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Dose Reduction in Brain [18F]FDG PET/MRI: Give It Half a Chance

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Abstract

Purpose

Integrated positron emission tomography (PET)/magnetic resonance imaging (MRI) offers promising tools for evaluating brain disorders, including the minimization of exposure to ionizing radiation. Considering the length of scanning time with PET/MRI systems and their high sensitivity, we assumed that the activity could be reduced by one half compared with recommended activity for brain 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) PET exams without degrading image quality.

Procedures

We retrospectively simulated the reduction of injected activity (1 vs. 2 MBq/kg, [18F]FDG) in 100 patients assessed for cognitive impairment with simultaneous PET/MRI imaging. A list-mode acquisition was used to generate a 20-min image set as a reference (PETSTD) and to simulate a low-dose injection with a 10-min image (PETLD). We tested the reproducibility between PETLD and PETSTD with a blinded visual interpretation by two nuclear physicians asked to classify metabolic patterns, and a quantitative analysis conducted with regions-of-interest. Voxelwise comparisons between patients suggestive of Alzheimer’s disease (AD) and frontotemporal dementia (FTD) were also conducted.

Results

The intra-operator agreement was high between the PETSTD and PETLD visual assessments for both readers (kappa 0.92 and 0.99). SUV ratios were strongly reproducible (intraclass correlation coefficient 0.95). The voxelwise and regional comparisons between AD vs. FTD metabolic profiles yielded very similar results with PETSTD and PETLD.

Conclusions

A reduction of the [18F]FDG dose down to 1 MBq/kg is possible when performing 20-min brain PET/MRI without modifying diagnostic performance and quantitative assessments. The advantage is a significant reduction in the patient effective dose, which is non-negligible in longitudinal follow-up studies and in research protocols involving healthy volunteers.

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Author information

Authors and Affiliations

  1. Médecine Nucléaire, Hôpital Pitié-Salpêtrière, AP-HP, F-75013, Paris, France

    Marine Soret, Eve Piekarski, Nathanaëlle Yeni, Jacques-Antoine Maisonobe, Marc Bertaux, Marie-Odile Habert & Aurélie Kas

  2. Laboratoire d’Imagerie Biomédicale, LIB CNRS, INSERM, Sorbonne Université, CNRS, INSERM, F-75006, Paris, France

    Marine Soret, Alain Giron, Jacques-Antoine Maisonobe, Claire Zaslavsky, Marie-Odile Habert & Aurélie Kas

  3. Institut du Cerveau et de la Moelle Epinière, CNRS UMR 7225, INSERM U1127, Université Paris 6 UPMC UMR S1127, F-75013, Paris, France

    Maya Khalifé

  4. Centre d’Acquisition et Traitement des Images (CATI), Paris, France

    Marie-Odile Habert

Authors
  1. Marine Soret
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  2. Eve Piekarski
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  3. Nathanaëlle Yeni
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Correspondence to Marine Soret.

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Conflict of Interest

The authors of this manuscript declare relationships with the following companies: General Electric Healthcare. Maya Khalifé was a PET/MR scientist sponsored by GE Healthcare. We have no other potential conflict of interest relevant to this article to declare.

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Soret, M., Piekarski, E., Yeni, N. et al. Dose Reduction in Brain [18F]FDG PET/MRI: Give It Half a Chance. Mol Imaging Biol 22, 695–702 (2020). https://doi.org/10.1007/s11307-019-01398-3

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  • DOI: https://doi.org/10.1007/s11307-019-01398-3

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