The utility of pharmacological and radiological interventions to optimize diagnostic information from PET/CT
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REVIEW
Open Access
The utility of pharmacological and radiological interventions to optimize diagnostic information from PET/CT David Dudoignon1, David A. Pattison2,3†, Damien Legallois4†, Rodney J. Hicks5,6 and Nicolas Aide1,7*
Abstract Background: Positron Emission Tomography with Computed Tomography (PET/CT) is widely used in the assessment of many diseases, particularly including cancer. However, many factors can affect image quality and diagnostic performance of PET scans using FDG or other PET probes. Main body: The aim of this pictorial essay is to review PET/CT protocols that can be useful to overcome these confounding factors in routine clinical situations, with a particular focus on pharmacological interventions and problem-oriented CT acquisition protocols. Conclusion: Imaging protocols and representative cases will be discussed, in addition to potential contraindications and precautions to be taken. Keywords: Positron emission tomography, False-negative, Intervention, Methodology, Protocol
Background There are many factors that can affect image quality and diagnostic performance of PET/CT examinations using FDG or other PET probes. We will review pharmacological interventions (including dosage and contraindications) and use of problem-oriented radiological imaging protocols designed to optimize diagnostic information and improve the overall accuracy of PET/CT in routine clinical practice. Herein, we present representative cases with and without drug intervention to illustrate how useful these simple protocols are. Illustrative cases are presented with a thresholding proposed by the Peter Mac Callum Cancer Centre (PMCC) team for FDG studies with the use the “rainbow” colour scale that has low activity regions displayed in the bluegreen range and higher intensity regions in the orange-red * Correspondence: [email protected] † David A. Pattison and Damien Legallois contributed equally to this work. 1 The Department of Nuclear Medicine, University Hospital, Caen, France 7 INSERM ANTICIPE, Normandie University, Caen, France Full list of author information is available at the end of the article
spectrum. With this colour scale, the SUV threshold should be adjusted so that the liver appears blue with flecks of green. This corresponds to an upper SUV window threshold of approximately 9, except in bariatric patients where the upper SUV threshold is typically 12 [1]. While the same colour scale is used for other tracers, the SUV range and reference organ may vary. For example, for somatostatin receptor imaging using 68Ga-DOTAoctrotate an upper SUV threshold of 30 is typically used while for PSMA ligands the corresponding upper threshold at PMCC is 15. Lower thresholds may increase sensitivity, but this is generally at the expense of specificity, whereas higher thresholds can provide greater appreciation of heterogeneity between tumour sites but lead to faint lesions becoming inapparent. While there has been a strong professional and industry focus on harmonisation of CT windowing for various tissues, thresh
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