Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 1999; 38(04): 108-114
DOI: 10.1055/s-0038-1632201

Originalarbeiten — Original Articles

Schattauer GmbH

F-18-FDG Positron Imaging in Oncological Patients: Gamma Camera Coincidence Detection versus Dedicated PET

F-18-FDG-Positronen-Emissions-Tomographie bei onkologischen Patienten: Doppelkopf-Koinzidenz-Gammakamera versus Vollring-PET

M. Zimny

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

,

H.-J. Kaiser

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

,

U. Cremerius

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

,

O. Sabri

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

,

M. Schreckenberger

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

,

P. Reinartz

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

,

U. Büll

¹Department of Nuclear Medicine, University Hospital, Aachen University of Technology, Germany

› Author Affiliations

Summary

Aim of the present study was to investigate the feasibility of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) imaging in oncological patients with a dual head gamma camera modified for coincidence detection (MCD). Methods: Phantom studies were done to determine lesion detection at various lesion-to-background ratios, system sensitivity and spatial resolution. Thirty-two patients with suspected or known malignant disease were first studied with a dedicated full-ring PET system (DPET) applying measured attenuation correction and subsequently with an MCD system without attenuation correction. MCD images were first interpreted without knowledge of the DPET findings. In a second reading, MCD and DPET were evaluated simultaneously. Results: The phantom studies revealed a comparable spatial resolution for DPET and MCD (5.9 × 6.3 × 4.2 mm vs. 5.9 × 6.5 × 6.0 mm). System sensitivity of MCD was less compared to DPET (91 cps/Bq/ml/cmF0V vs. 231 cps/ Bq/ml/cmFOv). At a lesion-to-background ratio of 4:1, DPET depicted a minimal phantom lesion of 1.0 cm in diameter, MCD a minimal lesion of 1.6 cm. With DPET, a total of 91 lesions in 27 patients were classified as malignant. MCD without knowledge of DPET results revealed increased FDG uptake in all patients with positive DPET findings. MCD detected 72 out of 91 DPET lesions (79.1 %). With knowledge of the DPET findings, 11 additional lesions were detected (+12%). MCD missed lesions in six patients with relevance for staging in two patients. All lesions with a diameter above 18 mm were detected. Conclusion: MCD FDG imaging yielded results comparable to dedicated PET in most patients. However, a considerable number of small lesions clearly detectable with DPET were not detected by MCD alone. Therefore, MCD cannot yet replace dedicated PET in all oncological FDG studies. Further technical refinement of this new method is needed to improve image quality (e.g. attenuation correction).

Zusammenfassung

Ziel dieser Studie war der Vergleich einer modifizierten, koinzidenzfähigen Doppelkopf-Gammakamera (MCD) mit einem dedizierten Vollring-Positronenemissionstomographen (DPET) zur PET mit 2-[18Fj-Fluor-2-Deoxy-D-Glukose (FDG) bei onkologischen Patienten. Methodik: Mittels Phantomstudien wurden Herderkennbarkeit, Systemsensitivität und räumliche Auflösung für beide Systeme verglichen. Zweiunddreißig Patienten mit gesicherten oder vermuteten malignen Erkrankungen wurden zunächst mit DPET unter Verwendung einer gemessenen Schwächungskorrektur untersucht. Im Anschluß erfolgte eine nicht schwächungskorrigierte MCD-Messung. Die MCD-Schnittbilder wurden zunächst ohne Kenntnis der DPET-Ergebnisse ausgewertet. In einem zweiten Schritt wurden die DPET-Bilder zur Befundung hinzugezogen. Ergebnisse: Die Phantomstudien ergaben eine vergleichbare räumliche Auflösung (DPET: 5,9 × 6,3 × 4,2 mm; MCD 5,9 × 6,5 × 6,0 mm). Im Vergleich zu DPET wies MCD eine geringere Systemsensitivität (91 cps/Bq/ml/cmFOv vs. 231 cps/Bq/ml/cmFOV) auf. Bei einem Herd-zu-Hintergrund-Quotienten von 4:1 konnte mittels DPET eine Kugel mit einem Durchmesser von 1,0 cm dargestellt werden, während die kleinste mit MCD abbildbare Kugel einen Durchmesser von 1,6 cm hatte. Mittels DPET waren 91 malignomtypische Herdbefunde bei 27 Patienten abgrenzbar. Ohne Kenntnis der DPET-Befunde konnten davon 72 mit MCD nachgewiesen werden (79,1%). Unter Zuhilfenahme der DPETBefunde wurden elf zusätzliche Herde abgrenzbar (+12%). Mit MCD wurden Herdbefunde bei sechs Patienten übersehen. Eine klinische Relevanz hinsichtlich Staging hätte sich hieraus bei zwei Patienten ergeben. Alle malignomtypischen Herdbefunde mit einem Durchmesser größer als 18 mm waren mit MCD nachweisbar. Schlußfolgerung: FDG-PET mit MCD ergibt zu DPET vergleichbare Ergebnisse bei der Mehrzahl der Patienten. Allerdings sind eine Reihe eindeutiger DPET-Befunde mit MCD allein nicht abgrenzbar. Daher kann MCD konventionelles PET derzeit nicht bei allen onkologischen FDG-Untersuchungen ersetzen. Weitere technische Verbesserungen dieser neuen Methode sind erforderlich, um die Bildqualität zu erhöhen (zum Beispiel Schwächungskorrektur).

Key words

Key words

Fluorine-18 fluorodeoxyglucose - coincidence gamma camera - positron emission tomography - lesion detection - oncology

Schlüsselwörter

Schlüsselwörter

FDG - Koinzidenz Gammakamera - Positronen-Emissions-Tomographie - Herderkennbarkeit - Onkologie

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