Quantification of FDG PET studies using standardised uptake values in multi-centre trials: effects of image reconstruction, resolution and ROI definition parameters

  • Marinke Westerterp
  • Jan Pruim
  • Wim Oyen
  • Otto Hoekstra
  • Anne Paans
  • Eric Visser
  • Jan van Lanschot
  • Gerrit Sloof
  • Ronald Boellaard
Original article



Standardised uptake values (SUVs) depend on acquisition, reconstruction and region of interest (ROI) parameters. SUV quantification in multi-centre trials therefore requires standardisation of acquisition and analysis protocols. However, standardisation is difficult owing to the use of different scanners, image reconstruction and data analysis software. In this study we evaluated whether SUVs, obtained at three different institutes, may be directly compared after calibration and correction for inter-institute differences.


First, an anthropomorphic thorax phantom containing variously sized spheres and activities, simulating tumours, was scanned and processed in each institute to evaluate differences in scanner calibration. Secondly, effects of image reconstruction and ROI method on recovery coefficients were studied. Next, SUVs were derived for tumours in 23 subjects. Of these 23 patients, four and ten were scanned in two institutes on an HR+ PET scanner and nine were scanned in one institute on an ECAT EXACT PET scanner. All phantom and clinical data were reconstructed using iterative reconstruction with various iterations, with both measured (MAC) and segmented attenuation correction (SAC) and at various image resolutions. Activity concentrations (AC) or SUVs were derived using various ROI isocontours.


Phantom data revealed differences in SUV quantification of up to 30%. After application-specific calibration, recovery coefficients obtained in each institute were equal to within 15%. Varying the ROI isocontour value resulted in a predictable change in SUV (or AC) for both phantom and clinical data. Variation of image resolution resulted in a predictable change in SUV quantification for large spheres/tumours (>5 cc) only. For smaller tumours (<2 cc), differences of up to 40% were found between high (7 mm) and low (10 mm) resolution images. Similar differences occurred when data were reconstructed with a small number of iterations. Finally, no significant differences between MAC and SAC reconstructed data were observed, except for tumours near the diaphragm.


Standardisation of acquisition, reconstruction and ROI methods is preferred for SUV quantification in multi-centre trials. Small unavoidable differences in methodology can be accommodated by performing a phantom study to assess inter-institute correction factors.


