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Cited by 157Medical Imaging Techniques and ApplicationsRadiomics and Machine Learning in Medical ImagingLung Cancer Diagnosis and Treatment

Repeatability of 18F-FDG Uptake Measurements in Tumors: A Metaanalysis

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de Langen, Adrianus J., Vincent, Andrew, Velasquez, Linda M., van Tinteren, Harm, Boellaard, Ronald, Shankar, Lalitha K., Boers, Maarten, Smit, Egbert F. +3 more·2012·Journal of Nuclear Medicine
DOI 10.2967/jnumed.111.095299
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Abstract

UNLABELLED: PET with the glucose analog (18)F-FDG is increasingly used to monitor tumor response to therapy. To use quantitative measurements of tumor (18)F-FDG uptake for assessment of tumor response, the repeatability of this quantitative metabolic imaging method needs to be established. Therefore, we determined the repeatability of different standardized uptake value (SUV) measurements using the available data. METHODS: A systematic literature search was performed to identify studies addressing (18)F-FDG repeatability in malignant tumors. The level of agreement between test and retest values of 2 PET uptake measures, maximum SUV (SUV(max)) and mean SUV (SUV(mean)), was assessed with the coefficient of repeatability using generalized linear mixed-effects models. In addition, the influence of tumor volume on repeatability was assessed. Principal component transformation was used to compare the reproducibility of the 2 different uptake measures. RESULTS: Five cohorts were identified for this metaanalysis. For SUV(max) and SUV(mean), datasets of 86 and 102 patients, respectively, were available. Percentage repeatability is a function of the level of uptake. SUV(mean) had the best repeatability characteristics; for serial PET scans, a threshold of a combination of 20% as well as 1.2 SUV(mean) units was most appropriate. After adjusting for uptake rate, tumor volume had minimal influence on repeatability. CONCLUSION: SUV(mean) had better repeatability performance than SUV(max). Both measures showed poor repeatability for lesions with low (18)F-FDG uptake. We recommend the evaluation of biologic effects in PET by reporting a combination of minimal relative and absolute changes to account for test-retest variability.

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  • Lesion SUVs in [18F]FDG-PET show a test-retest variability in the same patient with the same PET scanner of up to 20% and are usually even less comparable between different scanners and centers or under routine clinical conditions.

    “However, lesion SUVs in [18F]FDG-PET show a test-retest variability in the same patient with the same PET scanner of up to 20% [189] and are usually even less comparable between different scanners and centers or under routine clinical conditions [190].”

    From Influences on PET Quantification and Interpretation (2022) · cites this paper as [189]

    The Repeatability of SUVs section reports that a change exceeding both 1.2 SUV units and 20% surpasses 95% test–retest variability for SUVmean. The Discussion specifies that the results apply when the same scanner and imaging protocol are used. But 20% is not a general upper limit for lesion SUVs: the paper gives 25–30% relative-change thresholds for SUVmax. The different-scanner and routine-conditions clause is attached to a different citation and is not judged here. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Despite common use of SUVmax, SUVpeak and SUVmean have been shown to be slightly less variable under test-retest conditions.

    “Despite the common use of SUVmax in clinical practice, arising from its convenience, SUVpeak and SUVmean have been shown to be slightly less variable under test-retest conditions [189,191].”

    From Influences on PET Quantification and Interpretation (2022) · cites this paper as [189]

    The Discussion (page not provided) says SUVmean had better test–retest repeatability than SUVmax. It also says there were insufficient data to explore SUVpeak, so this paper does not establish that SUVpeak is less variable than SUVmax. (LLM, conf=0.93)

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Authors
de Langen, A. J., Vincent, A., Velasquez, L. M., van Tinteren, H., Boellaard, R., Shankar, L. K., Boers, M., Smit, E. F., Stroobants, S., Weber, W. A., & Hoekstra, O. S.
Affiliations
  • The Netherlands Cancer Institute (NL)
  • Bristol-Myers Squibb (United States) (US)
  • Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
  • National Cancer Institute (US)
  • Antwerp University Hospital (BE)
  • University of Freiburg (DE)
ORCID
Venue
Journal of Nuclear Medicine
Publisher
Society of Nuclear Medicine
Published
2012-04-10
Volume
53
Issue
5
Pages
701-708
ISSN
  • 0161-5505 (ISSN-L)
  • 2159-662X
DOI
10.2967/jnumed.111.095299
OpenAlex
W2149015860
Cited by
157
References
31
Citations by year
2026: 4 · 2025: 5 · 2024: 4 · 2023: 4 · 2022: 13 · 2021: 7 · 2020: 14 · 2019: 5 · 2018: 9 · 2017: 13 · 2016: 17 · 2015: 22 · 2014: 21 · 2013: 14 · 2012: 5
FWCI
14.97
Type
journal article
Language
en
Open access
Locations
  • Journal of Nuclear Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Pure Amsterdam UMC (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
  • Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiomics and Machine Learning in Medical Imaging
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
Keywords
18F-FDG PET, standardized uptake value, SUVmax, SUVmean, test-retest repeatability, tumor response assessment, tumor volume, uptake rate, cancer
MeSH terms
Biological Transport, Humans, Neoplasms, Reproducibility of Results, Fluorodeoxyglucose F18, Tumor Burden, Positron-Emission Tomography

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