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Head-to-head intra-individual comparison of total-body 2-[18F]FDG PET/CT and digital PET/CT in patients with malignant tumor: how sensitive could it be?

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To comparatively evaluate the lesion-detecting ability of 2-[18F]FDG total-body PET/CT (TB PET/CT) and conventional digital PET/CT.

Methods

This study enrolled 67 patients (median age, 65 years; 24 female and 43 male patients) who underwent a TB PET/CT scan and a conventional digital PET/CT scan after a single 2-[18F]FDG injection (3.7 MBq/kg). Raw PET data for TB PET/CT were acquired over the course of 5 min, and images were reconstructed using data from the first 1, 2, 3, and 4 min and the entire 5 min (G1, G2, G3, G4, and G5, respectively). The conventional digital PET/CT scan acquired in 2–3 min per bed (G0). Two nuclear medicine physicians independently assessed subjective image quality using a 5-point Likert scale and recorded the number of 2-[18F]FDG-avid lesions.

Results

A total of 241 lesions (69 primary lesions; 32 liver, lung, and peritoneum metastases; and 140 regional lymph nodes) among 67 patients with various types of cancer were analyzed. The subjective image quality score and SNR (signal-to-noise ratio) increased gradually from G1 to G5, and these values were significantly higher than the values at G0 (all p < 0.05). Compared to conventional PET/CT, G4 and G5 of TB PET/CT detected an additional 15 lesions (2 primary lesions; 5 liver, lung, and peritoneum lesions; and 8 lymph node metastases).

Conclusion

TB PET/CT was more sensitive than conventional whole-body PET/CT in detecting small (4.3 mm, maximum standardized uptake value (SUVmax) of 1.0) or low-uptake (tumor-to-liver ratio of 1.6, SUVmax of 4.1) lesions.

Clinical relevance statement

This study explored the gain of the image quality and lesion detectability of TB PET/CT, compared to conventional PET/CT, and recommended the appropriate acquisition time for TB PET/CT in clinical practice with an ordinary 2-[18F] FDG dose.

Key Points

• TB PET/CT increases the effective sensitivity to approximately 40 times that of conventional PET scanners.

• The subjective image quality score and signal-to-noise ratio of TB PET/CT from G1 to G5 were better than those of conventional PET/CT.

• 2-[ 18 F]FDG TB PET/CT with a 4-min acquisition time at a regular tracer dose detected an additional 15 lesions compared to conventional PET/CT.

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Abbreviations

2-[18F]FDG:

2-[18F]fluoro-2-deoxy-D-glucose

SD:

Standard deviation

SNR:

Signal-to-noise ratio

SUVmax :

Maximum standardized uptake value

SUVmean :

Mean standardized uptake value

TB PET/CT:

Total-body PET/CT

TFR:

Tumor-to-fatty-tissue ratio

TLR:

Tumor-to-liver ratio

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Funding

This study is supported by the Science and Technology Committee of Shanghai Municipality (20DZ2201800), Clinical Research Plan of SHDC (No. SHDC2020CR3079B), and Shanghai Municipal Key Clinical Specialty (shslczdzk03401).

Author information

Author notes

  1. Xueqi Chen and Pengcheng Hu equally contributed to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Xueqi Chen, Pengcheng Hu, Haojun Yu, Hui Tan, Yibo He & Hongcheng Shi

  2. Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China

    Xueqi Chen, Pengcheng Hu, Haojun Yu, Hui Tan, Yibo He & Hongcheng Shi

  3. Shanghai Institute of Medical Imaging, Shanghai, 200032, China

    Xueqi Chen, Pengcheng Hu, Haojun Yu, Hui Tan, Yibo He & Hongcheng Shi

  4. Central Research Institute, United Imaging Healthcare Group Co., Ltd., Shanghai, 201807, China

    Shuangliang Cao & Yun Zhou

  5. School of Biomedical Engineering, Shanghai Tech University, Shanghai, China

    Yun Zhou

Authors
  1. Xueqi Chen
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Corresponding author

Correspondence to Hongcheng Shi.

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Guarantor

The scientific guarantor of this publication is Hongcheng Shi.

Conflict of interest

The authors of this manuscript declare relationships with the following companies: Shuangliang Cao and Yun Zhou are members of Shanghai United Imaging Healthcare Co., serving uExplore (194 cm AFOV PET/CT), and playing an important role in image reconstruction and investigation. All authors declare that they have no other conflict of interest.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in Hu P, Zhang Y, Yu H et al Total-body (18)F-FDG PET/CT scan in oncology patients: how fast could it be? Eur J Nucl Med Mol Imaging 2021;48(8):2384-2394.

Methodology

• retrospective

• performed at one institution

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Chen, X., Hu, P., Yu, H. et al. Head-to-head intra-individual comparison of total-body 2-[18F]FDG PET/CT and digital PET/CT in patients with malignant tumor: how sensitive could it be?. Eur Radiol 33, 7890–7898 (2023). https://doi.org/10.1007/s00330-023-09825-4

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