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Quantifying the Effect of IV Contrast Media on Integrated PET/CT: Clinical Evaluation

¹ Department of Imaging Physics, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Blvd., Box 56, Houston, TX 77030.
² Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030.

View larger version (85K): [in a new window]   Fig. 1A —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Coronal images at level of subclavian vein and heart. Mean (maximum) region of interest (ROI) values for subclavian vein (short arrows) and left atrium (long arrows) were 36 (49) H and 35 (40) H, respectively, on unenhanced CT scan. Corresponding PET standardized uptake values (SUV) were 0.97 (1.0) and 1.88 (2.1), respectively. A, Unenhanced CT.

View larger version (68K): [in a new window]   Fig. 1B —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Coronal images at level of subclavian vein and heart. Mean (maximum) region of interest (ROI) values for subclavian vein (short arrows) and left atrium (long arrows) were 36 (49) H and 35 (40) H, respectively, on unenhanced CT scan. Corresponding PET standardized uptake values (SUV) were 0.97 (1.0) and 1.88 (2.1), respectively. B, Attentuation-corrected PET with unenhanced CT.

View larger version (85K): [in a new window]   Fig. 1C —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Coronal images at level of subclavian vein and heart. Mean (maximum) region of interest (ROI) values for subclavian vein (short arrows) and left atrium (long arrows) were 36 (49) H and 35 (40) H, respectively, on unenhanced CT scan. Corresponding PET standardized uptake values (SUV) were 0.97 (1.0) and 1.88 (2.1), respectively. C, Coregistered PET/CT.

View larger version (87K): [in a new window]   Fig. 1D —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Coronal images at level of subclavian vein (short arrows) and left atrium (long arrows) show visual quality of PET image is not compromised when IV contrast CT is used for attenuation correction. However, mean (maximum) ROI values of subclavian vein and left atrium increased to 1,962 (3,070) and 260 (283) on contrast-enhanced CT images compared with A–C, respectively. Corresponding PET SUV values were 1.3 (1.6) and 2.45 (3.0), an increase in SUVmax of 60% and 43%, respectively. D, IV contrast-enhanced CT.

View larger version (70K): [in a new window]   Fig. 1E —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Coronal images at level of subclavian vein (short arrows) and left atrium (long arrows) show visual quality of PET image is not compromised when IV contrast CT is used for attenuation correction. However, mean (maximum) ROI values of subclavian vein and left atrium increased to 1,962 (3,070) and 260 (283) on contrast-enhanced CT images compared with A–C, respectively. Corresponding PET SUV values were 1.3 (1.6) and 2.45 (3.0), an increase in SUVmax of 60% and 43%, respectively. E, Attenuation-corrected PET with unenhanced CT.

View larger version (86K): [in a new window]   Fig. 1F —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Coronal images at level of subclavian vein (short arrows) and left atrium (long arrows) show visual quality of PET image is not compromised when IV contrast CT is used for attenuation correction. However, mean (maximum) ROI values of subclavian vein and left atrium increased to 1,962 (3,070) and 260 (283) on contrast-enhanced CT images compared with A–C, respectively. Corresponding PET SUV values were 1.3 (1.6) and 2.45 (3.0), an increase in SUVmax of 60% and 43%, respectively. F, Coregistered PET/CT.

View larger version (95K): [in a new window]   Fig. 1G —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid small right upper lobe nodule (arrows). Mean (maximum) SUV values of nodule were 2.6 (3.9). Note slight misregistration of CT and PET images resulting from respiration. G, Unenhanced chest CT.

View larger version (64K): [in a new window]   Fig. 1H —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid small right upper lobe nodule (arrows). Mean (maximum) SUV values of nodule were 2.6 (3.9). Note slight misregistration of CT and PET images resulting from respiration. H, Attenuation-corrected PET with unenhanced CT.

View larger version (90K): [in a new window]   Fig. 1I —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid small right upper lobe nodule (arrows). Mean (maximum) SUV values of nodule were 2.6 (3.9). Note slight misregistration of CT and PET images resulting from respiration. I, Coregistered PET/CT.

