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Hofheinz F, Bütof R, Apostolova I, et al. An investigation of the relation between tumor-to-liver ratio (TLR) and tumor-to-blood standard uptake ratio (SUR) in oncological FDG PET. EJNMMI Res. 2016;6(1):19doi: 10.1186/s13550-016-0174-y.
Hofheinz, F., Bütof, R., Apostolova, I., Zöphel, K., Steffen, I. G., Amthauer, H., Kotzerke, J., Baumann, M., & van den Hoff, J. (2016). An investigation of the relation between tumor-to-liver ratio (TLR) and tumor-to-blood standard uptake ratio (SUR) in oncological FDG PET. EJNMMI research, 6(1), 19. https://doi.org/10.1186/s13550-016-0174-y
Hofheinz, Frank, et al. "An investigation of the relation between tumor-to-liver ratio (TLR) and tumor-to-blood standard uptake ratio (SUR) in oncological FDG PET." EJNMMI research vol. 6,1 (2016): 19. doi: https://doi.org/10.1186/s13550-016-0174-y
Hofheinz F, Bütof R, Apostolova I, Zöphel K, Steffen IG, Amthauer H, Kotzerke J, Baumann M, van den Hoff J. An investigation of the relation between tumor-to-liver ratio (TLR) and tumor-to-blood standard uptake ratio (SUR) in oncological FDG PET. EJNMMI Res. 2016 Dec;6(1):19. doi: 10.1186/s13550-016-0174-y. Epub 2016 Mar 02. PMID: 26936768; PMCID: PMC4775714.
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EJNMMI Res. 2016 Dec;6(1):19. doi: 10.1186/s13550-016-0174-y. Epub 2016 Mar 02.

An investigation of the relation between tumor-to-liver ratio (TLR) and tumor-to-blood standard uptake ratio (SUR) in oncological FDG PET.

EJNMMI research

Frank Hofheinz, Rebecca Bütof, Ivayla Apostolova, Klaus Zöphel, Ingo G Steffen, Holger Amthauer, Jörg Kotzerke, Michael Baumann, Jörg van den Hoff

Affiliations

  1. Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstraße, Dresden, Germany. [email protected].
  2. Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany. [email protected].
  3. OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany. [email protected].
  4. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany. [email protected].
  5. OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany. [email protected].
  6. Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany. [email protected].
  7. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany. [email protected].
  8. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Germany. [email protected].
  9. Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstraße, Dresden, Germany. [email protected].
  10. Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany. [email protected].
  11. Department of Radiation Oncology, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany. [email protected].
  12. OncoRay - National Center for Radiation Research in Oncology, Dresden, Germany. [email protected].
  13. German Cancer Consortium (DKTK), Dresden, Germany. [email protected].
  14. German Cancer Research Center (DKFZ), Heidelberg, Germany. [email protected].
  15. Helmholtz-Zentrum Dresden-Rossendorf, Institute of Radiooncology, Dresden, Germany. [email protected].
  16. Helmholtz-Zentrum Dresden-Rossendorf, PET Center, Institute of Radiopharmaceutical Cancer Research, Bautzner Landstraße, Dresden, Germany. [email protected].
  17. Department of Nuclear Medicine, University Hospital Carl Gustav Carus, Technische Universität, Dresden, Germany. [email protected].

PMID: 26936768 PMCID: PMC4775714 DOI: 10.1186/s13550-016-0174-y

Abstract

BACKGROUND: The standardized uptake value (SUV) is the nearly exclusive means for quantitative evaluation of clinical [18F-]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) whole body investigations. However, the SUV methodology has well-known shortcomings. In this context, it has been recognized that at least part of the problems can be eliminated if tumor SUV is normalized to the SUV of a reference region in the liver (tumor-to-liver [TLR] ratio). In recent publications, we have systematically investigated the tumor-to-blood SUV ratio (SUR) for normalization of tumor SUVs which in our view offers principal advantages in comparison to TLR. The aim of this study was a comprehensive comparison of TLR and SUR in terms of quantification of tumor lesions.

