Image Quality and Interpretation of [18F]-FES-PET: Is There any Effect of Food Intake?

Abstract

Background: High physiological 16α-[18F]-fluoro-17β-estradiol ([18F]-FES) uptake in the abdomen is a limitation of this positron emission tomography (PET) tracer. Therefore, we investigated the effect of food intake prior to PET acquisition on abdominal background activity in [18F]-FES-PET scans. Methods: Breast cancer patients referred for [18F]-FES-PET were included. Three groups were designed: (1) patients who consumed a chocolate bar (fatty meal) between tracer injection and imaging (n = 20), (2) patients who fasted before imaging (n = 20), and (3) patients without diet restrictions (control group, n = 20). We compared the physiological [18F]-FES uptake, expressed as mean standardized uptake value (SUVmean), in the abdomen between groups. Results: A significant difference in [18F]-FES uptake in the gall bladder and stomach lumen was observed between groups, with the lowest values for the chocolate group and highest for the fasting group (p = 0.015 and p = 0.011, respectively). Post hoc analysis showed significant differences in the SUVmean of these organs between the chocolate and fasting groups, but not between the chocolate and control groups. Conclusion: This exploratory study showed that, compared to fasting, eating chocolate decreases physiological gall bladder and stomach [18F]-FES uptake; further reduction through a normal diet was not seen. A prospective study is warranted to confirm this finding.

Analyzing the Estrogen Receptor Status of Liver Metastases with [18F]-FES-PET in Patients with Breast Cancer

“…Remarkably, a difference in tracer uptake in healthy liver tissue between ER+ and ER− metastases was found. The [ 18 F]-FES uptake in healthy liver tissue of patients with ER+ tumors in our study was similar to other studies in patients with (suspected) ER+ breast cancer (median SUV max 15.4, range: 12.5-18.7; median SUV mean 12, IQR: 10-14) [19,23,24]. However, no value of [ 18 F]-FES uptake specifically in healthy liver parenchyma of patients with ER− tumors was reported in these published studies.…”

Análise e comparação de protocolos em PET/CT para os radiofármacos ¹8F-FES, ¹8F-PSMA, ¹8F-NAF e ¹8F-FDG

“…2). Desta maneira, o radiofármaco deve ser administrado com atividade entre 185 a 220 MBq, imagens iniciadas após 60 minutos desta administração e o tempo de aquisição para cada imagem estabelecido entre 1-3 minutos [6,7,5,13,15,16,17,18]. Outras variações quanto ao protocolo encontradas são: atividade do radiofármaco administrada ao paciente entre 111 e 296 MBq, início das aquisições das imagens após 45 a 100 minutos da administração do radiofármaco e tempo de aquisição para cada imagem mantendo-se entre 1 a 3 minutos [5,19,14,20].…”

Non-conventional and Investigational PET Radiotracers for Breast Cancer: A Systematic Review

“…[ 18 F]F-FES PET/CT examinations do not require any specific preparation, however—mainly as a measure of standardization—fasting is recommended and some foods, such as chocolate, should be avoided ( 100 ). Nevertheless, some pharmacological aspects have to be taken into account: in case of staging, treatment with ER antagonists (e.g., tamoxifen or fulvestrant) should be discontinued for ≥5 weeks before the examination.…”