What is suvmax

CT images were used for attenuation correction for all the scanners and for visual assessment, but were not analyzed quantitatively in the current study. One scan was acquired 95 min post-injection due to mechanical troubles.

NET Core 3. For instance, in the case that the true SUVmax is 3. A nuclear medicine physician measured SUVmax by placing a spherical volume of interest VOI whose diameter can be changed by the operator. Another nuclear medicine physician independently confirmed all the values of SUVmax. Next, decay-corrected injection dosage D c was calculated as follows:. Here, D 0 represents the radionuclide total dose i. T a represents acquisition time stored at , T i represents the radiopharmaceutical start time i.

Here, w represents the patient's weight g , which is stored in kilograms at , and thus must be multiplied by Here, p represents the Philips Factor float stored as a float value at , We implemented a function that searches voxels satisfying the given SUV range and illustrate the locations in the whole body image Figures 2 — 4. The SUV range was determined as follows. Thus, the more precise the provided value of SUVmax i. We compared the results from integer precision to 4th DP precision.

Note that we do not show the results of 5th DP precision because there were no cases in which 5th DP precision improved the identification rate compared to 4th DP precision. Figure 2. The true SUVmax of the nodule in the left upper lobe was 2. When local maximum restriction was not applied, , , , 33, and 33 voxels were extracted for 3, 3. Figure 3. The same case as depicted in Figure 2.

The true SUVmax of the nodule in the right upper lobe was 1. When local maximum restriction was not applied, , , , , and voxels were extracted for 2, 1. Thus, identical detection was not achieved for this lesion.

Figure 4. The true SUVmax of the nodule in the spinal code lesion was 5. When local maximum restriction was not applied, , , , 25, and 5 voxels were extracted for 6, 5.

We performed experiments in different settings. First, the voxels within the range were extracted simply. Then, local maximum restriction was added to discard the voxel that was adjacent to the higher-value voxel, because such a voxel cannot have SUVmax. For local maximum restriction, milder restriction and stricter restriction were tested.

The relationship between SUVmax vs. The effects of the precision of SUVmax, i. Patient characteristics are summarized in Table 1. Diagnosis and lesion locations are summarized in Table 2. In this study population, head-and-neck cancer was the most common diagnosis, and the mediastinal and hilar lymph nodes were the most frequent locations.

In the lesions investigated, SUVmax ranged from 1. First, local maximum restriction was not applied. A number of voxels were identified corresponding to the given SUVmax Figure 5 , top row.

Generally, when a larger SUVmax was given, a smaller number of voxels was detected 0. Figure 5. The number of voxels extracted by a given SUVmax with various levels of precision.

Next, local maximum restriction was applied. More specifically, the rate of identical detection increased when the given SUVmax was more precise and local maximum restriction was stricter Figure 6.

For instance, while identical detection was successful only in 2. Figure 6. The overall rate of identical detection of the lesion. DP, decimal places. SUVmax and the short axis and long axis of lymph nodes were recorded. These parameters were compared among the five commonest causes of mediastinal lymphadenopathy: lymphoma, metastatic disease, sarcoidosis, tuberculosis, and lymphadenitis.

Histopathologic diagnosis was recorded as the final golden standard. The SUVmax of benign and malignant groups were However, the long axis and the short axis of lymph nodes in the benign and malignant groups were 2. Among the five common causes of mediastinal lymphadenopathy, significant differences could be seen in SUVmax and in the long axis and the short axis of lymph nodes. SUVmax, a commonly used semiquantitative measurement, was not helpful for differentiation between benign and malignant lesions in patients with enlarged mediastinal lymph nodes in this study.

Many benign lesions, such as sarcoidosis and tuberculosis, had high FDG uptake, possibly a trend that the size of the lymph nodes seems to have some diagnostic value.

Unexplained mediastinal lymphadenopathy is not uncommon in clinical. Some patients visit a doctor due to dysphagia, hoarseness, or enlarged lymph nodes occasionally found in the physical examination. The symptoms may be caused by enlarged lymph nodes that compress the esophagus and recurrent laryngeal nerves. Lymph nodes may be enlarged due to benign or malignant etiologies. Early and accurate diagnosis and characterization of the etiology of mediastinal lymphadenopathy are essential to formulating a treatment plan.

The mediastinum is not an organ, but an anatomical area. In this area, there are several important tissues and organs, such as heart, large blood vessels, esophagus, trachea, thymus, nerves, and lymphatic tissue.

