Top

Cancer Imaging

Published in:

Open Access 01-12-2020 | Positron Emission Tomography | Review

The utility of pharmacological and radiological interventions to optimize diagnostic information from PET/CT

Authors: David Dudoignon, David A. Pattison, Damien Legallois, Rodney J. Hicks, Nicolas Aide

Published in: Cancer Imaging | Issue 1/2020

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.

Hofman MS, Hicks RJ. How we read oncologic FDG PET/CT. Cancer Imaging. 2016;16:35. https://doi.org/10.1186/s40644-016-0091-3.CrossRefPubMedPubMedCentral

Torizuka T, Zasadny KR, Wahl RL. Diabetes decreases FDG accumulation in primary lung cancer. Clin Positron Imaging. 1999;2:281–7. https://doi.org/10.1016/s1095-0397(99)00029-1.CrossRefPubMed

Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer--a PET study. J Nucl Med. 1993;34:1–6.PubMed

Diederichs CG, Staib L, Glatting G, Beger HG, Reske SN. FDG PET: elevated plasma glucose reduces both uptake and detection rate of pancreatic malignancies. J Nucl Med. 1998;39:1030–3.PubMed

Delbeke D, Coleman RE, Guiberteau MJ, Brown ML, Royal HD, Siegel BA, et al. Procedure guideline for tumor imaging with 18f-FDG PET/CT 1.0. Journal of nuclear medicine : official publication. Soc Nucl Med. 2006;47:885–95.

Shankar LK, Hoffman JM, Bacharach S, Graham MM, Karp J, Lammertsma AA, et al. Consensus recommendations for the use of 18f-FGDG PET as an indicator of therapeutic response in patients in National Cancer Institute trials. J Nucl Med. 2006;47:1059–66.PubMed

Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: Eanm procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54. https://doi.org/10.1007/s00259-014-2961-x.CrossRefPubMed

International Atomic Energy Agency. Standard operating procedures for PET/CT: a practical approach for use in adult oncology, IAEA human health series no 26; 2013.

Pattison DA, MacFarlane LL, Callahan J, Kane EL, Akhurst T, Hicks RJ. Personalised insulin calculator enables safe and effective correction of Hyperglycaemia Prior to FDG PET/CT. EJNMMI Res. 2019;9:15. https://doi.org/10.1186/s13550-019-0480-2.CrossRefPubMedPubMedCentral

10.

Turcotte E, Leblanc M, Carpentier A, Benard F. Optimization of whole-body positron emission tomography imaging by using delayed 2-Deoxy-2-[F-18]Fluoro-D: -glucose injection following I.V. insulin in diabetic patients. Mol Imaging Biol. 2006;8:348–54. https://doi.org/10.1007/s11307-006-0064-1.CrossRefPubMed

11.

Gelfand MJ, O'Hara SM, Curtwright LA, Maclean JR. Pre-medication to block [(18)F]FDG uptake in the Brown adipose tissue of pediatric and adolescent patients. Pediatr Radiol. 2005;35:984–90. https://doi.org/10.1007/s00247-005-1505-8.CrossRefPubMed

12.

George A, Sinha P, Conrad G, Memon AA, Dressler EV, Wagner LM. Pilot study of propranolol premedication to reduce FDG uptake in Brown adipose tissue on PET scans of adolescent and young adult oncology patients. Pediatr Hematol Oncol. 2017;34:149–56. https://doi.org/10.1080/08880018.2017.1338806.CrossRefPubMed

13.

Chang CA, Pattison DA, Tothill RW, Kong G, Akhurst TJ, Hicks RJ, et al. (68)Ga-Dotatate and (18)F-FDG PET/CT in Paraganglioma and Pheochromocytoma: utility, patterns and heterogeneity. Cancer Imaging. 2016;16:22. https://doi.org/10.1186/s40644-016-0084-2.CrossRefPubMedPubMedCentral

14.

Tatsumi M, Engles JM, Ishimori T, Nicely O, Cohade C, Wahl RL. Intense (18)F-FDG uptake in Brown fat can be reduced pharmacologically. J Nucl Med. 2004;45:1189–93.PubMed

15.

Robinson B, Pattison DA, Lee K. FDG PET/CT cardiac Sarcoid imaging: monitoring ketone levels to avoid inadequate suppression of physiologic myocardial uptake. Intern Med J. 2018;48:7–19. https://doi.org/10.1111/imj.13801.CrossRef

16.

