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Optimization of Thyroid Volume Determination by Stitched 3D-Ultrasound Data Sets in Patients with Structural Thyroid Disease. Biomedicines 2023; 11:biomedicines11020381. [PMID: 36830918 PMCID: PMC9952922 DOI: 10.3390/biomedicines11020381] [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: 01/09/2023] [Revised: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Ultrasound (US) is the most important imaging method for the assessment of structural disorders of the thyroid. A precise volume determination is relevant for therapy planning and outcome monitoring. However, the accuracy of 2D-US is limited, especially in cases of organ enlargements and deformations. Software-based "stitching" of separately acquired 3D-US data revealed precise volume determination in thyroid phantoms. The purpose of this study is to investigate the feasibility and accuracy of 3D-US stitching in patients with structural thyroid disease. A total of 31 patients from the clinical routine were involved, receiving conventional 2D-US (conUS), sensor-navigated 3D-US (3DsnUS), mechanically-swept 3D-US (3DmsUS), and I-124-PET/CT as reference standard. Regarding 3DsnUS and 3DmsUS, separately acquired 3D-US images (per thyroid lobe) were merged to one comprehensive data set. Subsequently, anatomical correctness of the stitching process was analysed via secondary image fusion with the I-124-PET images. Volumetric determinations were conducted by the ellipsoid model (EM) on conUS and CT, and manually drawn segmental contouring (MC) on 3DsnUS, 3DmsUS, CT, and I-124-PET/CT. Mean volume of the thyroid glands was 44.1 ± 25.8 mL (I-124-PET-MC = reference). Highly significant correlations (all p < 0.0001) were observed for conUS-EM (r = 0.892), 3DsnUS-MC (r = 0.988), 3DmsUS-MC (r = 0.978), CT-EM (0.956), and CT-MC (0.986), respectively. The mean volume differences (standard deviations, limits of agreement) in comparison with the reference were -10.50 mL (±11.56 mL, -33.62 to 12.24), -3.74 mL (±3.74 mL, -11.39 to 3.78), and 0.62 mL (±4.79 mL, -8.78 to 10.01) for conUS-EM, 3DsnUS-MC, and 3DmsUS-MC, respectively. Stitched 3D-US data sets of the thyroid enable accurate volumetric determination even in enlarged and deformed organs. The main limitation of high time expenditure may be overcome by artificial intelligence approaches.
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Boers T, Braak SJ, Rikken NET, Versluis M, Manohar S. Ultrasound imaging in thyroid nodule diagnosis, therapy, and follow-up: Current status and future trends. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023. [PMID: 36655705 DOI: 10.1002/jcu.23430] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
Ultrasound, the primary imaging modality in thyroid nodule management, suffers from drawbacks including: high inter- and intra-observer variability, limited field-of-view and limited functional imaging. Developments in ultrasound technologies are taking place to overcome these limitations, including three-dimensional-Doppler, -elastography, -nodule characteristics-extraction, and novel machine-learning algorithms. For thyroid ablative treatments and biopsies, perioperative use of three-dimensional ultrasound opens a new field of research. This review provides an overview of the current and future applications of ultrasound, and discusses the potential of new developments and trends that may improve the diagnosis, therapy, and follow-up of thyroid nodules.
