FDG PET CT assessment of treatment response after yttrium-90 ibritumomab tiuxetan radioimmunotherapy.

Yttrium-90 ibritumomab tiuxetan (Zevalin; IDEC Pharmaceuticals Corp., San Diego, CA) is the first radioimmunotherapy agent approved by the U.S. Food and Drug Administration (FDA) for treatment of non-Hodgkin lymphoma. In a randomized clinical trial comparing Zevalin with rituximab, the overall response rate was 80% and 56%, respectively. Response was determined by assessing the size of lymph nodes on CT scans. FDG PET has been well accepted as an accurate imaging study for staging non-Hodgkin lymphoma and evaluating response to treatment. Simultaneous FDG PET and CT imaging (PET CT) provides coregistered functional PET images with anatomic CT images. We describe 2 cases of non-Hodgkin lymphoma treated in which response was followed using PET CT.

Single-detector helical CT in PET-CT: assessment of image quality.

OBJECTIVE: CT in positron emission tomography (PET)-CT imaging is often performed as a single scan from the base of the skull to the groin, potentially resulting in degradation of the quality of CT scans depending on the position of the patient's arms and mode of breathing and the use and timing of IV contrast injection. The aim of our study was to assess the impact of artifacts on the diagnostic quality of CT scans using a single-detector helical CT scanner in PET-CT imaging. MATERIALS AND METHODS: Two radiologists retrospectively evaluated the diagnostic image quality of CT scans obtained with PET-CT in 81 patients with lymphoma. The severity of the artifacts related to the position of the patient's arms beside the body, the influence of breathing motion, and the presence of contrast material in the upper thoracic veins were ranked using a 4-point scale. RESULTS: Performing CT with the patient's arms positioned beside the body resulted in streak artifacts, predominantly in the upper abdomen, that were graded as mild in 22%, moderate in 40%, and severe in 38% of the scans. A patient's weight significantly correlated with the degree of severity of the artifacts (p < 0.05). Shallow breathing by the patient during scanning caused blurring and double-imaging, again predominantly in the upper abdomen, that were graded as mild in 23%, moderate in 49%, or severe in 28% of the scans. In 84% of the CT scans obtained with IV contrast material, the image quality of the upper thoracic region was moderately (27%) or severely (57%) degraded by streak artifacts from highly concentrated contrast material in the upper thoracic veins. CONCLUSION: The use of a single-detector CT scanner in whole-body PET-CT decreases the image quality of CT scans because of streak artifacts that occur predominantly in scans of the upper abdomen. Scanning with the patient's arms raised eliminates the streak artifacts in scans of the abdominal region. With the new generation of PET-CT devices equipped with MDCT scanners, breathing motion artifacts can be expected to be eliminated if protocols for breath-hold CT are applied. Reversing the direction of CT scanning allows one to avoid imaging the thoracic region at a time when undiluted IV contrast material is still present in the upper thoracic veins.