Performance characteristics of a new 3-dimensional continuous-emission and spiral-transmission high-sensitivity and high-resolution PET camera evaluated with the NEMA NU 2-2001 standard.

The SET-3000 G/X (clinical tomograph with high resolution and a large axial field of view) is a 3-dimensional (3D) (only) dedicated PET camera with germanium oxyorthosilicate (GSO) and bismuth germanate (BGO) scintillators. The main characteristic of the SET-3000 G/X PET scanner is 3D continuous-emission and spiral-transmission (CEST) scanning, yielding a reduction in whole-body scan time. We evaluated the physical performance of the SET-3000 G/X PET scanner with the National Electrical Manufacturers Association (NEMA) NU 2-2001 standard. METHODS: A GSO 3D emission scanner is combined with a BGO transmission scanner separated axially by a lead shield. In the GSO scanner, small and thick scintillators (2.45 x 5.1 x 30 mm(3)) are arranged in small blocks (23.1 x 52 mm) to achieve high resolution and a high counting rate. The detector ring has a large solid angle with a diameter of 664 mm and an axial coverage of 260 mm (50 rings). The transmission scanner consists of BGO block detectors with a diameter of 798 mm and an axial width of 23.1 mm and is equipped with a rotating (137)Cs point source of 740 MBq and a tungsten collimator. The low- and high-energy thresholds are set to 400 and 700 keV, respectively, in the emission system. The coincidence time window is set to 6 ns. In CEST acquisition, the patient couch moves continuously through the emission and transmission scanners in a 1-way motion. Emission coincidence data are acquired in the histogram mode with on-the-fly Fourier rebinning, and transmission single data are acquired with emission contamination correction. RESULTS: With the NEMA NU 2-2001 standard, the main performance results were as follows: the average (radial and tangential) transverse and axial spatial resolutions (full width at half maximum) at 1 cm and at 10 cm off axis were 3.49 and 5.04 mm and 4.48 and 5.40 mm, respectively; the average sensitivity for the 2 radial positions (0 and 10 cm) was 20.71 cps/kBq; the scatter fraction was 50%; the peak noise equivalent count rate was 62.3 kcps at 9.8 kBq/mL; and the peak random rate was 542.1 kcps at 37.6 kBq/mL. CONCLUSION: The new integrated SET-3000 G/X PET scanner has good overall performance, including high resolution and sensitivity, and has the potential of reducing whole-body acquisition time to less than 10 min while improving small-lesion detectability with a low radiation dose.     

Performance evaluation of a large axial field-of-view PET scanner: SET-2400W

The SET-2400W is a newly designed whole-body PET scanner with a large axial field of view (20 cm). Its physical performance was investigated and evaluated. The scanner consists of four rings of 112 BGO detector units (22.8 mm in-plane × 50 mm axial × 30 mm depth). Each detector unit has a 6 (in-plane) × 8 (axial) matrix of BGO crystals coupled to two dual photomultiplier tubes. They are arranged in 32 rings giving 63 two-dimensional image planes. Sensitivity for a 20-cm cylindrical phantom was 6.1 kcps/kBq/m/ (224 kcps/μCi/ml) in the 2D clinical mode, and to 48.6 kcps/kBq/ ml (1.8 Mcps/μCi/ml) in the 3D mode after scatter correction. In-plane spatial resolution was 3.9 mm FWHM at the center of the field-of-view, and 4.4 mm FWHM tangentially, and 5.4 mm FWHM radially at 100 mm from the center. Average axial resolution was 4.5 mm FWHM at the center and 5.8 mm FWHM at a radial position 100 mm from the center. Average scatter fraction was 8% for the 2D mode and 40% for the 3D mode. The maximum count rate was 230 kcps in the 2D mode and 350 kcps in the 3D mode. Clinical images demonstrate the utility of an enlarged axial field-of-view scanner in brain study and whole-body PET imaging.     

Evaluation of optimized injection dose and acquisition time using body mass index for three-dimensional whole-body FDG-PET

