV metrics included SUV max  and SUV peak  as well as both parameters normalised to liver and mediastinal blood pool, respectively, yielding the SUV ratios  SUV max/liver , SUV max/mediastinum , SUV peak/liver , and SUV peak/mediastinum .    Results  The metrics SUV max , SUV peak , SUV max/liver , and SUV peak/liver  all proved to be sensitive for tumour differentiation ( p  ≤ 0.008); in contrast, SUV max/mediastinum  and SUV peak/mediastinum  revealed to be non-sensitive approaches. Correlation analyses showed inverse associations between reference region SUVs and SUV ratios  ( p  < 0.05). Multiple regression analyses demonstrated significant effects of factors as bodyweight and uptake time on reference region SUVs ( p  < 0.01), and thus indirectly on the corresponding SUV ratios .    Conclusions  In the paediatric population, the ability to differentiate between common tumours remarkably varies between SUV metrics. When using SUV ratios , the choice of reference region is crucial. Factors potentially influencing reference region SUVs (and thus SUV ratios ) should be taken into account in order to avoid erroneous conclusions. When not possible, SUV max  and SUV peak  represent less complex, more robust alternatives.

ejnmmi research

What and how should we measure in paediatric oncology FDG-PET/CT? Comparison of commonly used SUV metrics for differentiation between paediatric tumours