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Both metrics can be further normalised to SUVs in reference regions resulting in a SUV ratio (SUV<jats:sub>ratio<\/jats:sub>). The aim of the study was to directly compare several widely used SUVs\/SUV<jats:sub>ratios<\/jats:sub>with regard to differentiation between common tumours in paediatric patients; a special focus was put on characteristics of reference region SUVs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The final study population consisted of 61 children and adolescents with diagnoses of non-Hodgkin lymphoma (NHL,<jats:italic>n<\/jats:italic>= 25), Hodgkin lymphoma (HL,<jats:italic>n<\/jats:italic>= 14), and sarcoma (<jats:italic>n<\/jats:italic>= 22). SUV metrics included SUV<jats:sub>max<\/jats:sub>and SUV<jats:sub>peak<\/jats:sub>as well as both parameters normalised to liver and mediastinal blood pool, respectively, yielding the SUV<jats:sub>ratios<\/jats:sub>SUV<jats:sub>max\/liver<\/jats:sub>, SUV<jats:sub>max\/mediastinum<\/jats:sub>, SUV<jats:sub>peak\/liver<\/jats:sub>, and SUV<jats:sub>peak\/mediastinum<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The metrics SUV<jats:sub>max<\/jats:sub>, SUV<jats:sub>peak<\/jats:sub>, SUV<jats:sub>max\/liver<\/jats:sub>, and SUV<jats:sub>peak\/liver<\/jats:sub>all proved to be sensitive for tumour differentiation (<jats:italic>p<\/jats:italic>\u2264 0.008); in contrast, SUV<jats:sub>max\/mediastinum<\/jats:sub>and SUV<jats:sub>peak\/mediastinum<\/jats:sub>revealed to be non-sensitive approaches. Correlation analyses showed inverse associations between reference region SUVs and SUV<jats:sub>ratios<\/jats:sub>(<jats:italic>p<\/jats:italic>&lt; 0.05). Multiple regression analyses demonstrated significant effects of factors as bodyweight and uptake time on reference region SUVs (<jats:italic>p<\/jats:italic>&lt; 0.01), and thus indirectly on the corresponding SUV<jats:sub>ratios<\/jats:sub>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In the paediatric population, the ability to differentiate between common tumours remarkably varies between SUV metrics. When using SUV<jats:sub>ratios<\/jats:sub>, the choice of reference region is crucial. Factors potentially influencing reference region SUVs (and thus SUV<jats:sub>ratios<\/jats:sub>) should be taken into account in order to avoid erroneous conclusions. When not possible, SUV<jats:sub>max<\/jats:sub>and SUV<jats:sub>peak<\/jats:sub>represent less complex, more robust alternatives.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13550-019-0577-7","type":"journal-article","created":{"date-parts":[[2019,12,23]],"date-time":"2019-12-23T14:03:26Z","timestamp":1577109806000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["What and how should we measure in paediatric oncology FDG-PET\/CT? 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