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Journal of Nuclear Medicine Vol. 46 No. 10 1659-1663
© 2005 by Society of Nuclear Medicine

Brief Communication

Glucose-Normalized Standardized Uptake Value from 18F-FDG PET in Classifying Lymphomas

Ching-yee Oliver Wong, MD, PhD1, Joseph Thie, PhD2, Kelly J. Parling-Lynch, MD3, Dana Zakalik, MD3, Jeffrey H. Margolis, MD3, Marianne Gaskill, CNMT1, Jack Hill, PhD4, Feng Qing, MD, PhD1, Darlene Fink-Bennett, MD1 and Conrad Nagle, MD1

1 Nuclear Medicine, William Beaumont Hospital, Royal Oak, Michigan
2 Graduate School of Medicine, University of Tennessee Medical Center, Knoxville, Tennessee
3 Medical Oncology, William Beaumont Hospital, Royal Oak, Michigan
4 Medical Information Service, William Beaumont Hospital, Royal Oak, Michigan

Our objective was to derive the best glucose sensitivity factor (g-value) and the most discriminating standardized uptake value (SUV) normalized to glucose for classifying indolent and aggressive lymphomas. Methods: The maximum SUV obtained from 18F-FDG PET over the area of biopsy in 102 patients was normalized by serum glucose ([Glc]) to a standard of 100 mg/dL. Discriminant analysis was performed by using each SUV100 (SUV x {100/[Glc]}g, calculated using various g-values ranging from –3.0 to 0, one at a time) as a variable against the lymphoma grades, and plotting the percentage of correct classifications against g (g-plot) to search for the best g-value in normalizing SUV100 for classifying grades. To address the influence of the extreme glucose conditions, we repeated the same analyses in 12 patients with [Glc] ≤ 70 mg/dL or [Glc] ≥ 110 mg/dL. Results: SUV100 correctly classified lymphoma grades ranging from 62% to 73% (P < 0.0005), depending on the g-value, with a maximum at a g-value of –0.5. For the subgroup with extreme glucose values, the g-plot also revealed higher and more optimal discrimination at a g-value of –0.5 (92%) than at a g-value of 0 (83%) (P = 0.03). The discrimination deteriorated at g < –1 in both analyses. The box plot for all cases using a g-value of –0.5 showed little overlap in classifying lymphoma grades. For a visually selected threshold SUV100 of 7.25, the sensitivity, specificity, and accuracy of identifying aggressive grades were 82%, 79%, and 81%, respectively. Conclusion: The results suggest that metabolic discrimination between lymphoma grades using a glucose-normalized SUV from 18F-FDG PET is improved by introducing g-value as an extra degree of freedom.

Key Words: PET • lymphoma • SUV normalization • glucose sensitivity


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