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The Diagnostic Utility of the Lognormal Behavior of PET Standardized Uptake Values in Tumors

Department of Radiology, Biomedical Imaging Center, The University of Tennessee Medical Center at Knoxville, Knoxville, Tennessee

View larger version (18K): [in this window] [in a new window]   FIGURE 1. Histograms of 83 metastatic liver lesions from Delbeke et al. (9) as representative. Highly skewed FDG SUV distribution (A) becomes Gaussian when its logarithm is used (B). Mean and of latter are 0.89 and 0.18, respectively, from Table 1.

View larger version (20K): [in this window] [in a new window]   FIGURE 2. Diagnostic sensitivity for 921 malignant lesions from 25 FDG investigations of various cancer categories. Commonality seen here stems from Gaussian probability axis used in combination with severity, SUV/, expressed on logarithmic scale. Slope of fitting line is related to average 0.23 SD of log10SUVs for all cancer types in Table 1.

View larger version (51K): [in this window] [in a new window]   FIGURE 3. Generic ROCs for use in approximately describing any cancer category. Parameter shown identifying line is log10(mal/ben), where subscripts indicate malignant and benign, respectively. Better straight-line descriptions are possible, provided there is sufficient number of patients. These would improve on 0.23 used for SDs of both malignant and normal log10SUVs in calculations here.

View larger version (19K): [in this window] [in a new window]   FIGURE 4. ROC area for comparing tumor diagnostic protocols. Parameters identifying these lines are total SDs—that is, square root of sum of squares of s belonging to benign and malignant log10SUV distributions. For central line, its (0.232 + 0.232)1/2 = 0.33 is typical t of cancer categories of investigations here.