METHODS: 18F-FDG PET/CT was performed in 424 patients (557 scans) with different tumor entities prior to radio(chemo)therapy. In the PET images, SUVmax of the primary tumor was determined. SUVliver was calculated in the inferior right lobe of the liver. SUVblood was determined by manually delineating the aorta in the low-dose CT. TLR and SUR were computed and scan time corrected to 60 min p.i. (TLRtc and SURtc). Correlation analysis was performed for SUVliver vs. SUVblood, TLR vs. SUR, SUVliver/SUVblood vs. SUVblood,SURtc/TLR vs. SURtc, and SURtc/TLRtc vs. SURtc. Variability of the respective ratios was assessed via histogram analysis. The prognostic value of TLR and TLRtc for distant metastases-free survival (DM) was investigated with univariate Cox regression in a homogeneous subgroup (N = 130) and compared to previously published results for SUV and SURtc.

RESULTS: Correlation analysis revealed a linear correlation of SUVliver vs. SUVblood (R (2)=0.83) and of TLR vs. SURtc (R (2)=0.92). The SUVliver/SUVblood ratio (mean ± s.d.) was 1.47 ± 0.18. For the SURtc/TLR ratio, we obtained 1.14 ± 0.21 and for the SURtc/TLRtc ratio 1.38 ± 0.17. Survival analysis revealed TLR and TLRtc as significant prognostic factors for DM (hazard ratio [HR] = 3.3 and HR = 3, respectively). Both hazard ratios are lower than that of SURtc (HR = 4.1) although this reduction does not reach statistical significance for the given limited group size. HRs of TLR and SURtc are both significantly higher than HR of SUV (HR = 2.2).

CONCLUSIONS: Suitability of the liver as surrogate of arterial tracer supply for SUV normalization via TLR computation is limited. Further studies in sufficiently large patient groups are required to better characterize the relative performance of SUV, TLR, and SUR in different settings.

Keywords: FDG; PET; SUR; TLR; Tumor-to-blood ratio; Tumor-to-liver ratio

References

  1. Thorax. 2007 Aug;62(8):696-701 - PubMed
  2. EJNMMI Res. 2013 Nov 23;3(1):77 - PubMed
  3. J Nucl Med. 2013 May;54(5):677-82 - PubMed
  4. J Nucl Med. 1994 Jan;35(1):164-7 - PubMed
  5. Nucl Med Biol. 2000 Oct;27(7):643-6 - PubMed
  6. Eur J Cardiothorac Surg. 2011 Nov;40(5):1165-9 - PubMed
  7. Nuklearmedizin. 2012;51(1):9-16 - PubMed
  8. EJNMMI Res. 2013 Mar 13;3(1):16 - PubMed
  9. Eur J Nucl Med Mol Imaging. 2014 Dec;41(12 ):2273-80 - PubMed
  10. EJNMMI Res. 2014 Apr 03;4(1):18 - PubMed
  11. J Med Imaging Radiat Oncol. 2014 Apr;58(2):183-8 - PubMed
  12. Eur J Nucl Med Mol Imaging. 2015 May;42(6):848-57 - PubMed
  13. J Nucl Med. 2011 Feb;52(2):303-10 - PubMed
  14. Arch Surg. 1998 May;133(5):510-5; discussion 515-6 - PubMed
  15. J Nucl Med. 1994 Aug;35(8):1308-12 - PubMed
  16. Radiology. 1999 Nov;213(2):521-5 - PubMed
  17. J Nucl Med. 2015 Aug;56(8):1137-43 - PubMed
  18. J Nucl Med. 1995 Oct;36(10 ):1836-9 - PubMed
  19. J Nucl Med. 2015 Aug;56(8):1150-6 - PubMed
  20. Clin Nucl Med. 2012 Oct;37(10 ):949-52 - PubMed
  21. J Nucl Med. 1999 Oct;40(10 ):1637-43 - PubMed
  22. Radiology. 1994 Jul;192(1):79-86 - PubMed
  23. J Nucl Med. 2012 Jul;53(7):1041-7 - PubMed
  24. Lung Cancer. 2014 Aug;85(2):205-12 - PubMed
  25. Ann Oncol. 2002 Mar;13(3):361-8 - PubMed

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