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Deep-Inspiration Breath-Hold PET/CT: Clinical Findings with a New Technique for Detection and Characterization of Thoracic Lesions

Gustavo S.P. Meirelles1, Yusuf Emre Erdi2, Sadek A. Nehmeh2, Olivia D. Squire1, Steven M. Larson1, John L. Humm2 and Heiko Schöder1

1 Department of Radiology, Nuclear Medicine Service, Memorial Sloan-Kettering Cancer Center, New York, New York; and 2 Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York


Figure 1
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  		FIGURE 1.  (A) Patient with lung cancer with 2 additional nodules on left lung on BH CT (arrows). (B) Clinical CT does not show lesions.

 

Figure 2
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  		FIGURE 2.  Patient with widespread metastatic colonic adenocarcinoma to lungs, with consolidations and GGOs. Although clinical CT demonstrates findings (A and B), BH examination (C and D) has much better quality to define lesions' borders and characteristics.

 

Figure 3
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  		FIGURE 3.  (A) BH PET/CT of patient with adenocarcinoma of left lung, with 18F-FDG PET uptake in pulmonary mass (arrows) and SUVmax of 23.3 g/mL, which was 21.2 g/mL on clinical PET/CT. (B and C) Use of BH CT allows detection of carcinomatous lymphangitis adjacent to tumor, characterized by septal thickening (B, arrows), GGOs, and small nodules (C, arrows). (D) It is very hard to depict and characterize the same findings on clinical non-BH CT.

 

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  		FIGURE 4.  Lung cancer metastasis to subcarinal (level 7) lymph node. Although clinical PET/CT detects lesion (A, arrow), SUVmax of 7.8 mg/dL is significantly lower than SUVmax of 12.0 mg/dL measured on same lesion with BH PET/CT (B, arrow). (C) Coronal view of clinical PET/CT reveals breathing artifacts near diaphragm (dashed arrows) in addition to subcarinal node (solid arrow).

 

Figure 5
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  		FIGURE 5.  (A and B) Clinical PET/CT showed focus of 18F-FDG uptake projecting on upper lobe of right lung on transaxial (A) and coronal (B) images (arrows). (C and D) BH PET/CT clearly localized focus of 18F-FDG uptake to right third rib on transaxial (C) and coronal (D) images (arrows). This is clear example of mislocalization on standard PET/CT without BH technique.

 




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