A recovery coefficient method for partial volume correction of PET images.

OBJECTIVES: Correction of the "partial volume effect" has been an area of great interest in the recent times in quantitative PET imaging and has been mainly studied with count recovery models based upon phantoms that incorporate hot spheres in a cold background. The goal of this research study was to establish a similar model that is closer to a biological imaging environment, namely hot spheres/lesions in a warm background and to apply this model in a small cohort of patients. METHODS: A NEMA phantom with six spheres (diameters 1-3.7 cm) was filled with (18)FDG to give sphere:background activity ratios of 8:1, 6:1, and 4:1 for three different acquisitions on a Philips Allegro scanner. The hot sphere SUVmax and the background average SUV were measured for calculation of recovery coefficients (RCs). Using the RCs, the lesion diameters, and the lesion:background ratio, the SUVmax of 64 lesions from 17 patients with biopsy proven lung cancer were corrected. RESULTS: The RCs versus sphere diameters produced characteristic logarithmic curves for each phantom (RCs ranged from 80% to 11%). From a cohort of 17 patients with biopsy proven lung cancer, 64 lesions combined had a mean SUVmax of 7.0 and size of 2.5 cm. After partial volume correction of the SUVmax of each lesion, the average SUVmax increased to 15.5. CONCLUSIONS: Hot spheres in a warm background more closely resemble the actual imaging situation in a living subject when compared to hot spheres in a cold background. This method could facilitate generation of equipment specific recovery coefficients for partial volume correction. The clinical implications for the increased accuracy in SUV determination are certainly of potential value in oncologic imaging.

Follow-up FDG PET in the evaluation of unexplained focal activity in the abdomen.

PURPOSE: This study assessed the value of a follow-up FDG PET scan when the initial PET demonstrated unexplained findings of focal FDG uptake in the abdomen. METHOD: The records of 3634 patients with PET scans were retrospectively reviewed. Those patients who had follow-up PET scans after the initial PET scan showed unexplained FDG activity in the abdomen were further analyzed. The results from the second PET scan were compared with the follow-up data, which included the findings from other imaging modalities, clinical course, and biopsy or surgical pathology interpretations. RESULTS: A total of 59 patients were included in the final analysis. The average time interval between the initial and the follow-up PET scans was 4.2 + 2.3 months. The follow-up PET provided a clear-cut diagnosis in 55 (93.2%) of these patients, whereas diagnoses in only 4 patients remained indeterminate. Follow-up PET scans were negative for abdominal malignancy in 38 patients. Thirty-five of these 38 patients with negative follow-up PET were proven to be without abdominal malignancy, with a negative predictive value of 92.1% (35 of 38). The follow-up PET was positive in 17 patients. Fifteen of these 17 patients with a positive follow-up PET scans were found to have malignancy in the abdomen with a positive predicative value of 88.2% (15 of 17). All 4 patients with indeterminate follow-up scans were proven not to have malignancy. CONCLUSION: Follow-up FDG PET scan provides an effective means for diagnosing unexplained findings in the abdomen that were previously detected on initial PET scan.

Dual-time point FDG PET imaging in the evaluation of pulmonary nodules with minimally increased metabolic activity.

PURPOSE: FDG PET has high accuracy in the evaluation of lung nodules. A standardized uptake value (SUV) > or =2.5 is frequently used as a criterion for malignancy in this setting. However, some malignant nodules have only mild FDG activity with a SUV less than 2.5. Assessment of the etiology of lung nodules with only mild metabolic activity remains difficult. This study was undertaken to compare the accuracy of dual-time point and standard single-time FDG PET imaging in the evaluation of such lung nodules. METHODS: Four hundred fifty-seven dual-time FDG PET scans for lung nodules were retrospectively analyzed. Among them, 46 met the selection criteria and were included for the final analysis. Five methods of interpreting FDG PET results were compared. These methods included visual analysis for both initial and delayed images; SUV analysis for both initial and delayed images in which a SUV of 2.5 is regarded as criteria for malignancy; and finally, the retention index analysis in which a 10% increase in SUV on the delayed images was regarded as an indication of malignancy. RESULTS: The lowest accuracies came from the visual and single SUV analysis on the initial images. The visual and single SUV analyses on the delayed images produced increased accuracy. The highest accuracy (84.8%) was obtained when a retention index of more than 10% was used as criteria for malignancy. CONCLUSION: Dual-time FDG PET imaging has the potential for improving accuracy of a test in the evaluation of lung nodules with only borderline levels of increased metabolic activity.

Intense esophageal FDG activity caused by Candida infection obscured the concurrent primary esophageal cancer on PET imaging.

Esophageal cancer frequently causes a focal intense FDG uptake on positron emission tomography (PET) imaging while esophagitis often results in a mild to moderate degree of FDG activity in a diffuse pattern. However, detection of an esophageal cancer can become difficult in the presence of a diffuse esophageal activity because of esophagitis. We present such case in which esophageal cancer superimposed by Candidal esophagitis is difficult to recognize on FDG PET images.