OBJECTIVE: The standardized uptake value (SUV) is a relative measure of tracer uptake in tissue used in (18)F-FDG PET. However, the quality of ordered subset expectation maximization (OS-EM) images is sensitive to the number of iterations, because a large number of iterations leads to images with checkerboard noise. The main advantage of data acquisition in the three-dimensional (3D) mode is the high sensitivity to better exploit the intrinsic spatial resolution and the lower injection dose given to patients. In the 3D mode, the scatter fraction is higher, and, for a given administered dose, the random fraction is higher than that in the two-dimensional mode, which implies that correction methods need to be more accurate. Moreover, in clinical oncology (18)F-FDG PET studies, patients have a wide variety of body shapes and sizes, which may impact image statistics. Consequently, it is necessary to make constant the acquisition (true) counts. The purpose of this study was to optimize injection dose and acquisition time in consideration of body mass index (BMI) for 3D whole-body (18)F-FDG PET. METHODS: A dedicated PET scanner, SIEMENS ECAT EXACT HR(+), was used to scan images of clinical data. The injection dose for BMI of <14-19, 19-22, 22-25, and 25< (kg/m(2)) were, 92.5 MBq, 111.0 MBq, 129.5 MBq, and 148.0 MBq, respectively. The emission scan time per bed position for BMI of <14-19, 19-22, 22-25, and >25 (kg/m(2)) were, 120, 120, 180, and 240 sec, respectively. A total of 20 patient subjects were evaluated as to true counts per bin (T/bin) of sinogram data and measured activity concentrations for the region of interest in the liver section. RESULTS: T/bin was stable using an optimized protocol that took into consideration the BMI for any type of body morphology. The overall coefficient of variation was 7.27% for radioactivity concentration. Additionally, Gaussian filtering (8 mm FWHM) after reconstruction by the OS-EM method provided stable SUV values even when the iteration number was increased 30 times over. CONCLUSION: Optimization of injection dose and acquisition time indicated that BMI was a clinically useful acquisition protocol for 3D whole-body (18)F-FDG PET.     

18F-FDG PET/CT in patients with suspected recurrent or metastatic well-differentiated thyroid cancer.

PET using 18F-FDG has been shown to effectively detect various types of cancer by their increased glucose metabolism. The aim of this study was to evaluate the use of coregistered PET and CT (PET/CT) in patients with suspected thyroid cancer recurrence. METHODS: After total thyroidectomy followed by radioiodine ablation, 61 consecutive patients with elevated thyroglobulin levels or a clinical suspicion of recurrent disease underwent 18F-FDG PET/CT. Of these, 59 patients had negative findings on radioiodine (131I) whole-body scintigraphy (WBS). Fifty-three of the 61 patients had both negative 131I WBS findings and elevated thyroglobulin levels. PET/CT images were acquired 60 min after intravenous injection of 400-610 MBq of 18F-FDG using a combined PET/CT scanner. Any increased 18F-FDG uptake was compared with the coregistered CT image to differentiate physiologic from pathologic tracer uptake. 18F-FDG PET/CT findings were correlated with the findings of histology, postradioiodine WBS, ultrasound, or clinical follow-up serving as a reference. The diagnostic accuracy of 18F-FDG PET/CT was evaluated for the entire patient group and for those patients with serum thyroglobulin levels of less than 5, 5-10, and more than 10 ng/mL. RESULTS: Thirty patients had positive findings on 18F-FDG PET/CT; 26 were true-positive and 4 were false-positive. In 2 patients, increased 18F-FDG uptake identified a second primary malignancy. 18F-FDG PET/CT results were true-negative in 19 patients and false-negative in 12 patients. The overall sensitivity, specificity, and accuracy of 18F-FDG PET/CT were 68.4%, 82.4%, and 73.8%, respectively. The sensitivities of 18F-FDG PET/CT at serum thyroglobulin levels of less than 5, 5-10, and more than 10 ng/mL were 60%, 63%, and 72%, respectively. Clinical management changed for 27 (44%) of 61 patients, including surgery, radiation therapy, or chemotherapy. CONCLUSION: Coregistered 18F-FDG PET/CT can provide precise anatomic localization of recurrent or metastatic thyroid carcinoma, leading to improved diagnostic accuracy, and can guide therapeutic management. In addition, the findings of this study suggest that further assessment of 131I WBS-negative, thyroglobulin-positive patients by 18F-FDG PET/CT may aid in the clinical management of selected cases regardless of the thyroglobulin level.     

Increased (18)F-fluorodeoxyglucose uptake in benign, nonphysiologic lesions found on whole-body positron emission tomography/computed tomography (PET/CT): accumulated data from four years of experience with PET/CT

