Current generation time-of-flight 18F-FDG PET/CT provides higher SUVs for normal adrenal glands, while maintaining an accurate characterization of benign and malignant glands

Daniëlle Koopman, Daniëlle Koopman, Jorn A. van Dalen, Jos A. Stigt, Cornelis H. Slump, Siert Knollema, Pieter L. Jager

    Research output: Contribution to journalArticleAcademicpeer-review

    7 Citations (Scopus)
    95 Downloads (Pure)


    ObjectiveModern PET/CT scanners have significantly improved detectors and fast time-of-flight (TOF) performance and this may improve clinical performance. The aim of this study was to analyze the impact of a current generation TOF PET/CT scanner on standardized uptake values (SUV), lesion-background contrast and characterization of the adrenal glands in patients with suspected lung cancer, in comparison with literature data and commonly used SUV cut-off levels.MethodsWe included 149 adrenal glands from 88 patients with suspected lung cancer, who underwent 18F-FDG PET/CT. We measured the SUVmax in the adrenal gland and compared this with liver SUVmean to calculate the adrenal-to-liver ratio (AL ratio). Results were compared with literature derived with older scanners, with SUVmax values of 1.0 and 1.8 for normal glands [1, 2]. Final diagnosis was based on histological proof or follow-up imaging. We proposed cut-off values for optimal separation of benign from malignant glands.ResultsIn 127 benign and 22 malignant adrenal glands, SUVmax values were 2.3 ± 0.7 (mean ± SD) and 7.8 ± 3.2 respectively (p < 0.01). Corresponding AL ratios were 1.0 ± 0.3 and 3.5 ± 1.4 respectively (p < 0.01). With a SUVmax cut-off value of 3.7, 96 % sensitivity and 96 % specificity was reached. An AL ratio cut-off value of 1.8 resulted in 91 % sensitivity and 97 % specificity. The ability of both SUVmax and AL ratio to separate benign from malignant glands was similar (AUC 0.989 vs. 0.993, p = 0.22).ConclusionsCompared with literature based on the previous generation of PET scanners, current generation TOF 18F-FDG PET/CT imaging provides higher SUVs for benign adrenal glands, while it maintains a highly accurate distinction between benign and malignant glands. Clinical implementation of current generation TOF PET/CT requires not only the use of higher cut-off levels but also visual adaptation by PET readers.
    Original languageUndefined
    Pages (from-to)145-152
    Number of pages8
    JournalAnnals of nuclear medicine
    Issue number2
    Publication statusPublished - Feb 2016


    • EWI-26836
    • Lung cancer
    • PET/CT
    • Adrenal glands
    • IR-99601
    • 18F-FDG
    • METIS-316046

    Cite this