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Original Research

Liver SULmean at FDG PET/CT: Interreader Agreement and Impact of Placement of Volume of Interest

Published Online:May 1 2013https://doi.org/10.1148/radiol.12121385

Abstract

Liver mean standardized uptake value normalized to lean body mass, or SULmean, can be measured at the upper aspect of the right lobe of the liver for quality control, standardization, and therapy assessment purposes between fluorine 18 fluorodeoxyglucose PET/CT studies to facilitate quantitative imaging in oncology.

Purpose

To evaluate how interreader agreement and the site of the volume of interest (VOI) affect the agreement and variability of liver mean standardized uptake value normalized to lean body mass (SULmean) at fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT).

Materials and Methods

Institutional review board approval was obtained for this HIPAA-compliant retrospective review of PET/CT images and patient records. PET/CT images were reviewed in 116 randomly selected patients who had undergone a baseline PET/CT examination and who had normal livers according to imaging and biochemical test results. A 30-mm-diameter spherical VOI was placed within the right lobe of the liver above, below, and at the level of the main portal vein. Two readers performed all measurements independently. Analysis of variance, intraclass correlation coefficient (ICC) analysis, and Bland-Altman analysis were performed.

Results

The mean SULmean was between 2.11 and 2.17 at the upper, portal, and lower levels of the right lobe of the liver. The coefficient of variance was between 21.0% and 23.1%, without significant differences for location, with the least variance in the upper level. The ICC of the two readers varied between 0.98 and 0.99 (95% confidence interval [CI]: 0.97, 0.99; P = .0001) at each level. The greatest precision (narrowest CI) was also in the upper level. Bias was 0.025 ± 0.10 (standard deviation) at the upper level, was 0.004 ± 0.14 at the lower level, and was 0.047 ± 0.10 at the portal vein (P = .02). For each reader, there was almost perfect reliability between the SULmean measurements made at the three levels, with an ICC of 0.98 (95% CI: 0.98, 0.99; P = .0001).

Conclusion

Liver SULmean at FDG PET/CT has excellent interreader agreement, with similar values and variance whether measured at the upper, lower, or portal vein levels within the right lobe of the liver.

© RSNA, 2013

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Article History

Received June 22, 2012; revision requested July 30; revision received August 20; accepted September 5; final version accepted September 18.
Published online: May 2013
Published in print: May 2013