The use of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) in the field of oncology is rapidly evolving; however, (18)F-FDG is not tumor specific. Aside from physiological uptake (18)F-FDG also may accumulate in benign processes. Knowledge of these (18)F-FDG-avid nonmalignant lesions is essential for accurate PET interpretation in oncologic patients to avoid a false-positive interpretation. Through the systematic review of the reports of PET/computed tomography (CT) studies performed in oncologic patients during a 6-month period, we found benign nonphysiological uptake of (18)F-FDG in more than 25% of studies. In half of these, (18)F-FDG uptake was moderate or marked in intensity, similar to that of malignant sites. A total of 73% of benign lesions were inflammatory in nature, with post-traumatic bone and soft-tissue abnormalities (including iatrogenic injury) and benign tumors accounting for the remainder. The differentiation of benign from malignant uptake of (18)F-FDG on PET alone may be particularly challenging as a result of the low anatomical resolution of PET and paucity of anatomical landmarks. Fusion imaging, namely PET/CT, has been shown to improve not only the sensitivity of PET interpretation but also its specificity. Aside from better anatomical localization of lesions on PET/CT, morphological characterization of lesions on CT often may improve the diagnostic accuracy of nonspecific (18)F-FDG uptake. Correlation with CT on fused PET/CT data may obviate the need for further evaluation or biopsy in more than one-third of scintigraphic equivocal lesions. Familiarity with (18)F-FDG-avid nonmalignant lesions also may extend the use of (18)F-FDG-PET imaging beyond the field of oncology. We have tabulated our experience with benign entities associated with increased (18)F-FDG uptake on whole-body PET/CT from 12,000 whole-body (18)F-FDG-PET/CT studies performed during a 4-year period.     

Micro insert: a prototype full-ring PET device for improving the image resolution of a small-animal PET scanner

A full-ring PET insert device should be able to enhance the image resolution of existing small-animal PET scanners. METHODS: The device consists of 18 high-resolution PET detectors in a cylindric enclosure. Each detector contains a cerium-doped lutetium oxyorthosilicate array (12 x 12 crystals, 0.72 x 1.51 x 3.75 mm each) coupled to a position-sensitive photomultiplier tube via an optical fiber bundle made of 8 x 16 square multiclad fibers. Signals from the insert detectors are connected to the scanner through the electronics of the disabled first ring of detectors, which permits coincidence detection between the 2 systems. Energy resolution of a detector was measured using a (68)Ge point source, and a calibrated (68)Ge point source stepped across the axial field of view (FOV) provided the sensitivity profile of the system. A (22)Na point source imaged at different offsets from the center characterized the in-plane resolution of the insert system. Imaging was then performed with a Derenzo phantom filled with 19.5 MBq of (18)F-fluoride and imaged for 2 h; a 24.3-g mouse injected with 129.5 MBq of (18)F-fluoride and imaged in 5 bed positions at 3.5 h after injection; and a 22.8-g mouse injected with 14.3 MBq of (18)F-FDG and imaged for 2 h with electrocardiogram gating. RESULTS: The energy resolution of a typical detector module at 511 keV is 19.0% +/- 3.1%. The peak sensitivity of the system is approximately 2.67%. The image resolution of the system ranges from 1.0- to 1.8-mm full width at half maximum near the center of the FOV, depending on the type of coincidence events used for image reconstruction. Derenzo phantom and mouse bone images showed significant improvement in transaxial image resolution using the insert device. Mouse heart images demonstrated the gated imaging capability of the device. CONCLUSION: We have built a prototype full-ring insert device for a small-animal PET scanner to provide higher-resolution PET images within a reduced imaging FOV. Development of additional correction techniques are needed to achieve quantitative imaging with such an insert.     

Evaluation of 18F-FDG PET in patients with a, metastatic, or recurrent gastric cancer.

PET with (18)F-FDG has been widely used in oncology, but its application for stomach neoplasms has been limited. The aim of this study was to evaluate the visual diagnostic accuracy of (18)F-FDG PET for advanced, metastatic, or recurrent gastric cancer and to generate semiquantitative values for lesions. METHODS: (18)F-FDG PET scans were obtained on 42 patients (29 men, 13 women; age, 27-78 y; median age, 63 y): 20 patients with a PT931/04 scanner and 22 patients with a SET2400W scanner. The PT931/04 has a spatial resolution of 6.0 mm at full width at half maximum (FWHM) and covers 15 cm above and below the targeted lesion, and the SET2400W has a spatial resolution of 3.9 mm at FWHM and images the entire body. All PET images were interpreted visually, and tracer uptakes were quantitated as standardized uptake values (SUVs) on SET2400W images. RESULTS: The sensitivity, specificity, and accuracy as a whole were as follows: 71%, 74%, and 73%, respectively, with the SET2400W scanner and 47%, 79%, and 62%, respectively, with the PT931/04 scanner. Values were high for primary lesions, liver, lymph node, and lung metastases, but were low for bone metastases, ascites, peritonitis, and pleuritis carcinomatoses. SUVs were 8.9 +/- 4.2 (primary lesions, 19 patients/19 lesions), 6.5 +/- 2.2 (liver, 9/55), 6.1 +/- 2.5 (lymph nodes, 14/38), 6.5 +/- 1.8 (abdominal wall, 4/7), 3.9 +/- 2.0 (bone, 3/27), and 4.7 +/- 2.6 (lung, 2/3). Comparing SUVs and histologic findings for 17 untreated patients, values for well-differentiated and moderately differentiated adenocarcinomas versus poorly differentiated adenocarcinomas and signet ring cell carcinomas were 13.2 +/- 6.3 (4/4) versus 7.7 +/- 2.6 (13/13) (P < 0.05) for the primary lesions, 7.0 +/- 2.4 (5/39) versus 5.6 +/- 2.8 (2/2) for the liver, and 5.5 +/- 1.9 (9/28) versus 8.8 +/- 3.3 (3/8) (P < 0.05) for the lymph nodes. CONCLUSION: Our results indicate that (18)F-FDG PET is a useful diagnostic modality for advanced, metastatic, or recurrent gastric cancer but not for detecting bone metastases, peritonitis, or pleuritis carcinomatoses. (18)F-FDG uptake by gastric cancers is relatively high but does not parallel histopathologic features of malignancy.     

