Oral contrast medium in PET/CT: should you or shouldn’t you?

Abstract

The use of oral contrast medium in 18F-FDG PET studies should not be withheld as it improves image interpretation and does not produce clinically significant artefacts.

18F-FDG PET and PET/CT Patient Preparation: A Review of the Literature

“…The proposed protocol is described in Table 1, and a comparison of our proposed protocol with the recommendations of the SNMMI, EANM, ACR, and NCI is presented in Table 2. Readers are directed to previous publications (12)(13)(14)(15)(16) for detailed information on oral and intravenous contrast agents, CT protocols for diagnostic whole-body 18 F-FDG PET/CT, and dedicated brain and cardiac 18 F-FDG PET imaging, which are beyond the scope of this review.…”

Idiopathic Pulmonary Fibrosis and Diffuse Parenchymal Lung Disease: Implications from Initial Experience with18F-FDG PET/CT

“…Both attenuation-and non-attenuation-corrected images were reviewed visually ( Fig. 1) using similar methodology previously described (13) to ensure that areas of higher-density lung were not inducing attenuation-correction artifacts. The area of most intense pulmonary 18 F-FDG uptake was identified and measured (maximum standardized uptake value [SUV max ]), and the HRCT parenchymal pattern in the region was assessed.…”

Evaluation of the effects of oral water and low-density barium sulphate suspension on bowel appearance on FDG-PET/CT

“…Furthermore, oral contrast may aid in the evaluation of false-positive gastrointestinal FDG uptake. Nonspecific intestinal FDG uptake of moderate degree is commonly encountered in PET and PET/CT imaging [11,12] and attributed to be either due to peristalsis, bowel mucosal structures, lymphocytic cell concentration, or intestinal bacteria [10]. Oral contrast preparations distending these segments at CT may allow better assessment and exclusion of luminal or mural disease.…”

“…To date, oral contrast preparations/protocols routinely incorporated in CT imaging to delineate bowel from other abdominal structures, such as barium and gastrografin and less frequently water [5,6], are not routinely used at PET/CT [7]. Indeed the oral contrast results derived from dedicated CT studies cannot be directly applied to currently practiced PET/CT because, for example, positive oral contrast agents used in high concentration in routine CT imaging have been shown to artifactually bring about reconstruction artifacts on PET when CT data are used for attenuation correction [8][9][10]. This phenomenon is thought to be secondary to contrast desiccation in the right colon, and therefore PET/CT requires appropriate modifications compared to those of separate CT and PET acquisitions.…”