Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging
To dynamically detect and characterize 18F-fluorodeoxyglucose (FDG) dose infiltrations and evaluate their effects on positron emission tomography (PET) standardized uptake values (SUV) at the injection site and in control tissue.
Investigational gamma scintillation sensors were topically applied to patients with locally advanced breast cancer scheduled to undergo limited whole-body FDG-PET as part of an ongoing clinical study. Relative to the affected breast, sensors were placed on the contralateral injection arm and ipsilateral control arm during the resting uptake phase prior to each patient’s PET scan. Time-activity curves (TACs) from the sensors were integrated at varying intervals (0–10, 0–20, 0–30, 0–40, and 30–40 min) post-FDG and the resulting areas under the curve (AUCs) were compared to SUVs obtained from PET.
In cases of infiltration, observed in three sensor recordings (30 %), the injection arm TAC shape varied depending on the extent and severity of infiltration. In two of these cases, TAC characteristics suggested the infiltration was partially resolving prior to image acquisition, although it was still apparent on subsequent PET. Areas under the TAC 0–10 and 0–20 min post-FDG were significantly different in infiltrated versus non-infiltrated cases (Mann–Whitney, p < 0.05). When normalized to control, all TAC integration intervals from the injection arm were significantly correlated with SUVpeak and SUVmax measured over the infiltration site (Spearman ρ ≥ 0.77, p < 0.05). Receiver operating characteristic (ROC) analyses, testing the ability of the first 10 min of post-FDG sensor data to predict infiltration visibility on the ensuing PET, yielded an area under the ROC curve of 0.92.
Topical sensors applied near the injection site provide dynamic information from the time of FDG administration through the uptake period and may be useful in detecting infiltrations regardless of PET image field of view. This dynamic information may also complement the static PET image to better characterize the true extent of infiltrations.
KeywordsInfiltration Extravasation Standardized uptake value accuracy Time-activity curve Topical scintillation device Radiotracer injection
- 2.Hall NC, Zhang J, Reid R, Hurley D, Knopp MV. Impact of FDG extravasation on SUV measurements in clinical PET/CT. Should we routinely scan the injection site? J Nucl Med. 2006;47(Supplement 1):115P.Google Scholar
- 8.Knowland JG, Scarantino CW, Lattanze RK. System for the detection of gamma radiation from a radioactive analyte. Google Patents. 2013; US 20130324844 A1.Google Scholar
- 9.Atuegwu NC, Li X, Arlinghaus LR, Abramson RG, Williams JM, Chakravarthy AB, et al. Longitudinal, intermodality registration of quantitative breast PET and MRI data acquired before and during neoadjuvant chemotherapy: preliminary results. Med Phys. 2014;41(5):052302. doi:10.1118/1.4870966.CrossRefPubMedPubMedCentralGoogle Scholar
- 11.QIBA FDG-PET/CT Standardized Uptake Value (SUV) Technical Subcommittee. Vendor-neutral pseudo-code for SUV calculation. QIBA/RSNA. http://qibawiki.rsna.org/index.php?title=Standardized_Uptake_Value_(SUV). Accessed 30 Aug 2015.