Usefulness of whole-body (18)F-FDG PET in patients with suspected metastatic brain tumors.

The aim of this study was to evaluate the diagnostic value of whole-body (18)F-FDG PET imaging in the differentiation of metastatic brain tumor from primary brain tumor and in the localization of the primary lesion in patients with metastatic brain tumor. METHODS: The subjects consisted of 127 patients (77 men, 50 women; mean age +/- SD, 55 +/- 12 y) with brain masses that were suspected to be metastatic brain tumors on radiologic studies: 77 with confirmed metastatic brain tumor and 50 with primary brain tumor. Whole-body (18)F-FDG PET was performed on all patients. When the abnormal lesion was detected outside the brain, we interpreted the brain lesion as metastatic brain tumor. RESULTS: In 61 of the 77 patients with metastatic brain tumor, primary lesions were detected using whole-body (18)F-FDG PET. Of the remaining 16 patients (all false-negative cases), 7 were classified as metastases of unknown origin. In 47 of the 50 patients with primary brain tumor, whole-body (18)F-FDG PET did not show any other abnormal lesions. The sensitivity, specificity, positive and negative predictive values, and accuracy of PET for the detection of primary origin were 79.2%, 94.0%, 95.3%, 74.6%, and 85.0%, respectively. The most common primary origin of metastatic brain tumors on PET examination was lung cancer (48/61, 78.7%). The concordance rate between (18)F-FDG PET and conventional radiologic work-up was 80% in identifying primary lesion. Unknown bone or bone marrow metastases and unsuspected distant metastases were found in 14 patients (18%) and 24 patients (31%), respectively, on PET examination. CONCLUSION: Screening the patients with suspected metastatic brain tumors using whole-body (18)F-FDG PET could be helpful in differentiating metastatic brain tumor from primary brain tumor and in detecting the primary lesion.     

Dual time point 18F-FDG PET for the evaluation of pulmonary nodules.

18F-FDG PET has reached widespread application in the assessment of pulmonary nodules. This study compares the diagnostic accuracy of standard 18F-FDG PET scanning with those of dual time point 18F-FDG PET scanning. METHODS: Thirty-six patients (21 women, 15 men; mean age, 67 y; range, 36-88 y) with 38 known or suspected malignant pulmonary nodules underwent PET of the thorax at 2 time points: scan 1 at 70 min (range, 56-110 min) and scan 2 at 123 min (range, 100-163 min) after the intravenous injection of 2.5 MBq 18F-FDG per kilogram of body weight. All scanning was performed on a dedicated C-PET scanner. The mean interval between the scans was 56 min (range, 49-64 min). Regions of interest were overlaid onto each fully corrected image in the areas of the radiographically known lung densities. The standardized uptake values (SUVs) were calculated for both time points. RESULTS: Surgical pathology and follow-up revealed 19 patients with 20 malignant tumors, whereas 16 patients had benign lesions. The tumor SUVs (mean +/- SD) were 3.66 +/- 1.95 (scan 1) and 4.43 +/- 2.43 (scan 2) (20.5% +/- 8.1% increase; P < 0.01). Four of 20 malignant tumors had SUVs of <2.5 on scan 1 (range, 1.12-1.69). Benign lesions had SUVs of 1.14 +/- 0.64 (scan 1) and 1.11 +/- 0.70 (scan 2) (P = not significant). Standard PET scanning (single time point) with a threshold SUV of 2.5 (at time point 1) reached a sensitivity of 80% and a specificity of 94%; dual time point scanning with a threshold value of 10% increase between scan 1 and scan 2 reached a sensitivity of 100% with a specificity of 89%. CONCLUSION: Dual time point 18F-FDG PET results in a very high sensitivity and specificity for detection of malignant lung tumors.     

