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Metrard G, Cohen C, Bailly M. Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward? Front Med (Lausanne) 2024; 11:1373260. [PMID: 38566921 PMCID: PMC10985176 DOI: 10.3389/fmed.2024.1373260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
The integration of diagnostic CT scans into PET/CT facilitates a comprehensive single examination, presenting potential advantages for patients seeking a thorough one-shot check-up. The introduction of iodinated contrast media during PET scanning raises theoretical concerns about potential interference with uptake quantification, due to the modification of tissue density on CT. Nevertheless, this impact appears generally insignificant for clinical use, compared to the intrinsic variability of standardized uptake values. On the other hand, with the growing indications of PET, especially 18F-FDG PET, contrast enhancement increases the diagnostic performances of the exam, and provides additional information. This improvement in performance achieved through contrast-enhanced PET/CT must be carefully evaluated considering the associated risks and side-effects stemming from the administration of iodinated contrast media. Within this article, we present a comprehensive literature review of contrast enhanced PET/CT, examining the potential impact of iodinated contrast media on quantification, additional side-effects and the pivotal clinically demonstrated benefits of an all-encompassing examination for patients. In conclusion, the clinical benefits of iodinated contrast media are mainly validated by the large diffusion in PET protocols. Contrary to positive oral contrast, which does not appear to offer any major advantage in patient management, intravenous iodine contrast media provides clinical benefits without significant artifact on images or quantification. However, studies on the benefit-risk balance for patients are still lacking.
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Affiliation(s)
- Gilles Metrard
- Nuclear Medicine Department, Orléans University Hospital, Orléans, France
- Centre de Biophysique Moléculaire, CNRS UPR 4301, Université d’Orléans, Orléans, France
| | - Clara Cohen
- Radiology Department, Orléans University Hospital, Orléans, France
| | - Matthieu Bailly
- Nuclear Medicine Department, Orléans University Hospital, Orléans, France
- Centre de Biophysique Moléculaire, CNRS UPR 4301, Université d’Orléans, Orléans, France
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Black R, Barentsz J, Howell D, Bostwick DG, Strum SB. Optimized 18F-FDG PET-CT Method to Improve Accuracy of Diagnosis of Metastatic Cancer. Diagnostics (Basel) 2023; 13:diagnostics13091580. [PMID: 37174971 PMCID: PMC10178450 DOI: 10.3390/diagnostics13091580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/28/2023] [Accepted: 04/12/2023] [Indexed: 05/15/2023] Open
Abstract
The diagnosis of cancer by FDG PET-CT is often inaccurate owing to subjectivity of interpretation. We compared the accuracy of a novel normalized (standardized) method of interpretation with conventional non-normalized SUV. Patients (n = 393) with various malignancies were studied with FDG PET/CT to determine the presence or absence of cancer. Target lesions were assessed by two methods: (1) conventional SUVmax (conSUVmax) and (2) a novel method that combined multiple factors to optimize SUV (optSUVmax), including the patient's normal liver SUVmax, a liver constant (k) derived from a review of the literature, and use of site-specific thresholds for malignancy. The two methods were compared to pathology findings in 154 patients being evaluated for mediastinal and/or hilar lymph node (MHLNs) metastases, 143 evaluated for extra-thoracic lymph node (ETLNs) metastases, and 96 evaluated for liver metastases. OptSUVmax was superior to conSUVmax for all patient groups. For MHLNs, sensitivity was 83.8% vs. 80.7% and specificity 88.7% vs. 9.6%, respectively; for ETLNs, sensitivity was 92.1% vs. 77.8% and specificity 80.1% vs. 27.6%, respectively; and for lesions in the liver parenchyma, sensitivity was 96.1% vs. 82.3% and specificity 88.8% vs. 23.0%, respectively. Optimized SUVmax increased diagnostic accuracy of FDG PET-CT for cancer when compared with conventional SUVmax interpretation.
