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Research ArticleOncology

Feasibility of 18F-FDG Dose Reductions in Breast Cancer PET/MRI

Bert-Ram Sah, Soleen Ghafoor, Irene A. Burger, Edwin E.G.W. ter Voert, Tetsuro Sekine, Gaspar Delso, Martin Huellner, Konstantin J. Dedes, Andreas Boss and Patrick Veit-Haibach
Journal of Nuclear Medicine December 2018, 59 (12) 1817-1822; DOI: https://doi.org/10.2967/jnumed.118.209007
Bert-Ram Sah
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
2Department of Cancer Imaging, King`s College London, London, United Kingdom
3Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
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Soleen Ghafoor
3Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
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Irene A. Burger
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
5Cancer Center Zurich, Zurich, Switzerland
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Edwin E.G.W. ter Voert
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
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Tetsuro Sekine
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
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Gaspar Delso
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
6GE Healthcare, Waukesha, Wisconsin
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Martin Huellner
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
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Konstantin J. Dedes
5Cancer Center Zurich, Zurich, Switzerland
7Department of Gynaecology, University Hospital of Zurich, Zurich, Switzerland
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Andreas Boss
3Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
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Patrick Veit-Haibach
1Department of Nuclear Medicine, University Hospital of Zurich, Zurich, Switzerland
3Department of Diagnostic and Interventional Radiology, University Hospital of Zurich, Zurich, Switzerland
4University of Zurich, Zurich, Switzerland
8Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada; and
9University of Toronto, Toronto, Ontario, Canada
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    FIGURE 1.

    (A–E) Axial PET images of 57-y-old patient showing invasive left-sided breast cancer (top), axillary lymph node metastasis (middle), and internal mammary lymph node (bottom, arrow) after injection with 180 MBq of 18F-FDG (body weight, 60 kg): 2-min TOF (A), 100% of 18F-FDG dose (B), 36 MBq of 18F-FDG (20% dose) (C), 18 MBq of 18F-FDG (10% dose) (D), and 9 MBq of 18F-FDG (5% dose) (E). For PET/MRI examination with images shown in column D, this patient would receive an estimated radiation burden of 0.36 mSv. (F and G) Axial fused PET/MR images of primary lesion (F) and internal mammary lymph node (G) (PET with 10% dose).

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    TABLE 1

    Image Grading

    GradeGeneral image quality + artifactImage sharpnessImage noiseLesion detectability
    1Excellent: no artifactsClear, excellent imagesNegligibleExcellent
    2Good: some diagnostically irrelevant artifactsDiagnostically irrelevant image blurringDiagnostically irrelevantGood
    3Average: diagnostically relevant artifactsDiagnostically relevant image blurringDiagnostically relevantAverage
    4Inadequate: marked artifactsInadequate image with blurringMarkedPoor
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    TABLE 2

    Image Quality Ratings

    General image quality + artifactsImage sharpnessImage noiseLesion detectability
    ParameterMeanSDMeanSDMeanSDMeanSD
    2 min1.840.62.280.62.160.61.460.7
    20 min 100%1.080.41.120.31.040.21.030.2
    20 min 20%1.320.61.640.71.440.51.140.4
    20 min 10%1.400.61.760.71.480.61.280.6
    20 min 5%1.880.52.600.82.280.51.620.8
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    TABLE 3

    P Values for Comparison with 2-Minute Scan (Wilcoxon testing)

    General image quality + artifactsLesion detectability
    ParameterImage sharpnessImage noisePrimary lesionLymph nodes
    20 min 100%<0.001<0.001<0.0010.0380.001
    20 min 20%<0.001<0.001<0.0010.2570.001
    20 min 10%0.0010.0010.0010.7630.032
    20 min 5%0.3170.0050.1800.1420.593

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Journal of Nuclear Medicine: 59 (12)
Journal of Nuclear Medicine
Vol. 59, Issue 12
December 1, 2018
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Feasibility of 18F-FDG Dose Reductions in Breast Cancer PET/MRI
Bert-Ram Sah, Soleen Ghafoor, Irene A. Burger, Edwin E.G.W. ter Voert, Tetsuro Sekine, Gaspar Delso, Martin Huellner, Konstantin J. Dedes, Andreas Boss, Patrick Veit-Haibach
Journal of Nuclear Medicine Dec 2018, 59 (12) 1817-1822; DOI: 10.2967/jnumed.118.209007

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Feasibility of 18F-FDG Dose Reductions in Breast Cancer PET/MRI
Bert-Ram Sah, Soleen Ghafoor, Irene A. Burger, Edwin E.G.W. ter Voert, Tetsuro Sekine, Gaspar Delso, Martin Huellner, Konstantin J. Dedes, Andreas Boss, Patrick Veit-Haibach
Journal of Nuclear Medicine Dec 2018, 59 (12) 1817-1822; DOI: 10.2967/jnumed.118.209007
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