Abstract
Purpose
The purpose of this study was to assess whether digital photon counting technology in digital PET/CT influences the quantification of SUVmax in target lesions and regions of reference compared to analog PET/CT before an interchangeable use of either system in follow up studies.
Methods
From January to June of 2018, 100 oncological patients underwent successive PET/CT imaging with digital and analog systems in the same day. Fifty-eight patients underwent analog imaging first and digital imaging thereafter, and 42 patients the other way round. SUVmax was measured in reference regions (liver and mediastinal blood pool) and in the most metabolically active target lesion in each patient. According to the sequence order of PET/CT acquisition, two groups of SUVmax values were obtained, i.e. group 1: analog PET/CT performed first; group 2: digital PET/CT performed first.
Results
Mean SUVmax in the total sample (regardless of the order of PET/CT acquisition) in the target lesions with the analog PET/CT was 8.14 ± 6.39 and the digital 9.97 ± 6.14 (P = 0.000). Total mean SUVmax in the liver with the analog was 4.39 ± 2.59 and the digital 4.46 ± 3.18 (P = 0.477). Total mean SUVmax in the mediastinal blood pool with the analog was 2.30 ± 0.67 and the digital 2.54 ± 0.74 (P = 0.000).
Group 1: mean SUVmax in the target lesions with the analog system was 6.64 ± 4.71 and the digital 9.48 ± 5.60 (P = 0.000). Mean liver SUVmax with the analog was 4.70 ± 2.90 and the digital 4.80 ± 3.72 (P = 0.088). Mediastinal blood pool SUVmax with the analog was 2.33 ± 0.66 and the digital 2.45 ± 0.73 (P = 0.041).
Group 2: mean SUVmax in target lesions with the digital system was 10.63 ± 6.88 and the analog 10.16 ± 7.76 (P = 0.046). Mean liver SUVmax with the digital was 3.99 ± 2.20 and the analog 3.96 ± 2.04 (P = 0.218). Mediastinal blood pool SUVmax with the digital was 2.66 ± 0.75 and the analog 2.27 ± 0.68 (P = 0.000).
No significant differences between both time delays were found.
Conclusions
Improved photon counting technology in the digital PET/CT, and the effect of delayed increased uptake and retention significantly increases SUVmax values. This has to be taken into account before interchangeable use of either system in follow up studies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
09 February 2019
The article Digital vs. analog PET/CT: intra-subject comparison of the SUVmax in target lesions and reference regions, written by Francisco Fuentes-Ocampo, Diego Alfonso López-Mora, Albert Flotats, Gabriela Paillahueque
References
Rausch I, Ruiz A, Valverde-Pascual I, Cal-Gonzalez J, Beyer T, Carrio I. Performance evaluation of the Philips Vereos PET/CT system according to the NEMA NU2-2012 standard. J Nucl Med. 2018; in press.
Slomka PJ, Pan T, Germano G. Recent advances and future progress in PET instrumentation. Semin Nucl Med. 2016;46:5–19.
Slomka PJ, Pan T, Berman DS, Germano G. Advances in SPECT and PET hardware. Prog Cardiovasc Dis. 2015;57:566–78.
Nguyen NC, Vercher-Conejero JL, Sattar A, Miller MA, Maniawski PJ, Jordan DW, et al. Image quality and diagnostic performance of a digital PET prototype in patients with oncologic diseases: initial experience and comparison with analog PET. J Nucl Med. 2015;56:1378–85.
Wright CL, Binzel K, Zhang J, Knopp MV. Advanced functional tumor imaging and precision nuclear medicine enabled by digital PET technologies. Contrast Media Mol Imaging. 2017. https://doi.org/10.1155/2017/5260305.
Roncali E, Cherry SR. Application of silicon photomultipliers to positron emission tomography. Ann Biomed Eng. 2011;39:1358–77.