Pathology results in [18F]fluorodeoxyglucose positron emission tomography of the thyroid gland

The aim of this retrospective study was to evaluate pathologically increased uptake of [18F]fluorodeoxyglucose (18F-FDG) in positron emission tomography (PET) results of the thyroid gland. Results of 18F-FDG PET and [99mTc]pertechnetate scintigraphy of the thyroid gland are shown, compared to each other and discussed. In a retrospective study 16 patients underwent whole-body 18F-FDG PET and [99mTc]pertechnetate scintigraphy of the thyroid gland within 3 weeks. In addition, an examination of the thyroid gland by using ultrasound and laboratory tests was carried out. The 18F-FDG PET studies were carried out on a dedicated whole-ring PET scanner. Eight patients had a pathological FDG uptake in the thyroid and a cold nodule in [99mTc]pertechnetate scintigraphy of the thyroid gland (in 7/8 cases histology showed malignancy). Five patients had an inhomogeneous FDG uptake in the thyroid gland and were suspected of thyroiditis in 18F-FDG PET (in 3/5 cases thyroiditis was confirmed). Three patients had an especially low FDG uptake compared to normal physiological FDG uptake (no malignancy). Results from studies using 18F-FDG represent a growing body of evidence showing the differentiation between malignant and benign disease: we saw many pathological results in the thyroid gland. High uptake of 18F-FDG in the thyroid gland suggests possible malignancy. Thyroiditis can only be suspected based upon the results of 18F-FDG PET. We conclude that 18F-FDG PET has a potential clinical impact for detecting possible malignant lesions of the thyroid gland, but further studies, in which a higher number of patients are evaluated, are necessary.     

18F-FDG PET/CT in suspected recurrences of epithelial malignant pleural mesothelioma in asbestos-fibers-exposed patients (comparison to standard diagnostic follow-up)

This retrospective study evaluated the role of 18-fluorine-labeled 2-deoxy-2-fluoro-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with previous occupational or environmental exposure to asbestos, with histopathological diagnosis of epithelial malignant pleural mesothelioma and suspected recurrences, comparing the data from 18F-FDG PET/CT and computed tomography with contrast enhancement (CECT). 18F-FDG PET/CT has greater sensitivity than CECT in identifying local extent, lymph nodes, and metastasis. 18F-FDG PET/CT whole-body explorations are useful to monitor the follow-up and evaluate the metabolic response to chemo- and radiotherapy, modifying the scheduled treatment plan.     

Performance of a whole-body PET scanner using curve-plate NaI(Tl) detectors.

A whole-body PET scanner, without interplane septa, has been designed to achieve high performance in clinical applications. The C-PET scanner, an advancement of the PENN PET scanners, is unique in the use of 6 curved NaI(Tl) detectors (2.54 cm thick). The scanner has a ring diameter of 90 cm, a patient port diameter of 56 cm, and an axial field of view of 25.6 cm. A (137)Cs point source is used for transmission scans. METHODS: Following the protocols of the International Electrotechnical Commission ([IEC] 61675-1) and the National Electrical Manufacturers Association ([NEMA] NU-2-1994 and an updated version, NU2-2001), point and line sources, as well as uniform cylinders, were used to determine the performance characteristics of the C-PET scanner. An image-quality phantom and patient data were used to evaluate image quality under clinical scanning conditions. Data were rebinned with Fourier rebinning into 2-dimensional (slice-oriented) datasets and reconstructed with an iterative reconstruction algorithm. RESULTS: The spatial resolution for a point source in the transaxial direction was 4.6 mm (full width at half maximum) at the center, and the axial resolution was 5.7 mm. For the NU2-1994 analysis, the sensitivity was 12.7 cps/Bq/mL (444 kcps/microCi/mL), the scatter fraction was 25%, and the peak noise equivalent count rate (NEC) for a uniform cylinder (diameter = 20 cm, length = 19 cm) was 49 kcps at an activity concentration of 11.2 kBq/mL. For the IEC protocol, the peak NEC was 41 kcps at 12.3 kBq/mL, and for the NU2-2001 protocol, the peak NEC was 14 kcps at 3.8 kBq/mL. The NU2-2001 NEC value differed significantly because of differences in the data analysis and the use of a 70-cm-long phantom. CONCLUSION: Compared with previous PENN PET scanners, the C-PET, with its curved detectors and improvements in pulse shaping, integration dead time, and triggering, has an improved count-rate capability and spatial resolution. With the refinements in the singles transmission technique and iterative reconstruction, image quality is improved and scan time is shortened. With single-event transmission scans interleaved between sequential emission scans, a whole-body study can be completed in <1 h. Overall, C-PET is a cost-effective PET scanner that performs well in a broad variety of clinical applications.     

