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Standardized Uptake Values of FDG: Body Surface Area Correction is Preferable to Body Weight Correction

Division of Nuclear Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Division of Nuclear Medicine, Creighton University Medical Center, Omaha, Nebraska

Correspondence: For correspondence or reprints contact: Chun K. Kim, MD, Dept. of Nuclear Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029.

ABSTRACT

Standardized uptake values (SUVs) are widely used to measure ¹⁸F-fluorodeoxyglucose (FDG) uptake in various tumors. It has been reported that normalization of FDG uptake for patient body weight (SUV_bw) overestimates FDG uptake in heavy patients, as their fraction of body fat (with low FDG uptake) is often increased. The objective of this study was to determine if "normalization of FDG uptake for the body surface area" (SUV_bsa) is independent of the patient's body size and is more reliable than SUV_bw. Methods: FDG-PET images were acquired on 44 patients (body weight range: 45–115 kg) with cancer. SUV_bw [(mCi/g of tissue)/(mCi injected/patient body weight in g)] and SUV_bsa [(mCi/g of tissue)/(mCi injected/patient BSA in m²)] were determined for the liver. Since most observers are accustomed to using the SUV_bw, the two values were compared by setting the mean SUV_bsa equal to that of SUV_bw. Results: SUV_bw and SUV_bsa were 3.42 ± 0.85 (mean ± s.d.) and 3.42 ± 0.60, respectively. The standard deviation of the SUV_bsa was smaller than that of SUV_bw. More importantly, there was a strong positive correlation between SUV_bw and, not only body weight (r = 0.75) but also BSA (r = 0.68), whereas only a weak correlation between SUV_bsa and body weight (r = 0.41) or BSA (r = 0.38) was found with a near flat regression line. Conclusion: SUV_bw over-estimates FDG uptake in large patients. SUV_bsa appears preferable to SUV_bw, since it is minimally affected by the body size.

Key Words: fluorine-18-fluorodeoxyglucose • standardized uptake values • body fat

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