Optimization of injection dose in 18F-FDG PET/CT based on the 2020 national diagnostic reference levels for nuclear medicine in Japan

Synthesis, preclinical assessment, and first-in-human study of [18F]d4-FET for brain tumor imaging

PURPOSE

Tumor-to-background ratio (TBR) is a critical metric in oncologic PET imaging. This study aims to enhance the TBR of [18F]FET in brain tumor imaging by substituting deuterium ("D") for hydrogen ("H"), thereby improving the diagnostic sensitivity and accuracy.

METHODS

[18F]d4-FET was synthesised by two automated radiochemistry modules. Biodistribution studies and imaging efficacy were evaluated in vivo  and ex vivo in rodent models, while metabolic stability and radiation dosimetry were assessed in non-human primates. Additionally, preliminary imaging evaluations were carried out in five brain tumor patients: three glioma patients underwent imaging with both [18F]d4-FET and [18F]FET, and two patients with brain metastases were imaged using [18F]d4-FET and [18F]FDG.

RESULTS

[18F]d4-FET demonstrated high radiochemical purity and yield. PET/MRI in rodent models demonstrated superior TBR for [18F]d4-FET compared to [18F]FET, and autoradiography showed tumor margins that correlated well with pathological extents. Studies in cynomolgus monkeys indicated comparable in vivo stability and effective dose with [18F]FET. In glioma patients, [18F]d4-FET showed enhanced TBR, while in patients with brain metastases, [18F]d4-FET displayed superior lesion delineation compared to [18F]FDG, especially in smaller metastatic sites.

CONCLUSION

We successfully synthesized the novel PET radiotracer [18F]d4-FET, which retains the advantageous properties of [18F]FET while potentially enhancing TBR for glioma imaging. Preliminary studies indicate excellent stability, efficacy, and sensitivity of [18F]d4-FET, suggesting its potential in clinical evaluations of brain tumors.

TRIAL REGISTRATION

ChiCTR2400081576, registration date: 2024-03-05, https://www.chictr.org.cn/bin/project/edit?pid=206162.

Predictive role of [18F]FDG PET-CT radiomic parameters for KRAS/BRAF/EGFR mutations in metastatic colorectal cancer patients

OBJECTIVES

The objective of this study was to evaluate the predictive value of 18F-fluorodeoxyglucose [18F]FDG positron emission tomography (PET-CT) radiomic parameters in relation to KRAS/BRAF/EGFR mutations in patients with metastatic colorectal cancer (mCRC).

METHODS

Blood samples were collected from 90 mCRC patients to assess KRAS G13V, BRAF V600E, and EGFR exon 20 mutations. [18F]FDG PET-CT scans were performed, and radiomic parameters, including the SUV max, max TBR, total MTV, and total TLG, were calculated and correlated with different genotypes and haplotypes of the aforementioned mutations.

RESULTS

The SUV max, TLG, and TBR were significantly greater in patients with the KRAS G13V and BRAF V600E mutations than in patients with the wild-type genotype. The SUVmax was also significantly greater in patients with EGFR exon 20 mutations. Haplotype analysis revealed that the SUVmax was significantly greater in patients with KRAS/BRAF/EGFR mutations than in other patients, with a specificity of 68.18% and sensitivity of 65.28%.

CONCLUSION

The results suggest that [18F] FDG PET-CT radiomic parameters, particularly the SUV max, have the potential to serve as noninvasive tools for predicting the KRAS/BRAF/EGFR mutation status in mCRC patients.