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Affiliation(s)
| | - Jelle Barentsz
- Department of Radiology, Andros Clinics, Meester E.N. van Kleffensstraat 5, 6842 CV Arnhem, The Netherlands
| | - David Howell
- Department of Radiation Oncology, Ohio Health Cancer Center, 75 Hospital Drive, Athens, OH 45701, USA
| | - David G Bostwick
- Rampart Health, 601 Biotech Drive, North Chesterfield, VA 23235, USA
| | - Stephen B Strum
- Community Practice of Hematology, Oncology and Internal Medicine, Focus on Prostate Cancer and Prostate Diseases, Medford, OR 97504, USA
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IV Contrast Material for PET/CT: Counterpoint-Critical Concerns Remain. AJR Am J Roentgenol 2022; 219:882-883. [PMID: 35611920 DOI: 10.2214/ajr.22.27841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Jacquet-Francillon N, Morelec I, Germain N, Prades JM, Habouzit V, Mariat C, Bonnefoy PB, Prevot N. Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study). Front Med (Lausanne) 2022; 9:956580. [PMID: 35983092 PMCID: PMC9380568 DOI: 10.3389/fmed.2022.956580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective [18F]Fluorocholine positron emission tomography/computed tomography (PET/CT) is used frequently in addition to [99mTc]Tc-Sestamibi scintigraphy and ultrasonography for the location of hyperfunctioning parathyroid glands. The aim of this study is to evaluate the performance of quantitative criteria in [18F]fluorocholine PET/CT for localization of hyperfunctioning parathyroid glands. The secondary objective is to highlight a correlation between the detection rate of [18F]fluorocholine PET/CT and serum parathyroid hormone (PTH) level. Materials and methods In two academic centers, we retrospectively included patients with biological hyperparathyroidism (HPT) and who had [18F]fluorocholine PET/CT. After a visual analysis, to measure the overall performance of [18F]fluorocholine PET/CT, a blind reading was carried out with standardized measurements of maximum standardized uptake value (SUVmax), liver ratio, thyroid ratio, and size ratio. We analyzed the quantitative criteria of [18F]fluorocholine PET/CT compared to the histological results, in particular to identify differences between adenomas and hyperplasias. We compared the performance of each quantitative criterion to the overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [18F]fluorocholine PET/CT. The detection rate of hyperfunctioning parathyroid glands was calculated in subgroups of serum PTH level. Results The quantitative criteria in [18F]fluorocholine PET/CT were measured for 120 patients (135 lesions). The areas under the receiver operating characteristic (ROC) curve representing SUVmax and liver ratio were significantly increased. The optimal cut-off values represented by the maximum Youden index was >4.12 for SUVmax and >27.4 for liver ratio. Beyond certain threshold values of SUVmax (>4.12) or liver ratio (>38.1), all the lesions were histologically proven adenomas. SUVmax and liver ratio were significantly higher for adenomas than for hyperplasias and differential diagnosis (p = 0.0085 and p = 0.0002). The positivity of [18F]fluorocholine PET/CT was correlated with PTH level. Detection rates were 55.56, 75.56, and 87.5%, respectively, for serum PTH < 70, 70 to 120, and >120 ng/ml. Conclusion Semi-quantitative measurements (SUVmax and liver ratio) should be considered as additional tools in interpretation of [18F]fluorocholine PET/CT. These quantitative parameters have lower overall performance but higher specificity than overall visual analysis in identifying an adenoma. Above certain threshold values, all lesions are adenomas. [18F]fluorocholine PET/CT confirms excellent performance for the detection of hyperfunctional parathyroids. For serum PTH levels < 70 ng/ml, the detection rate of [18F]fluorocholine PET/CT is strongly decreased.
