title: Glucose-corrected standardized uptake value in the differentiation of high-grade glioma versus post-treatment changes.
abstract: BACKGROUND
  Standardized uptake values (SUVs) of fluorine-18 fluorodeoxyglucose PET ((18)F-FDG PET) are used widely to differentiate residual or recurrent high-grade gliomas from post-treatment changes in patients with brain tumors. The aim of this study is to assess the accuracy of SUV corrected by blood glucose level (SUV(gluc)) compared with various quantitative methods in this role.
  
  
  METHODS
  In 55 patients with dynamic F-FDG PET scans, there were 97 glioma lesions: glioblastoma (n=60), grade III gliomas (n=22), grade III or IV gliomas (n=6), grade I/II (n=7), and prebiopsy lesions (n=2). The final actual diagnosis was made on the basis of pathology (n=33) and clinical outcome (n=64). Dynamic F-FDG PET scans were processed to generate parametric images of SUV(gluc), SUV(max), and glucose metabolic rate (GMR). Lesion to cerebellum ratios (SUV(Rc)) and contralateral white matter ratios (SUV(Rw)) were also measured. The SUV(gluc) was calculated as SUV(max)×blood glucose level/100.
  
  
  RESULTS
  Using the thresholds of SUV(max)>4.6, SUV(Rc)>0.9, SUV(Rw)>1.8, SUV(gluc)>4.3, and GMR>12.2 μmol/min/100 g to represent positivity for viable tumors, the accuracies were the same for the SUV(gluc) and SUV(Rw) (80%) and were higher than the conventional SUV(max) (72%). The area under the receiver operating characteristic curve for the SUV(gluc) (0.8933) was better than that for the SUV(max) (0.8266) (P<0.01) and was similar to those of the GMR (0.8622), SUV(Rc) (0.8606), and SUV(Rw) (0.8981).
  
  
  CONCLUSIONS
  These results suggest that SUV(gluc) may aid in the differentiation of residual or recurrent high-grade tumor from post-treatment changes in patients with abnormal blood glucose levels. The simplicity of the SUV(gluc) avoids the complexity of kinetic analysis or the requirement of a reference tissue.
authors.affiliation: Departments of aRadiology bNeurosciences, UC San Diego cTranslational Neuro-Oncology Laboratories, Moores Cancer Center, UC San Diego Health System, La Jolla, California, USA dDepartment of Diagnostic Radiology, Gifu Prefectural General Medical Center eDepartment of Radiology, Gifu University, Gifu, Japan.
authors.forename: Asae
authors.initials: A
authors.lastname: Nozawa
authors.forename: Ali Hosseini
authors.initials: AH
authors.lastname: Rivandi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanematsu
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hoshi
authors.forename: David
authors.initials: D
authors.lastname: Piccioni
authors.forename: Santosh
authors.initials: S
authors.lastname: Kesari
authors.forename: Carl K
authors.initials: CK
authors.lastname: Hoh
mesh_terms: D000328:Adult; D000368:Aged; D001692:Biological Transport; D001786:Blood Glucose / Q000378:metabolism*; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000378:metabolism; D005500:Follow-Up Studies; D005910:Glioma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D018365:Neoplasm, Residual; D049268:Positron-Emission Tomography; D012008:Recurrence
chemical_list: D001786:Blood Glucose; D019788:Fluorodeoxyglucose F18