Scholtens AM, Verberne HJ, Budde RP, Lam MG. Additional heparin Preadministration improves cardiac glucose metabolism suppression over low-carbohydrate diet alone in (1)(8)F-FDG PET imaging. J Nucl Med. 2016;57:568–73. https://doi.org/10.2967/jnumed.115.166884.CrossRefPubMed

17.

Martel N, Lee J, Wells PS. Risk for heparin-induced thrombocytopenia with unfractionated and low-molecular-weight heparin Thromboprophylaxis: a meta-analysis. Blood. 2005;106:2710–5. https://doi.org/10.1182/blood-2005-04-1546.CrossRefPubMed

18.

Le Roux PY, Duong CP, Cabalag CS, Parameswaran BK, Callahan J, Hicks RJ. Incremental diagnostic utility of gastric distension FDG PET/CT. Eur J Nucl Med Mol Imaging. 2016;43:644–53. https://doi.org/10.1007/s00259-015-3211-6.CrossRefPubMed

19.

Zhang L, Liang ML, Zhang YK, Hu SS, Chen L, Li HT, et al. The effects of hypotonic and isotonic negative contrast agent on gastrointestinal distention and physiological intake of 18F-FDG. Nucl Med Commun. 2015;36:180–6. https://doi.org/10.1097/mnm.0000000000000226.CrossRefPubMed

20.

Kamimura K, Fujita S, Nishii R, Wakamatsu H, Nagamachi S, Yano T, et al. An analysis of the physiological Fdg uptake in the stomach with the water gastric distention method. Eur J Nucl Med Mol Imaging. 2007;34:1815–8. https://doi.org/10.1007/s00259-007-0477-3.CrossRefPubMed

21.

Kamimura K, Nagamachi S, Wakamatsu H, Fujita S, Nishii R, Umemura Y, et al. Role of gastric distention with additional water in differentiating locally advanced gastric carcinomas from physiological uptake in the stomach on 18F-Fluoro-2-Deoxy-D-glucose PET. Nucl Med Commun. 2009;30:431–9. https://doi.org/10.1097/MNM.0b013e3283299a2f.CrossRefPubMed

22.

Yun M, Choi HS, Yoo E, Bong JK, Ryu YH, Lee JD. The role of gastric distention in differentiating recurrent tumor from physiologic uptake in the remnant stomach on 18F-FDG PET. J Nucl Med. 2005;46:953–7.PubMed

23.

Anjos DA, Etchebehere EC, Ramos CD, Santos AO, Albertotti C, Camargo EE. 18F-FDG PET/CT delayed images after diuretic for restaging invasive bladder cancer. J Nucl Med. 2007;48:764–70. https://doi.org/10.2967/jnumed.106.036350.CrossRefPubMed

24.

Kamel EM, Jichlinski P, Prior JO, Meuwly JY, Delaloye JF, Vaucher L, et al. Forced diuresis improves the diagnostic accuracy of 18F-FDG PET in Abdominopelvic malignancies. J Nucl Med. 2006;47:1803–7.PubMed

25.

Nayak B, Dogra PN, Naswa N, Kumar R. Diuretic 18F-FDG PET/CT imaging for detection and Locoregional staging of urinary bladder cancer: prospective evaluation of a novel technique. Eur J Nucl Med Mol Imaging. 2013;40:386–93. https://doi.org/10.1007/s00259-012-2294-6.CrossRefPubMed

26.

Iravani A, Hofman MS, Mulcahy T, Williams S, Murphy D, Parameswaran BK, et al. (68)Ga PSMA-11 PET with CT urography protocol in the initial staging and biochemical relapse of prostate cancer. Cancer Imaging. 2017;17:31. https://doi.org/10.1186/s40644-017-0133-5.CrossRefPubMedPubMedCentral

27.

Will L, Giesel FL, Freitag MT, Berger AK, Mier W, Kopka K, et al. Integration of CT urography improves diagnostic confidence of (68)Ga-PSMA-11 PET/CT in prostate cancer patients. Cancer Imaging. 2017;17:30. https://doi.org/10.1186/s40644-017-0132-6.CrossRefPubMedPubMedCentral

28.

Burger IA, Scheiner DA, Crook DW, Treyer V, Hany TF, von Schulthess GK. FDG uptake in vaginal tampons is caused by urinary contamination and related to tampon position. Eur J Nucl Med Mol Imaging. 2011;38:90–6. https://doi.org/10.1007/s00259-010-1618-7.CrossRefPubMed

29.

