Quantification of Tumour (18) F-FDG Uptake: Normalise to Blood Glucose or Scale to Liver Uptake?

Overview

Journal Eur Radiol

Specialty Radiology

Date 2015 Apr 23

PMID 25899414

Citations 22

Authors

Georgia Keramida

Sabina Dizdarevic

Janice Bush

A Michael Peters

Affiliations

Soon will be listed here.

Abstract

Purpose: To compare normalisation to blood glucose (BG) with scaling to hepatic uptake for quantification of tumour (18) F-FDG uptake using the brain as a surrogate for tumours.

Methods: Standardised uptake value (SUV) was measured over the liver, cerebellum, basal ganglia, and frontal cortex in 304 patients undergoing (18) F-FDG PET/CT. The relationship between brain FDG clearance and SUV was theoretically defined.

Results: Brain SUV decreased exponentially with BG, with similar constants between cerebellum, basal ganglia, and frontal cortex (0.099-0.119 mmol/l(-1)) and similar to values for tumours estimated from the literature. Liver SUV, however, correlated positively with BG. Brain-to-liver SUV ratio therefore showed an inverse correlation with BG, well-fitted with a hyperbolic function (R = 0.83), as theoretically predicted. Brain SUV normalised to BG (nSUV) displayed a nonlinear correlation with BG (R = 0.55); however, as theoretically predicted, brain nSUV/liver SUV showed almost no correlation with BG. Correction of brain SUV using BG raised to an exponential power of 0.099 mmol/l(-1) also eliminated the correlation between brain SUV and BG.

Conclusion: Brain SUV continues to correlate with BG after normalisation to BG. Likewise, liver SUV is unsuitable as a reference for tumour FDG uptake. Brain SUV divided by liver SUV, however, shows minimal dependence on BG.

Key Points: • FDG standard uptake value in tumours helps clinicians assess response to treatment. • SUV is influenced by blood glucose; normalisation to blood glucose is recommended. • An alternative approach is to scale tumour SUV to liver SUV. • The brain used as a tumour surrogate shows that neither approach is valid. • Applying both approaches, however, appropriately corrects for blood glucose.

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References

Zhuang H, Cortes-Blanco A, Pourdehnad M, Adam L, Yamamoto A, Martinez-Lazaro R . Do high glucose levels have differential effect on FDG uptake in inflammatory and malignant disorders?. Nucl Med Commun. 2001; 22(10):1123-8. DOI: 10.1097/00006231-200110000-00011. View

Torizuka T, Tamaki N, Inokuma T, Magata Y, Sasayama S, Yonekura Y . In vivo assessment of glucose metabolism in hepatocellular carcinoma with FDG-PET. J Nucl Med. 1995; 36(10):1811-7. View

van Kouwen M, Jansen J, Goor H, de Castro S, Oyen W, Drenth J . FDG-PET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging. 2004; 32(4):399-404. DOI: 10.1007/s00259-004-1689-4. View

Decarie P, Lepanto L, Billiard J, Olivie D, Murphy-Lavallee J, Kauffmann C . Fatty liver deposition and sparing: a pictorial review. Insights Imaging. 2012; 2(5):533-538. PMC: 3259375. DOI: 10.1007/s13244-011-0112-5. View

Choi Y, Hawkins R, Huang S, Brunken R, Hoh C, Messa C . Evaluation of the effect of glucose ingestion and kinetic model configurations of FDG in the normal liver. J Nucl Med. 1994; 35(5):818-23. View

Lee S, Kim T, Lee J, Kim S, Park S, Han S . Improved prognostic value of standardized uptake value corrected for blood glucose level in pancreatic cancer using F-18 FDG PET. Clin Nucl Med. 2011; 36(5):331-6. DOI: 10.1097/RLU.0b013e31820a9eea. View

Abikhzer G, Alabed Y, Azoulay L, Assayag J, Rush C . Altered hepatic metabolic activity in patients with hepatic steatosis on FDG PET/CT. AJR Am J Roentgenol. 2010; 196(1):176-80. DOI: 10.2214/AJR.10.4679. View

Claeys J, Mertens K, DAsseler Y, Goethals I . Normoglycemic plasma glucose levels affect F-18 FDG uptake in the brain. Ann Nucl Med. 2010; 24(6):501-5. DOI: 10.1007/s12149-010-0359-9. View

Kamimura K, Nagamachi S, Wakamatsu H, Higashi R, Ogita M, Ueno S . Associations between liver (18)F fluoro-2-deoxy-D-glucose accumulation and various clinical parameters in a Japanese population: influence of the metabolic syndrome. Ann Nucl Med. 2010; 24(3):157-61. DOI: 10.1007/s12149-009-0338-1. View

10.

Khandani A, Wahl R . Applications of PET in liver imaging. Radiol Clin North Am. 2005; 43(5):849-60, vii. DOI: 10.1016/j.rcl.2005.05.008. View

11.

Diederichs C, Staib L, Glatting G, Beger H, Reske S . FDG PET: elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med. 1998; 39(6):1030-3. View

12.

Delbeke D, Coleman R, Guiberteau M, Brown M, Royal H, Siegel B . Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006; 47(5):885-95. View

13.

Lindholm P, Minn H, Bergman J, Ruotsalainen U, Joensuu H . Influence of the blood glucose concentration on FDG uptake in cancer--a PET study. J Nucl Med. 1993; 34(1):1-6. View

14.

Busing K, Schonberg S, Brade J, Wasser K . Impact of blood glucose, diabetes, insulin, and obesity on standardized uptake values in tumors and healthy organs on 18F-FDG PET/CT. Nucl Med Biol. 2012; 40(2):206-13. DOI: 10.1016/j.nucmedbio.2012.10.014. View

15.

Ramos C, Erdi Y, Gonen M, Riedel E, Yeung H, Macapinlac H . FDG-PET standardized uptake values in normal anatomical structures using iterative reconstruction segmented attenuation correction and filtered back-projection. Eur J Nucl Med. 2001; 28(2):155-64. DOI: 10.1007/s002590000421. View

16.

Bural G, Torigian D, Burke A, Houseni M, Alkhawaldeh K, Cucchiara A . Quantitative assessment of the hepatic metabolic volume product in patients with diffuse hepatic steatosis and normal controls through use of FDG-PET and MR imaging: a novel concept. Mol Imaging Biol. 2009; 12(3):233-9. DOI: 10.1007/s11307-009-0258-4. View

17.

Oya N, Nagata Y, Ishigaki T, Abe M, Tamaki N, Magata Y . Evaluation of experimental liver tumors using fluorine-18-2-fluoro-2-deoxy-D-glucose PET. J Nucl Med. 1993; 34(12):2124-9. View

18.

Hasselbalch S, Knudsen G, Capaldo B, Postiglione A, Paulson O . Blood-brain barrier transport and brain metabolism of glucose during acute hyperglycemia in humans. J Clin Endocrinol Metab. 2001; 86(5):1986-90. DOI: 10.1210/jcem.86.5.7490. View

19.

Boellaard R, ODoherty M, Weber W, Mottaghy F, Lonsdale M, Stroobants S . FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging. 2009; 37(1):181-200. PMC: 2791475. DOI: 10.1007/s00259-009-1297-4. View

20.

Boyce C, Pickhardt P, Kim D, Taylor A, Winter T, Bruce R . Hepatic steatosis (fatty liver disease) in asymptomatic adults identified by unenhanced low-dose CT. AJR Am J Roentgenol. 2010; 194(3):623-8. DOI: 10.2214/AJR.09.2590. View