SUV- standardised uptake values in pet scanning

SUV’s - A Brief Overview of Silly Useless Values

1. Hunter Health Imaging Service
Todd Charge
Senior Technologist
Nuclear Medicine and PET Centre
Hunter Health Imaging Service
SUV’s - A Brief Overview of Silly Useless Values.

2. Hunter Health Imaging Service
Standardised Uptake Values


Quantification has always held a pervasive
allure for Nuclear Medicine.
There is a sense that anything that can be
quantified should be.

J.W. Keyes Jr. PET Centre North Carolina USA
Journal Nuclear Medicine 1995; 36:1836- 1839

3. Hunter Health Imaging Service
What are SUV’s?

A measure of FDG uptake as a function of
time
Quantitative evaluation of tumour
metabolism
Often used as a measure of malignancy vs.
benignancy of lesion

4. Hunter Health Imaging Service
Standardised Uptake Value
Data courtesy Mount Vernon Hospital

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Standardised Uptake Value
Pre Treatment
SUV = 18
Post Treatment
SUV = 4

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Standardised Uptake Value
eightdose/bodyw
SUV
)/(TC
=
Where C/(T) = FDG concentration in tissue
at time T

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Standardised Uptake Value

Tracer concentration is usually determined
from the image pixel that shows the highest
lesion activity
Average concentration was once used but
is not routinely in use now

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Assumptions of SUV’s

Negligible free FDG in tissue at time of PET
scan
Equilibrium reached between plasma and
free FDG in tissue
All tissues are affected in the same way by
glucose levels

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Variables Influencing SUV’s
Large number of variables which need to be
taken into account.
Patient size
Measurement times
Plasma Glucose
ROI
Partial Volume Effect
Camera specifications

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Summary
Use of Lean Body Mass instead of true
weight
Take plasma glucose levels into account,
tumour type & possible treatment effects
Standardise uptake time, attenuation
correction, scatter correction and filtering
Consider ROI placement and use of max
pixel

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Summary

Only use SUV within institution and even
camera specific
Be careful when using SUV threshold to
distinguish tumour from normal tissue
Consider SUV in conjunction with a
subjective analysis of a lesion.

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Summary


Overall, recognise SUV’s for what they are:

A helpful clue, but not the final answer.

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References



DiChiro G, Brooks RA. “PET quantitation: Blessing and Curse.” J Nucl Med
1988:29;1603- 1604
S Meikle “Quantitative Methods and Factors Affecting SUV Calculation”
ANZSNM PET Workshop 2003
JW Keyes “SUV: Standard Uptake or Silly Useless Value?” J Nucl Med
36:1836- 1839, 1995