Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer

Pfannenberg, Anna C.; Aschoff, Philip; Brechtel, Klaus; Müller, Mark; Bares, Roland; Paulsen, Frank; Scheiderbauer, Jutta; Friedel, Godehard; Claussen, Claus D.; Eschmann, Susanne Martina

doi:10.1007/s00259-006-0186-3

Cited by 93 publications

(43 citation statements)

References 23 publications

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“…It has already been shown for several other oncologic diseases that contrast media in PET/CT can enhance the diagnostic accuracy and certainty (18,19). Our data do not contradict these studies, even though diagnostic certainty was equal between non-cePET/CT and cePET/CT.…”

Section: Discussioncontrasting

confidence: 50%

“…On follow-up with cePET/ CT, this lesion increased in size on CT and the patient underwent a hemihepatectomy, which revealed a metastasis. Another patient had a false-positive finding: A liver lesion with 18 F-FDG-avid uptake was stated as metastasis. However, liver surgery detected only a granulomatous inflammation.…”

Section: Disease Characteristicsmentioning

confidence: 99%

“…However, both offer primarily only morphologic data. 18 F-FDG PET/CT gives additional functional information that has also been found to be accurate in the detection of local recurrence and distant metastases (10,11). Therefore, where available, patients may also be referred for a PET/CT examination, particularly if the ceCT showed indeterminate findings.…”

mentioning

confidence: 99%

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Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Soyka¹,

Veit-Haibach²,

Strobel³

et al. 2008

J Nucl Med

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18 F-FDG PET/CT has gained wide acceptance for evaluation of recurrent colorectal carcinoma. However in clinical practice, contrast-enhanced CT (ceCT) is still the first-line restaging tool. The aim of this study was to investigate the value of contrastenhanced PET/CT (cePET/CT) as a first-line restaging tool with a special focus on the importance of the use of intravenous contrast. Methods: Fifty-four patients (17 women, 37 men; mean age, 60.3 y), referred for restaging of colorectal carcinoma, were examined with cePET/CT. Retrospective analysis was performed by 2 experienced readers by consensus: first, ceCT alone; second, non-cePET/CT; and third, cePET/CT. The number, localization, and diagnostic certainty of lesions were evaluated. Additionally, the therapeutic impact of the findings was determined. In 29 patients, histology, clinical imaging, and clinical follow-up served as the reference standard. In 25 patients, clinical follow-up and imaging served as the reference standard. Results: Overall, non-cePET/CT delivered correct additional information to the ceCT findings in 27 of 54 patients (50%). This occurred in (a) 20 of 30 patients, where ceCT was found to be inconclusive, and in (b) 7 of 24 patients with conclusive ceCT findings, where non-cePET/CT found additional lesions, leading to a therapy modification in 5 patients. Compared with non-cePET/ CT, cePET/CT revealed additional information in 39 of 54 patients (72%), with therapeutic relevance in 23 patients. This large number was primarily due to correct segmental localization of liver metastases, which is crucial for surgical therapy planning. Conclusion: On the basis of its higher accuracy and therapeutic impact compared with ceCT, our data suggest that cePET/CT might be considered as the first-line diagnostic tool for restaging in patients with colorectal cancer.

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Section: Discussioncontrasting

confidence: 50%

Section: Disease Characteristicsmentioning

confidence: 99%

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Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Soyka¹,

Veit-Haibach²,

Strobel³

et al. 2008

J Nucl Med

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“…Today, different approaches are adopted for integrated PET/ CT scanning, with the CT protocol positioned between two possible extremes: 1) in which CT is used as a fast transmission source for attenuation correction and approximate anatomical mapping, and is performed with a low radiation dose (lowdose 10-40 mA CT); or 2) in which CT is used for both attenuation correction and diagnostic purposes, being performed with a standard radiation dose and i.v. and oral contrast (diagnostic o80 mA CT) [27]. With regard to the questions of whether we need oral and/or i.v.…”

Section: What Kind Of Ct Is Needed?mentioning

confidence: 99%

Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration

Wever

Stroobants²,

Coolen³

et al. 2008

Eur Respir J

107

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Lung cancer is a common disease and is a leading cause of death in many countries. The management of lung cancer is directed by an optimal staging of the tumour. Integrated positron emission tomography (PET)/computed tomography (CT) is an anatomo-metabolic imaging modality that has recently been introduced to clinical practice and combines two different techniques: CT, which provides very detailed anatomic information; and PET, which provides metabolic information. One of the advantages of PET/CT is the improved image interpretation. This improvement can result in the detection of lesions initially not seen on CT or PET, a more precise location of lesions, a better characterisation of the lesion as benign or malignant and a better differentiation between tumour and surrounding structures. Initial studies demonstrate better results for PET/CT in the staging of lung cancer in comparison with PET alone, CT alone or visual correlation of PET and CT. The purpose of the present article is to discuss technical aspects of integrated PET/CT and to attempt to outline how to introduce integrated PET/ CT in clinical and daily practice.