National and local diagnostic reference levels for adult18F-FDG and CT in Jordanian PET/CT: findings and implications in practice

This study aims to report the findings of Jordanian national diagnostic reference level (NDRL) survey for fluorodeoxyglucose (18F-FDG) and local diagnostic reference level (LDRL) of computed tomography (CT) used for attenuation correction and anatomical localisation (AC-AL); and AC and diagnostic CT (AC-DX) within the context of whole-body WB and half-body HB adult oncology PET/CT scanning. Two-structured questionnaires were prepared to gather the necessary information: dosimetry data, patient demographics, equipment specification, and acquisition protocols for identified18F-FDG PET/CT procedures. The NDRL and achievable dose were reported based on the 75th and 50th percentiles for18F-FDG administered activity (AA), respectively. The LDRL was reported based on the 50th percentile for (CTDIvol) and (DLP). Data from 562 patients from four Jordanian PET/CT centres were collected. The survey revealed that Jordanian NDRL for AA (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240-590 MBq). However, the18F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDIvoland DLP of CT used for (AC-AL) was 4.3 mGy and 459.3 mGy.cm for HB CT scan range, and 4.1 mGy and 659.9 mGy.cm for WB CT scans. The reported LDRL for CTDIvoland DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Concurrently, in the context of WB CT, the reported values (i.e. CTDIvol and DLP) were also higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm). The reported HB CT(AC-DX) was higher than Nordic, New Zealand and Swiss NDRLs and for WB (AC-DX) CT it was higher than Swiss NDRLs. This study reported the first Jordanian NDRL for18F-FDG and LDRL for HB and WB CT associated with18F-FDG PET/CT scans. This data is useful for Jordanian PET/CT centres to compare their LDRL to the suggested DRLs and utilise it in the process of optimising CT radiation doses.

Low 18F-fluorodeoxyglucose dose positron emission tomography assisted by a deep-learning image-denoising technique in patients with lymphoma

Background

Patients with lymphoma receive multiple positron emission tomography/computed tomography (PET/CT) exams for monitoring of the therapeutic response. With PET imaging, a reduced level of injected fluorine-18 fluorodeoxyglucose ([18F]FDG) activity can be administered while maintaining the image quality. In this study, we investigated the efficacy of applying a deep learning (DL) denoising-technique on image quality and the quantification of metabolic parameters and Deauville score (DS) of a low [18F]FDG dose PET in patients with lymphoma.

Methods

This study retrospectively enrolled 62 patients who underwent [18F]FDG PET scans. The low-dose (LD) data were simulated by taking a 50% duration of routine-dose (RD) PET list-mode data in the reconstruction, and a U-Net-based denoising neural network was applied to improve the images of LD PET. The visual image quality score (1 = undiagnostic, 5 = excellent) and DS were assessed in all patients by nuclear radiologists. The maximum, mean, and standard deviation (SD) of the standardized uptake value (SUV) in the liver and mediastinum were measured. In addition, lesions in some patients were segmented using a fixed threshold of 2.5, and their SUV, metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) were measured. The correlation coefficient and limits of agreement between the RD and LD group were analyzed.

Results

The visual image quality of the LD group was improved compared with the RD group. The DS was similar between the RD and LD group, and the negative (DS 1-3) and positive (DS 4-5) results remained unchanged. The correlation coefficients of SUV in the liver, mediastinum, and lesions were all >0.85. The mean differences of SUVmax and SUVmean between the RD and LD groups, respectively, were 0.22 [95% confidence interval (CI): -0.19 to 0.64] and 0.02 (95% CI: -0.17 to 0.20) in the liver, 0.13 (95% CI: -0.17 to 0.42) and 0.02 (95% CI: -0.12 to 0.16) in the mediastinum, and -0.75 (95% CI: -3.42 to 1.91), and -0.13 (95% CI: -0.57 to 0.31) in lesions. The mean differences in MTV and TLG were 0.85 (95% CI: -2.27 to 3.98) and 4.06 (95% CI: -20.53 to 28.64) between the RD and LD groups.

Conclusions

The DL denoising technique enables accurate tumor assessment and quantification with LD [18F]FDG PET imaging in patients with lymphoma.