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Affiliation(s)
- Nicolas Jacquet-Francillon
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
- *Correspondence: Nicolas Jacquet-Francillon,
| | - Isabelle Morelec
- Department of Nuclear Medicine, Hospices Civils de Lyon, Lyon, France
| | - Natacha Germain
- Division of Endocrinology, Diabetes, Metabolism and Eating Disorders, Centre Hospitalo-Universitaire (CHU) de Saint-Étienne, Saint-Étienne, France
- Eating Disorders, Addictions and Extreme Bodyweight Research Group (TAPE) EA 7423, Université Jean Monnet, Saint-Étienne, France
| | - Jean-Michel Prades
- Department of Otorhinolaryngology, Head and Neck Surgery, Hospital Saint-Étienne, Saint-Étienne, France
- Laboratory of Human Anatomy, Faculty of Medicine, University of Saint-Étienne, Saint-Étienne, France
| | - Vincent Habouzit
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
| | - Christophe Mariat
- Department of Nephrology, Dialysis and Renal Transplantation, Hôpital Nord, Centre Hospitalo-Universitaire (CHU) de Saint-Étienne, Jean Monnet University, Université de Lyon, Saint-Étienne, France
- Groupe Immunité des Muqueuses et Agents Pathogènes GIMAP, EA 3065, University of Jean Monnet and Université de Lyon, Saint-Étienne, France
| | - Pierre-Benoit Bonnefoy
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
| | - Nathalie Prevot
- Department of Nuclear Medicine, Saint-Étienne University Hospital, University of Saint-Étienne, Saint-Étienne, France
- INSERM, U1059, SAINBIOSE, Univ Lyon, Univ Saint-Etienne, Saint-Etienne, France
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Ragab A, Wu J, Ding X, Clark A, Mischen B, Chauhan A, Oates ME, Anthony L, El Khouli R. 68Ga-DOTATATE PET/CT: The Optimum Standardized Uptake Value (SUV) Internal Reference. Acad Radiol 2022; 29:95-106. [PMID: 34756348 DOI: 10.1016/j.acra.2020.08.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/18/2020] [Accepted: 08/18/2020] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVES Standardized Uptake Value (SUV) is an important semiquantitative measurement used in the clinical and research domains to assess radiopharmaceutical concentration in tumors versus normal organs, but is susceptible to many factors beyond the tumor biological environment. So, the aim of this study is to identify the optimum internal reference among organs with physiological uptake in 68Ga-DOTATATE PET/CT (DOTA PET/CT) scans. MATERIALS AND METHODS This HIPAA-compliant, IRB-approved study with waiver of consent included retrospective imaging review of 180 consecutive patients with neuroendocrine tumors presenting for DOTA PET/CT image acquisition: Ga-68 DOTATATE dose was reported as (0.054 mCi/Kg) scans between September 2018 and May 2019. Mean value of body weight normalized SUV (SUVbw) and lean body mass normalized SUV (SUL) of liver and spleen were measured. Information about the patients and scan characteristics were collected. The paired Grambsch test was used to compare variance among the measured SUVs. Spearman's rank correlation coefficient was used to assess correlation between SUVs and potential patient- and scan-specific confounding factors. RESULTS Variance of SUL was significantly lower than variance of SUVbw in both liver and spleen (p-value < 0.0001). Variances of liver SUVbw and SUL were significantly lower than the corresponding spleen SUVs. Liver SUL showed the lowest variance (3.69% ± 1.25%) among all measured SUVs. CONCLUSION SUL is a more reproducible, less variable, and therefore more reliable quantitative measure in DOTA PET/CT scans, compared SUVbw. Among the available organs with physiological uptake, liver SUL is the optimum internal reference given the liver's larger size and uniform SUL values resulting in lower variability and better reproducibility.
