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Accurate quantification of tracer uptake is essential for assessing disease activity and treatment response. This study aimed to determine optimal simplified metrics for Na[\n                      <jats:sup>18<\/jats:sup>\n                      F]F uptake and evaluate their performance compared to net influx rate (\n                      <jats:italic>K<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>i<\/jats:italic>\n                      <\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A prospective study included 54 SpA patients undergoing Na[\n                      <jats:sup>18<\/jats:sup>\n                      F]F PET\/CT scans at baseline and after 12 weeks of therapy. Dynamic PET in combination with venous blood sampling was analyzed to derive kinetic parameters, including\n                      <jats:italic>K<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>i<\/jats:italic>\n                      <\/jats:sub>\n                      in 43 scans that included pathological uptake in the dynamic field of view. Semi-quantitative standardized uptake values (SUVs) corrected body weight (BW), lean body mass (LBM), body surface area (BSA) and skeletal volume (SV) were compared and correlations between\n                      <jats:italic>K<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>i<\/jats:italic>\n                      <\/jats:sub>\n                      and SUVs were assessed cross-sectionally and longitudinally. Based on analysis of the blood sample data, there was a significant difference between SUV corrected for BW between patients who weighted more and less than 85 kg (p\u2009&lt;\u20090.01 at all sample moments). When LBM or SV was used, this difference disappeared (p\u2009&gt;\u20090.05). There was a significant correlation between\n                      <jats:italic>K<\/jats:italic>\n                      <jats:sub>\n                        <jats:italic>i<\/jats:italic>\n                      <\/jats:sub>\n                      and various SUV-metrics, with SUV\n                      <jats:sub>peak-LBM<\/jats:sub>\n                      at 25\u201330 min yielding the highest correlation both cross-sectionally (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.77, p\u2009&lt;\u20090.01), and longitudinally (R\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.54, p\u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Na[\n                      <jats:sup>18<\/jats:sup>\n                      F]F uptake quantification of lesions in the axial skeleton of SpA patients can be performed cross-sectionally and longitudinally with simplified uptake measures, particularly SUV\n                      <jats:sub>peak<\/jats:sub>\n                      , normalized using LBM or SV. This offers a more reliable approach to evaluating disease activity and treatment responses compared to BW.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13550-025-01337-0","type":"journal-article","created":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T10:35:28Z","timestamp":1766572528000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Na[18F]F PET\/CT quantification in spondyloarthritis: comparative evaluation of SUV normalization approaches"],"prefix":"10.1186","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0453-8157","authenticated-orcid":false,"given":"Wouter R. 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