Evaluation of SUVlean consistency in FDG and PSMA PET/MR with Dixon-, James-, and Janma-based lean body mass correction
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Abstract
Purpose: To systematically evaluate the consistency of various standardized uptake value (SUV) lean body mass (LBM) normalization methods in a clinical positron emission tomography/magnetic resonance imaging (PET/MR) setting. Methods: SUV of brain, liver, prostate, parotid, blood, and muscle were measured in 90 18 F-FDG and 28 18 F-PSMA PET/MR scans and corrected for LBM using the James, Janma (short for Janmahasatian), and Dixon approaches. The prospective study was performed from December 2018 to August 2020 at Shanghai East Hospital. Forty dual energy X-ray absorptiometry (DXA) measurements of non-fat mass were used as the reference standard. Agreement between different LBM methods was assessed by linear regression and Bland-Altman statistics. SUV’s dependency on BMI was evaluated by means of linear regression and Pearson correlation. Results: Compared to DXA, the Dixon approach presented the least bias in LBM/weight% than James and Janma models (bias 0.4±7.3%, − 8.0±9.4%, and − 3.3±8.3% respectively). SUV normalized by body weight (SUVbw) was positively correlated with body mass index (BMI) for both FDG (e.g., liver: r = 0.45, p < 0.001) and PSMA scans ( r = 0.20, p = 0.31), while SUV normalized by lean body mass (SUVlean) revealed a decreased dependency on BMI ( r = 0.22, 0.08, 0.14, p = 0.04, 0.46, 0.18 for Dixon, James, and Janma models, respectively). The liver SUVbw of obese/overweight patients was significantly larger ( p < 0.001) than that of normal patients, whereas the bias was mostly eliminated in SUVlean. One-way ANOVA showed significant difference ( p < 0.001) between SUVlean in major organs measured using Dixon method vs James and Janma models. Conclusion: Significant systematic variation was found using different approaches to calculate SUVlean. A consistent correction method should be applied for serial PET/MR scans. The Dixon method provides the most accurate measure of LBM, yielding the least bias of all approaches when compared to DXA.
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[18F]FDG-PET SUV is more closely correlated with BMI than PSMA-PET SUV.
“However, when compared to SUV in prostate-specific membrane antigen (PSMA)-PET, those in [18F]FDG-PET are more closely correlated with BMI [5].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [5]
The Results section (‘Liver SUV among four BMI subgroups’; page unavailable) reports a significant positive association between BMI and body-weight-normalized liver SUV in the FDG group. The Discussion (page unavailable) says SUV–BMI correlations in the PSMA group were not statistically significant for most organs, except the blood pool. These findings support a narrower comparison, but not the unqualified claim that FDG-PET SUV is more closely correlated with BMI than PSMA-PET SUV across sites or SUV measures. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThe correlation between SUV and BMI can be partly explained mathematically by incorrect estimation of distribution volume in obese patients if total body mass is used instead of lean body mass.
“This correlation can be partly explained mathematically by the incorrect estimation of the distribution volume in obese patients if total body mass is used instead of lean body mass (due to the relatively low [18F]FDG accumulation in fat tissue [4]) [5].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [5]
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- Authors
- Zhao, J., Xue, Q., Chen, X., You, Z., Wang, Z., Yuan, J., Liu, H., & Hu, L.
- Affiliations
- Tongji University (CN)
- United Imaging Healthcare (China) (CN)
- Corresponding author
- Zhao, Jun
- Venue
- EJNMMI Physics
- Published
- 2021-02-17
- Volume
- 8
- Issue
- 1
- Pages
- 17-17
- ISSN
- 2197-7364 (ISSN-L)
- PMC
- PMC7889776
- OpenAlex
- W3102510319
- Cited by
- 12
- References
- 44
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 1 · 2023: 1 · 2022: 3
- FWCI
- 0.66
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- EJNMMI Physics (publishedVersion, cc-by)
- Research Square (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Key Specialty Construction Project of Pudong Health and Family Planning Commission of Shanghai (PWZzk2017-24)
- Project of Science and Technology Commission of Shanghai Municipality (19DZ1930703)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiopharmaceutical Chemistry and Applications
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Advanced MRI Techniques and Applications
- Keywords
- standardized uptake value, PET/MR, FDG-PET, PSMA PET, Dixon method, body mass index, obesity, liver SUV, dual-energy X-ray absorptiometry
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