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Affiliation(s)
- Ahmed Ragab
- Yale New Haven Health - Bridgeport Hospital, Bridgeport, Connecticut
| | - Jianrong Wu
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Cancer Biostatistics, Lexington, Kentucky; University of Kentucky College of Medicine, Markey Cancer Center, Biostatistics and Bioinformatics Shared Resource Facility, Lexington, Kentucky
| | - Xue Ding
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Cancer Biostatistics, Lexington, Kentucky
| | - Aurela Clark
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY
| | - Blaine Mischen
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY
| | - Aman Chauhan
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Medical Oncology, Lexington, Kentucky; University of Kentucky College of Medicine, Markey Cancer Center, Lexington, Kentucky
| | - M Elizabeth Oates
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY
| | - Lowell Anthony
- University of Kentucky College of Medicine, Department of Internal Medicine, Division of Medical Oncology, Lexington, Kentucky; University of Kentucky College of Medicine, Markey Cancer Center, Lexington, Kentucky
| | - Riham El Khouli
- University of Kentucky College of Medicine, Department of Radiology, Division of Nuclear Medicine and Molecular imaging, 800 Rose street, Lexington, 40536 KY; University of Kentucky College of Medicine, Markey Cancer Center, Lexington, Kentucky.
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Nguyen T, Baun C, Høilund-Carlsen PF. An account of data entry inconsistencies and their impact on positron emission tomography quantification. Medicine (Baltimore) 2018; 97:e12312. [PMID: 30212971 PMCID: PMC6156030 DOI: 10.1097/md.0000000000012312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Reproducibility is essential to clinical application of positron emission tomography (PET) quantification. Human lapses in data registration and protocol compliance are pervasive sources of intrasite quantification variability. Although rarely assessed or reported, these lapses are ultimately a limitation to harmonization in multicenter clinical trials. A comprehensive account of their possible extent is relayed here.This is a retrospective audit of errors in manual registration of study parameters and in protocol adherence across a sample of in-center research projects over one year (201 patients, 222 PET/CT scans). Discrepancies in patient height and weight; tracer type; dose; injection; and scan times were listed. Correspondent variances in standardized uptake values (SUVs) normalized by body weight, SUV (BW), and body surface area, SUV (BSA), were assessed.Manual misregistrations totalled 41.8%. These were mainly small, but with a few large deviations, and most significant in weight (range: -1-100 kg) and dose (-19 to 12 MBq). Errors were more frequent and generally larger in non-routine studies. This also applied to protocol compliance. A 50.7% noncompliance was found with significant deviations in dose (-106 to 208 MBq) and especially in early scan uptake times (-37 to 54 min). Although misregistrations did not overall translate into significant SUV variability, noncompliance did. These errors contributed a factor 0.02 to 1.45 and 0.71 to 3.09 SUV (BW) change, respectively. SUV (BSA) saw a significant 21% to 22% decrease with mistyped height and weight.Inconsistency was frequent but less prominent in data entry than in protocol compliance. As both caused some substantial SUV variances, intra-site assessments and data checking are required for clinical trials.