ECAT ART — a continuously rotating PET camera: Performance characteristics, initial clinical studies, and installation considerations in a nuclear medicine department

Advances in fully three-dimensional (3D) image reconstruction techniques have permitted the development of a commercial, rotating, partial ring, fully 3D positron emission tomographic (PET) scanner, the ECAT ART. The system has less than one-half the number of bismuth germanate detectors compared with a full ring scanner with the equivalent field of view, resulting in reduced capital cost. The performance characteristics, implications for installation in a nuclear medicine department, and clinical utility of the scanner are presented in this report. The sensitivity (20 cm diameter×20 cm long cylindrical phantom, no scatter correction) is 11400 cps·kBq^–1·ml^–1. This compares with 5800 and 40500 cps·kBq^–1·ml^–1 in 2D and 3D respectively for the equivalent full ring scanner (ECAT EXACT). With an energy window of 350–650 keV the maximum noise equivalent count (NEC) rate was 27 kcps at a radioactivity concentration of ~15 kBq·ml^–1 in the cylinder. Spatial resolution is ~6 mm full width at half maximum on axis degrading to just under 8 mm at a distance of 20 cm off axis. Installation and use within the nuclear medicine department does not appreciably increase background levels of radiation on gamma cameras in adjacent rooms and the dose rate to an operator in the same room is 2 µSv·h^–1 for a typical fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) study with an initial injected activity of 370 MBq. The scanner has been used for clinical imaging with¹⁸F-FDG for neurological and oncological applications. Its novel use for imaging iron-52 transferrin for localising erythropoietic activity demonstrates its sensitivity and resolution advantages over a conventional dual-headed gamma camera. The ECAT ART provides a viable alternative to conventional full ring PET scanners without compromising the performance required for clinical PET imaging.     

Prevalence, challenges, and solutions for (18)F-FDG PET studies of obese patients: a technologist's perspective

Obesity has reached epidemic proportions in the United States; hence, it is frequently encountered in patients undergoing (18)F-FDG PET studies. The purpose of the current study was to present a technologist's perspective on the prevalence of obesity and the challenges and solutions in imaging obese patients in our PET facility. METHODS: From October 2002 to October 2003, whole-body (18)F-FDG PET was performed on 1,164 patients with a known or suspected malignancy. Images were acquired 45-60 min after (18)F-FDG injection (7.4 MBq [0.2 mCi]/kg, with a maximum of 925 MBq [25 mCi]) on a PET scanner using a 4-min emission and 3-min transmission time per bed position. A database was maintained of patient height and weight, and body mass index (BMI) was calculated. Patient obesity was classified as overweight (BMI > or = 25 kg/m(2)), obese (BMI > or = 30 kg/m(2)), or malignantly obese (BMI > or = 40 kg/m(2)). In addition, PET technologists recorded any problems and attempted solutions related to the patient weight. RESULTS: BMI calculations showed that 528 patients (45.4%) were overweight or obese (322 men and 206 women; mean age, 55 y). Of those, 201 (38%) were overweight, 270 (51%) were obese, and 57 (11%) were malignantly obese. Problems encountered in these patients included difficult intravenous access (15%), difficult patient positioning (10%), patient motion (7%), an incomplete study (emission only) (1%), and potentially higher radiation exposure to the technologist because of extra time spent near the patient. Attempted solutions included adjusting the schedule to allow more time per patient, adjusting the dose based on body weight, using varied positioning techniques, dividing the study to allow a respite between different image combinations, and dividing time spent with obese patients among the technologists involved. CONCLUSION: Excessive body weight and related problems have commonly been encountered in our PET facility. (18)F-FDG PET studies of obese patients represent an ongoing challenge, which requires patient-tailored solutions to avoid compromising image quality and risking higher radiation exposure to the technologists.     

