Ultra-low-activity total-body dynamic PET imaging allows equal performance to full-activity PET imaging for investigating kinetic metrics of 18F-FDG in healthy volunteers

Liu, Guobing; Hu, Pengcheng; Yu, Haojun; Tan, Hui; Zhang, Yiqiu; Yin, Hongyan; Hu, Yan; Gu, Jiande; Shi, Hongcheng

doi:10.1007/s00259-020-05173-3

Cited by 65 publications

(32 citation statements)

References 28 publications

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“…Whereas previous studies report the clinical acceptability of "half-dose" protocols in LAFOV PET/CT [21], our data suggest that further and more significant activity reductions are feasible and confirm previous proof-of-concept studies showing the practicability of "low dose" protocols for LAFOV [11,22]. In contrast to previously reported lowactivity protocols proposed for digital SAFOV [24], such LAFOV protocols, are not at the cost of imaging quantification or missed target lesions, where such protocols may raise concerns about potential for clinical detriment [25].…”

Section: Discussionsupporting

confidence: 88%

“…4 Boxplots showing signalto-noise ratio (SNR) for the liver background, which is the reciprocal of the coefficient of variation. The measured SNR for SAFOV scanner (blue) was equivalent to between 1-and 2min scans obtained on the LAFOV (red) volunteers [22]. However, the full potential of LAFOV systems is yet to be characterised in a clinical setting.…”

Section: Discussionmentioning

confidence: 99%

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Clinical performance of long axial field of view PET/CT: a head-to-head intra-individual comparison of the Biograph Vision Quadra with the Biograph Vision PET/CT

Alberts

Hünermund

Prenosil

et al. 2021

Eur J Nucl Med Mol Imaging

149

116

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Purpose To investigate the performance of the new long axial field-of-view (LAFOV) Biograph Vision Quadra PET/CT and a standard axial field-of-view (SAFOV) Biograph Vision 600 PET/CT (both: Siemens Healthineers) system using an intra-patient comparison. Methods Forty-four patients undergoing routine oncological PET/CT were prospectively included and underwent a same-day dual-scanning protocol following a single administration of either 18F-FDG (n = 20), 18F-PSMA-1007 (n = 16) or 68Ga-DOTA-TOC (n = 8). Half the patients first received a clinically routine examination on the SAFOV (FOVaxial 26.3 cm) in continuous bed motion and then immediately afterwards on the LAFOV system (10-min acquisition in list mode, FOVaxial 106 cm); the second half underwent scanning in the reverse order. Comparisons between the LAFOV at different emulated scan times (by rebinning list mode data) and the SAFOV were made for target lesion integral activity, signal to noise (SNR), target lesion to background ratio (TBR) and visual image quality. Results Equivalent target lesion integral activity to the SAFOV acquisitions (16-min duration for a 106 cm FOV) were obtained on the LAFOV in 1.63 ± 0.19 min (mean ± standard error). Equivalent SNR was obtained by 1.82 ± 1.00 min LAFOV acquisitions. No statistically significant differences (p > 0.05) in TBR were observed even for 0.5 min LAFOV examinations. Subjective image quality rated by two physicians confirmed the 10 min LAFOV to be of the highest quality, with equivalence between the LAFOV and the SAFOV at 1.8 ± 0.85 min. By analogy, if the LAFOV scans were maintained at 10 min, proportional reductions in applied radiopharmaceutical could obtain equivalent lesion integral activity for activities under 40 MBq and equivalent doses for the PET component of <1 mSv. Conclusion Improved image quality, lesion quantification and SNR resulting from higher sensitivity were demonstrated for an LAFOV system in a head-to-head comparison under clinical conditions. The LAFOV system could deliver images of comparable quality and lesion quantification in under 2 min, compared to routine SAFOV acquisition (16 min for equivalent FOV coverage). Alternatively, the LAFOV system could allow for low-dose examination protocols. Shorter LAFOV acquisitions (0.5 min), while of lower visual quality and SNR, were of adequate quality with respect to target lesion identification, suggesting that ultra-fast or low-dose acquisitions can be acceptable in selected settings.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Clinical performance of long axial field of view PET/CT: a head-to-head intra-individual comparison of the Biograph Vision Quadra with the Biograph Vision PET/CT

Alberts

Hünermund

Prenosil

et al. 2021

Eur J Nucl Med Mol Imaging

149

116

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“…Furthermore, our previous results showed that total-body PET/CT with half-dose (1.85 MBq/kg) 18 F-FDG of 2 min acquisition, could achieve an equivalent image quality to that of whole-body PET/CT with full-dose (3.7 MBq/kg) in lung cancer [9]. Recently, Liu et.al reported that dynamic PET imaging of ultra-low-dose (0.37MBq/kg) injected activity achieved relevant kinetic metrics of 18 F-FDG and comparable image contrast with full-dose imaging [10].…”

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confidence: 99%

Can the BMI-based dose regimen be used to reduce injection activity and to obtain a constant image quality in oncological patients by 18F-FDG total-body PET/CT imaging?

