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European Journal of Nuclear Medicine

, Volume 24, Issue 9, pp 1091–1098 | Cite as

Whole-body positron emission tomography in clinical oncology: Comparison between attenuation-corrected and uncorrected images

  • Frank M. Bengel
  • Sibylle I. Ziegler
  • Norbert Avril
  • Wolfgang Weber
  • Christian Laubenbacher
  • Markus Schwaiger
Original Article

Abstract

The clinical need for attenuation correction of whole-body positron emission tomography (PET) images is controversial, especially because of the required increase in imaging time. In this study, regional tracer distribution in attenuation-corrected and uncorrected images was compared in order to delineate the potential advantages of attenuation correction for clinical application. An ECAT EXACT scanner and a protocol including five to seven bed positions, emission scans of 9 min and post-injection transmission scans of 10 min per bed position were used. Uncorrected and attenuation-corrected images were reconstructed by filtered backprojection. In total, 109 areas of focal fluorine-18 fluorodeoxyglucose (FDG) uptake in 34 patients undergoing PET for the staging of malignancies were analysed. To measure focus contrast, a ratio of focus (target) to background average countrates (t/b ratio) was obtained from transaxial slices using a region of interest technique. Calculation of focus diameters by a distance measurement tool and visual determination of focus borders were performed. In addition, images of a body phantom with spheres to simulate focal FDG uptake were acquired. Transmission scans with and without radioactivity in the phantom were used with increasing transmission scanning times (2–30 min). The t/b ratios of the spheres were calculated and compared for the different imaging protocols. In patients, the t/b ratio was significantly higher for uncorrected images than for attenuation-corrected images (5.0±3.6 vs 3.1±1.4;P<0.001). This effect was independent of focus localization, tissue type and distance to body surface. Compared with the attenuation-corrected images, foci in uncorrected images showed larger diameters in the anterior-posterior dimension (27±14 vs 23±12 mm;P<0.001) but smaller diameters in the leftright dimension (19±11 vs 21±11 mm;P<0.001). Phantom data confirmed higher contrast in uncorrected images compared with attenuation-corrected images. It is concluded that, although distortion of foci was demonstrated, uncorrected images provided higher contrast for focal FDG uptake independent of tumour localization. In most clinical situations, the main issue of whole-body PET is pure lesion detection with the highest contrast possible, and not quantification of tracer uptake. The present data suggest that attenuation correction may not be necessary for this purpose.

Key words

Whole-body positron emission tomography Fluorine-18 fluorodeoxyglucose Attenuation correction 