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Affiliation(s)
- Tim Boers
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Sicco J Braak
- Department of Radiology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Nicole E T Rikken
- Department of Endocrinology, Ziekenhuisgroep Twente, Hengelo, the Netherlands
| | - Michel Versluis
- Physics of Fluids Group, TechMed Centre, University of Twente, Enschede, the Netherlands
| | - Srirang Manohar
- Multi-Modality Medical Imaging Group, TechMed Centre, University of Twente, Enschede, the Netherlands
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Ultrasound Cine Loop Standard Operating Procedure for Benign Thyroid Diseases-Evaluation of Non-Physician Application. Diagnostics (Basel) 2021; 11:diagnostics11010067. [PMID: 33406645 PMCID: PMC7824138 DOI: 10.3390/diagnostics11010067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/18/2020] [Accepted: 12/31/2020] [Indexed: 11/16/2022] Open
Abstract
Conventional ultrasound (US) is time-consuming, and results are subjected to high interobserver variability. In this study, the reliability of a novel thyroid US cine loop standard operating procedure (SOP) applied by non-physicians (Medical Technical Assistant, MTA) is investigated. Thirty-three consecutive patients (22 females, 11 males) were enrolled. Patients underwent conventional thyroid US performed by a nuclear medicine physician and additional MTA US cine loop according to a local SOP that includes transversal and sagittal cine loops covering the entire thyroid. The video sequences were transferred to the Picture Archiving and Communication System (PACS) for second reading purposes. MTA US data were not considered for medical reports but for blinded second reading review of the PACS images. The results of conventional physician US reports and reviewed MTA US cine loops were compared regarding size determinations of the thyroid and its nodules, as well as Thyroid Imaging Reporting and Data Systems (TIRADS) classification of all identified lesions. The results revealed very high concordance between conventional physician US and MTA US cine loop review for both size measurements and TIRADS classifications (r(s) = 0.84-0.99, p < 0.0001 each). Minor technical impairments were identified. The evaluated thyroid US cine loop SOP enables reliable second reading results and can be applied by non-physicians.
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Stevenson GN, Noble JA, Welsh AW, Impey L, Collins SL. Automated Visualization and Quantification of Spiral Artery Blood Flow Entering the First-Trimester Placenta, Using 3-D Power Doppler Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:522-531. [PMID: 29305123 PMCID: PMC6479225 DOI: 10.1016/j.ultrasmedbio.2017.11.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/29/2017] [Accepted: 11/27/2017] [Indexed: 06/07/2023]
Abstract
The goal of our research was to quantify the placental vascularity in 3-D at 11-13 + 6 wk of pregnancy at precise distances from the utero-placental interface (UPI) using 3-D power Doppler ultrasound. With this automated image analysis technique, differences in vascularity between normal and pathologic pregnancies may be observed. The algorithm was validated using a computer-generated image phantom and applied retrospectively in 143 patients. The following features from the PD data were recorded: The number of spiral artery jets into the inter-villous space, total geometric and PD area. These were automatically measured at discrete millimeter distances from the UPI. Differences in features were compared with pregnancy outcomes: Pre-eclamptic versus normal, all small-for-gestational age (SGA) to appropriate-for-gestational age (AGA) patients and AGA versus SGA in normotensives (Mann-Whitney). The Benjamini-Hochberg procedure was used (false discovery rate 10%) for multiple comparison testing. Features decreased with increasing distance from the UPI (Kruskal-Wallis test; p <0.001). At 2- 3 mm from the UPI, all features were smaller in pre-eclamptic compared with normal patients and for some in SGA compared with AGA patients (p <0.05). For AGA versus SGA in normotensive patients, no significant differences were found. Number of jets measured at 2-5 mm from the UPI did not vary because of the position of the placenta in the uterus (ANOVA; p > 0.05). This method provides a new in-vivo imaging tool for examining spiral artery development through pregnancy. Size and number of entrances of blood flow into the UPI could potentially be used to identify high-risk pregnancies and may provide a new imaging biomarker for placental insufficiency.
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Affiliation(s)
- Gordon N Stevenson
- School of Womens' & Childrens' Health, Faculty of Medicine, University of New South Wales, Sydney, Australia.
