Consensus Recommendations on the Use of¹⁸F-FDG PET/CT in Lung Disease

Abstract

Positron emission tomography (PET) with 18 F-fluorodeoxyglucose (18 F-FDG) has been increasingly applied, predominantly in the research setting, to study drug effects and pulmonary biology and monitor disease progression and treatment outcomes in lung diseases, disorders that interfere with gas exchange through alterations of the pulmonary parenchyma, airways and/or vasculature. To date, however, there are no widely accepted standard acquisition protocols and imaging data analysis methods for pulmonary 18 F-FDG PET/CT in these diseases, resulting in disparate approaches. Hence, comparison of data across the literature is challenging. To help harmonize the acquisition and analysis and promote reproducibility, acquisition protocol and analysis method details were collated from seven PET centers. Based on this information and discussions among the authors, the consensus recommendations reported here on patient preparation, choice of dynamic versus static imaging, image reconstruction, and image analysis reporting were reached.

Advances in PET to assess pulmonary inflammation: A systematic review

“…To improve reproducibility in 18 F-FDG PET, standardisation of acquisition and analysis protocols are of paramount importance [11,32]. To that end, further work is currently being undertaken by a wide-ranging group of experts to provide recommendations on optimal protocols (manuscript in preparation [33]). Although this will no doubt improve reliability of imaging endpoints, further studies providing technical and clinical validation of quantitative FDG-PET could foment more widespread confidence in the technique.…”

“…In particular, respiratory motion, blood radioactivity and air within the lung all impact the accuracy of quantitative PET [20,28,77]. For 18 F-FDG, a forthcoming consensus paper aims to alleviate these issues by providing specific recommendations on image acquisition and analysis reporting [33] (manuscript submitted). Further, this will enable harmonisation of studies and improve the comparison of results across institutions.…”

Imaging standardisation in metastatic colorectal cancer: A joint EORTC-ESOI-ESGAR expert consensus recommendation

“…Imaging recommendations are often part of guidelines that cover acquisition, interpretation, and reporting. Protocol recommendations with high adherence in clinical trials exist for prostate cancer screening [21], metastatic prostate cancer [22], breast cancer [23], endometrial cancer [24], multiple myeloma [25], and lung cancer [26].…”

[18F]FDG PET signal correlates with markers of neo-angiogenesis in patients with fibrotic interstitial lung disease who underwent lung biopsy: Implication for the use of PET/CT in diffuse lung diseases

“…18 patients with fILD underwent [ 18 F]FDG PET before lung biopsy (of a part of the lung determined clinically). The PET-CT acquisition consisted of a CT scan performed for attenuation correction and then, maintaining the patient position, a whole-body [ 18 F]FDG PET emission scan was performed covering an area identical to that covered by CT as previously described [2,7]. Our analysis of pulmonary FDG uptake used a derived target-to-background ratio (TBR) of maximum pulmonary uptake of FDG (SUVmax) divided by the lung background (SUVmin) as previously described [2] and in keeping with current international consensus methodology for PET signal quanti cation in diffuse lung diseases [7].…”