Annals of Nuclear Medicine

, Volume 27, Issue 6, pp 508–514 | Cite as

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

  • Xuexian Yan
  • Jian Kang
  • Yanli Zhou
  • Ramisa Ehsan
  • Raghuveer Halkar
  • Kimberly E. Applegate
  • David M. Schuster
Original Article

Abstract

Objective

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.

Methods

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).

Results

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).

Conclusions

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.

Keywords

F-18-FDG PET/CT Quality control 

Notes

Conflict of interest

None of the authors of the above manuscript has declared any conflict of interest within the last 3 years which may arise from being named as an author on the manuscript.

References

  1. 1.
    Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med. 2000;41(8):1369–79.PubMedGoogle Scholar
  2. 2.
    Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of 18F-FDG PET in oncology. J Nucl Med. 2008;49(3):480–508.PubMedCrossRefGoogle Scholar
  3. 3.
    Bouffet E, Frappaz D, Pinkerton R, Favrot M, Philip T. Burkitt’s lymphoma: a model for clinical oncology. Eur J Cancer Clin Oncol. 1991;27(4):504–9.CrossRefGoogle Scholar
  4. 4.
    Jhanwar YS, Straus DJ. The role of PET in lymphoma. J Nucl Med. 2006;47:1326–34.PubMedGoogle Scholar
  5. 5.
    Delbeke D, Coleman RE, Guiberteau MJ, Brown ML, Royal HD, Siegel BA, et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. J Nucl Med. 2006;47(5):885–95.PubMedGoogle Scholar
  6. 6.
    Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer—a PET study. J Nucl Med. 1993;34(1):1–6.PubMedGoogle Scholar
  7. 7.
    Team RDC. R: a language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2011.Google Scholar
  8. 8.
    Adams MC, Turkington TG, Wilson JM, Wong TZ. A systematic review of the factors affecting accuracy of SUV measurements. Am J Roentgenol. 2010;195(2):310–20.CrossRefGoogle Scholar
  9. 9.
    Nahmias C, Wahl LM. Reproducibility of standardized uptake value measurements determined by 18F-FDG PET in malignant tumors. J Nucl Med. 2008;49(11):1804–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Paquet N, Albert A, Foidart J, Hustinx R. Within-patient variability of (18)F-FDG: standardized uptake values in normal tissues. J Nucl Med. 2004;45(5):784–8.PubMedGoogle Scholar
  11. 11.
    Retif P, Jegouic C, Slosman DO. Quality assessment of fluorodeoxyglucose positron emission tomography imaging in clinical setting: definition of standard quality control parameters for patients treated for lymphoma. Nucl Med Commun. 2011;32(9):794–801.PubMedCrossRefGoogle Scholar
  12. 12.
    Graham MM, Badawi RD, Wahl RL. Variations in PET/CT methodology for oncologic imaging at U.S. academic medical centers: an imaging response assessment team survey. J Nucl Med. 2011;52(2):311–7.PubMedCrossRefGoogle Scholar
  13. 13.
    Wong KP, Sha W, Zhang XL, Huang SC. Effects of administration route, dietary condition, and blood glucose level on kinetics and uptake of 18F-FDG in mice. J Nucl Med. 2011;52:800–7.PubMedCrossRefGoogle Scholar
  14. 14.
    Groot MD, Meeuwis APW, Kok PJM, Corstens FH, Oyen WJ. Influence of blood glucose level, age and fasting period on non-pathological FDG uptake in heart and gut. Eur J Nucl Med Mol Imaging. 2005;32:98–101.PubMedCrossRefGoogle Scholar
  15. 15.
    Kushner M, Tobin M, Alavi A, Chawluk J, Rosen M, Fazekas F, et al. Cerebellar glucose consumption in normal and pathologic states using fluorine-FDG and PET. J Nucl Med. 1987;28(11):1667–70.PubMedGoogle Scholar
  16. 16.
    Growdon WA, Bratton TS, Houston MC, Tarpley HI, Regen DM. Brain glucose metabolism in the intact mouse. Am J Physiol. 1971;221:1738–45.PubMedGoogle Scholar
  17. 17.
    Nomori H, Watanabe K, Ohtsuka T, Naruke T, Suemasu K, Uno K, et al. Visual and semiquantitative analyses for F-18 fluorodeoxyglucose PET scanning in pulmonary nodules 1 cm to 3 cm in size. Ann Thorac Surg. 2005;79:984–9.PubMedCrossRefGoogle Scholar
  18. 18.
    Obrzut S, Pham RH, Vera DR, Badran K, Hoha CK. Comparison of lesion-to-cerebellum uptake ratios and standardized uptake values in the evaluation of lung nodules with 18F-FDG PET. Nucl Med Commun. 2007;28(1):7–13.PubMedCrossRefGoogle Scholar
  19. 19.
    Keyes JW Jr. SUV: standard uptake or silly useless value? J Nucl Med. 1995;36(10):1836–9.PubMedGoogle Scholar
  20. 20.
    Kim CK, Gupta NC, Chandramouli B, Alavi A, et al. Standardized uptake values of FDG: body surface area correction is preferable to body weight correction. J Nucl Med. 1994;35(1):164–7.PubMedGoogle Scholar
  21. 21.
    Tatsumi M, Clark PA, Nakamoto Y, Wahl RL. Impact of body habitus on quantitative and qualitative image quality in whole-body FDG-PET. Eur J Nucl Med Mol Imaging. 2003;30(1):40–5.PubMedCrossRefGoogle Scholar

Copyright information

© The Japanese Society of Nuclear Medicine 2013

Authors and Affiliations

  • Xuexian Yan
    • 1
    • 4
  • Jian Kang
    • 1
    • 2
  • Yanli Zhou
    • 1
    • 3
  • Ramisa Ehsan
    • 1
  • Raghuveer Halkar
    • 1
  • Kimberly E. Applegate
    • 1
  • David M. Schuster
    • 1
  1. 1.Department of RadiologyEmory University HospitalAtlantaUSA
  2. 2.Department of Biostatistics and Bioinformatics, Rollins School of Public HealthEmory UniversityAtlantaUSA
  3. 3.Division of Nuclear Cardiology, Department of Cardiology, The First Affiliated HospitalNanjing Medical UniversityNanjingChina
  4. 4.Department of Nuclear Medicine and PETSingapore General HospitalSingaporeSingapore

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