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Journal of Nuclear Medicine Vol. 44 No. 2 240-243
© 2003 by Society of Nuclear Medicine

Brief Communications

Clinically Significant Inaccurate Localization of Lesions with PET/CT: Frequency in 300 Patients

Medhat M. Osman, MD, PhD1, Christian Cohade, MD2, Yuji Nakamoto, MD, PhD2, Laura T. Marshall, BS2, Jeff P. Leal, BA2 and Richard L. Wahl, MD2

1 Division of Nuclear Medicine, Department of Internal Medicine, School of Medicine, St. Louis University, St. Louis, Missouri
2 Division of Nuclear Medicine, Department of Radiology, School of Medicine, The Johns Hopkins University, Baltimore, Maryland

ABSTRACT

This study evaluated lesion mislocalization between PET and CT on PET/CT studies when CT instead of germanium is used for attenuation correction (AC). Methods: PET/CT scans were obtained for 300 clinical patients. Both CT and germanium scans were used to correct PET emission data. Cases were noted of suspected inaccurate localization of lesions on any of the 5 sets of images (PET using germanium AC [GeAC] fused and not fused with CT, PET using CT AC fused and not fused with CT, and PET with no AC [NAC]). Independent CT or MRI was used to determine true lesion locations. Results: Six of 300 patients (2%) had lesion mislocalization when CT was used for AC or fusion. True liver dome lesions were mislocalized to the right lung base on PET/CT, likely because of a respiratory motion difference between PET and CT. No mislocalization was present on NAC PET or non-CT-fused GeAC PET images. Conclusion: Serious lesion mislocalization on PET/CT studies may occur, albeit very infrequently, when CT is used for either AC or fusion.

Key Words: PET/CT • image fusion • artifact • respiratory motion




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