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“…In conventional PET/CT, low-dose CT information is used not only for attenuation correction but also for anatomic allocation of PET findings, when diagnostic CT is not performed (24). In addition, even on low-dose CT some PET-negative pathologies can be detected, such as small pulmonary lesions or bone metastases (25,26). MRI offers high-resolution diagnostic sequences, providing detailed anatomic information.…”

mentioning

confidence: 99%

First Clinical Experience with Integrated Whole-Body PET/MR: Comparison to PET/CT in Patients with Oncologic Diagnoses

Drzezga

Souvatzoglou²,

Eiber³

et al. 2012

J Nucl Med

465

312

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The recently introduced first integrated whole-body PET/MR scanner allows simultaneous acquisition of PET and MRI data in humans and, thus, may offer new opportunities, particularly regarding diagnostics in oncology. This scanner features major technologic differences from conventional PET/CT devices, including the replacement of photomultipliers with avalanche photodiodes and the need for MRI-based attenuation correction. The aim of this study was to evaluate the comparability of clinical performance between conventional PET/CT and PET/MR in patients with oncologic diseases. Methods: Thirty-two patients with different oncologic diagnoses underwent a single-injection, dual-imaging protocol consisting of a PET/CT and subsequent PET/MR scan. PET/CT scans were performed according to standard clinical protocols (86 6 8 min after injection of 401 6 42 MBq of 18 F-FDG, 2 min/ bed position). Subsequently (140 6 24 min after injection), PET/ MR was performed (4 min/bed position). PET images of both modalities were reconstructed iteratively. Attenuation and scatter correction as well as regional allocation of PET findings were performed using low-dose CT data for PET/CT and Dixon MRI sequences for PET/MR. PET/MR and PET/CT were compared visually by 2 teams of observers by rating the number and location of lesions suspicious for malignancy, as well as image quality and alignment. For quantitative comparison, standardized uptake values (SUVs) of the detected lesions and of different tissue types were assessed. Results: Simultaneous PET/MR acquisition was feasible with high quality in short acquisition time (#20 min). No significant difference was found between the numbers of suspicious lesions (n 5 80) or lesion-positive patients (n 5 20) detected with PET/MR or PET/CT. Anatomic allocation of PET/ MR findings by means of the Dixon MRI sequence was comparable to allocation of PET/CT findings by means of low-dose CT. Quantitative evaluation revealed a high correlation between mean SUVs measured with PET/MR and PET/CT in lesions (r = 0.93) and background tissue (r = 0.92). Conclusion: This study demonstrates, for what is to our knowledge the first time, that integrated whole-body PET/MR is feasible in a clinical setting with high quality and in a short examination time. The reliability of PET/ MR was comparable to that of PET/CT in allowing the detection of hypermetabolic lesions suspicious for malignancy in patients with oncologic diagnoses. Despite different attenuation correction approaches, tracer uptake in lesions and background correlated well between PET/MR and PET/CT. The Dixon MRI sequences acquired for attenuation correction were found useful for anatomic allocation of PET findings obtained by PET/MR in the entire body. These encouraging results may form the foundation for future studies aiming to define the added value of PET/MR over PET/CT.

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Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer

Cited by 93 publications

References 23 publications

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration

First Clinical Experience with Integrated Whole-Body PET/MR: Comparison to PET/CT in Patients with Oncologic Diagnoses

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Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer

Cited by 93 publications

References 23 publications

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced 18F-FDG PET/CT the Diagnostic Tool of Choice?

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced 18F-FDG PET/CT the Diagnostic Tool of Choice?

Integrated PET/CT in the staging of nonsmall cell lung cancer: technical aspects and clinical integration

First Clinical Experience with Integrated Whole-Body PET/MR: Comparison to PET/CT in Patients with Oncologic Diagnoses

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Product

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Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?

Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced ¹⁸F-FDG PET/CT the Diagnostic Tool of Choice?