^18F-FDG PET／CT及增强CT诊断原发性肝癌及肝癌术后复发的价值

目的比较^18F-脱氧葡萄糖（FDG）PET／CT与增强CT对原发性肝癌或肝癌术后复发的诊断价值。方法回顾性分析诊断为原发性肝癌或肝癌术后复发且进行^18F-FDG PET／CT与增强CT检查的病例共25例,2种检查间隔时间在1周内。其中原发性肝癌经手术或穿刺证实,肝癌术后复发经临床随访证实。结果25例患者中,确诊为原发性肝癌14例,其中肝细胞肝痛13例,胆管细胞癌1例;肝癌术后复发11例。^18F-FDG PET／CT对原发性肝癌的诊断阳性率为78．6％（11／14）,增强CT阳性率为92．9％（13／14）。在肝癌术后复发中,^18F-FDGPET／CT诊断阳性牢为100．0％（11／11）,增强CT阳性率为63．6％（7／11）。结论在原发性肝癌诊断中,增强CT优于^18F-FDG PET／CT,^18F-FDG PET／CT显像联合增强CT可明显提高诊断率。而在肝癌术后复发检测中,^18F-FDG PET／CT优于增强CT。     

Whole-body 18F-FDG PET in recurrent or metastatic nasopharyngeal carcinoma.

The aim of this retrospective study was to evaluate the sensitivity and prognostic significance of whole-body (18)F-FDG PET for nasopharyngeal carcinoma (NPC) patients for whom there was a suspicion of recurrence or metastasis by conventional radiologic or clinical findings during their follow-up examinations. METHODS: Whole-body (18)F-FDG PET examinations were performed on 64 Taiwanese NPC patients (14 female, 50 male; mean age +/- SD, 45.8 +/- 13.0 y; age range, 16-75 y) 4-70 mo (mean +/- SD, 14.1 +/- 13.5 mo) after radiotherapy or induction chemotherapy followed by concurrent chemoradiotherapy from February 1997 to May 2001. The accuracy of (18)F-FDG PET detection for each patient was determined by the histopathologic results or other clinical evidence. RESULTS: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of (18)F-FDG PET images in the diagnosis of NPC recurrence or metastases and secondary primary cancers were 92%, 90%, 92%, 90%, and 91%, respectively. Furthermore, the presence of (18)F-FDG hypermetabolism was highly correlated with the survival time of NPC patients. CONCLUSION: Whole-body (18)F-FDG PET is a sensitive follow-up diagnostic tool for the evaluation of NPC recurrences and metastases. It is also an effective prognostic indicator for NPC patients. To determine the optimized utilization of (18)F-FDG PET in the follow-up for NPC patients, further cost-effectiveness analysis of (18)F-FDG PET in combination with conventional management is necessary.     

Investigation of the resolution and count recovery coefficients of a whole-body PET scanner (Shimadzu SET-2400W) in 2D and 3D mode image

We measured the resolution and count recovery coefficients (RC) of the SET-2400W whole-body PET scanner (Shimadzu Co., Japan) in the 2D and 3D clinical modes. METHOD: The 3D images were reconstructed by using the full 3D image reconstruction method (3-D reprojection algorithm: 3DRP) and the Fourier rebinning method (FORE). The 2D images were reconstructed with conventional filtered back-projection method (FBP). The measurements of resolution and recovery coefficient were according to JRIA (Japan Radioisotope Association) protocols. RESULTS: The transaxial resolutions of all methods were better than 7 mm FWHM at a radius of 10 cm with 1.25 cm-1 cutoff frequency. The average slice width of 2D FBP, 3DRP and FORE are 5.8 mm, 8.0 mm and 6.8 mm respectively at the center of transaxial field of view. The RC values were measured in a range from 10 mm to 27 mm at 6 cm from the center with the cylindrical and spherical hot area phantoms. In all methods, RC values at 27 mm diameter were nearly 1.0 in both type of hot area. RC values at 10 mm diameter in 2D FBP, 3DRP and FORE of cylindrical hot area were 0.69, 0.72, 0.73 and those of spherical hot area were 0.52, 0.51, 0.53 respectively. CONCLUSION: At the SET-2400W, resolution and recovery coefficient of 3D mode image under the clinical mode showed the value which did not differ from the 2D mode image.     

Performance of Philips Gemini TF PET/CT scanner with special consideration for its time-of-flight imaging capabilities.

