Glucose-corrected standardized uptake value (SUVgluc) is the most accurate SUV parameter for evaluation of pulmonary nodules

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Abstract

Standardized uptake values (SUVs) of 18F-fluorodeoxyglucose positron emission tomography (FDG PET) are widely used to help characterize pulmonary nodules. The purpose of this study is to assess the accuracy of the SUV corrected by blood glucose levels (SUVgluc), compared to four other commonly used semi-quantitative methods: maximal SUV normalized to body weight (SUVmax), ratio of SUV of nodule to cerebellum (SUVcer), SUV normalized to body surface area (SUVbsa) and SUV normalized to body mass index (SUVbmi). 52 patients with lung nodules had FDG PET scans, consecutively imaged between 7/1/2015 and 6/7/2016. Histopathologic result of the nodules, obtained within two months after the FDG PET scan, demonstrated 10 benign and 42 malignant lung nodules. The SUVgluc was defined as SUVmax × blood glucose level/100. The average SUVmax was 2.8 for benign nodules and 7.7 for malignant nodules. No significant difference in the receiver operating characteristic (ROC) area under the curves (AUCs) were found between the SUVmax (0.84) and the SUVcer (0.87) or SUVbsa (0.86), or SUVbmi (0.86) with p-values greater than 0.05; however, the ROC AUC for the SUVgluc (0.90) was larger than that for the SUVmax with p-value of 0.03. These results suggest that SUVgluc may assist in more accurately representing the glucose metabolism of malignant lung nodules by accounting for the patient's blood glucose level (BGL). The simplicity of the SUVgluc method avoids an additional reference ROI, uses preexisting clinical data, i.e. pre-injection blood glucose level, and retains the familiar SUV reference values.

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