Japanese guideline for the oncology FDG-PET/CT data acquisition protocol: synopsis of Version 2.0

This synopsis outlines the Japanese guideline Version 2.0 for the data acquisition protocol of oncology FDG-PET/CT scans that was created by a joint task force of the Japanese Society of Nuclear Medicine Technology, the Japanese Society of Nuclear Medicine and the Japanese Council of PET Imaging, and was published in Kakuigaku-Gijutsu 2013; 33:377–420 in Japanese. The guideline aims at standardizing the PET image quality among PET centers and different PET camera models by providing criteria for the IEC body phantom image quality as well as for the patient PET image quality based on the noise equivalent count (NEC), NEC density and liver signal-to-noise ratio, so that the appropriate scanning parameters can be determined for each PET camera. This Version 2.0 covers issues that were not focused on in Version 1.0, including the accuracy of the standardized uptake value (SUV), effect of body size together with adjustment of scanning duration, and time-of-flight (TOF) reconstruction technique. Version 2.0 also presents data acquired with new PET camera models that were not tested in Version 1.0. Reference values for physical indicators of phantom image quality have been updated as well.     

FDG-PET/CT in oncology. German Guideline

FDG-PET/CT examinations combine metabolic and morphologic imaging within an integrated procedure. Over the past decade PET/CT imaging has gained wide clinical acceptance in the field of oncology. This FDG-PET/CT guideline focuses on indications, data acquisition and processing as well as documentation of FDG-PET/CT examinations in oncologic patients within a clinical and social context specific to Germany. Background information and definitions are followed by examples of clinical and research applications of FDG-PET/CT. Furthermore, protocols for CT scanning (low dose and contrast-enhanced CT) and PET emission imaging are discussed. Documentation and reporting of examinations are specified. Image interpretation criteria and sources of errors are discussed. Quality control for FDG and PET/CT-systems, qualification requirements of personnel as well as legal aspects are presented.     

Detection of unexpected emergency diseases using FDG-PET/CT in oncology patients

Purpose

To evaluate the frequency of emergency diseases that were detected unexpectedly using FDG-PET/CT.

Materials and methods

Interpretation reports for 11,663 FDG-PET/CT studies in our hospital were retrospectively reviewed. Patients with major emergency diseases were extracted according to the following exclusion criteria: (1) relevant findings had been recognized prior to the PET/CT; (2) an intervention or operation that may have been relevant to the present findings was performed within 1 month prior to the PET/CT; and (3) the clinical course could not be investigated sufficiently (e.g., in cases where the patients were introduced from other hospitals).

Results

Forty-one patients (0.35%) with unexpected emergency diseases were identified. The most frequent disease was pneumothorax (8 patients), followed by chronic subdural hematoma (CSH) (7 patients), ureteral stone (7 patients), and abdominal aortic aneurysm (AAA) with a dirty fat sign or a high-attenuation crescent sign visualized on CT (4 patients). Nine patients (2 pneumothorax, 3 CSH, 1 cerebral hemorrhage, 1 acute cholecystitis, 1 acute pancreatitis, and 1 acute appendicitis) were hospitalized and/or underwent therapeutic intervention within 1 week after the PET/CT.

Conclusion

Although rare, an unexpected emergency disease requiring urgent management can be detected using FDG-PET/CT in oncology patients.

     

A positron emission tomography/computed tomography (PET/CT) acquisition protocol for CT radiation dose optimization

BACKGROUND: In current combined positron emission tomography/computed tomography (PET/CT) systems, high-quality CT images not only increase diagnostic value by providing anatomic delineation of hyper- and hypometabolic tissues, but also shorten the acquisition time for attenuation correction compared with standard PET imaging. However, this technique potentially introduces more radiation burden to patients as a result of the higher radiation exposure from CT. METHODS: In this study, the radiation doses delivered from typical germanium-based and CT-based transmission scans were measured and compared using an anthropomorphic Rando Alderson phantom with insertions of thermoluminescent dosimeters. Image geometric distortion and quantified uptake values in PET images with different manipulating CT acquisition protocols for attenuation correction were also evaluated. RESULTS: It was found that radiation doses during germanium-based transmission scans were almost negligible, while doses from CT-based transmission scans were significantly higher. Using a lower radiation dose, the CT acquisition protocol did not significantly affect attenuation correction and anatomic delineation in PET. CONCLUSIONS: This study revealed the relation between image information and dose. The current PET/CT imaging acquisition protocol was improved by decreasing the radiation risks without sacrificing the diagnostic values.     

Key factors in the acquisition of contrast kinetic data for oncology.

Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) has recently emerged as a promising method for both diagnosis and prognosis of cancer despite considerable variation in both the methods of data acquisition and analysis. Both to facilitate integration of results from multiple institutions and to ensure that the data reflect the underlying physiology as accurately as possible, several aspects of data acquisition should be taken into account when developing protocols for DCE-MRI regardless of how the data are analyzed. Among the relevant issues are the relationship between signal enhancement and contrast agent concentration, intra- or inter-patient variation in the blood contrast agent concentration as a function of time, requirements for spatial and temporal resolution, the impact of tumor heterogeneity, and the impact of patient motion during the study. This review considers these factors and, when possible, makes specific recommendations for addressing them experimentally.     

