Purpose: We designed standard parameters for quality controls (QCs) of F-fluorodeoxyglucose positron emission tomography (FDG PET) images in the clinical setting, and validated them in both cross-sectional and longitudinal cohorts of patients with lymphoma under treatment.
Methods: The procedure is based on the measurement of mean standardized uptake value (SUV mean) in three specific regions of interest drawn within pulmonary, liver, and bone tissues [reference (Ref)]. Intraobserver and interobserver reproducibility [percentage of coefficient of variation (CV%)] were calculated using PET scans of healthy participants. Cross-sectional interpatient QCs were defined as the 95% ranges of normal values of Ref-SUV mean. Transversal QCs were applied on PET scans of patients treated for lymphoma (n=378) looking at Ref-SUV mean out of range. Longitudinal intrapatient QCs were defined as the 95% limits of the SUV mean variation between two consecutive scans (ΔSUV limits). Longitudinal QCs were applied in a group of 94 pairs of consecutive PET scans under treatment for lymphoma looking at patients having Ref-ΔSUV limits out of range.
Results: Intraobserver CV% remained below 3%, whereas interobserver CV% was a maximum of 5.3%. Both in transversal and longitudinal cohorts of patients treated for lymphoma, none of the PET scans simultaneously showed the three Ref-SUV mean out of range. Similar results were obtained with ΔSUV limits. Situations in which these limits were exeeded were associated with a recent history of acute infectious pulmonary disease (lung tissues) and granulocytes colony-stimulating factors concomitant treatment and stimulation of bone marrow (bone tissues).
Conclusion: A standardized and reproducible FDG PET QC protocol using SUV mean measurements using three tissues of Ref was validated, and may be applied in the clinical setting or in a clinical trial.
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