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.
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Funding was provided by the National Cancer Institute (U01 CA142565, P50 CA098131, and P30 CA68485) and the Kleberg Foundation.
JMW, LRA, and TEY participated in study design, implementation, data analysis, and manuscript preparation. SDR, WJG, and SRP were involved in data analysis and manuscript preparation. DWT and RGA participated in study design and manuscript preparation. JGK, RKL, and CWS conceptualized and developed the investigational device and participated in manuscript preparation. MDS, VGA, PP, and ABC were involved in the clinical implementation of the study and manuscript preparation. All authors read and approved the final manuscript.
Disclosure of potential conflicts of interest
WJG, JGK, RKL, SRP, and CWS are employees of Lucerno Dynamics, LLC, which provided the investigational device to Vanderbilt without charge. DWT is a Scientific Advisor for Lucerno.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Williams, J.M., Arlinghaus, L.R., Rani, S.D. et al. Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging. Eur J Nucl Med Mol Imaging 43, 2374–2380 (2016). https://doi.org/10.1007/s00259-016-3477-3
- Standardized uptake value accuracy
- Time-activity curve
- Topical scintillation device
- Radiotracer injection