OtherClinical Investigations

Optimized Intravenous Contrast Administration for Diagnostic Whole-Body 18F-FDG PET/CT

Thomas Beyer, Gerald Antoch, Andreas Bockisch and Joerg Stattaus
Journal of Nuclear Medicine March 2005, 46 (3) 429-435;

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A) Diagnostic image quality and contrast-induced abnormalities were assessed independently for 3 axial imaging ranges: neck, thorax, and abdomen. (B) Examples of diagnostic quality of thoracic CT images: 3 (very good), 2 (good), 1 (poor). (C) Examples of PET images after CT-based attenuation correction without and with artifact from intravenous contrast (arrow) are shown.

  • FIGURE 2.
    FIGURE 2.

    (A) Diagnostic quality of CT images averaged over ratings by 3 radiology reviewers. CT image quality was lowest for nonenhanced studies (protocol A) but increased throughout whole-body imaging range when intravenous contrast was used (protocols B–D). Examples of CT images (B) of abdomen for subjects enrolled in protocols A (nonenhanced) and B–D (intravenous contrast according to Table 1) are shown. Prot = protocol.

  • FIGURE 3.
    FIGURE 3.

    Average number of CT image artifacts attributed to intravenous contrast in neck, thorax, and abdomen. Examples of CT images are shown to illustrate artifacts (arrows) for protocols B and C. Zoomed inserts are shown to the left and right for B and C, respectively. Protocol B also resulted in 1 case with reported high-density artifacts in abdomen as reported by 1 radiology reader (example not shown).

  • FIGURE 4.
    FIGURE 4.

    Average CT attenuation in major vessels of whole-body CT images from PET/CT examinations with contrast administration protocols A–D (Table 1).

  • FIGURE 5.
    FIGURE 5.

    Number of attenuation-corrected PET studies with abnormal tracer uptake attributed to focal accumulations of intravenous contrast through protocols A–D. Axial PET images (after CT-based attenuation correction) through apex of lungs are shown for protocols A–D with arrows pointing to reported artifactual findings on PET.

  • FIGURE 6.
    FIGURE 6.

    18F-FDG PET/CT study following the modified contrast injection protocol D. Coronal CT view illustrates uniform vessel enhancement throughout whole-body imaging range. Axial CT and corrected PET images are shown through area of subclavian vein to demonstrate absence of contrast-induced abnormalities.

Tables

  • TABLE 1

    Patient Groups for Adapted Intravenous Contrast Injection Protocols and Parameters for Intravenous Contrast Injection

    GroupProtocol
    ABCD
    DescriptorNonenhancedStandardExtendedModified
    Patients10101010
        Male/female5/56/46/45/5
        Mean age* (y)61 ± 1461 ± 1260 ± 762 ± 10
        Mean body mass index*24 ± 424 ± 523 ± 425 ± 4
    Intravenous contrast administration
        Intravenous contrastNoYesYesYes
        Contrast materialXenetix 300Xenetix 300Xenetix 300
        PhaseDualTripleDual
        Total contrast volume (mL)140: 90, 50170: 90, 40, 40140: 80, 60
        Flow rate (mL/s)3, 1.53, 2, 1.53, 1.5
        Delay (s)303050
        Scan directionCraniocaudalCraniocaudalCraniocaudalCaudocranial

    • ↵* Mean ± SD.

  • TABLE 2

    Mean CT Attenuation (HU) and SD (%) in Major Vessels of Interest in Neck, Thorax, and Abdomen in Whole-Body PET/CT Studies with Intravenous Contrast Injection According to Administration Protocols A–D

    ProtocolNeckThoraxAbdomen, PV
    IJVCCABVAA
    A48 (13)47 (15)46 (17)41 (12)49 (10)
    B140 (43)200 (40)1,300 (31)200 (15)150 (27)
    C220 (27)230 (35)600 (83)170 (18)160 (13)
    D160 (19)160 (19)140 (21)170 (18)180 (22)
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