Abstract
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Introduction: PET imaging offers great value in patient management in a variety of oncological and non-oncological indications. The traditional clinical paradigm includes delayed single time point/single phase imaging after adequate radiopharmaceutical biodistribution and optimized target to background visualization. Delayed imaging is a good technique and offers much needed clinical information in most cases but may have some limitations. Novel cameras such as total body PET offer the opportunity for dynamic imaging, multiphase imaging as well as more complex kinetic modeling. However, traditional PET-CT cameras can also perform multiphase imaging.
Methods: We propose to showcase and discuss the value of triple phase (3Ph) PET imaging with various radiopharmaceuticals. Similarly, to general nuclear medicine SPECT gamma camera triple phase scans, 3Ph PET is possible. We will review flow, blood pool and delayed PET imaging technique, results and benefit for FDG and Fluoride PET in pediatric patients. Patients were scanned on a GE Discovery 690 PET/CT scanner with an axial field of view of 15.7 cm. Dynamic flow images were obtained for 60 seconds of the region of interest, followed by 3 mn per bed single or multibed blood pool acquisition and delayed multibed acquisition. A low dose CT scan was performed only once for delayed images. No difference in radiation exposure between technique used and the standard protocol.
Results: Nonattenuation corrected flow and blood pool images were of good quality. Diagnostic certainty as to abnormal or normal findings was acceptable and comparable to delayed images. Flow and blood pool images added reader confidence when negative to the total negativity of the scan and allowed conservative management. Flow and blood pool images may be positive in soft tissue infectious/inflammatory conditions with negative delayed images. On the other hand, early flow and blood pool images may be negative with a positive scan on delayed images suggesting a chronic non active inflammatory/infectious condition. 18F Fluoride and 18F FDG can be used successfully with 3Ph PET acquisitions to evaluate femoral head viability following orthopedic procedures including prosthesis placement. Viability can also be assessed in the shoulders, knees, elbows and other skeletal regions when osteonecrosis is suspected. 3Ph PET can also be valuable in assessing infections in prosthetic spinal or other implants. 3Ph PET can also be helpful in assessing the activity of osteoid osteomas pre and postintervention as well as any residual active component postintervention.
Conclusions: Triple phase PET imaging is an important technique and holds value in pediatric patients and can be used with no significant disruption in general workflow and with no additional radiation exposure. Additional applications and large cohorts analysis may be further assessed.
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