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Affiliation(s)
- Tram Nguyen
- Department of Nuclear Medicine, Odense University Hospital, Odense
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kongens Lyngby
| | - Christina Baun
- Department of Nuclear Medicine, Odense University Hospital, Odense
- Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital, Odense
- Clinical Physiology and Nuclear Medicine, University of Southern Denmark, Odense, Denmark
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Mahmud MH, Nordin AJ, Saad FFA, Azman AZF. Estimation of patient radiation dose from whole body18F- FDG PET/CT examination in cancer imaging: a preliminary study. ACTA ACUST UNITED AC 2014. [DOI: 10.1088/1742-6596/546/1/012008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Present and future role of FDG-PET/CT imaging in the management of gynecologic malignancies. Jpn J Radiol 2014; 32:313-23. [DOI: 10.1007/s11604-014-0317-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/02/2014] [Indexed: 01/03/2023]
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Verburg FA, Kuhl CK, Pietsch H, Palmowski M, Mottaghy FM, Behrendt FF. The influence of different contrast medium concentrations and injection protocols on quantitative and clinical assessment of FDG–PET/CT in lung cancer. Eur J Radiol 2013; 82:e617-22. [DOI: 10.1016/j.ejrad.2013.06.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
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Lasnon C, Quak E, Briand M, Gu Z, Louis MH, Aide N. Contrast-enhanced small-animal PET/CT in cancer research: strong improvement of diagnostic accuracy without significant alteration of quantitative accuracy and NEMA NU 4-2008 image quality parameters. EJNMMI Res 2013; 3:5. [PMID: 23327687 PMCID: PMC3563455 DOI: 10.1186/2191-219x-3-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 01/09/2013] [Indexed: 02/05/2023] Open
Abstract
Background The use of iodinated contrast media in small-animal positron emission tomography (PET)/computed tomography (CT) could improve anatomic referencing and tumor delineation but may introduce inaccuracies in the attenuation correction of the PET images. This study evaluated the diagnostic performance and accuracy of quantitative values in contrast-enhanced small-animal PET/CT (CEPET/CT) as compared to unenhanced small animal PET/CT (UEPET/CT). Methods Firstly, a NEMA NU 4–2008 phantom (filled with 18F-FDG or 18F-FDG plus contrast media) and a homemade phantom, mimicking an abdominal tumor surrounded by water or contrast media, were used to evaluate the impact of iodinated contrast media on the image quality parameters and accuracy of quantitative values for a pertinent-sized target. Secondly, two studies in 22 abdominal tumor-bearing mice and rats were performed. The first animal experiment studied the impact of a dual-contrast media protocol, comprising the intravenous injection of a long-lasting contrast agent mixed with 18F-FDG and the intraperitoneal injection of contrast media, on tumor delineation and the accuracy of quantitative values. The second animal experiment compared the diagnostic performance and quantitative values of CEPET/CT versus UEPET/CT by sacrificing the animals after the tracer uptake period and imaging them before and after intraperitoneal injection of contrast media. Results There was minimal impact on IQ parameters (%SDunif and spillover ratios in air and water) when the NEMA NU 4–2008 phantom was filled with 18F-FDG plus contrast media. In the homemade phantom, measured activity was similar to true activity (−0.02%) and overestimated by 10.30% when vials were surrounded by water or by an iodine solution, respectively. The first animal experiment showed excellent tumor delineation and a good correlation between small-animal (SA)-PET and ex vivo quantification (r2 = 0.87, P < 0.0001). The second animal experiment showed a good correlation between CEPET/CT and UEPET/CT quantitative values (r2 = 0.99, P < 0.0001). Receiver operating characteristic analysis demonstrated better diagnostic accuracy of CEPET/CT versus UEPET/CT (senior researcher, area under the curve (AUC) 0.96 versus 0.77, P = 0.004; junior researcher, AUC 0.78 versus 0.58, P = 0.004). Conclusions The use of iodinated contrast media for small-animal PET imaging significantly improves tumor delineation and diagnostic performance, without significant alteration of SA-PET quantitative accuracy and NEMA NU 4–2008 IQ parameters.
