Deep Inspiration Breath Hold [18F]FDG PET-CT on 4-rings scanners in evaluating lung lesions: Evidences from a phantom and a clinical study

Abstract Objective To investigate the clinical feasibility of a Deep Inspiration Breath Hold (DIBH) 18 F-FDG PET-CT acquisition in apnea and compare the results obtained between these acts of acquisition in apnea and in Free Breathing in the evaluation of lung lesions. Material and methods A pre-clinical phantom study was performed to evaluate the shortest simulated DIBH time according to the minimum detectable lesion that can be detected by our ultrasound scanner. This study was conducted by changing acquisition time and sphere-to-background activity ratio values and by using radioactivity densities similar to those generally found in clinical examinations. In the clinical study, 25 patients with pulmonary lesions underwent a standard whole body 18 F-FDG PET-CT scan in free breathing followed by a 20 s single thorax acquisition PET/CT in DIBH acquisition. Results The phantom study indicated that a 20-s acquisition time provides an accurate evaluation of smallest sphere shaped lesions. In the clinical study, PET-CT scans obtained in DIBH studies showed a significant reduction of misalignment between the PET and CT scan images and an increase of SUV max compared to free breathing acquisitions. A correlation between the %BH-index and lesion displacement between PET and CT images in FB acquisition was demonstrated, significantly higher for lesions with a displacement > 8 mm. Conclusion The single 20 s acquisition of DIBH PET-CT is a feasible technique for lung lesion detection in the clinical setting. It only requires a minor increase in examination time without special patient training. 20 s DIBH scan provided a more precise measurement of SUV max , especially for lesions in the lower lung lobes which usually show greater displacement between PET and CT scan images in FB acquisition.