Frach T, Prescher G, Degenhardt C, de Gruyter R, Schmitz A, Ballizany R. The digital silicon photomultiplier — principle of operation and intrinsic detector performance. IEEE Nuclear Science Symposium Conference Record (NSS/MIC), Orlando, FL. 2009. https://doi.org/10.1109/NSSMIC.2009.5402143.
Cheng G, Torigian DA, Zhuang H, Alavi A. When should we recommend use of dual time-point and delayed time-point imaging techniques in FDG PET? Eur J Nucl Med Mol Imaging. 2013;40:779–87.
Chin BB, Green ED, Turkington TG, Hawk TC, Coleman RE. Increasing uptake time in FDG-PET: standardized uptake values in normal tissues at 1 versus 3 h. Mol Imaging Biol. 2009;11:118–22.
Oprea-Lager DE, Vincent AD, van Moorselaar RJ, Gerritsen WR, van den Eertwegh AJ, Eriksson J, et al. Dual-phase PET-CT to differentiate [18F]Fluoromethylcholine uptake in reactive and malignant lymph nodes in patients with prostate cancer. PLoS One. 2012;7:e48430. https://doi.org/10.1371/journal.pone.0048430.
Beheshti M, Imamovic L, Broinger G, Vali R, Waldenberger P, Stoiber F, et al. 18F choline PET/CT in the preoperative staging of prostate cancer in patients with intermediate or high risk of extracapsular disease: a prospective study of 130 patients. Radiology. 2010;254:925–33.
Kwee SA, Wei H, Sesterhenn I, Yun D, Coel MN. Localization of primary prostate cancer with dual-phase 18F-fluorocholine PET. J Nucl Med. 2006;47:262–9.
Cimitan M, Bortolus R, Morassut S, Canzonieri V, Garbeglio A, Baresic T, et al. [18F]fluorocholine PET/CT imaging for the detection of recurrent prostate cancer at PSA relapse: experience in 100 consecutive patients. Eur J Nucl Med Mol Imaging. 2006;33:1387–98.
Tong AK, Zhang ZX, Zaheer S, Yan XS. Dual-phase (18)F-fluorocholine PET/CT to detect locoregional recurrence of prostate cancer: comparison between each time point of imaging and a summation scan. Clin Imaging. 2016;40:486–91.
Cheng G, Alavi A, Lim E, Werner TJ, Del Bello CV, Akers SR. Dynamic changes of FDG uptake and clearance in normal tissues. Mol Imaging Biol. 2013;15:345–52.
Jaskowiak CJ, Bianco JA, Perlman SB, Fine JP. Influence of reconstruction iterations on 18F-FDG PET/CT standardized uptake values. J Nucl Med. 2005;46:424–8.
Boellaard R, Krak NC, Hoekstra OS, Lammertsma AA. Effects of noise, image resolution, and ROI definition on the accuracy of standard uptake values: a simulation study. J Nucl Med. 2004;45:1519–27.
Armstrong IS, Kelly MD, Williams HA, Matthews JC. Impact of point spread function modelling and time of flight on FDG uptake measurements in lung lesions using alternative filtering strategies. EJNMMI Phys. 2014;1:99.
Sharifpour R, Ghafarian P, Bakhshayesh-Karam M, Jamaati H, Ay MR. Impact of time-of-flight and point-spread-function for respiratory artifact reduction in PET/CT imaging: focus on standardized uptake value. Tanaffos. 2017;16:127–35.
Acknowledgments
Supported in part by an unrestricted Philips Healthcare grant.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare no conflicts of interest.
Ethical approval
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
Informed consent was obtained from all individual participants included in the study.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
The original version of this article was revised due to cancellation of open access order
Rights and permissions
About this article
Cite this article
Fuentes-Ocampo, F., López-Mora, D.A., Flotats, A. et al. Digital vs. analog PET/CT: intra-subject comparison of the SUVmax in target lesions and reference regions. Eur J Nucl Med Mol Imaging 46, 1745–1750 (2019). https://doi.org/10.1007/s00259-018-4256-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00259-018-4256-0