Therefore, the mediastinal anatomy is complicated, and the tissue biopsy is difficult. The advantages of these methods are visual and intuitive and can be obtained with accurate pathological diagnosis.

The reason for the difference of the sensitivity may be related to the biopsy methods which could not access all the lymph nodes in mediastinum.

Although these methods can obtain pathological results and have high specificity, they are invasive and may lead to complications.

The traditional noninvasive examinations, chest computed tomography CT and magnetic resonance imaging MRI , are the standard imaging modalities for assessment of mediastinal lymph nodes. However, MRI spatial resolution is relatively poor due to the presence of the air in the lungs, and the calcification of lymph nodes is often ignored by MRI [ 6 ].

CT could detect lesions, but it is also difficult to obtain the differential diagnosis of benign and malignant lymph nodes [ 6 ]. In the PET imaging analysis, standard uptake value SUV , as a semiquantitative data, points off the degree of metabolic activity aerobic glycolysis in selected tissues [ 10 ].

The maximum standardized uptake value SUVmax is the maximum number of counts within the pixels in a region of interest ROI. The SUVmax cutoff value of 2. Kumar et al. When 2. There are a significant number of false positives due to inflammatory diseases and false negatives due to low-grade malignancies [ 14 ]. Research on unexplained enlarged mediastinal lymph nodes is relatively rare.

This is mainly due to the complicated mediastinal anatomy, fewer pathology results, and number of cases, which makes the research impossible. In particular, the significance of SUVmax in diagnosing mediastinal lymph nodes has not yet been reported in detail. Patients with diabetes were excluded. PET images were acquired from the level of the head to the upper part of the legs usually 6—8 bed positions at 3 minutes per bed position.

PET data were reconstructed with the ordered-subset expectation maximization algorithm. An ROI was carefully drawn on the lymph nodes, and then the SUVmax was calculated according to the following formula:. According to the new lung cancer lymph node distribution made by the International Association for the Study of Lung Cancer IASLC , we located each lymph node and measured the long axis and short axis of the largest lymph node.

If some lymph nodes were fused together, we measured it as one node [ 15 ]. The data were collected and analyzed using commercial software SPSS The SUVmax, the long axis, and the short axis of benign and malignant lymph nodes were compared using a two-sample t -test.

A receiver operating characteristics ROC curve was drawn to find the best differential diagnostic point. The SUVmax, the long axis, and the short axis of lymph nodes among common mediastinal lymphadenopathy diseases were compared using the analysis of variance. These diseases included lymphoma, metastatic lymph nodes, sarcoidosis, tuberculosis, and lymphadenitis. Multiple comparisons between multiple samples were made using LSD least significant difference , t -test homogeneity of variance , and the Tamhane test heterogeneity of variance.

There were 94 cases finally included in this study. Forty-two cases were found to have benign, and 52 had malignant etiologies on histopathology. Among the 42 benign pathologies, 16 were sarcoidosis, 17 were tuberculosis, eight were lymphadenitis, and one was Castleman disease. Among the 52 malignant pathologies, 25 were lymphoma, 26 were metastatic lymph nodes, and one was acute leukemic infiltration.

The relevant features of all cases are summarized in Table 1. Lesions of tuberculosis were easily misdiagnosed as malignant lesions among these false-positive cases. A typical case is shown in Figure 1 case no. The SUVmax, long axis, and short axis of lymph nodes in the two groups are listed in Table 3.

No statistical difference was seen in SUVmax between the malignant The long axis and the short axis of lymph nodes in the benign and malignant groups were 2. These results indicated that SUVmax is not useful in determining whether the lymph nodes are benign or malignant; however, the size of the nodes measured on CT may provide more accurate information. An ROC curve was drawn to find the best diagnostic differential point of the long axis and the short axis of lymph nodes in the distinction between benign and malignant diseases.

The optimal threshold of the long axis of lymph nodes was calculated at 4. The optimal threshold of the short axis of the lymph nodes was calculated at 2. Comparing the diagnostic efficiency of long and short axis, the short axis measurement was superior to the long axis measurement.

SUVmax, the long axis, and the short axis of five common causes of mediastinal lymphadenopathy are listed in Table 5. The three measures of five diseases were statistically different by the analysis of variance. SUVmax of sarcoidosis is statistically higher than that of tuberculosis and lymphadenitis; however, it had no significant difference with that of lymphoma Figure 3 a.