| | - J Alison Noble
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Alec W Welsh
- School of Womens' & Childrens' Health, Faculty of Medicine, University of New South Wales, Sydney, Australia; Department of Maternal-Fetal Medicine, Royal Hospital for Women, Randwick, NSW, Australia
| | - Lawrence Impey
- The Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sally L Collins
- The Fetal Medicine Unit, The Women's Centre, John Radcliffe Hospital, Oxford, United Kingdom; Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Oxford, United Kingdom
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Kotzerke J, Luster M, Freesmeyer M. Gebt mir einen festen Punkt im All, und ich hebe die Welt aus den Angeln. Nuklearmedizin 2017; 51:65-6. [PMID: 22641376 DOI: 10.3413/nukmed-2012030001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/16/2012] [Indexed: 01/08/2023]
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Freesmeyer M, Winkens T, Opfermann T, Kühnel C. Radiation exposure of the investigator's hand during fusion imaging of the thyroid with 99mTcO4-free-hand SPECT and ultrasound. RADIATION PROTECTION DOSIMETRY 2016; 168:531-536. [PMID: 26231559 DOI: 10.1093/rpd/ncv375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/08/2015] [Indexed: 06/04/2023]
Abstract
The objective of this study was to assess the radiation exposure of the investigators' hand during free-hand single photon emission tomography/ultrasound ((99m)TcO4-fhSPECT/US) of the thyroid. Conventional dosimetry by rings with thermoluminescent detectors (TLDs) was performed in 32 patients (Group A), followed by TLD-chipstrate dosimetry in further 20 patients (Group B). In both the groups, the ambient dose rate was measured by dose rate meter (DRM). The applied activity was in the range of 60-80 MBq (99m)TcO4. In Group A, the exposure per investigation was 7.53 µSv (calculated average) by ring dosimetry and 9.02±5.64 µSv by DRM; in Group B, 10.93 and 9.51 ± 1.76 µSv, respectively. Based on estimated 1224 yearly thyroid investigations per nuclear medicine specialist in Germany, the estimated cumulative yearly exposure of the hand was 11.32 mSv. The hand exposure during a thyroid (99m)TcO4-fhSPECT/US of 20-min duration proved modest and comparable with different methods. Yearly examinations in excess of 1000 per investigator are not expected to add a relevant cumulative risk.
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Affiliation(s)
| | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Opfermann
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Christian Kühnel
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany Medical Engineering and Biotechnology, Jena University of Applied Sciences (EAH Jena), Jena, Germany
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Freesmeyer M, Winkens T, Kühnel C. Real-time handheld emission spot allocator (rthESA) for simultaneous fusion imaging with ultrasound. Nuklearmedizin 2014; 53:265-71. [PMID: 25056639 DOI: 10.3413/nukmed-0681-14-06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 07/20/2014] [Indexed: 02/04/2023]
Abstract
OBJECTIVES First, to report on initial experiences and technical parameters of a newly developed real-time handheld emission spot allocator (rthESA), and second, to report on the simultaneous acquisition of rthESA and US data as rthESA/US fusion images. METHODS The rthESA consisted of five semiconductor-detectors arranged in alternate position in two rows. This design allowed the examination of focal activities in the same plane as US. The signals were interpreted by an ad hoc software and the real-time allocation of spot radiation sources within air- and water phantoms was investigated for (99m)Tc, 131I, and 18F. A compact US probe was fixed in plane with the rthESA and connected to a standard US equipment. Experiments with a liver phantom were performed to verify the integration of (99m)Tc-rthESA data and US images. RESULTS The allocation proved to be successful for all radionuclides. The system showed a noticeable performance latency, most pronounced for positions far from the detector (1 cm distance: 0.7 ± 0.5 s; 4 cm distance: 6.1 ± 3.2 s). Within the liver phantom, the rthESA enabled the correct allocation of a spot radiation source within a live US image. CONCLUSIONS The rthESA allowed an exact localization of spot radiation sources in single plane, with additional consideration of the distance from the detector, leading to real-time allocation and simultaneous overlay with US images. In spite of clear technical limitations in need of further development, this proof-of-concept study shows that this hybrid detector has the potential to provide integrated simultaneous nuclear medicine and US images.
