Original Article

Annals of Nuclear Medicine

, Volume 27, Issue 6, pp 508-514

First online:

Imaging quality of F-18-FDG PET/CT in the inpatient versus outpatient setting

  • Xuexian YanAffiliated withDepartment of Radiology, Emory University HospitalDepartment of Nuclear Medicine and PET, Singapore General Hospital Email author 
  • , Jian KangAffiliated withDepartment of Radiology, Emory University HospitalDepartment of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University
  • , Yanli ZhouAffiliated withDepartment of Radiology, Emory University HospitalDivision of Nuclear Cardiology, Department of Cardiology, The First Affiliated Hospital, Nanjing Medical University
  • , Ramisa EhsanAffiliated withDepartment of Radiology, Emory University Hospital
  • , Raghuveer HalkarAffiliated withDepartment of Radiology, Emory University Hospital
  • , Kimberly E. ApplegateAffiliated withDepartment of Radiology, Emory University Hospital
  • , David M. SchusterAffiliated withDepartment of Radiology, Emory University Hospital

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The purpose of this study is to investigate potential differences in the image quality of inpatient versus outpatient F-18-FDG PET/CT to provide evidence for appropriate policies and procedures to be promulgated on inpatient referrals.


100 consecutive inpatient and 100 outpatient F-18-FDG PET/CT scans were compared from the same time period and PET/CT scanner. Each study was evaluated for a subjective overall rating (optimal vs. suboptimal), and also by objective measurements (SUVmean) in four background structures (brain, blood pool, liver, and muscle).


96 outpatient scans were rated optimal and 4 suboptimal whereas corresponding numbers for inpatient scans were 77 and 23 (p < 0.001). Of the objective indices, cerebellar SUV was significantly different in inpatient versus outpatient (5.3 vs. 6.9; p < 0.001) as well as suboptimal versus optimal rated groups (4.8 vs. 6.3; p < 0.001). While mean blood glucose was higher for inpatients (108.01 vs. 101.49 mg/dl; p = 0.017), it was not significantly different between optimal and suboptimal exams. Linear regression analysis between blood glucose levels and cerebellar uptake revealed an inverse relationship (R = −0.38, p < 0.001).


There was a significantly higher number of inpatient PET/CT scans rated as suboptimal in comparison to outpatient scans. Decreased cerebellar uptake was present in suboptimal rated studies and in inpatient studies. Altered biodistribution is thus a potential etiology of reduced scan quality among inpatients. These findings, if duplicated among other readers and centers, may form the basis of quality control recommendations for inpatient PET/CT ordering patterns.


F-18-FDG PET/CT Quality control