title: Repeatability of the Maximum Standard Uptake Value (SUVmax) in FDG PET.
abstract: OBJECTIVE
  SUVmax is often calculated at FDG PET examinations in systematic studies as well as at clinical examinations. Since SUVmax represents a very small portion of a lesion it may be questioned how statistically reliable the figure is. This was studied by assessing the repeatability of SUVmax between two FDG acquisitions acquired immediately upon each other in patients with chest lesions.
  
  
  METHODS
  In 100 clinical patients with a known chest lesion, two identical 3 min PET registrations (PET1 and PET2, respectively) were initiated within 224±31 sec of each other. The difference in SUVmax between the lesion for the two PET scans (ΔSUVmax) was calculated and the uncertainty expressed as the coefficient of variation, CV (%). The correlation between ΔSUVmax and the lowest SUVmax from PET1 or PET2, the approximate metabolic lesion volume, the time from FDG injection to PET1 and the time between PET1 and PET2, respectively, was also assessed.
  
  
  RESULTS
  In 56 patients SUVmax increased at the second acquisition and in 44 patients it decreased. Mean of SUVmax was 7.8±6.1 and 7.8±6.2 for PET1 and PET2, respectively. The mean percentage difference was 0.9±7.8. The difference was not significant (p=0.20). CV gave an uncertainty of 4.3% between the two measurements which is a strong indicator of equivalence. There was no correlation between ΔSUVmax and any of the assessed four parameters. The difference between the acquisitions, 0.9%, was much lower compared to the 3 previous published similar, but more restricted studies where the difference was 2.5-8.2%.
  
  
  CONCLUSIONS
  From camera and computational perspectives, SUVmax is a stable parameter Conflict of interest:None declared.
authors.affiliation: Karolinska University Hospital, Department of Radiology, Stockholm, Sweden.
authors.forename: Henry
authors.initials: H
authors.lastname: Lindholm
authors.affiliation: Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Staaf
authors.affiliation: Karolinska University Hospital, Department of Radiology, Stockholm, Sweden.
authors.forename: Hans
authors.initials: H
authors.lastname: Jacobsson
authors.affiliation: Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden.
authors.forename: Fredrik
authors.initials: F
authors.lastname: Brolin
authors.affiliation: Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden.
authors.forename: Robert
authors.initials: R
authors.lastname: Hatherly
authors.affiliation: Karolinska University Hospital, Department of Hospital Physics, Stockholm, Sweden.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Sânchez-Crespo
keywords: Examinations and diagnoses; Fluorodeoxyglucose F18; Positron-emission tomography; reproducibility of results