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Revisiting detection of in-transit metastases in melanoma patients using digital 18F-FDG PET/CT with small-voxel reconstruction

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Abstract

Aim

To evaluate the use of digital 18F-FDG PET/CT with small-voxels reconstruction for detecting in-transit metastases in melanoma patients with primary lesion located on the upper or lower limbs, in comparison with standard reconstruction and European Association of Nuclear Medicine Research limited (EARL)-compliant reconstruction mimicking former generation PET systems.

Methods

Forty-six PET examinations acquired in list mode on a Vereos digital PET/CT system were reconstructed with (1) the standard reconstruction [2 iterations, 10 subsets (2i10s), point-spread function (PSF) modelling and time-of-flight enabled, no post-filtering and voxel size of 2 mm], (2) a small-voxel reconstruction using 1 mm voxels otherwise using the same parameters, (3) an EARL-compliant reconstruction mimicking a former generation system. Comparison of results across these reconstructions was made for a blind randomized review using a 3-point scale for the presence of in-transit metastases and image quality as well as for tumour-to-background (T/B) ratios and noise level in reference organs.

Results

Seven of the thirty-two EARL-compliant images classified as negative moved to positive on 1mmPSF images, and 5 of the 6 EARL-compliant images classified as indeterminate moved to positive on 1mmPSF images (P = 0.01). Amongst a total of 20 PET examinations classified as positive using the 1mmPSF reconstruction, fifteen were considered true positive, five false positive results occurred. Twenty-four patients with 1 mm PSF images were classified as negative, none of those under active surveillance experienced in-transit metastases during the 17 months following their PET examination. The positive likelihood ratio for the 1 mm reconstruction was much higher than that observed for EARL-compliant images (14.7 vs 7.82). Importantly, negative likelihood ratios for the 1 mm and 1mmPSF reconstruction were almost perfect. Compared to EARL-compliant data, T/B ratios extracted from the 1mmPSF showed a 2.84-fold increase (P < 0.001). A similar pattern of statistically significant increase was observed for noise level in organs of reference. Image quality for the torso was found to be significantly lower for 1mmPSF reconstruction (P = 0.03). Image quality for the limbs was found to be better for 1mmPSF (P < 0.001).

Conclusion

Digital PET with small-voxel reconstruction brings an additional value for the detection of in-transit metastases by reducing the number of indeterminate findings and making up for falsely negative scans using former generation PET systems. An acquisition encompassing lower or upper limbs as appropriate should be performed.

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Acknowledgements

Ms Lapasset is thanked for English editing.

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Author notes

  1. Nicolas Aide and Charline Lasnon share senior authorship.

Authors and Affiliations

  1. Nuclear Medicine Department, University Hospital, Caen, France

    Pierre-André Zimmermann, Benjamin Houdu & Nicolas Aide

  2. Dermatology Department, University Hospital, Caen, France

    Laure Césaire, Ines Nakouri & Michel De Pontville

  3. Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France

    Charline Lasnon

  4. Service de Médecine Nucléaire, CHU de Caen, Avenue Côte de Nacre, Caen, France

    Nicolas Aide

Authors
  1. Pierre-André Zimmermann
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Correspondence to Nicolas Aide.

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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. This study was approved by the regional Ethics Committee (registration number: CERES 27669).

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Authorization to use additional reconstructions for research purpose was sought from every patient.

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Zimmermann, PA., Houdu, B., Césaire, L. et al. Revisiting detection of in-transit metastases in melanoma patients using digital 18F-FDG PET/CT with small-voxel reconstruction. Ann Nucl Med 35, 669–679 (2021). https://doi.org/10.1007/s12149-021-01608-5

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  • DOI: https://doi.org/10.1007/s12149-021-01608-5

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