A new simpler image quality index based on body size for FDG-PET/CT

Noise equivalent count density (NEC density ) is often used to evaluate the image quality of whole-body fluorodeoxyglucose tomography tests. However, this index is calculated using the patient volume, which is difficult to obtain at every facility. In this study, we proposed new image quality indices that can be evaluated at all facilities. In total, 94 patients were enrolled in the study. The correlations of patients' body weight and BMI with volume were examined. New image quality indices normalized by body weight and BMI were defined as NEC bw and NEC bmi , respectively. Correlations between NEC bw , NEC bmi , and NEC density were examined. Further, the correlations between these two new indices and visual scores were evaluated. Good correlations were observed between volume and body weight (r = 0.861, P  < 0.001) and between volume and BMI (r = 0.728, P  < 0.001). NEC bw and NEC bmi correlated well with NEC density (r = 0.954 for NEC bw and r = 0.897 for NEC bmi , P  < 0.001). These correlations improved when the examined bed positions were set to the same number. Additionally, the correlations of visual scores with NEC bw and NEC bmi were similar to those between the visual score and NEC density . Our investigation indicated that the newly proposed image quality metrics, NEC bw and NEC bmi , were easily calculated and as useful as NEC density for evaluating image quality when subjects had similar physiques.

Aiming for [18F]FDG-PET acquisition time reduction in clinical practice for neurological patients

PURPOSE

Positron emission tomography (PET) imaging with [18F]FDG provides valuable information regarding the underlying pathological processes in neurodegenerative disorders. PET imaging for these populations should be as short as possible to limit head movements and improve comfort. This study aimed to validate an optimized [18F]FDG-PET image reconstruction protocol aiming to reduce acquisition time while maintaining adequate quantification accuracy and image quality.

METHODS

A time-reduced reconstruction protocol (5 min) was evaluated in [18F]FDG-PET retrospective data from healthy individuals and Alzheimer's disease (AD) patients. Standard (8 min) and time-reduced protocols were compared by means of image quality and quantification accuracy metrics, as well as standardized uptake value ratio (SUVR) and Z-scores (pons was used as reference). Images were randomly and blindly presented to experienced physicians and scored in terms of image quality.

RESULTS

No differences between protocols were identified during the visual assessment. Small differences (p < 0.01) in the pons SUVR were observed between the standard and time-reduced protocols for healthy individuals (-0.002 ± 0.011) and AD patients (-0.007 ± 0.013). Likewise, incorporating the PSF correction in the reconstruction algorithm resulted in small differences (p < 0.01) in SUVR between protocols (healthy individuals: -0.003 ± 0.011; AD patients: -0.007 ± 0.014).

CONCLUSION

Quality metrics were similar between time-reduced and standard protocols. In the visual assessment of the images, the physicians did not consider the use of PSF adequate, as it degraded the quality image. Shortening the acquisition time is possible by optimizing the image reconstruction parameters while maintaining adequate quantification accuracy and image quality.

Local Diagnostic Reference Levels for Common Adult Computed Tomography Procedures in Addis Ababa

Background

Computed Tomography has become the major source of population exposure in diagnostic x-rays. This concerned issue will be resolved by stetting Local Diagnostic Reference Levels.

Objectives

The main objective of this study is to assess dose indicators for the establishment of Local Diagnostic Reference Levels.

Materials and methods

A prospective cross-sectional study design was conducted on 8 public and private hospitals performing CT examinations. A total of 725 adult patients who underwent abdominopelvic, chest, and head CT examinations were evaluated from October 2021 to March 2022. Patients' demography, exposure parameters, and dose descriptors were collected. The minimum, maximum, mean, median, and third quartile values were analyzed using SPSS software version 26. Finally, the third quartile values of collected data were compared with national and international values.

Results

The third quartile values obtained from median of volumetric computed tomography dose index (mGy) and dose length product (mGy.cm) which are considered as local DRLs for head, chest, and abdominopelvic CT examination, respectively, were 53 mGy, 14 mGy and 13 mGy; 1307 mGy.cm, 575 mGy.cm, and 932 mGy.cm.

Conclusion

The results of this study showed that practices of CT imaging in both public and private hospitals in Addis Ababa were comparable to other national and international values.