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Deep-Inspiration Breath-Hold PET/CT of Lung Cancer: Maximum Standardized Uptake Value Analysis of 108 Patients

¹ Division of Nuclear Medicine, Kanagawa Cancer Center, Yokohama, Japan; and ² Department of Radiology, Yokohama City University School of Medicine, Yokohama, Japan

Correspondence: For correspondence or reprints contact: Tsuyoshi Kawano, Division of Nuclear Medicine, Kanagawa Cancer Center Nakao 1-1-2, Asahi-ku, Yokohama, 241-0815, Japan. E-mail: kawanotsuyoshi{at}hotmail.com

Our aim was to compare the maximum standardized uptake value (SUVmax) between breath-hold (BH) PET/CT and free-breathing (FB) PET/CT. Methods: The features of phantom data were analyzed, after which a clinical study was performed. A total of 108 consecutive patients with lung cancer were examined using lutetium oxyorthosilicate (LSO)–based PET/CT. The patients were instructed to breathe freely during FB PET/CT. In BH PET/CT, the patients were instructed to hold their breath in the maximal inspiration position during the scout scan, for 10 s of the CT scan, and for as long as possible during the PET scan. BH time was recorded using a respiratory monitoring device. The %BH-index was defined as the percentage difference between SUVmax of FB PET and that of BH PET. Statistical analyses were performed using the following factors: %BH-index, age, body mass index, ¹⁸F-FDG dosage, blood glucose, BH time, lesion size, and location. Results: The highest %BH-index was 223.2. %BH-index in the lower lung area was significantly higher than that in the upper lung area (51.8 ± 49.5 vs. 16.9 ± 25.6, respectively). Lesion volume and maximum diameter in the high–%BH-index group were significantly lower than those in the low–%BH-index group, with the use of a %BH-index cutoff value of 37.l. Conclusion: SUVmax of FB PET should not be taken as accurate, especially in the lower lung area and for small pulmonary lesions. BH PET/CT is expected to enable precise measurement of SUVmax and is thus recommended as part of the standard protocol for lung cancer.

Key Words: deep-inspiration breath-hold • PET/CT • maximum SUV • lutetium oxyorthosilicate • lung cancer

COPYRIGHT © 2008 by the Society of Nuclear Medicine, Inc.

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