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18F-FDG PET/CT已广泛应用于临床各类疾病的诊断、分期、疗效评价和预后分析中。尤其在肿瘤良恶性的判断和活性程度的评估中,很多半定量参数发挥了重要的作用。SUV作为测量放射性物质积累的量化参数,也成为实体肿瘤疗效评价的标准[1]。理想情况下,使用SUV能消除放射性药物注射剂量的差异引起的变异,但在测量放射性计数及将其转换为SUV时引入了多种偏差,从而导致SUV发生实质性的差异。我们对SUV测量准确性的影响因素进行分析,并提出SUV规范化使用的建议,希望最大程度地减少SUV的偏差。
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SUV的测量方法为在组织中勾画ROI,并在ROI内测量标准化的放射性活度。在量化参数的选择上,常用的有ROI中所有体素的最大值(SUVmax),平均值(mean standardized uptake value,SUVmean)和峰值(peak standardized uptake value,SUVpeak)。SUVmean合并了来自多个体素的信息,是根据ROI中包含的所有体素计算的平均值,故其对ROI的定义比较敏感。SUVmax是ROI中最高的体素值,其更容易受到噪声的影响,也是最常用的SUV参数。SUVpeak是在活动性最高的体素周围的一组体素的SUV平均值[2]。
常见的分布标准化指标有体重、瘦体重(lean body mass,LBM)以及体表面积(body surface area,BSA)等,目前,最常用的是体重,即公式(1)。但放射性物质在人体各组织中的分布是不均匀的,如肥胖人群的脂肪组织中放射性摄取较低,单纯应用体重进行标准化校正可能导致SUV测量值偏高。因此,研究者们提出了以下几种代替体重对显像剂的分布进行标准化校正的指标:LBM即SUVLBM、BSA即SUVBSA、体重指数(body mass index,BMI)即SUVBMI,计算公式见(2)、(3)、(4)。
$ {\rm{SUV}} = \frac{{{\text{单位组织中的放射性活度}}\left( {{\rm{Bq}}/{\rm{mL}}} \right)}}{{{\text{注射活度}}\left( {{\rm{Bq}}} \right)/{\text{体重}}\left( {{\rm{kg}}} \right)}} $ $ {\rm{SU}}{{\rm{V}}_{{\rm{LBM}}}} = \frac{{{\text{单位组织中的放射性活度}}\left( {{\rm{Bq}}/{\rm{mL}}} \right)}}{{{\text{注射活度}}\left( {{\rm{Bq}}} \right)/{\rm{LBM}}\left( {{\rm{kg}}} \right)}} $ $ {\rm{SU}}{{\rm{V}}_{{\rm{BSA}}}} = \frac{{{\text{单位组织中的放射性活度}}\left( {{\rm{Bq}}/{\rm{mL}}} \right)}}{{{\text{注射活度}}\left( {{\rm{Bq}}} \right)/{\rm{BSA}}\left( {{{\rm{m}}^2}} \right)}} $ $ {\rm{SU}}{{\rm{V}}_{{\rm{BMI}}}} = \frac{{{\text{单位组织中的放射性活度}}\left( {{\rm{Bq}}/{\rm{mL}}} \right)}}{{{\text{注射活度}}\left( {{\rm{Bq}}} \right)/{\rm{BMI}}\left( {{\rm{kg}}/{{\rm{m}}^2}} \right)}} $ 如果没有特殊说明,SUV为按照体重进行标准化校正,即公式(1)。
SUV测量准确性的影响因素及其解决对策
The influencing factors on the accuracy of SUV measurement and their solutions
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摘要: 标准化摄取值(SUV)是18F-FDG PET/CT在临床应用中最重要的半定量指标,其在多种疾病的诊断、肿瘤疗效的评价和预后的评估等方面都有重要作用。但SUV的测量准确性受生物学因素和技术性因素等多种因素的影响,为了提高SUV的测量准确性,更精准地评估病情,笔者就SUV测量准确性的影响因素及其解决对策进行总结,以期为临床应用提供帮助。
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关键词:
- 标准化摄取值 /
- 正电子发射断层显像术 /
- 体层摄影术,X线计算机 /
- 影响因素 /
- 重建参数
Abstract: Standardized uptake value (SUV) is the most important semi-quantitative index in the clinical application of 18F-FDG PET/CT. It plays an important role in the diagnosis of various diseases, evaluation of therapeutic efficacy and prognosis in tumors. However, the accuracy of SUV measurement can be affected by many factors, such as biological and technical factors. This review summarizes the influencing factors on the accuracy of SUV measurement and their solutions in order to provide assistance for clinical setting. -
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