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. 2018 May 8;8:7201. doi: 10.1038/s41598-018-25350-7

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© The Author(s) 2018

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.

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Prognostic relevance of ¹⁸F-FET PET based standardized uptake ratio (SUR). SUR is calculated by normalizing SUV_max in the tumor lesion to the average background SUV (SUV_bg) within a region of similar size to GTV in the contralateral part of the brain, as shown (a). SUR was slightly but not significantly higher in grade IV glioma compared to grade III glioma (b). In grade IV tumors, the median value of SUR = 2.92 clearly separated patients into two prognostic subgroups as shown in KM-plot (c). This did not apply to grade III tumors (see supplements). For PET contouring, large interindividual heterogeneity of ¹⁸F-FET PET uptake was found limiting the use of a fixed threshold for all patients as illustrated in two patients (d,e). However, based on SUR, thresholds for the reasonable applicability of isocontours could be drawn as SUR > 2.73 for an isocontour of 40%, SUR > 2.55 for an isocontour of 50% and SUR > 1.62 for an isocontour of 60%. This was not possible using SUV_max.