Standardized Uptake Values in 2-Deoxy-2-[ 18F]Fluoro-D-Glucose with Positron Emission Tomography : Clinical Significance of Iterative Reconstruction and Segmented Attenuation Compared with Conventional Filtered Back Projection and Measured Attenuation Correction

Abstract

Purpose: To evaluate the clinical significance of differences in 2-deoxy-2-[ 18F]fluoro-D-glucose positron emission tomography (FDG-PET) lymph node standardized uptake values (SUV) in human immunodeficiency virus (HIV) infection using iterative reconstruction with segmented attenuation correction (IR SAC) compared to filtered back-projection with measured attenuation correction (FBP MAC). Procedures: Seven patients with HIV infection and multiple focal lymph node abnormalities were investigated with whole-body FDG-PET. Mean and maximum SUVs from lymph node regions of interest (n = 961) were compared for quantitative differences between reconstruction techniques. Results: IR MAC resulted in significantly lower mean SUV [0.06; 95% (confidence interval (CI)) = 0.04–0.07] and maximum SUV (0.82; 95% CI = 0.77–0.88) values compared to FBP MAC. With IR, segmentation of attenuation correction (AC) resulted in significantly higher mean SUV (0.12; 95% CI = 0.11–0.13) and maximum SUV (0.21; 95% CI = 0.18–0.23) values compared to IR MAC. The overall effect of both IR and SAC was a slight but significant increase in mean SUV (0.06; 95% CI = 0.06–0.08; bias = 2.1%) and a significant decrease in maximum SUV (0.62; 95% CI = 0.56–0.67) compared to FBP MAC. Conclusions: With our reconstruction parameters, significant differences in mean and maximum SUV values were observed. The magnitude of the mean SUV difference, however, was small. IR SAC is a promising method to accurately quantify standardized uptake values for clinical use.