View larger version (95K): [in a new window]   Fig. 1J —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show minimal perceived difference in visual uptake of 18F-FDG in nodule (arrows) compared with G–I, Mean (maximum) SUV values of nodule increased to 2.8 (4.2) compared with G–I, an increase of 8%. Note slight misregistration of CT and PET images resulting from respiration. J, IV contrast-enhanced chest CT.

View larger version (67K): [in a new window]   Fig. 1K —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show minimal perceived difference in visual uptake of 18F-FDG in nodule (arrows) compared with G–I, Mean (maximum) SUV values of nodule increased to 2.8 (4.2) compared with G–I, an increase of 8%. Note slight misregistration of CT and PET images resulting from respiration. K, Attenuation-corrected PET with enhanced CT.

View larger version (91K): [in a new window]   Fig. 1L —60-year-old man with esophageal cancer and lung metastasis. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show minimal perceived difference in visual uptake of 18F-FDG in nodule (arrows) compared with G–I, Mean (maximum) SUV values of nodule increased to 2.8 (4.2) compared with G–I, an increase of 8%. Note slight misregistration of CT and PET images resulting from respiration. L, Coregistered PET/CT.

View larger version (83K): [in a new window]   Fig. 2A —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid mediastinal nodal metastasis (arrows). Mean (maximum) standardized uptake values (SUV) values of lymph node were 3.2 (4.3). A, Unenhanced chest CT.

View larger version (81K): [in a new window]   Fig. 2B —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid mediastinal nodal metastasis (arrows). Mean (maximum) standardized uptake values (SUV) values of lymph node were 3.2 (4.3). B, Attenuation-corrected PET with enhanced CT.

View larger version (95K): [in a new window]   Fig. 2C —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid mediastinal nodal metastasis (arrows). Mean (maximum) standardized uptake values (SUV) values of lymph node were 3.2 (4.3). C, Coregistered PET/CT.

View larger version (84K): [in a new window]   Fig. 2D —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show slight perceived visual increase in 18F-FDG in node (arrows) when images are reconstructed with IV contrast-enhanced CT. Mean (maximum) SUV values of lymph node were 3.75 (5.1), an increase of 5% compared with A–C. Note mediastinal background 18F-FDG activity is similar compared with A–C and quality of PET image is not compromised when IV contrast-enhanced CT is used for attenuation correction. D, IV contrast-enhanced chest CT.

View larger version (82K): [in a new window]   Fig. 2E —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show slight perceived visual increase in 18F-FDG in node (arrows) when images are reconstructed with IV contrast-enhanced CT. Mean (maximum) SUV values of lymph node were 3.75 (5.1), an increase of 5% compared with A–C. Note mediastinal background 18F-FDG activity is similar compared with A–C and quality of PET image is not compromised when IV contrast-enhanced CT is used for attenuation correction. E, Attenuation-corrected PET with unenhanced CT.

View larger version (96K): [in a new window]   Fig. 2F —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show slight perceived visual increase in 18F-FDG in node (arrows) when images are reconstructed with IV contrast-enhanced CT. Mean (maximum) SUV values of lymph node were 3.75 (5.1), an increase of 5% compared with A–C. Note mediastinal background 18F-FDG activity is similar compared with A–C and quality of PET image is not compromised when IV contrast-enhanced CT is used for attenuation correction. F, Coregistered PET/CT.

View larger version (114K): [in a new window]   Fig. 2G —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid hepatic metastasis (arrows). Mean (maximum) SUV values of metastasis were 6.3 (7). G, Unenhanced abdomen CT.

View larger version (99K): [in a new window]   Fig. 2H —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid hepatic metastasis (arrows). Mean (maximum) SUV values of metastasis were 6.3 (7). H, Attenuation-corrected PET with enhanced CT.

