The Effect of Intravenous Contrast on SUV Value in 18F-FDG PET/CT using Diagnostic High Energy CT

Jeong, Young Jin; Kang, Do Young

Abstract

PURPOSE: According to the development of CT scanner in PET/CT system, the role of CT unit as a diagnostic tool has been more important. To improve the diagnostic ability of CT scanner, it is a key aspect that CT scanning has to be performed with high dose energy and intravenous (IV) contrast. So we investigated the effect of IV contrast media on the maximum SUV (maxSUV) of normal tissues and pathologic lesions using PET/CT scanner with high dose CT scanning.
MATERIALS AND METHODS
The study enrolled 13 patients who required PET/CT evaluation. At first, the patients were performed whole body non-contrast CT (NCCT - 120 kVp, 130 mAs) scan. Then contrast enhanced CT (CECT) scan was performed immediately. Finally PET scan was followed. The PET emission data were reconstructed twice, once with the NCCT and again with the CECT. We measured the maxSUV of 10 different body regions that were considered as normal in all patients. Also pathologic lesions were investigated.
RESULTS
There were not seen focal artifacts in PET images based on CT with IV contrast agent. Firstly, 130 normal regions in 13 patients were evaluated. The maxSUV was significantly different between two PET images (p<0.001). The maxSUV was 1.1+/-0.5 in PET images with CECT-corrected attenuation and 1.0+/-0.5 in PET images with NCCT-corrected attenuation. The limit of agreement was 0.1+/-0.3 in Bland-Altman analysis. Especially there were significant differences in 6 of 10 regions, apex and base of the right lung, ascending aorta, segment 6 and segment 8 of the liver and spleen (p<0.05). Secondly, 39 pathologic lesions were evaluated. The maxSUV was significantly different between two PET images (p<0.001). The maxSUV was 4.7+/-2.0 in PET images with CECT-corrected attenuation and 4.4+/-2.0 in PET images with NCCT-corrected attenuation. The limit of agreement was 0.4+/-0.8 in Bland-Altman analysis.
CONCLUSION
Although there were increases of maxSUVs in the PET images based on CT with IV contrast agent, it was very narrow in the range of limit of agreement. So there was no significant effect to clinical interpretation for PET images that were corrected attenuation with high dose CT using IV contrast.