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Malladi A, Viner M, Jackson T, Mercier G, Subramaniam RM. PET/CT mediastinal and liver FDG uptake: effects of biological and procedural factors. J Med Imaging Radiat Oncol 2012; 57:169-75. [PMID: 23551774 DOI: 10.1111/1754-9485.12015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 08/28/2012] [Indexed: 01/04/2023]
Abstract
INTRODUCTION To establish the effects of biological and procedural factors on mediastinal and liver [(18) F]-fluorodeoxyglucose (FDG) uptake in oncological FDG positron emission tomography/computed tomography (PET/CT). METHODS This retrospective study included 557 patients who had a baseline FDG PET/CT scan in 2008 and 2009. Mediastinal and liver standardised uptake values mean normalised to lean body mass (SUVlbm mean) were measured in each patient. Univariate and multivariate regression models were established. Study population was then dichotomised into low and high body mass index (BMI) groups, and linear regression models were established for the effects of age, incubation period and blood glucose levels. RESULTS BMI had the highest adjusted effect (standardised beta coefficient, b = 0.43) (P < 0.001) and partial correlation, adjusting for covariates included in the final model (r = 0.45; P < 0.001) on mediastinal FDG uptake. Partial correlations (r) were 0.22 for age, -0.17 for male gender, -0.25 for incubation period and 0.14 for blood glucose (P < 0.001). The linear regression models showed significant differences in mediastinal FDG uptake between the low and high BMI groups and the effects of age, incubation period and basal blood glucose levels (P < 0.001). Similar results were observed for liver FDG uptake except the partial correlation for incubation period was r = -0.09 (P = 0.02). CONCLUSION BMI has the highest effect and correlation on mediastinal and liver FDG uptake. FDG uptake time has a greater effect on mediastinal than liver SUVlbm mean.
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Affiliation(s)
- Ashish Malladi
- Department of Radiology, Boston Medical Center and Boston University, School of Medicine, Boston, MA, USA
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Behrendt FF, Temur Y, Verburg FA, Palmowski M, Krohn T, Pietsch H, Kuhl CK, Mottaghy FM. PET/CT in lung cancer: Influence of contrast medium on quantitative and clinical assessment. Eur Radiol 2012; 22:2458-64. [DOI: 10.1007/s00330-012-2515-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 04/17/2012] [Accepted: 04/27/2012] [Indexed: 10/28/2022]
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DeSouza N, Hoekstra OS, Nestle U, Stroobants S, Boellaard R, Schaefer-Prokop C, Shankar L, Pylkkanen L, Hristova I, Bean J. EORTC Imaging Group. EJC Suppl 2012. [DOI: 10.1016/s1359-6349(12)70015-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Abdul Razak HR, Nordin AJ, Ackerly T, Van Every B, Martin R, Geso M. Quantifying the effects of iodine contrast media on standardised uptake values of FDG PET/CT images: an anthropomorphic phantom study. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2011; 34:367-74. [PMID: 21786083 DOI: 10.1007/s13246-011-0088-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 07/06/2011] [Indexed: 01/05/2023]
Abstract
This study aimed to quantify the amount of change in Standardised Uptake Values (SUVs) of PET/CT images by simulating the set-up as closely as possible to the actual patient scanning. The experiments were conducted using an anthropomorphic phantom, which contained an amount of radioactivity in the form of Fluorodeoxyglucose (FDG) in a primary plastic test tube and one litre saline bags, including the insertion of bony structures and another two test tubes containing different concentrations of iodine contrast media. Standard scanning protocols were employed for the PET/CT image acquisition. The highest absolute differences in the SUVmax and SUVmean values of the saline bags were found to be about 0.2 and 0.4, respectively. The primary test tube showed the largest change of 1.5 in both SUVs; SUV max and SUVmean. However, none of these changes were found to be statistically significant. The clinical literature also contains no evidence to suggest that the changes of this magnitude would change the final diagnosis. Based on these preliminary data, we propose that iodine contrast media can be used during the CT scan of PET/CT imaging, without significantly affecting the diagnostic quality of this integrated imaging modality.