Wang G, Lau EW, Shakher R, Rischin D, Ware RE, Hong E, et al. How do oncologists Deal with incidental abnormalities on whole-body Fluorine-18 Fluorodeoxyglucose PET/CT? Cancer. 2007;109:117–24. https://doi.org/10.1002/cncr.22370.CrossRefPubMed

30.

Hicks RJ, Iravani A, Sandhu S. (18)F-Fluorodeoxyglucose positron emission tomography/computed tomography for assessing tumor response to immunotherapy in solid tumors: melanoma and beyond. PET Clin. 2020;15:11–22. https://doi.org/10.1016/j.cpet.2019.08.007.CrossRefPubMed

31.

Oh JR, Song HC, Chong A, Ha JM, Jeong SY, Min JJ, et al. Impact of medication discontinuation on increased intestinal FDG accumulation in diabetic patients treated with metformin. AJR Am J Roentgenol. 2010;195:1404–10. https://doi.org/10.2214/AJR.10.4663.CrossRefPubMed

32.

Lee SH, Jin S, Lee HS, Ryu JS, Lee JJ. Metformin discontinuation less than 72 H is suboptimal for F-18 FDG PET/CT interpretation of the bowel. Ann Nucl Med. 2016;30:629–36. https://doi.org/10.1007/s12149-016-1106-7.CrossRefPubMed

33.

Hamidizadeh R, Eftekhari A, Wiley EA, Wilson D, Alden T, Benard F. Metformin discontinuation Prior to FDG PET/CT: a randomized controlled study to compare 24- and 48-hour bowel activity. Radiology. 2018;289:418–25. https://doi.org/10.1148/radiol.2018180078.CrossRefPubMed

34.

Lasnon C, Coudrais N, Houdu B, Nganoa C, Salomon T, Enilorac B, et al. How fast can we scan patients with modern (digital) PET/CT systems? Eur J Radiol. 2020;129:109144. https://doi.org/10.1016/j.ejrad.2020.109144.CrossRefPubMed

35.

Beyer T, Hicks R, Brun C, Antoch G, Freudenberg LS. An international survey on hybrid imaging: do Technology advances preempt our training and education efforts? Cancer Imaging. 2018;18:15. https://doi.org/10.1186/s40644-018-0148-6.CrossRefPubMedPubMedCentral

36.

Hicks RJ, Ware RE, Lau EW. PET/CT: Will it change the way that we use CT in cancer imaging? Cancer Imaging. 2006;6:S52–62. https://doi.org/10.1102/1470-7330.2006.9012.CrossRefPubMedPubMedCentral

37.

Lasocki A, Hicks RJ. How we read: the combined use of MRI and novel PET tracers for the characterisation and treatment planning of masses in Neuro-oncology. Cancer Imaging. 2019;19:57. https://doi.org/10.1186/s40644-019-0241-5.CrossRefPubMedPubMedCentral

38.

Coquan E, Lasnon C, Joly F, Lefort JM, Aide N. Diuretic (1)(8)F-FDG PET/CT for therapy monitoring in Urothelial bladder cancer. Eur J Nucl Med Mol Imaging. 2014;41:1818–9. https://doi.org/10.1007/s00259-014-2800-0.CrossRefPubMed

Title: The utility of pharmacological and radiological interventions to optimize diagnostic information from PET/CT
Authors: David Dudoignon
David A. Pattison
Damien Legallois
Rodney J. Hicks
Nicolas Aide
Publication date: 01-12-2020
Publisher: BioMed Central
Keywords: Positron Emission Tomography
Insulins
Insulins
Published in: Cancer Imaging / Issue 1/2020
Electronic ISSN: 1470-7330
DOI: https://doi.org/10.1186/s40644-020-00344-9

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Main body

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Gallbladder carcinoma: an initial clinical experience of reduced field-of-view diffusion-weighted MRI

How to develop a meaningful radiomic signature for clinical use in oncologic patients

Network-level functional connectivity alterations in chemotherapy treated breast cancer patients: a longitudinal resting state functional MRI study

PSMA PET for primary lymph node staging of intermediate and high-risk prostate cancer: an expedited systematic review

MRI features predict microvascular invasion in intrahepatic cholangiocarcinoma

Prognostic value of 18F-fluorodeoxyglucose positron emission tomography in patients with small hepatocellular carcinoma treated by radiofrequency ablation

Keynote webinar | Spotlight on antibody–drug conjugates in cancer