Dynamic whole-body 18F-FDG PET for differentiating abnormal lesions from physiological uptake

• Published in: European journal of nuclear medicine and molecular imaging Vol. 47; no. 10; pp. 2293 - 2300
• Main Authors: Nishimura, Motoki, Tamaki, Nagara, Matsushima, Shigenori, Kiba, Maki, Kotani, Tomoya, Bamba, Chisa, Nakamura, Yasunori, Yamada, Kei
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.09.2020; Springer Nature B.V
• Subjects: Cardiology; Colon; Evaluation; Fluorine isotopes; Image quality; Imaging; Intestine; Lesions; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Oncology; Oncology – General; Original Article; Orthopedics; Physicians; Physiology; Positron emission; Positron emission tomography; Quality assessment; Radiology; Small intestine; Tomography; Urinary tract; F-FDG; Whole-body PET; Dynamic acquisition; Cancer
• ISSN: 1619-7070; 1619-7089
• DOI: 10.1007/s00259-020-04726-w

Purpose Serial assessment of visual change in 18 F-FDG uptake on whole-body 18 F-FDG PET imaging was performed to differentiate pathological uptake from physiological uptake in the urinary and gastrointestinal tracts. Methods In 88 suspected cancer patients, serial 3-min dynamic whole-body PET imaging was performed four times, from 60 min after 18 F-FDG administration. In dynamic image evaluation, high 18 F-FDG uptake was evaluated by two nuclear medicine physicians and classified as “changed” or “unchanged” based on change in uptake shape over time. Detectability of pathological uptake based on these criteria was assessed and compared with conventional image evaluation. Results Dynamic whole-body PET imaging provided images of adequate quality for visual assessment. Dynamic image evaluation was “changed” in 118/154 regions of high physiological 18 F-FDG uptake (77%): in 9/19 areas in the stomach (47%), in 32/39 in the small intestine (82%), in 17/33 in the colon (52%), and in 60/63 in the urinary tract (95%). In the 86 benign or malignant lesions, 84 lesions (98%) were “unchanged.” A high 18 F-FDG uptake area that shows no change over time using these criteria is highly likely to represent pathological uptake, with sensitivity of 97%, specificity of 76%, PPV of 70%, NPV of 98%, and accuracy of 84%. Conclusion Dynamic whole-body 18 F-FDG PET imaging enabled differentiation of pathological uptake from physiological uptake in the urinary and gastrointestinal tracts, based on visual change of uptake shape.