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Total-body 18F-FDG PET/CT scan in oncology patients: how fast could it be?

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Abstract

Purpose

The aim of the study was to determine a faster PET acquisition protocol for a total-body PET/CT scanner by assessing the image quality that is equivalent to a conventional digital PET/CT scanner from both a phantom and a clinical perspective.

Methods

A phantom study using a NEMA/IEC NU-2 body phantom was first performed in both a total-body PET/CT (uEXPLORER) and a routine digital PET/CT (uMI 780), with a hot sphere to background activity concentration ratio of 4:1. The contrast recovery coefficient (CRC), background variability (BV), and recovery coefficient (RC: RCmax and RCmean) were assessed in the uEXPLORER with different scanning durations and reconstruction protocols, which were compared to those acquired from the uMI 780 with clinical acquisition settings. The coefficient of variation (COV) of the uMI 780 with clinical settings was calculated and used as a threshold reference to determine the optimized scanning duration and reconstruction protocol for the uEXPLORER. The obtained protocol from the phantom study was subsequently tested and validated in 30 oncology patients. Images acquired from the uMI 780 with 2–3 min per bed position were referred as G780 and served as the reference for comparison. All PET raw data from the uEXPLORER were reconstructed using the data-cutting technique to simulate a 30-s, 45-s, or 60-s acquisition duration, respectively. The iterations were 2 and 3 for the uEXPLORER, referred as G30s_3i, G45s_2i, G45s_3i, G60s_2i, and G60s_3i, respectively. A 5-point Likert scale was used in the qualitative analysis to assess the image quality. The image quality was also evaluated by the liver COV, the lesion target-to-background ratio (TBR), and the lesion signal-to-noise ratio (SNR).

Results

In the phantom study, CRC, BV, RCmax, and RCmean in the uEXPLORER with different scanning durations and reconstruction iterations were compared with those in the uMI 780 with clinical settings. A minor fluctuation was found among different scanning durations. COV of the uMI 780 with clinical settings was 11.6%, and a protocol with a 30–45-s scanning duration and 2 or 3 iterations for the uEXPLORER was found to provide an equivalent image quality as the uMI 780. An almost perfect agreement was shown with a kappa value of 0.875. The qualitative score of the G30s_3i in the uEXPLORER was inferior to the G780 reference (p = 0.001); however, the scores of other groups in the uEXPLORER with a 45-s and above acquisition time were higher than the G780 in the uMI 780. In quantitative analysis, the delay time between the two scans in the two orders was not significantly different. There was no significant difference of the liver COV between the G780 and G30s_3i (p = 0.162). A total of 33 lesions were analyzed in the clinical patient study. There was no significant difference in lesion TBR between the reference G780 and the G45s_2i obtained from the uEXPLORER (p = 0.072), while the latter showed a higher lesion SNR value compared to that in uMI 780 with clinical settings (p < 0.001).

Conclusions

This study showed that a fast PET protocol with a 30–45-s acquisition time in the total-body uEXPLORER PET/CT can provide an equivalent image quality as the conventional digital uMI 780 PET/CT with longer clinical acquisition settings.

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Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Funding

This study is supported by Shanghai Municipal Key Clinical Specialty Project (shslczdzk03401), Clinical Research Plan of SHDC (SHDC2020CR3079B), Science and Technology Committee of Shanghai Municipality (20DZ2201800), Special Fund for Clinical Research of Zhongshan Hospital, Fudan University (2020ZSLC63), and The Youth Medical Talents-Medical Imaging Practitioner Program of Shanghai “Rising Stars of Medical Talent” Youth Development Program (SHWRS[2020]_087).

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Author notes

  1. Pengcheng Hu and Yiqiu Zhang contributed equally to this work.

Authors and Affiliations

  1. Department of Nuclear Medicine, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    Pengcheng Hu, Yiqiu Zhang, Haojun Yu, Shuguang Chen, Hui Tan, Chi Qi & Hongcheng Shi

  2. Nuclear Medicine Institute of Fudan University, Shanghai, 200032, China

    Pengcheng Hu, Yiqiu Zhang, Haojun Yu, Shuguang Chen, Hui Tan, Chi Qi & Hongcheng Shi

  3. Shanghai Institute of Medical Imaging, Shanghai, 200032, China

    Pengcheng Hu, Yiqiu Zhang, Haojun Yu, Shuguang Chen, Hui Tan, Chi Qi & Hongcheng Shi

  4. United Imaging Healthcare Co., Ltd., Shanghai, China

    Yun Dong, Ying Wang & Zilin Deng

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  1. Pengcheng Hu
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Contributions

Pengcheng Hu and Yiqiu Zhang were involved in the study design, data analysis, and manuscript preparation. Hui Tan, Chi Qi, and Ying Wang helped with data processing. Haojun Yu, Yusen Gu, and Shuguang Chen helped with image acquisition and processing. Yun Dong and Zilin Deng were responsible for the preparation of the NEMA phantom and of the acquisition. Hongcheng Shi designed the study and contributed to the data analysis and writing of the manuscript. All authors discussed the results and commented on the manuscript.

Corresponding author

Correspondence to Hongcheng Shi.

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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.

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The authors declare no competing interests.

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Hu, P., Zhang, Y., Yu, H. et al. Total-body 18F-FDG PET/CT scan in oncology patients: how fast could it be?. Eur J Nucl Med Mol Imaging 48, 2384–2394 (2021). https://doi.org/10.1007/s00259-021-05357-5

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  • DOI: https://doi.org/10.1007/s00259-021-05357-5

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