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Affiliation(s)
- M Freesmeyer
- Martin Freesmeyer, M.D., Clinic of Nuclear Medicine, Jena University Hospital, Bachstraße 18, 07743 Jena, Germany, Tel. +49/(0)36 41/93 32 20, Fax +49/(0)36 41/93 32 44, E-mail:
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Freesmeyer M, Wiegand S, Schierz JH, Winkens T, Licht K. Multimodal evaluation of 2-D and 3-D ultrasound, computed tomography and magnetic resonance imaging in measurements of the thyroid volume using universally applicable cross-sectional imaging software: a phantom study. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:1453-1462. [PMID: 24768486 DOI: 10.1016/j.ultrasmedbio.2014.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/16/2013] [Accepted: 02/08/2014] [Indexed: 06/03/2023]
Abstract
A precise estimate of thyroid volume is necessary for making adequate therapeutic decisions and planning, as well as for monitoring therapy response. The goal of this study was to compare the precision of different volumetry methods. Thyroid-shaped phantoms were subjected to volumetry via 2-D and 3-D ultrasonography (US), computed tomography (CT) and magnetic resonance imaging (MRI). The 3-D US scans were performed using sensor navigation and mechanical sweeping methods. Volumetry calculation ensued with the conventional ellipsoid model and the manual tracing method. The study confirmed the superiority of manual tracing with CT and MRI volumetry of the thyroid, but extended this knowledge also to the superiority of the 3-D US method, regardless of whether sensor navigation or mechanical sweeping is used. A novel aspect was successful use of the same universally applicable cross-imaging software for all modalities.
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Affiliation(s)
- Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany.
| | - Steffen Wiegand
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | | | - Thomas Winkens
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
| | - Katharina Licht
- Clinic of Nuclear Medicine, Jena University Hospital, Jena, Germany
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Freesmeyer M, Winkens T, Schierz JH. Contrast between hypervascularized liver lesions and hepatic parenchyma: early dynamic PET versus contrast-enhanced CT. Ann Nucl Med 2014; 28:664-8. [PMID: 24903245 DOI: 10.1007/s12149-014-0862-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 05/18/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To detect hypervascularized liver lesions, early dynamic (ED) (18)F-FDG PET may be an alternative when contrast-enhanced (CE) imaging is infeasible. This retrospective pilot analysis compared contrast between such lesions and liver parenchyma, an important objective image quality variable, in ED PET versus CE CT. MATERIALS AND METHODS Twenty-eight hypervascularized liver lesions detected by CE CT [21 (75%) hepatocellular carcinomas; mean (range) diameter 4.9 ± 3.5 (1-14) cm] in 20 patients were scanned with ED PET. Using regions of interest, maximum and mean lesional and parenchymal signals at baseline, arterial and venous phases were calculated for ED PET and CE CT. RESULTS Lesional/parenchymal signal ratio was significantly higher (P < 0.005) with ED PET versus CE CT at the arterial phase and similar between the methods at the venous phase. CONCLUSION In liver imaging, ED PET generates greater lesional-parenchymal contrast during the arterial phase than does CE CT; these observations should be formally, prospectively evaluated.
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Affiliation(s)
- Martin Freesmeyer
- Clinic of Nuclear Medicine, Jena University Hospital, Bachstrasse 18, 07740, Jena, Germany,
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First experience with early dynamic 18F-NaF-PET/CT in patients with chronic osteomyelitis. Ann Nucl Med 2014; 28:314-21. [DOI: 10.1007/s12149-014-0810-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/13/2014] [Indexed: 11/25/2022]
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Licht K, Darr A, Opfermann T, Winkens T, Freesmeyer M. 3D ultrasonography is as accurate as low-dose CT in thyroid volumetry. Nuklearmedizin 2013; 53:99-104. [PMID: 24276677 DOI: 10.3413/nukmed-0615-13-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 11/12/2013] [Indexed: 11/20/2022]
Abstract
