SUV variability in EARL-accredited conventional and digital PET

Daniëlle Koopman, Pieter L Jager, Cornelis H Slump, Siert Knollema, Jorn A van Dalen, Daniëlle Koopman, Pieter L Jager, Cornelis H Slump, Siert Knollema, Jorn A van Dalen

Abstract

Background: A high SUV-reproducibility is crucial when different PET scanners are in use. We evaluated the SUV variability in whole-body FDG-PET scans of patients with suspected or proven cancer using an EARL-accredited conventional and digital PET scanner. In a head-to-head comparison we studied images of 50 patients acquired on a conventional scanner (cPET, Ingenuity TF PET/CT, Philips) and compared them with images acquired on a digital scanner (dPET, Vereos PET/CT, Philips). The PET scanning order was randomised and EARL-compatible reconstructions were applied. We measured SUVmean, SUVpeak, SUVmax and lesion diameter in up to 5 FDG-positive lesions per patient. The relative difference ΔSUV between cPET and dPET was calculated for each SUV-parameter. Furthermore, we calculated repeatability coefficients, reflecting the 95% confidence interval of ΔSUV.

Results: We included 128 lesions with an average size of 19 ± 14 mm. Average ΔSUVs were 6-8% with dPET values being higher for all three SUV-parameters (p < 0.001). ΔSUVmax was significantly higher than ΔSUVmean (8% vs. 6%, p = 0.002) and than ΔSUVpeak (8% vs. 7%, p = 0.03). Repeatability coefficients across individual lesions were 27% (ΔSUVmean and ΔSUVpeak) and 33% (ΔSUVmax) (p < 0.001).

Conclusions: With EARL-accredited conventional and digital PET, we found a limited SUV variability with average differences up to 8%. Furthermore, only a limited number of lesions showed a SUV difference of more than 30%. These findings indicate that EARL standardisation works.

Trial registration: This prospective study was registered on the 31th of October 2017 at ClinicalTrials.cov. URL: https://ichgcp.net/clinical-trials-registry/NCT03457506?id=03457506&rank=1.

Keywords: Cancer; Conventional PET; Digital PET; EARL-accreditation; FDG-PET.

Conflict of interest statement

This work was supported by a research agreement between the Department of Nuclear Medicine, Isala, and Philips Healthcare regarding new PET technologies. The content of the article was solely the responsibility of the authors. The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
SUVmean (a), SUVpeak (b) and SUVmax (c) as measured on cPET and dPET across all lesions (n = 128). The y-axis is shown on a log scale. Average dPET values were significantly higher than cPET values for all three parameters (p < 0.001). This boxplot shows the median, interquartile range and outliers (o): values that are between 1.5 and 3.0 box length from the percentile borders
Fig. 2
Fig. 2
ΔSUV variability for SUVmean, SUVpeak and SUVmax between cPET and dPET across all lesions (n = 128). The average variability in ΔSUVmax was larger than the variability in ΔSUVmean (p = 0.002) and ΔSUVpeak (p = 0.03). Furthermore, ΔSUVmax had a higher variance as compared with ΔSUVmean and ΔSUVpeak (p < 0.001). This boxplot shows the median and the interquartile range
Fig. 3
Fig. 3
Scatterplot comparing the relative change in SUVmean (a), SUVpeak (b) and SUVmax (c) with ΔTdPET, defined as the time between FDG-administration and start of the dPET scan. ΔSUVmean, ΔSUVpeak and ΔSUVmax increased with prolonged ΔTdPET (p < 0.001)
Fig. 4
Fig. 4
Scatterplot comparing the relative change in SUVmean (a), SUVpeak (b) and SUVmax (c) with lesion diameter. The x-axis is shown on a log scale. There were no significant correlations between ΔSUV and lesion diameter with R = 0.09 for ΔSUVmean and ΔSUVpeak (p = 0.32), and R = 0.01 for ΔSUVmax (p = 0.96)
Fig. 5
Fig. 5
Axial FDG-PET/CT images (a, b and c) from a lung cancer patient with bilateral adrenal gland metastases showing higher SUVs on the dPET scan (b) that was acquired 24 min after the cPET scan (a). The left-gland metastasis (diameter 11 mm) showed ΔSUVs of 7% (SUVmean), 10% (SUVpeak) and 15% (SUVmax). ΔSUVs of the right-gland metastasis (diameter 14 mm) were 13% (SUVmean) and 11% (SUVpeak and SUVmax). In this case the impact of the digital scanner cannot be separated from the SUV rise caused by the prolonged FDG-uptake. Meanwhile, the visual image quality of both PET scans appeared comparable in terms of image noise, texture and FDG-uptake as intended with an EARL-compatible protocol

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