Performance profile of FDG-PET and PET/CT for cancer screening based on a Japanese nationwide survey

A total of 50,558 healthy subjects underwent an FDG-PET (including PET/CT) scan with or without combination of other tests for cancer screening in 46 PET centers during fiscal year of 2005 in Japan. Thorough examination was indicated for 9.8% of the cases due to positive findings suggesting possible cancer. On analyzing 43,996 cases from 38 PET centers, where detailed information was obtained, 500 cases of cancers (1.14%) were found, of which 0.90% was PET positive and 0.24% was PET negative, resulting in the relative sensitivity of PET being 79.0%. Cancers of thyroid, colon/rectum, lung and breast were most frequently found (107, 102, 79, 35 cases, respectively) with high PET sensitivity (88%, 90%, 80%, 92%). PET showed an overall positive predictive value of 29.0%. PET/CT had better detection rate, sensitivity, and positive predictive value than dedicated PET (p<0.01).     

Performance profile of FDG-PET and PET/CT for cancer screening on the basis of a Japanese Nationwide Survey

Objective The aim of this study is to survey the situation of ¹⁸F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening in Japan and to describe its performance profile. Methods “FDG-PET for cancer screening” was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. We sent questionnaires regarding FDG-PET cancer screening to 99 facilities in which FDG-PET tests were performed during the fiscal year 2005. Replies were obtained from 68 of the 99 facilities, of which 46 facilities performed FDG-PET cancer screening. The total number of subjects who underwent FDG-PET cancer screening was 50 558. From 38 of 46 facilities, reliable results of thorough examinations were obtained for the subjects who were positive by FDG-PET and/or one or more of the combined screening tests was performed and were referred for further evaluation. The total number of subjects in these 38 facilities amounted to 43 996. Results A total of 50 558 healthy subjects underwent FDG-PET (including PET/CT) scanning with or without other tests for cancer screening in 46 PET centers during the fiscal year of 2005 in Japan. Thorough examination was indicated for 9.8% of the cases as a result of positive findings suggesting possible cancer. On analyzing 43 996 cases from 38 PET centers from which detailed information was obtained, 500 cases of cancers (1.14%) were found, of which 0.90% were PET positive and 0.24% were PET negative, resulting in the relative sensitivity of PET being 79.0%. Cancers of the thyroid, colon/rectum, lung, and breast were most frequently found (107, 102, 79, and 35 cases, respectively) with high PET sensitivity (88%, 90%, 80%, and 92%). PET showed an overall positive predictive value of 29.0%. PET/CT had a better detection rate, sensitivity, and positive predictive value than dedicated PET (P < 0.01). Conclusions We were able to clarify the performance profile of “FDG-PET for cancer screening” on the basis of a Japanese nationwide survey. The number of facilities possessing PET is increasing steadily, highlighting the necessity of evaluating the usefulness of “FDG-PET cancer screening” as soon as possible by undertaking long-term investigations of large series of subjects.     

[18F]Fluciclovine PET/CT: joint EANM and SNMMI procedure guideline for prostate cancer imaging—version 1.0

European Journal of Nuclear Medicine and Molecular Imaging - The aim of this guideline is to provide standards for the recommendation, performance, interpretation, and reporting of...     

FDG-PET/CT imaging of elastofibroma dorsi

Objective  

The purpose of this study was to assess retrospectively the characteristics of FDG uptake in elastofibroma dorsi using integrated PET/CT.     

Shortened PET data acquisition protocol for the quantification of 18F-FDG kinetics.

A modified short dynamic protocol was defined and evaluated to predict kinetic parameters of (18)F-FDG metabolism from a dynamic data acquisition. METHODS: The evaluation included 151 datasets obtained from 60 patients examined with (18)F-FDG and a dynamic data acquisition protocol of 60 min. Standardized uptake values (SUVs) were calculated for the individual time frames, and a 2-compartment model was applied to the data. The kinetic parameters and the (18)F-FDG influx, calculated from the model data, served as the reference for the analysis. Correlation was analyzed for the SUVs and the reference data. Subset analysis identified time intervals that can be used to predict the reference parameters based on a second-order polynomial function. RESULTS: Significant correlations were noted for SUVs and (18)F-FDG influx, vascular fraction (VB), and the rate constant k1. The influx was associated mainly with SUVs of late acquisition times, whereas higher correlations were noted for early acquisition intervals and VB, as well as k1. A short dynamic acquisition protocol was defined on the basis of a short dynamic sequence 1-10 min after tracer injection and a static acquisition 56-60 min after tracer application. The correlation coefficients exceeded 0.9 for influx, VB, and k1 when the SUVs of the input area (blood) and the target area were used to predict the kinetic parameters. CONCLUSION: A short dynamic data acquisition protocol can be used to obtain more detailed information about (18)F-FDG kinetics. The results demonstrate that (18)F-FDG influx, VB, and k1 can be estimated with high accuracy from SUVs.     

Use of integrated FDG-PET/CT in sarcoidosis

We studied five patients with mediastinal lymph node enlargement suggestive of malignant lymphoma, lung cancer, or sarcoidosis. Integrated [(18)F]fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) was performed on all patients. Sarcoidosis can be a pitfall in PET/CT imaging, which may lead to false-positive results of malignancy. Increased FDG uptake in mediastinal lymph nodes is often comparable with malignant lymphoma or lymph node metastases. Histological confirmation of the lesions should be mandatory, except for patients in whom sarcoidosis can be accurately confirmed by other diagnostic methods.     

EANM practice guideline/SNMMI procedure standard for dopaminergic imaging in Parkinsonian syndromes 1.0

European Journal of Nuclear Medicine and Molecular Imaging - This joint practice guideline or procedure standard was developed collaboratively by the European Association of Nuclear Medicine (EANM)...