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Limitations of CT During PET/CT

¹ Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York; ² Department of Radiology, New York–Presbyterian Hospital/Weill Cornell Medical Center, New York, New York; and ³ Department of Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York

Correspondence: For correspondence contact: Marc J. Gollub, MD, Room C 276F, Department of Radiology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021. E-mail: gollubm{at}mskcc.org

Our aim was to determine the diagnostic limitations of low-dose, unenhanced CT scans performed for anatomic reference and attenuation correction during PET/CT. Methods: The Radiology Information System at our oncologic hospital was queried during the 9-mo period from July 2002 to April 2003 for patients with PET/CT scans and diagnostic enhanced CT within 2 wk of each other. One radiologist interpreted the CT portion of the PET/CT (CT^p) unaware of the PET results and the associated enhanced diagnostic CT (CT^d). A medical student compared this interpretation with the official report of the CT^d and listed all discrepancies between reports. A separate radiologist compared CT^p and CT^d images and classified true discrepant findings as due to lack of intravenous contrast, arm-position artifact, lack of enteric contrast, low milliamperage (mA), and quality of lung images. Results: Among 100 patients, the most common malignancies were lymphoma (n = 37), cancer of the colorectum (n = 31), and esophageal cancer (n = 15). Among 194 true discrepancies in which findings were missed at CT^p, causes were as follows: (a) lack of intravenous contrast (128/194, 66%), (b) arm-down artifact (17/194, 9%), (c) quality of lung images (26/194, 13%), (d) lack of enteric contrast (15/194, 8%), and (e) low mA (8/194, 4%). Discrepancies were seen most commonly in detecting lymphadenopathy and visceral metastases. Conclusion: Most missed findings on the unenhanced CT portion of the PET/CT scans were due to technical factors that could be altered. Discrepant findings would have led to altered management in only 2 patients, suggesting a role for limited repeat imaging to reduce radiation and use of valuable resources.

Key Words: PET/CT • diagnostic CT • limitations of CT

COPYRIGHT © 2007 by the Society of Nuclear Medicine, Inc.

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