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References

  1. 1.
    Adler LP. Bloom AD. Positron emission tomography of thyroid masses.Thyroid 1993; 3: 195–200.PubMedGoogle Scholar
  2. 2.
    Avril N, Dose J, Janicke F, et al. Metabolic characterization of breast tumours with positron emission tomography using F-18 fluorodeoxyglucose.J Clin Oncol 1996; 14: 1848–1857.PubMedGoogle Scholar
  3. 3.
    Casey MJ, Gupta NC, Muths CK. Experience with positron emission tomography (PET) scans in patients with ovarian cancer.Gynecol Oncol 1994; 53: 331–338.PubMedGoogle Scholar
  4. 4.
    Falk PM, Gupta NC, Thorson AG, et al. Positron emission tomography for preoperative staging of colorectal carcinoma.Dis Colon Rectum 1994; 37: 153–6.PubMedGoogle Scholar
  5. 5.
    Gritters LS, Francis IR, Zasadny KR, Wahl RL. Initial assessment of positron emission tomography using 2-fluorine-18fluoro-2-deoxy-d-glucose in the imaging of malignant melanoma.J Nucl Med 1993; 34: 1420–1427.PubMedGoogle Scholar
  6. 6.
    Laubenbacher C, Saumweber D, Wagner MC, et al. Comparison of fluorine- l8-fluorodeoxyglucose PET, MRI and endoscopy for staging head and neck squamous-cell carcinomas.J Nucl Med 1995: 36: 1747–57.PubMedGoogle Scholar
  7. 7.
    Stollfuss JC, Glatting G, Friess H, Kocher F, Berger HG, Reske SN. 2-(fluorine-18)-fluoro-2-deoxy-d-glucose PET in detection of pancreatic cancer: value of quantitative image interpretation.Radiology 1995; 195: 339–344.PubMedGoogle Scholar
  8. 8.
    Wahl RL, Quint LE, Greenough RL, Meyer CR, White RI, Orringer MB. Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluation.Radiology 1994; 191: 371–377.PubMedGoogle Scholar
  9. 9.
    Hoh CK, Hawkins RA, Glaspy JA, et al. Cancer detection with whole-body PET using 2-[18F]fluoro-2-deoxy-d-glucose.J Comput Assist Tomogr 1993; 17: 582–589.PubMedGoogle Scholar
  10. 10.
    Dahlbom M, Hoffman EJ, Hoh CK, et al. Whole-body positron emission tomography: Part I. Methods and performance characteristics.J Nucl Med 1992; 33: 1191–1199.PubMedGoogle Scholar
  11. 11.
    Beets G, Penninckx F, Schiepers C, et al. Clinical value of whole-body positron emission tomography with [18F]fluoro-deoxyglucose in recurrent colorectal cancer. Br J Surg 1994; 81: 1666–1670.PubMedGoogle Scholar
  12. 12.
    Lewis P, Griffin S, Marsden P, et al. Whole-body 18F-fluorodeoxyglucose positron emission tomography in preoperative evaluation of lung cancer.Lancet 1994; 344: 1265–1266.PubMedGoogle Scholar
  13. 13.
    Rege SD, Hoh CK, Glaspy JA, et al. Imaging of pulmonary mass lesions with whole-body positron emission tomography and fluorodeoxyglucose.Cancer 1993; 72: 82–90.PubMedGoogle Scholar
  14. 14.
    Karlan BY, Hawkins R, Hoh C,et al. Whole-body positron emission tomography with 2-[18F]-fluoro-2-deoxy-d-glucose can detect recurrent ovarian carcinoma.Gynecol Oncol 1993; 51: 175–181.PubMedGoogle Scholar
  15. 15.
    Steinert HC, HuchBoni R, Buck A, et al. Malignant melanoma: staging with whole-body positron emission tomography and 2-[F-18]-fluoro-2-deoxy-d-glucose.Radiology 1995; 195: 705–709.PubMedGoogle Scholar
  16. 16.
    Engel H, Steinert H, Buck A, Berthold T, HuchBoni RA, von Schulthess GK. Whole-body PET: physiological and artifactual fluorodeoxyglucose accumulations.J Nucl Med 1996; 37: 441–446.PubMedGoogle Scholar
  17. 17.
    Hamacher K, Coenen HH, Stocklin G. Efficient stereospecific synthesis of no-carrier-added 2-[18F]-fluoro-2-deoxy-d-glu-cose using aminopolyether supported nucleophilic substitution.J Nucl Med 1986; 27: 235–238.PubMedGoogle Scholar
  18. 18.
    Wienhard K, Eriksson L, Grootoonk S, Casey M, Pietrzyk U, Heiss WD. Performance evaluation of the positron scanner ECAT EXACT.J Comput Assist Tomogr 1992; 16: 804–813.PubMedGoogle Scholar
  19. 19.
    Ziegler SI, Schad D, Kuhnel D, Kruschke C, Schwaiger M. Postinjection and simultaneous transmission measurements for clinical PET.Eur J Nucl Med 1995; 22: 788.Google Scholar
  20. 20.
    Zasadny KR, Kison PV, Quint LE, Wahl RE. Quantification of systematic distortion in non-attenuation corrected FDG-PET images in patients with untreated lung cancers.J Nucl Med 1995; 36: 5P.Google Scholar
  21. 21.
    Carson RE, DaubeWitherspoon M, Green MV. A method for postinjection PET transmission measurements with a rotating source.J Nucl Med 1988; 29: 1558–1567.PubMedGoogle Scholar
  22. 22.
    Huang SC, Hoffman EJ, Phelps ME, Kuhl DE. Quantitation in positron emission computed tomography: 2. Effects of inaccurate attenuation correction.J Comput Assist Tomogr 1979; 3: 804–814.PubMedGoogle Scholar
  23. 23.
    Hawkins RA, Hoh C, Glaspy J, et al. The role of positron emission tomography in oncology and other whole-body applications.Semin Nucl Med 1992; 22: 268–284.PubMedGoogle Scholar
  24. 24.
    Keyes JJ. SUV: standard uptake or silly useless value?J Nucl Med 1995; 36: 1836–1839.PubMedGoogle Scholar
  25. 25.
    Xu EZ, Mullani NA, Gould KL, Anderson WL. A segmented attenuation correction for PET.J Nucl Med 1991; 32: 161–165.PubMedGoogle Scholar
  26. 26.
    Meikle SR, Dahlbom M, Cherry SR. Attenuation correction using count-limited transmission data in positron emission tomography.J Nucl Med 1993; 34: 143–150.PubMedGoogle Scholar
  27. 27.
    Meikle SR, Bailey DL, Hooper PK, et al. Simultaneous emission and transmission measurements for attenuation correction in whole-body PET.J Nucl Med 1995; 36: 1680–1688.PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • Frank M. Bengel
    • 1
  • Sibylle I. Ziegler
    • 1
  • Norbert Avril
    • 1
  • Wolfgang Weber
    • 1
  • Christian Laubenbacher
    • 1
  • Markus Schwaiger
    • 1
  1. 1.Department of Nuclear MedicineTechnische Universität MünchenMunichGermany

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