Progress of Total-Body PET technical developments and clinical applications: what has changed since the innovation?

Introduction: This exhibit explores the utility of FDG PET in renal cell carcinoma subtypes. Additionally, the use of FDG in Total Body PET imaging of renal cancer will also be discussed.

Unlike its routine use in imaging of other malignancies, 18F-fluorodeoxyglucose PET/CT has limited application in renal cell carcinoma (RCC). This is due to the kidneys' natural excretion of FDG, which lowers the contrast between renal lesions and normal tissue, potentially obscuring or masking renal tumors. Despite its drawbacks, FDG PET imaging of kidney cancers has certain benefits that are worth investigating. In individuals with recurrent or metastatic RCCs, hybrid PET/CT was demonstrated to have a greater sensitivity and specificity. FDG PET scans have also been demonstrated to be effective in monitoring response to therapy to tyrosine kinase inhibitors (TKIs) in advanced RCC; PET/CT is therefore being utilized more often to assess therapeutic response to TKIs. Additionally, FDG PET has greater sensitivity and accuracy for detecting renal metastases to the bone than a bone scan.

Methods: A literature review of recent advancements and current clinical applications of TB-PET was performed. In doing so, novel challenges and opportunities facing this technology and its translation into routine clinical practice were identified.

Results: With a 40-fold increase in effective sensitivity compared to standard PET scanners, TB-PET enables reduced radiation exposure, delayed imaging, and increased temporal resolution, enabling a more comprehensive approach to molecular imaging. The increased sensitivity of TB scanners may be attributable to a greater coincident photon detection efficacy as well as decreased bed positions due to the broader axial field of view (FOV). With its novel scientific and clinical uses, TB-PET has the ability to revolutionize the field.

In terms of clinical opportunities, TB-PET enables:

Functional assessment and dynamic imaging of living tissues by collecting physiological and pharmacokinetic data from a radiotracer

Higher signal-to-noise ratio

Reduced scan times

Delayed imaging

Lower radiotracer dose

Dynamic 18F-FDG TB-PET imaging employed as a predictive indicator for assessment of response to chemo-immunotherapy

18F-FDG TB-PET imaging to assess parametric imaging according to early dynamics after FDG injection. (See Figure 1)

In terms of research applications, TB-PET can enable systems biology imaging:

Simultaneous capture of pharmacokinetic data from all organs

Measurement of arterial input function for all organs.

Quantification of organ-to-organ communication

Possibility for clinical trials to be accelerated.

Conclusions: There is no doubt that TB-PET is a transformative technology that has opened many doors for novel clinical and research applications. However, TB-PET’s significant learning curve and device cost have hampered the adoption of this technology in the clinic. Appropriate knowledge on this topic is important to understand that TB-PET has the potential to push the boundaries of nuclear medicine and that its benefits will outweigh the costs when it is more widely adopted.

• Download figure
• Open in new tab
• Download powerpoint