Xiao

Sui

et al. 2021

Eur J Nucl Med Mol Imaging

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Purpose PET image quality is influenced by the patient size according to the current guideline. The purpose was to propose an optimized dose regimen to yield a constant image quality independent of patient size to meet the clinical needs.Methods A first patient cohort of 78 consecutives for oncological patients (59.7±13.7 years) who underwent a total-body PET/CT scan were retrospectively enrolled to develop the regimen. The patients were equally distributed in four BMI groups according to WHO criteria. The liver SNR (Signal noise ratio, SNR L ) was obtained through manually drawing ROIs and normalized (SNR norm ) by the injected activity and acquisition time. And fits of SNR norm against different patient-dependent parameters were performed to determine the best correlating parameter and fit method. A qualitative assessment on image quality was performed using a 5-point Likert scale to determine the acceptable threshold of SNR L . And thus, an optimized regimen was proposed and validated by a second patient cohort with prospectively enrolled 38 oncological patients. ResultsThe linear fit showed SNR norm was the strongest correlation (R 2 = 0.69) with the BMI than other patient-dependent parameters. The qualitative assessment revealed a SNR L of 14.0 as a threshold to achieve a sufficient image quality. The optimized dose regimen was determined as a quadratic relation with BMI: Injected activity = 39.2 MBq/(-0.03*BMI+1.49) 2 . In the validation study, the SNR L no longer decreased with the increase of BMI. There was no significant difference of the image quality, the SNR L , between different BMI groups (p > 0.05). In addition, the injected activity was reduced by 75.6±2.9 %, 72.1±4.0 %, 67.1±4.4 % and 64.8±3.5 % compared to the first cohort for the four BMI groups, respectively. ConclusionThe study recommended a quadratic relation between the 18 F-FDG injected activity and the patient's BMI and propose a regimen for total-body PET imaging. In the regimen, the image quality can maintain in a constant level independent of patient size and meet the clinical requirement even with a reduced injected activity.

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“…Elongating the axial FOV length to 2 meters allows a 40-fold increase in the detection e ciency of emitted photons in total-body PET imaging. The emergence of the state-of-the-art PET/CT scanner with 194-cm-long axial FOV, provides an opportunity to further reduce acquisition duration and/or injected 18 F-FDG activity for paediatric patients [22][23][24][25][26]. A newly published study by Liu et al on ultra-low-activity total-body dynamic PET imaging in 12 healthy adults concluded that total-body PET imaging allowed injected activity to be reduced down to 0.37MBq/kg while maintaining 18 F-FDG kinetics and acceptable image contrast [26].…”

Section: Introductionmentioning

confidence: 99%

Image quality and lesion detectability in low-dose paediatric 18F-FDG scans using total-body PET/CT

Zhao

Chen

et al. 2021

Preprint

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Purpose: To investigate the effects of dose reduction on image quality and lesion detectability of oncological 18F-FDG total-body PET/CT in paediatric oncological patients, and explore the minimum threshold of administered tracer activity.Methods: A total of 33 paediatric patients (weight, 8.5–58.5 kg; age 0.8–17.6 years) underwent total-body PET/CT using uEXPLORER scanner with an 18F-FDG administered dose of 3.7 MBq/kg and an acquisition time of 600 s were retrospectively enrolled. Low-dose images (0.12 – 1.85 MBq/kg) were simulated by truncating the list-mode PET data to reducing count density. Subjective image quality was rated on a 5-point scale. Semi-quantitative uptake metrics for low-dose images were assessed using region-of-interest (ROI) analysis of healthy liver and suspected lesions and were compared to full-dose images. The micro-lesion detectability was compared among the dose-dependent PET images.Results: Our analysis shows that sufficient subjective image quality and lesion conspicuity could be maintained down to 1/30th (0.12 MBq/kg) of the administered dose of 18F-FDG, where good image quality scores were given to 1/2- and 1/10- dose groups. The image noise was significantly more deranged than the overall quality and lesion conspicuity in 1/30- to 1/10-dose groups (all P < 0.05). With reduced doses, quantitative analysis of ROIs showed that SUVmax and SD in the liver increased gradually (P < 0.05), but SUVmax in the lesions and lesion-to-background ratio (LBR) showed no significant deviation down to 1/30-dose. 100% of the 18F-FDG-avid micro-lesions identified in full-dose images were localised down to 1/15-dose images; while 97% of the lesion were localized in 1/30-dose images.Conclusion: The total-body PET/CT might significantly decrease the administered dose upon maintaining the image quality and diagnostic performance of micro-lesions in paediatric patients. Data suggests that using total-body PET/CT, optimal image quality could be achieved with an administered dose-reduction down to 1/10-dose (0.37 MBq/kg).

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Ultra-low-activity total-body dynamic PET imaging allows equal performance to full-activity PET imaging for investigating kinetic metrics of 18F-FDG in healthy volunteers

Cited by 65 publications

References 28 publications

Clinical performance of long axial field of view PET/CT: a head-to-head intra-individual comparison of the Biograph Vision Quadra with the Biograph Vision PET/CT

Clinical performance of long axial field of view PET/CT: a head-to-head intra-individual comparison of the Biograph Vision Quadra with the Biograph Vision PET/CT

Can the BMI-based dose regimen be used to reduce injection activity and to obtain a constant image quality in oncological patients by 18F-FDG total-body PET/CT imaging?

Image quality and lesion detectability in low-dose paediatric 18F-FDG scans using total-body PET/CT

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