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Tissue standardized uptake value is a closer surrogate of blood fluorine-18 fluorodeoxyglucose clearance after division by blood standardized uptake value, illustrated in brain and liver

Keramida, Georgiaa; Peters, A. Michaelb

Nuclear Medicine Communications: May 2019 - Volume 40 - Issue 5 - p 552–554
doi: 10.1097/MNM.0000000000001003

The numerator and denominator of the left-hand side of the Gjedde–Patlak–Rutland (GPR) equation for measurement of blood fluorine-18 fluorodeoxyglucose (18F-FDG) clearance into tissue (Ki) are the standardized uptake values (SUVs) of tissue and blood, respectively. The extent to which normalized time (NT) in the GPR equation exceeds real time depends on half-time of clearance of 18F-FDG from blood. A literature review shows that NT is fairly constant, about 100 min at 60 min postinjection of 18F-FDG, in keeping with our own finding of no significant difference in maximum SUV in blood 60 min postinjection of 18F-FDG between 39 patients with 18F-FDG-avid malignancy on routine PET/CT (1.74±0.31) and 21 patients with normal PET/CT (1.79±0.32), and similar blood glucose levels (BGLs). Volume of distribution (V0) in the GPR equation is ∼0.4 ml/ml for brain and ∼0.9 ml/ml for lean liver. Using these values of V0 and an NT of 100 min, we used the GPR equation to calculate Ki from our own published values of SUVliver/SUVblood and SUVbrain/SUVblood at 60 min postinjection, obtaining 0.0045 ml/min/ml for liver and 0.036 ml/min/ml for brain at BGL of 5 mmol/l. These values for Ki at this BGL are close to literature values of Ki, which for liver and brain are ∼0.0033 and ∼0.035 ml/min/ml, respectively. We conclude, therefore, that following division with blood pool SUV, tissue SUV becomes a closer surrogate of Ki. This division also eliminates the controversy over which whole body metric to use in the calculation of SUV.

aDepartment of Nuclear Medicine, Royal Brompton and Harefield NHS Foundation Trust

bDepartment of Nuclear Medicine, King’s College Hospital NHS Foundation Trust, London, UK

Correspondence to A. Michael Peters, MA, MD, DSc, FMedSci, Department of Nuclear Medicine, King’s College Hospital, Denmark Hill, Brixton, London SE5 9RS, UK Tel: +44 203 299 3440; fax: +44 127 352 3366; e-mail:

Received October 29, 2018

Received in revised form February 4, 2019

Accepted February 9, 2019

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