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The appropriate whole body metric for calculating standardised uptake value and the influence of sex

Keramida, Georgiaa,c; Peters, A. Michaelb

Nuclear Medicine Communications: January 2019 - Volume 40 - Issue 1 - p 3–7
doi: 10.1097/MNM.0000000000000935

Aim To compare weight, lean body mass and body surface area for calculation of standardised uptake value (SUV) in fluorine-18-fluorodeoxyglucose PET/computed tomography, taking sex into account.

Patients and methods This was a retrospective study of 161 (97 men) patients. Maximum standardised uptake value (SUVmax) and mean standardised uptake value (SUVmean) were obtained from a 3-cm region of interest over the right lobe of the liver and scaled to weight, scaled to lean body mass (SUL) and scaled to body surface area (SUA). Mean hepatic computed tomography density was used to adjust SUVmean for hepatic fat (SUVFA). Hepatic SUV indices were divided by SUV from left ventricular cavity, thereby, eliminating whole body metric, to obtain a surrogate of blood fluorine-18-fluorodeoxyglucose clearance into liver, and multiplied by blood glucose to give a surrogate of hepatic glucose uptake rate (mSUV).

Results SULmax, SUAmax and all scaled to weight indices correlated strongly with weight. SULmean, SULFA, SUAmean and SUAFA, however, correlated weakly or not at all with weight, nor with their corresponding whole body metric in men or women, but correlated strongly when the sexes were combined into one group. This was the result of sex differences in SUL (greater in men) and SUA (greater in women). There was, however, no sex difference in mSUV.

Conclusion Weight is unsuitable for calculating SUV. SUL and SUA are also inappropriate as maxima but appropriate as mean and fat-adjusted values. However, SUL is recommended for both sexes because SUA is influenced by both body fat and weight. Sex differences in SUL and SUA give rise to misleading correlations when sexes are combined into one group.

aClinical Imaging Sciences Centre

bBrighton and Sussex Medical School, Brighton

cRoyal Brompton and Harefield Foundation Trust, London, UK

Correspondence to A. Michael Peters, MA, MD, DSc, FMedSci, Audrey Emerton Building, Brighton and Sussex Medical School, Eastern Road, Brighton BN2 5BE, UK Tel: +44 012 7352 3360; fax: +44 012 7352 3366;e-mail:

Received April 26, 2018

Received in revised form September 2, 2018

Accepted October 5, 2018

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