Using the Tamhane test, the pairwise comparison of the long axis of five groups showed significant differences between lymphoma and all other diseases including metastatic lymph nodes, which indicated that the size of lymphomatous nodes was larger than that of the other lesions. The size of lymphadenitis nodes was smaller compared with the other diseases except tuberculosis Figure 3 b.

Using the Tamhane test, the pairwise comparison result of the short axis of five groups is shown in Figure 3 c. Obviously, the size of lymphoma and metastatic lymph nodes was significantly larger than that of benign lesions. These results indicate that the short axis of lymph nodes is important in the distinction between benign and malignant lesions.

Enlarged mediastinal lymph nodes incidentally found on chest X-ray or CT need evaluation to determine their benign or malignant etiology. Because of the complicated anatomy of the mediastinum and the possible risk of tissue biopsy, noninvasive methods play an important role in the diagnosis of the benign and malignant mediastinal lymph nodes.

In this study, a total of 94 patients with pathological diagnosis were included with 42 benign and 52 malignant etiologies on histopathology. However, SUVmax had no significant relationship with the benignity or malignancy of lesions in this set of cases. The long axis and the short axis of lymph nodes had a certain diagnostic value in benign and malignant lesions, with the risk of malignancy increasing with size. Our results are consistent with prior research [ 6 , 10 ]. The major causes of false-positive lymph nodes are lymph node involvement by underlying inflammatory processes such as reaction to the presence of lung tumor, obstructive pneumonia, anthracosis, or granulomatous inflammation [ 18 — 21 ].

The major cause of false positivity may vary from region to region. In a study from Alabama, histoplasmosis infection was the most common cause of false positives [ 19 ]. Silicosis has been found to be a cause of false positives in a study from Germany [ 22 ]. Article PubMed Google Scholar. Eur Respir J. Clin Transl Oncol. Cancer Imaging. Ann Nucl Med. Article Google Scholar. Ann Thorac Surg. J Thorac Oncol. J Nucl Med. PubMed Google Scholar.

Volume 2. The lymph nodes. Lu P, Yu L, Li Y, Sun Y: A correlation study between maximum standardized uptake values and pathology and clinical staging in non-small cell lung cancer. Nucl Med Commun.

J Hematol Oncol. Eur J Cardiothorac Surg. Int J Cancer. Ann Thorac Cardiovasc Surg. Download references. You can also search for this author in PubMed Google Scholar. Correspondence to Deniz Koksal. All authors disclose that there is not any actual or potential conflict of interest including any financial, personal or other relationships with other people or organizations that could inappropriately influence bias their work.

DK designed the study, collected the data, interpret the results and draft the article. FD carried out the pathological evaluation. HB conceived of the study, and participated in its design and coordination and helped to draft the manuscript. BB participated in the design of the study and performed the statistical analysis.

KA participated in the design of the study and coordination. EY participated in the design of the study and coordination. All authors read and approved the final manuscript. This article is published under license to BioMed Central Ltd. Reprints and Permissions. Koksal, D. J Cardiothorac Surg 8, 63 Download citation. Received : 20 September Accepted : 26 March Published : 04 April Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

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Basic study idea by G. Patients search by G. Manuscript editing and review by D. Correspondence to Gerhard F. Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Reprints and Permissions. Sci Rep 8, Download citation. Received : 30 April Accepted : 24 July Published : 07 August Anyone you share the following link with will be able to read this content:.

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Advanced search. Skip to main content Thank you for visiting nature. Download PDF. Subjects Predictive markers Surgical oncology. Abstract The aim of this study was to investigate the predictability of occult lymph node metastasis using maximum standardized uptake value SUV max in the primary tumor on pre-treatment fluorodeoxyglucose positron emission tomography FDG-PET in oral squamous cell carcinoma OSCC patients who were clinically node negative cN0 before surgery.

Introduction Oral squamous cell carcinoma OSCC is an aggressive malignancy characterized by local invasiveness and high propensity to lymph node metastases 1 , 2. Results Patient and Tumor Characteristics A total of 71 consecutive patients were included in the study. Full size table. Figure 1. Full size image. Figure 2. Figure 3. Figure 4. References 1. Article PubMed Google Scholar 6. Article PubMed Google Scholar 7. Article PubMed Google Scholar 8. Article Google Scholar Article PubMed Google Scholar PubMed Article Google Scholar Author information Author notes Gerhard F.

Huber and Martin W.