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Prone position [18F]FDG PET/CT to reduce respiratory motion artefacts in the evaluation of lung nodules

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) positron-emission tomography/computed tomography (PET/CT) is widely used to evaluate lung nodules, although respiratory motion artefacts may occur. We investigated the value of prone position PET/CT (pPET/CT) in lung nodule evaluation compared with standard supine position PET/CT (sPET/CT).

Methods

We retrospectively reviewed 28 consecutive patients (20 men; age, 65.6 ± 12.1 years) with a lung nodule (size, 16.8 ± 5.5 mm) located below the sub-carinal level who underwent [18F]FDG PET/CT in a standard supine position and additional prone position. The maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV), difference of diaphragm position between PET and CT (DDP), Dice’s similarity coefficient (DSC) and occurrence of mis-registration were analysed. The [18F]FDG uptake of 20 biopsy-confirmed (15 malignant) nodules was evaluated visually.

Results

pPET/CT yielded a significantly higher SUVmax, lower MTV and shorter DDP than with sPET/CT (p = 0.043, 0.007 and 0.021, respectively). Mis-registration occurred in 53.6% of cases in sPET/CT and in 28.6% of cases in pPET/CT (p = 0.092). Among the 15 patients with mis-registration in sPET/CT, 10 patients (66.7%) did not show mis-registration in pPET/CT. DSC was higher in pPET/CT than in sPET/CT in 18 out of 28 patients (64.3%). In visual analysis, malignant nodules exhibited a higher [18F]FDG uptake positivity than benign nodules in pPET/CT (93.3% vs. 40.0%, p = 0.032) but not in sPET/CT (80.0% vs. 40.0%, p = 0.131).

Conclusions

pPET/CT reduces respiratory motion artefact and enables more-precise measurements of PET parameters.

Key Points

• In prone position PET/CT, the decrease in the blurring effect caused by reduced respiratory motion resulted in a higher SUV max and lower MTV in lung nodules than that with supine position PET/CT.

• Prone position PET/CT was useful to interpret correctly malignant lung nodules as being positive in individual cases that had a negative result in supine position PET/CT.

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Abbreviations

[18F]FDG:

2-Deoxy-2-[18F]fluoro-D-glucose

CT:

Computed tomography

DDP:

Difference of diaphragm position between PET and CT

IPF:

Idiopathic pulmonary fibrosis

MTV:

Metabolic tumour volume

PET/CT:

Positron-emission tomography/computed tomography

PET:

Positron-emission tomography

pPET/CT:

Prone position positron-emission tomography/computed tomography

SD:

Standard deviation

sPET/CT:

Supine position positron-emission tomography/computed tomography

SUVmax :

Maximum standardised uptake value

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Authors and Affiliations

  1. Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea

    Hyung Ju Lee, Jung Won Moon, Yoo Na Kim, Ji Young Woo & Suk Hyun Lee

  2. Department of Nuclear Medicine, Dankook University Medical Center, Cheonan, Chungnam, Republic of Korea

    Hye Joo Son

  3. Department of Nuclear Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea

    Mijin Yun

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  1. Hyung Ju Lee
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Lee, H.J., Son, H.J., Yun, M. et al. Prone position [18F]FDG PET/CT to reduce respiratory motion artefacts in the evaluation of lung nodules. Eur Radiol 31, 4606–4614 (2021). https://doi.org/10.1007/s00330-021-07894-x

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