Interobserver variability of image-derived arterial blood SUV in whole-body FDG-PET

Ziel/Aim:

The standardized uptake value (SUV) is essentially the only means for quantitative evaluation of static FDG PET. However, the SUV approach has well-known shortcomings which adversely affect the reliability of the SUV as a surrogate of the metabolic rate of glucose consumption. The standard uptake ratio (SUR), i.e. the uptake time corrected ratio of tumor SUV to image-derived arterial blood SUV, has been shown to overcome most of these shortcomings and to increase the prognostic value in comparison to SUV. However, it is unclear, to what extent the SUR approach is vulnerable to observer variability of the required blood SUV (BSUV) determination. The goal of the present work was the investigation of the interobserver variability of image-derived BSUV.

Methodik/Methods:

FDG PET/CT scans from 83 patients were included. BSUV was determined by 8 individuals, each applying a dedicated delineation tool for the BSUV determination in the aorta. Altogether 5 different delineation tools were used. With each used tool, delineation was performed for the whole patient group, resulting in 12 distinct observations per patient. Interobserver variability of BSUV determination was assessed using the fractional deviations of the individual observers from the observer-average for the considered patient.

Ergebnisse/Results:

Interobserver variability in the pooled data amounts to SD = 2.8% and is much smaller than the intersubject variability of BSUV (SD = 16%). Averaged over the whole patient group, deviations of individual observers from the observer average are very small and fall in the range [-0.96,1.05]%. However, interobserver variability partly differs distinctly for different patients (range: [0.7,7.4]%).

Schlussfolgerungen/Conclusions:

The present investigation proofs unambiguously that the image-based manual determination of BSUV in the aorta provides sufficient accuracy and reproducibility for the purposes of the SUR approach. This finding is in line with the already demonstrated superiority of SUR in comparison to SUV in first clinical studies.