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Affiliation(s)
- Hairil Rashmizal Abdul Razak
- Discipline of Medical Radiations, School of Medical Sciences, Bundoora West Campus, RMIT University, VIC 3083, Australia
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Kitajima K, Murakami K, Kaji Y, Sakamoto S, Sugimura K. Established, emerging and future applications of FDG-PET/CT in the uterine cancer. Clin Radiol 2011; 66:297-307. [PMID: 21356392 DOI: 10.1016/j.crad.2010.07.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/12/2010] [Accepted: 07/18/2010] [Indexed: 10/18/2022]
Abstract
Integrated positron emission tomography/computed tomography (PET/CT) with 2-[¹⁸F]fluoro-2-deoxy-D-glucose (FDG) is a useful technique to acquire both glucose metabolic and anatomic imaging data using a single device in a single diagnostic session and has opened a new field in clinical oncologic imaging. FDG-PET/CT has been used successfully for the staging, optimization of treatment, re-staging, therapy monitoring, and prognostic prediction of uterine cervical cancer and endometrial cancer as well as various malignant tumours. The present review discusses the current role of FDG-PET/CT in the management of uterine cancer, discussing its usefulness and limitations in the imaging of these patients.
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Affiliation(s)
- K Kitajima
- PET Diagnosis, Institute of Biomedical Research and Innovation, Kobe, Japan.
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Kitajima K, Murakami K, Sakamoto S, Kaji Y, Sugimura K. Present and future of FDG-PET/CT in ovarian cancer. Ann Nucl Med 2010; 25:155-64. [PMID: 21113691 DOI: 10.1007/s12149-010-0449-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 10/08/2010] [Indexed: 10/18/2022]
Abstract
Integrated FDG-PET/CT has been used successfully for the diagnosis, staging, restaging, therapy monitoring and prognostic prediction of ovarian cancer as well as various other malignant tumors. Compared with conventional PET/non-contrast CT images, combined PET/contrast-enhanced CT images with intravenous iodine contrast medium and sufficient radiation dose may contribute to a more accurate diagnosis with higher confidence. In the future, tracers other than FDG and integrated PET/MRI will be realized. We herein review the place and role of FDG-PET/CT in the management of ovarian cancer, discussing its usefulness and limitations in the imaging of these patients.
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Affiliation(s)
- Kazuhiro Kitajima
- Department of PET Diagnosis, Institute of Biomedical Research and Innovation, 2-2 Minatojima-Minamimachi, Chuo-ku, Kobe, 650-0047, Japan.
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Abstract
OBJECTIVE There is growing interest in using PET/CT for evaluating early response to therapy in cancer treatment. Although widely available and convenient to use, standardized uptake value (SUV) measurements can be influenced by a variety of biologic and technologic factors. Many of these factors can be addressed with close attention to detail and appropriate quality control. This article will review factors potentially affecting SUV measurements and provide recommendations on ways to minimize when using serial PET to assess early response to therapy. CONCLUSION Scanner and reconstruction parameters can significantly affect SUV measurements. When using serial SUV measurements to assess early response to therapy, imaging should be performed on the same scanner using the same image acquisition and reconstruction protocols. In addition, attention to detail is required for accurate determination of the administered radiopharmaceutical dose.
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Sattler B, Lee JA, Lonsdale M, Coche E. PET/CT (and CT) instrumentation, image reconstruction and data transfer for radiotherapy planning. Radiother Oncol 2010; 96:288-97. [PMID: 20709416 DOI: 10.1016/j.radonc.2010.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 07/08/2010] [Accepted: 07/08/2010] [Indexed: 10/19/2022]
Abstract
The positron emission tomography in combination with CT in hybrid, cross-modality imaging systems (PET/CT) gains more and more importance as a part of the treatment-planning procedure in radiotherapy. Positron emission tomography (PET), as a integral part of nuclear medicine imaging and non-invasive imaging technique, offers the visualization and quantification of pre-selected tracer metabolism. In combination with the structural information from CT, this molecular imaging technique has great potential to support and improve the outcome of the treatment-planning procedure prior to radiotherapy. By the choice of the PET-Tracer, a variety of different metabolic processes can be visualized. First and foremost, this is the glucose metabolism of a tissue as well as for instance hypoxia or cell proliferation. This paper comprises the system characteristics of hybrid PET/CT systems. Acquisition and processing protocols are described in general and modifications to cope with the special needs in radiooncology. This starts with the different position of the patient on a special table top, continues with the use of the same fixation material as used for positioning of the patient in radiooncology while simulation and irradiation and leads to special processing protocols that include the delineation of the volumes that are subject to treatment planning and irradiation (PTV, GTV, CTV, etc.). General CT acquisition and processing parameters as well as the use of contrast enhancement of the CT are described. The possible risks and pitfalls the investigator could face during the hybrid-imaging procedure are explained and listed. The interdisciplinary use of different imaging modalities implies a increase of the volume of data created. These data need to be stored and communicated fast, safe and correct. Therefore, the DICOM-Standard provides objects and classes for this purpose (DICOM RT). Furthermore, the standard DICOM objects and classes for nuclear medicine (NM, PT) and computed tomography (CT) are used to communicate the actual image data created by the modalities. Care must be taken for data security, especially when transferring data across the (network-) borders of different hospitals. Overall, the most important precondition for successful integration of functional imaging in RT treatment planning is the goal orientated as well as close and thorough communication between nuclear medicine and radiotherapy departments on all levels of interaction (personnel, imaging protocols, GTV delineation, and selection of the data transfer method).