AIM The purpose of this study was to compare thyroid volumetry by three-dimensional mechanically swept ultrasonography (3DmsUS) and low-dose computed tomography (ldCT). PATIENTS, METHODS 30 subjects referred for radioiodine therapy of benign thyroid diseases were subjected to 3DmsUS and ldCT. A prerequisite of 3DmsUS analyses was that the scans had to capture the entire thyroid, excluding therefore cases with a very large volume or retrosternal portions. The 3DmsUS data were transformed into a DICOM format, and volumetry calculations were performed via a multimodal workstation equipped with standard software for cross-sectional imaging. Volume was calculated applying both the ellipsoid model and a manually tracing method. Statistical analyses included 95% confidence intervals (CI) of the means and limits of agreement according to Bland and Altman, the latter including 95% of all expected values. RESULTS Volumetric measurements by 3DmsUS and ldCT resulted in very high, significant correlation coefficients, r = 0.997 using the ellipsoid model and r = 0.993 with the manually tracing method. The mean relative differences of the two imaging modalities proved very small (-1.2±4.0% [95% CI -2.62; 0.28] using the ellipsoid model; -1.1±5.2% [95% CI -2.93; 0.80] using the manually tracing method) and the limits of agreement sufficiently narrow (-9.1% to 6.8%; -11.3% to 9.2%, respectively). CONCLUSION For moderately enlarged thyroids, volumetry with 3DmsUS proved comparable to that of ldCT, irrespective of whether the ellipsoid model or the manually tracing method was applied. Thus, 3DmsUS qualifies as a potential alternative to ldCT, provided that the organ is completely accessible. The use of a standard workstation for cross-sectional imaging with routine software did not prove problematic.
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Affiliation(s)
| | | | | | | | - M Freesmeyer
- Martin Freesmeyer, MD, Clinic of Nuclear Medicine, Jena University Hospital, Bachstraße 18, 07743 Jena, Germany, Tel. +49/(0)36 41/93 32 20, Fax +49/(0)36 41/93 32 44, E-mail:
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Low-Activity 124I-PET/Low-Dose CT Versus 99mTc-Pertechnetate Planar Scintigraphy or 99mTc-Pertechnetate Single-Photon Emission Computed Tomography of the Thyroid. Clin Nucl Med 2013; 38:770-7. [DOI: 10.1097/rlu.0b013e3182a20d26] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stecker FF, Schierz JH, Opfermann T, Driesch D, Hofmann GO, Winkens T, Freesmeyer M. Early dynamic 18F-FDG PET/CT to diagnose chronic osteomyelitis following lower extremity fractures. A pilot study. Nuklearmedizin 2013; 53:117-22. [PMID: 23780221 DOI: 10.3413/nukmed-0572-13-03] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 06/10/2013] [Indexed: 11/20/2022]
Abstract
AIM The study investigates whether early dynamic PET/CT (edPET/CT) using 18F-fluorodeoxyglucose (FDG) discriminates between affected versus non-affected sites in patients with complicated, protracted fracture healing and suspected COM in the lower extremities. PATIENTS, METHODS In nine consecutive patients (1 woman, 8 men; age 54 ± 13 years), before standard late FDG-PET/CT, altogether 10 edFDG-PET/CT examinations were performed in list mode over 5 min starting with radiopharmaceutical injection. Eight consecutive time intervals (frames), four 15-s, then four 60-s, were reconstructed. For every patient, several volumes-of-interest were selected. To measure early FDG influx and accumulation, maximum and mean ed standardized uptake values (respectively, edSUVmax, edSUVmean) were calculated in each volume-of-interest during each frame. Results were compared between affected and non-affected (contralateral) bone. RESULTS Starting in the 31-45s frame, the affected bone area showed significantly higher edSUVmax and edSUVmean than did the healthy contralateral region. In conventional PET/CT, affected bone areas also significantly differed from non-affected contralateral regions. CONCLUSION This pilot study suggests that edFDG-PET may offer a less time consuming add on to standard FDG-PET/CT while being equally accurate. The results should be validated prospectively in larger trials.
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Affiliation(s)
| | | | | | | | | | | | - M Freesmeyer
- Dr. Martin Freesmeyer, Jena University Hospital, Clinic of Nuclear Medicine, Bachstraße 18, 07740 Jena, Germany, Tel. +49/(0)36 41/93 32 20; Fax +49/(0)36 41/93 32 44, E-mail: , www.nuklearmedizin.uniklinik-jena.de
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