Assessment of alteration in liver 18F–FDG uptake due to steatosis in lymphoma patients and its impact on the Deauville score
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We read with interest the article recently published in EJNMMI by Salomon et al.  that described a negative relationship between hepatic steatosis and SUV, and recommended the use of SULmax rather than SUVmax as the comparator in the Deauville scoring (DS) system because it minimises the influence of body mass index (BMI). They found, nevertheless, that it made little difference to DS whether SULmax or SUVmax was used. It is stated (but only in the Abstract) that in their scoring system, SULmax was applied to the lymphoma. Provided lymphoma and liver are compared either on the basis of SUV or SUL, body weight will cancel out and remove any influence of BMI on DS. It makes no sense to compare an SUL with an SUV, or vice versa, so normalising any tumour to liver removes the need to choose between SUL and SUV, provided whichever one is used is applied to both tissues.
In any event, in our view, the liver is just about the least appropriate tissue against which to normalise...
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