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Affiliation(s)
- Bernhard Sattler
- Department of Nuclear Medicine, University Hospital Leipzig, Germany.
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Patel C, Goldstone A, Chowdhury F, Scarsbrook A. FDG PET/CT in oncology: “raising the bar”. Clin Radiol 2010; 65:522-35. [DOI: 10.1016/j.crad.2010.01.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 12/23/2009] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
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Vriens D, Visser EP, de Geus-Oei LF, Oyen WJG. Methodological considerations in quantification of oncological FDG PET studies. Eur J Nucl Med Mol Imaging 2009; 37:1408-25. [PMID: 19936745 PMCID: PMC2886126 DOI: 10.1007/s00259-009-1306-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Accepted: 10/15/2009] [Indexed: 11/26/2022]
Abstract
Purpose This review aims to provide insight into the factors that influence quantification of glucose metabolism by FDG PET images in oncology as well as their influence on repeated measures studies (i.e. treatment response assessment), offering improved understanding both for clinical practice and research. Methods Structural PubMed searches have been performed for the many factors affecting quantification of glucose metabolism by FDG PET. Review articles and references lists have been used to supplement the search findings. Results Biological factors such as fasting blood glucose level, FDG uptake period, FDG distribution and clearance, patient motion (breathing) and patient discomfort (stress) all influence quantification. Acquisition parameters should be adjusted to maximize the signal to noise ratio without exposing the patient to a higher than strictly necessary radiation dose. This is especially challenging in pharmacokinetic analysis, where the temporal resolution is of significant importance. The literature is reviewed on the influence of attenuation correction on parameters for glucose metabolism, the effect of motion, metal artefacts and contrast agents on quantification of CT attenuation-corrected images. Reconstruction settings (analytical versus iterative reconstruction, post-reconstruction filtering and image matrix size) all potentially influence quantification due to artefacts, noise levels and lesion size dependency. Many region of interest definitions are available, but increased complexity does not necessarily result in improved performance. Different methods for the quantification of the tissue of interest can introduce systematic and random inaccuracy. Conclusions This review provides an up-to-date overview of the many factors that influence quantification of glucose metabolism by FDG PET.
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Affiliation(s)
- Dennis Vriens
- Department of Nuclear Medicine (internal postal code 444), Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Diagnostic value of PET/CT for the staging and restaging of pediatric tumors. Eur J Nucl Med Mol Imaging 2008; 36:23-36. [DOI: 10.1007/s00259-008-0911-1] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2008] [Accepted: 07/16/2008] [Indexed: 10/21/2022]
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22
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Wong TZ, Fras IM. PET/CT Protocols and Practical Issues for the Evaluation of Patients with Head and Neck Cancer. PET Clin 2007; 2:413-21. [DOI: 10.1016/j.cpet.2008.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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