How much intravenous contrast is needed in FDG-PET/CT?

Summary:

Intravenous, iodinated contrast agents are used routinely for CT (ceCT) imaging but only applied reluctantly for FDGPET/ CT due to possible artefacts. Only for few oncological PET/CT indications, the role of IV contrast agent has been clarified. Essentially, if any knowledge regarding vascular structures or tumour invasion into adjacent structures are needed, a ceCT as part of the combined PET/CT exam should be implemented. However, for some indications like lymphoma, contrast seems not to be necessary. Therefore, imaging procedures for the use of IV contrast for PET/CT have to be adapted individually for each FDG-PET/CT indication to especially reduce unnecessary radiation burden to the patient.

Zusammenfassung:

Die intravenöse Gabe von iodhaltigem Kontrastmittel (KM) erfolgt routinemäßig für die Computertomographie (KMCT). Wegen möglicher Bildartefakte wurde diese beim FDGPET/ CT zuerst nur vereinzelt verwendet. Zurzeit liegen nur begrenzte Ergebnisse bezüglich des Nutzens der KM beim FDG-PET/CT für onkologische Indikationen vor. Soll bei der FDG-PET/CT Untersuchung die Gefäßsituation oder eine Tumorinvasion in andere Strukturen beurteilt werden, so ist die Gabe von KM notwendig. Bei bestimmten Indikationen hingegen (z.B. Lymphom) scheint eine KM-Gabe nicht notwendig. Demzufolge muss die dezidierte Anwendung von KM für die jeweiligen FDG-PET/CT-Indikationen geklärt werden, um insbesondere unnötige Strahlenbelastung für den Patienten zu reduzieren.

Key words:

FDG-PET/CT

Schlüsselwörter:

FDG-PET/CT

• References

• 1 Kinahan PE, Townsend DW, Beyer T. et al. Attenuation correction for a combined 3D PET/CT scanner. Med Phys 1998; 25: 2046-53.
• 2 Antoch G, Freudenberg LS, Egelhof T. et al. Focal tracer uptake: a potential artifact in contrast-enhanced dual-modality PET/CT scans. J Nucl Med 2002; 43: 1339-42.
• 3 Goerres GW, Burger C, Kamel E. et al. Respiration- induced attenuation artifact at PET/CT: technical considerations. Radiology 2003; 226: 906-10.
• 4 Kamel EM, Burger C, Buck A. et al. Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner. Eur Radiol 2003; 13: 724-8.
• 5 Kamel E, Hany TF, Burger C. et al. CT vs 68Ge attenuation correction in a combined PET/CT system: evaluation of the effect of lowering the CT tube current. Eur J Nucl Med Mol Imaging 2002; 29: 346-50.
• 6 Dizendorf E, Hany TF, Buck A. et al. Cause and magnitude of the error induced by oral CT contrast agent in CT-based attenuation correction of PET emission studies. J Nucl Med 2003; 44: 732-8.
• 7 Yau YY, Chan WS, Tam YM. et al. Application of intravenous contrast in PET/CT: does it really introduce significant attenuation correction error?. J Nucl Med 2005; 46: 283-91.
• 8 Bangerter M, Moog F, Buchmann I. et al. Wholebody 2-[¹⁸F]-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for accurate staging of Hodgkin’s disease. Ann Oncol 1998; 9: 1117-22.
• 9 Moog F, Bangerter M, Diederichs CG. et al. Lymphoma: role of whole-body 2-deoxy-2-[F-18]fluoro- D-glucose (FDG) PET in nodal staging. Radiology 1997; 203: 795-800.
• 10 Stumpe KD, Urbinelli M, Steinert HC. et al. Whole-body positron emission tomography using fluorodeoxyglucose for staging of lymphoma: effectiveness and comparison with computed tomography. Eur J Nucl Med 1998; 25: 721-8.
• 11 Jerusalem G, Hustinx R, Beguin Y. et al. The value of positron emission tomography (PET) imaging in disease staging and therapy assessment. Ann Oncol 2002; 13: 227-34.
• 12 Jerusalem GH, Beguin YP. Positron emission tomography in non-Hodgkin’s lymphoma (NHL): relationship between tracer uptake and pathological findings, including preliminary experience in the staging of low-grade NHL. Clin Lymphoma 2002; 3: 56-61.
• 13 Metser U, Goor O, Lerman H. et al. PET-CT of extranodal lymphoma. AJR Am J Roentgenol 2004; 182: 1579-86.
• 14 Schaefer NG, Hany TF, Taverna C. et al. Non- Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging-- do we need contrast-enhanced CT?. Radiology 2004; 232: 823-9.
• 15 Lardinois D, Weder W, Hany TF. et al. Staging of non-small-cell lung cancer with integrated positron- emission tomography and computed tomography. N Engl J Med 2003; 348: 2500-7.
• 16 Keidar Z, Haim N, Guralnik L. et al. PET/CT using ¹⁸F-FDG in suspected lung cancer recurrence: Diagnostic value and impact on patient management. J Nucl Med 2004; 45: 1640-6.
• 17 Antoch G, Stattaus J, Nemat AT. et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 2003; 229: 526-33.
• 18 Goldberg RM, Fleming TR, Tangen CM. et al. Surgery for recurrent colon cancer: strategies for identifying resectable recurrence and success rates after resection. Eastern Cooperative Oncology Group, the North Central Cancer Treatment Group, and the Southwest Oncology Group. Ann Intern Med 1998; 129: 27-35.
• 19 Flamen P, Stroobants S, van Cutsem E. et al. Additional value of whole-body positron emission tomography with fluorine-18–2-fluoro-2-deoxy- D-glucose in recurrent colorectal cancer. J Clin Oncol 1999; 17: 894-901.
• 20 Ruers TJ, Langenhoff BS, Neeleman N. et al. Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective study. J Clin Oncol 2002; 20: 388-95.
• 21 Valk PE, Pounds TR, Tesar RD. et al. Cost-effectiveness of PET imaging in clinical oncology. Nucl Med Biol 1996; 23: 737-43.
• 22 Cohade C, Osman M, Leal J. et al. Direct comparison of ¹⁸F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003; 44: 1797-803.
• 23 Even-Sapir E, Parag Y, Lerman H. et al. Detection of recurrence in patients with rectal cancer: PET/ CT after abdominoperineal or anterior resection. Radiology 2004; 232: 815-22.
• 24 Selzner M, Hany TF, Wildbrett P. et al. Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer to the liver?. Ann Surg 2004; 240: 1027-34.
• 25 Joensuu H, Roberts PJ, Sarlomo-Rikala M. et al. Effect of the tyrosine kinase inhibitor STI571 in a patient with a metastatic gastrointestinal stromal tumour. N Engl J Med 2001; 344: 1052-6.
• 26 Goerres GW, Stupp R, Barghouth G. et al. The value of PET, CT and in-line PET/CT in patients with gastrointestinal stromal tumours: long-term outcome of treatment with imatinib mesylate. Eur J Nucl Med Mol Imaging 2005; 32: 153-62.
• 27 Antoch G, Kanja J, Bauer S. et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumours. J Nucl Med 2004; 45: 357-65.
• 28 Kitagawa Y, Nishizawa S, Sano K. et al. Prospective comparison of ¹⁸F-FDG PET with conventional imaging modalities (MRI, CT, and 67Ga scintigraphy) in assessment of combined intraarterial chemotherapy and radiotherapy for head and neck carcinoma. J Nucl Med 2003; 44: 198-206.
• 29 Sironi S, Messa C, Mangili G. et al. Integrated FDG PET/CT in patients with persistent ovarian cancer: Correlation with histologic findings. Radiology 2004; 233: 433-40.
• 30 Pannu HK, Cohade C, Bristow RE. et al. PET-CT detection of abdominal recurrence of ovarian cancer: radiologic-surgical correlation. Abdom Imaging 2004; 29: 398-403.
• 31 Picchio M, Sironi S, Messa C. et al. Advanced ovarian carcinoma: usefulness of ¹⁸F-FDG-PET in combination with CT for lesion detection after primary treatment. Q J Nucl Med 2003; 47: 77-84.
• 32 Heinrich S, Goerres GW, Schäfer M. et al. PET/CT influences on the management of resectable pancreatic cancer and is cost-effective. Annual Meeting of the European Surgical Association (ESA) Barcelona: 2004