Quantitative assessment of 18F-FDG PET in patients with Hodgkin lymphoma: is it significantly affected by contrast-enhanced computed tomography attenuation correction?
Open accessAbstract
OBJECTIVE: The reliability of visual and quantitative response assessment may be impaired owing to inconsistent scanning protocols and image reconstruction methods of 2-deoxy-2-[F]fluoro-D-glucose (F-FDG) PET. Hence, this study investigates the effect of contrast-enhanced computed tomography (CT) attenuation correction in patients with Hodgkin lymphoma. PATIENTS AND METHODS: In 10 consecutive patients undergoing either staging or response assessment, F-FDG PET images were attenuation-corrected once on the basis of unenhanced CT and additionally using contrast-enhanced CT. Reconstruction was performed in both cases with ordered subset expectation maximization (OSEM) and ultra-high definition (UHD) algorithm. While maximum and peak standardized uptake value (SUV) were obtained from tumour tissue (lesionSUVmax and lesionSUVpeak), maximum and mean SUVs were determined within the background regions liver (liverSUVmax and liverSUVmean) and mediastinal blood pool (mbpSUVmax and mbpSUVmean). RESULTS: After switching to contrast-enhanced CT attenuation correction, lesionSUVmax and lesionSUVpeak increased on average by 2.55±3.24 (P=0.018) and 3.64±3.22% (P=0.008), respectively, with OSEM and by 4.59±5.49 (P=0.005) and 3.84±5.65% (P=0.005), respectively, with UHD reconstruction. LiverSUVmax and liverSUVmean showed a mean rise of 7.15±4.27 (P=0.005) and 6.97±2.18% (P=0.005), respectively, in the OSEM data sets and of 7.24±6.59 (P=0.017) and 6.29±2.83% (P=0.005), respectively, in the UHD images. The average increases of mbpSUVmax and mbpSUVmean were 10.82±4.89 (P=0.005) and 12.40±3.73% (P=0.005), respectively, after OSEM, compared with 13.11±14.93 (P=0.005) and 11.50±12.19% (P=0.005), respectively, after UHD reconstruction. CONCLUSION: As the use of CT contrast fluids results in a stronger SUV increase within the liver and mediastinal blood pool than within lymphoma tissue, this may have clinical consequences regarding visual and quantitative response assessment. Ideally, CT scans for PET attenuation correction should therefore be performed in the absence of a contrast agent.
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In organs with a particularly high concentration of contrast agent (e.g., liver, kidney, or blood vessels), contrast-induced SUV deviations can be higher.
“However, in organs with a particularly high concentration of the contrast agent (e.g., the liver, kidney, or blood vessels), these deviations can be higher [116,120,121].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [121]
The Abstract reports that CT contrast fluids produce a stronger SUV increase in the liver and mediastinal blood pool than in lymphoma tissue. It does not establish that high contrast-agent concentration causes the larger deviations, or report this effect for the kidney. (LLM, conf=0.85)
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- Authors
- Voltin, C.-A., Mettler, J., Boellaard, R., Kuhnert, G., Dietlein, M., Borchmann, P., Drzezga, A., & Kobe, C.
- Affiliations
- Amsterdam UMC Location Vrije Universiteit Amsterdam (NL)
- University Hospital Cologne (DE)
- Corresponding author
- Voltin, Conrad-Amadeus
- ORCID
- Venue
- Nuclear Medicine Communications
- Published
- 2019-03
- Volume
- 40
- Issue
- 3
- Pages
- 249-257
- ISSN
- 0143-3636 (ISSN-L)
- OpenAlex
- W2900466857
- Cited by
- 13
- References
- 27
- Citations by year
- 2026: 2 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 2 · 2020: 2
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- green
- pure.amsterdamumc.nl
- Licence
- other-oa
- Locations
- Nuclear Medicine Communications (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
- Health Sciences › Medicine › Pathology and Forensic Medicine › Lymphoma Diagnosis and Treatment
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- Hodgkin's disease, attenuation correction, contrast-enhanced CT, standardized uptake value, SUVmax, SUVpeak, liver SUV, image reconstruction, OSEM, treatment response assessment, staging, image quality, image sharpness, image smoothness
- MeSH terms
- Adult, Aged, Contrast Media, Female, Hodgkin Disease, Humans, Image Processing, Computer-Assisted, Male, Middle Aged, Neoplasm Staging, Tomography, X-Ray Computed, Fluorodeoxyglucose F18, Young Adult
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