Standardised uptake value PET Multi-centre Quantification Standardisation 


  1. 1.
    Avril NE, Weber WA. Monitoring response to treatment in patients utilizing PET. Radiol Clin North Am 2005;43:189–204.PubMedCrossRefGoogle Scholar
  2. 2.
    Krak NC, Hoekstra OS, Lammertsma AA. Measuring response to chemotherapy in locally advanced breast cancer: methodological considerations. Eur J Nucl Med Mol Imaging 2004;31:S103–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Scheidhauer K, Walter C, Seemann MD. FDG PET and other imaging modalities in the primary diagnosis of suspicious breast lesions. Eur J Nucl Med Mol Imaging 2004;31:S70–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Vansteenkiste J, Fischer BM, Dooms C, Mortensen J. Positron-emission tomography in prognostic and therapeutic assessment of lung cancer: systematic review. Lancet Oncol 2004;5:531–40.PubMedCrossRefGoogle Scholar
  5. 5.
    Wahl RL, Zasadny K, Helvie M, Hutchins GD, Weber B, Cody R. Metabolic monitoring of breast cancer chemohormonotherapy using positron emission tomography: initial evaluation. J Clin Oncol 1993;11:2101–11.PubMedGoogle Scholar
  6. 6.
    Weber WA, Ziegler SI, Thodtmann R, Hanauske AR, Schwaiger M. Reproducibility of metabolic measurements in malignant tumors using FDG PET. J Nucl Med 1999;40:1771–7.PubMedGoogle Scholar
  7. 7.
    Young H, Baum R, Cremerius U, Herholz K, Hoekstra O, Lammertsma AA, et al. Measurement of clinical and subclinical tumour response using [18F]-fluorodeoxyglucose and positron emission tomography: review and 1999 EORTC recommendations. Eur J Cancer 1999;35:1773–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med 2004;45:1519–27.PubMedGoogle Scholar
  9. 9.
    Bourguet P, Blanc-Vincent MP, Boneu A, Bosquet L, Chauffert B, Corone C, et al. Summary of the standards, options and recommendations for the use of positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDP-PET scanning) in oncology (2002). Br J Cancer 2003;89 Suppl 1:S84–91.PubMedCrossRefGoogle Scholar
  10. 10.
    Coleman RE, Laymon CM, Turkington TG. FDG imaging of lung nodules: a phantom study comparing SPECT, camera-based PET, and dedicated PET. Radiology 1999;210:823–8.PubMedGoogle Scholar
  11. 11.
    Schelbert HR, Hoh CK, Royal HD, Brown M, Dahlbom MN, Dehdashti F, et al. Procedure guideline for tumor imaging using fluorine-18-FDG. J Nucl Med 1998;39:1302–5.PubMedGoogle Scholar
  12. 12.
    Brix G, Zaers J, Adam LE, Bellemann ME, Ostertag H, Trojan H, et al. Performance evaluation of a whole-body PET scanner using the NEMA protocol. J Nucl Med 1997;38:1614–23.PubMedGoogle Scholar
  13. 13.
    Wienhard K, Eriksson L, Grootoonk S, Casey M, Pietrzyk U, Heiss WD. Performance evaluation of the positron scanner ECAT EXACT. J Comput Assist Tomogr 1992;16:804–13.PubMedCrossRefGoogle Scholar
  14. 14.
    Hudson HM, Larkin RS. Accelerated image reconstruction usig ordered subsets or projection data. IEEE Trans Med Imaging 1994;13:601–9.CrossRefGoogle Scholar
  15. 15.
    Watson CC. New, faster, image-based scatter correction for 3D PET. IEEE Trans Nucl Sci 2000;47:1587–94.CrossRefGoogle Scholar
  16. 16.
    Defrise M, Kinahan PE, Townsend DW, Michel C, Sibomana M, Newport DF. Exact and approximate rebinning algorithms for 3-D PET data. IEEE Trans Med Imaging 1997;16:145–58.PubMedCrossRefGoogle Scholar
  17. 17.
    Visvikis D, Cheze-LeRest C, Costa DC, Bomanji J, Gacinovic S, Ell PJ. Influence of OSEM and segmented attenuation correction in the calculation of standardised uptake values for [18F]FDG PET. Eur J Nucl Med 2001;28:1326–35.PubMedCrossRefGoogle Scholar
  18. 18.
    Boellaard R, van Lingen A, Lammertsma AA. Experimental and clinical evaluation of iterative reconstruction (OSEM) in dynamic PET: quantitative characteristics and effects on kinetic modeling. J Nucl Med 2001;42:808–17.PubMedGoogle Scholar
  19. 19.
    Lartizien C, Kinahan PE, Swensson R, Comtat C, Lin M, Villemagne V, et al. Evaluating image reconstruction methods for tumor detection in 3-dimensional whole-body PET oncology imaging. J Nucl Med 2003;44:276–90.PubMedGoogle Scholar
  20. 20.
    Jaskowiak CJ, Bianco JA, Perlman SB, Fine JP. Influence of reconstruction iterations on 18F-FDG PET/CT standardized uptake values. J Nucl Med 2005;46:424–8.PubMedGoogle Scholar
  21. 21.
    Krak NC, Boellaard R, Hoekstra OS, Twisk JW, Hoekstra CJ, Lammertsma AA. Effects of ROI definition and reconstruction method on quantitative outcome and applicability in a response monitoring trial. Eur J Nucl Med Mol Imaging 2005;32:294–301.PubMedCrossRefGoogle Scholar
  22. 22.
    van Balen S, Hoving BG, Boellaard R, Lammertsma AA. Quality control and calibration of the ECAT HR plus PET scanner. Eur J Nucl Med 1999;26:1022.Google Scholar
  23. 23.
    Greuter HN, Boellaard R, van Lingen A, Franssen EJ, Lammertsma AA. Measurement of 18F-FDG concentrations in blood samples: comparison of direct calibration and standard solution methods. J Nucl Med Technol 2003;31:206–9.PubMedGoogle Scholar
  24. 24.
    Thie JA. Understanding the standardized uptake value, its methods, and implications for usage. J Nucl Med 2004;45:1431–4.PubMedGoogle Scholar
  25. 25.
    van der Weerdt AP, Boellaard R, Knaapen P, Visser CA, Lammertsma AA, Visser FC. Postinjection transmission scanning in myocardial 18F-FDG PET studies using both filtered backprojection and iterative reconstruction. J Nucl Med 2004;45:169–75.PubMedGoogle Scholar
  26. 26.
    Smith IC, Welch AE, Hutcheon AW, Miller ID, Payne S, Chilcott F, et al. Positron emission tomography using [18F]-fluorodeoxy-D-glucose to predict the pathologic response of breast cancer to primary chemotherapy. J Clin Oncol 2000;18:1676–88.PubMedGoogle Scholar
  27. 27.
    Geworski L, Knoop BO, de Wit M, Ivancevic V, Bares R, Munz DL. Multicenter comparison of calibration and cross calibration of PET scanners. J Nucl Med 2002;43:635–9.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Marinke Westerterp
    • 1
    • 2
  • Jan Pruim
    • 3
  • Wim Oyen
    • 4
  • Otto Hoekstra
    • 5
  • Anne Paans
    • 3
  • Eric Visser
    • 4
  • Jan van Lanschot
    • 1
  • Gerrit Sloof
    • 2
  • Ronald Boellaard
    • 5
  1. 1.Department of SurgeryAcademic Medical CenterAmsterdamThe Netherlands
  2. 2.Department of Nuclear MedicineAcademic Medical CenterAmsterdamThe Netherlands
  3. 3.Department of Nuclear Medicine and Molecular ImagingUniversity Medical Center GroningenGroningenThe Netherlands
  4. 4.Department of Nuclear MedicineUniversity Medical Centre NijmegenNijmegenThe Netherlands
  5. 5.Department of Nuclear Medicine and PET ResearchVU University Medical CentreAmsterdamThe Netherlands

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