Abstract
Purpose
To determine if the minimum administered radiopharmaceutical activity for hepatobiliary scintigraphy can be reduced while preserving diagnostic image quality using enhanced planar processing (EPP).
Methods
A total of 40 infants between 10 and 270 days old (body mass 2.2 – 6.5 kg) had hepatobiliary scintigraphy during the period 2004 – 2010 following the intravenous administration of either 99mTc-mebrofenin (18 patients) or 99mTc-disofenin (22 patients). Due to the small size of these patients, they all received the minimum administered activity of 18.5 MBq consistent with the North American Consensus Guidelines. Six nuclear medicine physicians subjectively graded the acceptability of the image quality for clinical interpretation using a four-point scale (not acceptable, fair, good, excellent). Each physician independently graded seven image sets including the original study (full activity) and simulated reduced activity studies using binomial subsampling (50 % of full activity, 25 % of full activity and activity reduced by weight), with and without EPP.
Results
For full-activity studies, 98 % were deemed acceptable by the six physicians for clinical interpretation. The percentages of acceptable 50 % reduced activity studies with and without EPP were not significantly different from the percentage of acceptable full-activity studies (P = 0.193 and P = 0.998, respectively). The percentage of acceptable 25 % reduced activity studies without EPP was significantly different from the percentage of acceptable full-activity studies (P < 0.001); however, this difference vanished when EPP was applied (P = 0.482). The activity reduced by weight ranged from 1.85 to 4.81 MBq (10 % to 26 % of full dose) and the percentages of acceptable studies with and without EPP were significantly different from the percentage of acceptable full-activity studies (P < 0.001 and P = 0.02, respectively).
Conclusion
Clinically interpretable hepatobiliary scintigraphy images can be obtained in infants when the minimum administered activity is substantially reduced. Without EPP, clinically acceptable images may be produced with a reduction of 50 %, and with EPP, a reduction of 75 % or more may be possible.
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Conflicts of interest
Three of the authors (A.H.V., M.B., X.D.) were employed by the company (Siemens Medical Solutions USA, Hoffman Estates, IL, USA) that provided both the count and noise reduction software used in this investigation. These individuals were not involved in the design or execution of the project and were not included in the collection and analysis of the data. They were, however, provided an opportunity to review the manuscript to ensure that the description of the software tools utilized was appropriate.
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Fahey, F., Zukotynski, K., Zurakowski, D. et al. Beyond current guidelines: reduction in minimum administered radiopharmaceutical activity with preserved diagnostic image quality in pediatric hepatobiliary scintigraphy. Eur J Nucl Med Mol Imaging 41, 2346–2353 (2014). https://doi.org/10.1007/s00259-014-2860-1
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DOI: https://doi.org/10.1007/s00259-014-2860-1