Results from a new PET/CT scanner using lutetium-yttrium oxyorthosilicate (LYSO) crystals for the PET component are presented. This scanner, which operates in a fully 3-dimensional mode, has a diameter of 90 cm and an axial field of view of 18 cm. It uses 4 x 4 x 22 mm(3) LYSO crystals arranged in a pixelated Anger-logic detector design. This scanner was designed to perform as a high-performance conventional PET scanner as well as provide good timing resolution to operate as a time-of-flight (TOF) PET scanner. METHODS: Performance measurements on the scanner were made using the National Electrical Manufacturers Association (NEMA) NU2-2001 procedures to benchmark its conventional imaging capabilities. The scatter fraction and noise equivalent count (NEC) measurements with the NEMA cylinder (20-cm diameter) were repeated for 2 larger cylinders (27-cm and 35-cm diameter), which better represent average and heavy patients. New measurements were designed to characterize its intrinsic timing resolution capability, which defines its TOF performance. Additional measurements to study the impact of pulse pileup at high counting rates on timing, as well as energy and spatial, resolution were also performed. Finally, to characterize the effect of TOF reconstruction on lesion contrast and noise, the standard NEMA/International Electrotechnical Commission torso phantom as well as a large 35-cm-diameter phantom with both hot and cold spheres were imaged for varying scan times. RESULTS: The transverse and axial resolution near the center is 4.8 mm. The absolute sensitivity of this scanner measured with a 70-cm-long line source is 6.6 cps/kBq, whereas scatter fraction is 27% measured with a 70-cm-long line source in a 20-cm-diameter cylinder. For the same line source cylinder, the peak NEC rate is measured to be 125 kcps at an activity concentration of 17.4 kBq/mL (0.47 microCi/mL). The 2 larger cylinders showed a decrease in the peak NEC due to increased attenuation, scatter, and random coincidences, and the peak occurs at lower activity concentrations. The system coincidence timing resolution was measured to be 585 ps. The timing resolution changes as a function of the singles rate due to pulse pileup and could impact TOF image reconstruction. Image-quality measurements with the torso phantom show that very high quality images can be obtained with short scan times (1-2 min per bed position). However, the benefit of TOF is more apparent with the large 35-cm-diameter phantom, where small spheres are detectable only with TOF information for short scan times. CONCLUSION: The Gemini TF whole-body scanner represents the first commercially available fully 3-dimensional PET scanner that achieves TOF capability as well as conventional imaging capabilities. The timing resolution is also stable over a long duration, indicating the practicality of this device. Excellent image quality is achieved for whole-body studies in 10-30 min, depending on patient size. The most significant improvement with TOF is seen for the heaviest patients.     

Three-dimensional positron emission tomography imaging with 124I and 86Y

BACKGROUND: Impure positron emitters have physical characteristics that degrade image quality compared to conventional positron emitters like 18F. Two impure positron emitters with potentially interesting applications are 124I and 86Y. The degradation in image quality due to the imperfection of these isotopes is quantified for a human three-dimensional (3-D) positron emission tomography (PET) system. An acquisition protocol to obtain similar image quality as for 18F imaging is determined by Monte Carlo simulations. METHODS: The effects of larger positron range, associated singles and the other decay modes on image quality are determined by extensive Monte Carlo simulations of the Allegro scanner. Spatial resolution was evaluated for both isotopes and compared to spatial resolution of 18F. The loss in sensitivity due to triple coincidences was determined as a function of the axial acceptance angle of the PET scanner. The performance of the scanner at low count rates was studied by determining the noise equivalent count (NEC) values for different upper energy thresholds. The image degrading effect of spurious coincidences is taken into account by adding another factor to the NEC calculation. This allowed the contribution of spurious coincidences to be minimized by using a setting for the appropriate energy window. For this optimal energy window the amount of spurious and scattered coincidences was quantified. Simulations of count rate performance were also done to determine the peak NEC and the activity at which the maximum occurred. RESULTS: Spatial resolution degradation, compared to 18F, is about 0.5 mm for 86Y and 1 mm for 124I. Associated singles have a similar effect as scattered coincidences, as they also add a background to the image. The effect, however, is less important than the effect of scatter. The fraction of triple coincidences is quite small for a 3-D PET scanner used for humans as the axial acceptance angle is still moderate. For the Allegro with an energy resolution of 18% the optimal upper energy threshold was determined at 600 keV. For 124I this leads to 2.5% extra contamination that needs to be added to the scatter fraction. For 86Y this fraction is about 5.5%. CONCLUSION: 3-D PET images of 124I and 86Y have lower spatial resolution. For PET scanners used for humans the difference is not as important as for scanners used for animals. The limited positron decay fraction of both isotopes can be compensated by increasing the imaging time by a factor of 3-5 (same activity). A short coincidence window limits the contamination from other decay modes. Good energy resolution allows setting a selective upper energy threshold to limit the effect of spurious coincidences. With an appropriate setting of the energy window it should be possible to obtain good image quality in a relatively short time because of the high sensitivity of 3-D PET scanners.