Feasibility of Acquisitions Using Total-Body PET/CT with an Ultra-Low¹⁸F-FDG Activity

Abstract

The present study aimed to evaluate the feasibility of ultra-low ¹⁸F-fluorodeoxyglucose (FDG) activity in total-body positron emission tomography (PET)/computed tomography (CT) oncological studies. <b>Methods:</b> Thirty patients with cancer were enrolled prospectively and underwent a total-body PET/CT examination with an ultra-low ¹⁸F-FDG activity (0.37 MBq/kg) after an uptake time of 60 minutes. Among the enrolled patients, 11 were diagnosed with colorectal cancer (CRC). PET raw data were acquired within 15 minutes and reconstructed using data from the first 1, 2, 4, 8, 10 and the entire 15 min (G1, G2, G4, G8, G10, G15). Image quality was assessed qualitatively by two readers using a 5-point Likert scale twice. Cohen’s kappa test was performed to investigate the intra-reader and inter-reader agreement. The standard uptake value (SUV)max of lesions, SUV_max, SUVmean, and standard deviation (SD) of the livers, the tumor-to-background ratio (TBR), and the signal-to-noise ratio (SNR) were measured and compared. The acquisition time for a clinically acceptable image quality was determined using an ultra low activity injection. In a matched-pair study, 11 patients with CRC who received a full FDG activity (3.7 MBq/kg) with a 2-min PET acquisition were selected retrospectively with matched sex, height, weight, body mass index, glucose level, uptake time, and pathological types with the 11 CRC subjects in the prospective study. Qualitative and quantitative analyses were performed and compared between the 11 patients with CRC in the ultra-low activity group and their matched full activity controls. <b>Results:</b> Qualitative analysis of image quality showed good intra- and inter-reader agreements (all kappa &gt; 0.7). All the images acquired for 8-min or longer scored over 3 (indicating clinical acceptability). There was no significant difference in TBR and liver SNR among all the images acquired for 8-min or longer. In the matched study, no significant difference was found in the image quality score and quantitative parameters between the ultra­low activity group with an 8-min acquisition and the full activity group with a 2-min acquisition. <b>Conclusion:</b> Ultra-low FDG activity injection with 8-min acquisition in a total-body PET/CT study can achieve acceptable image quality equivalent to that in the full activity group using 2-min acquisition.