View larger version (103K): [in a new window]   Fig. 2I —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show 18F-FDG-avid hepatic metastasis (arrows). Mean (maximum) SUV values of metastasis were 6.3 (7). I, Coregistered PET/CT.

View larger version (120K): [in a new window]   Fig. 2J —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show slight visual increase in 18F-FDG activity in hepatic metastasis (arrows). Mean (maximum) SUV values of hepatic metastasis were 7.2 (8.1), an increase of 16% compared with G–I. Note 18F-FDG activity in contrast-enhanced liver is similar to G–I when unenhanced CT is used for attenuation correction. J, IV contrast-enhanced abdomen CT.

View larger version (96K): [in a new window]   Fig. 2K —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show slight visual increase in 18F-FDG activity in hepatic metastasis (arrows). Mean (maximum) SUV values of hepatic metastasis were 7.2 (8.1), an increase of 16% compared with G–I. Note 18F-FDG activity in contrast-enhanced liver is similar to G–I when unenhanced CT is used for attenuation correction. K, Attenuation-corrected PET with enhanced CT.

View larger version (102K): [in a new window]   Fig. 2L —71-year-old man with non–small cell lung cancer after pneumonectomy presenting with nodal and hepatic metastases. Attenuation correction performed using unenhanced CT (A–C), (G–I) and IV contrast-enhanced CT (D–F), (J–L). Axial images show slight visual increase in 18F-FDG activity in hepatic metastasis (arrows). Mean (maximum) SUV values of hepatic metastasis were 7.2 (8.1), an increase of 16% compared with G–I. Note 18F-FDG activity in contrast-enhanced liver is similar to G–I when unenhanced CT is used for attenuation correction. L, Coregistered PET/CT.

View larger version (81K): [in a new window]   Fig. 3A —56-year-old man with non–small cell lung cancer manifesting as left upper lobe mass. Attenuation correction performed using unenhanced CT (A–C) and IV contrast-enhanced CT (D–F). Coronal images show 18F-FDG-avid mass (arrows). Mean (maximum) standardized uptake values (SUV) values of mass were 15.3 (21.4). A, Unenhanced chest CT.

View larger version (82K): [in a new window]   Fig. 3B —56-year-old man with non–small cell lung cancer manifesting as left upper lobe mass. Attenuation correction performed using unenhanced CT (A–C) and IV contrast-enhanced CT (D–F). Coronal images show 18F-FDG-avid mass (arrows). Mean (maximum) standardized uptake values (SUV) values of mass were 15.3 (21.4). B, Attenuation-corrected PET with unenhanced CT.

View larger version (90K): [in a new window]   Fig. 3C —56-year-old man with non–small cell lung cancer manifesting as left upper lobe mass. Attenuation correction performed using unenhanced CT (A–C) and IV contrast-enhanced CT (D–F). Coronal images show 18F-FDG-avid mass (arrows). Mean (maximum) standardized uptake values (SUV) values of mass were 15.3 (21.4). C, Coregistered PET/CT.

View larger version (84K): [in a new window]   Fig. 3D —56-year-old man with non–small cell lung cancer manifesting as left upper lobe mass. Attenuation correction performed using unenhanced CT (A–C) and IV contrast-enhanced CT (D–F). Coronal images show no perceived visual increase in 18F-FDG activity in mass (arrows) compared with A–C. Mean (maximum) SUV values of mass were 17.3 (24.6), an increase of 14.9% compared with A–C. Note 18F-FDG activity in contrast-enhanced right subclavian vein and heart is similar to A–C when unenhanced CT is used for attenuation correction. D, IV contrast-enhanced chest CT.

View larger version (85K): [in a new window]   Fig. 3E —56-year-old man with non–small cell lung cancer manifesting as left upper lobe mass. Attenuation correction performed using unenhanced CT (A–C) and IV contrast-enhanced CT (D–F). Coronal images show no perceived visual increase in 18F-FDG activity in mass (arrows) compared with A–C. Mean (maximum) SUV values of mass were 17.3 (24.6), an increase of 14.9% compared with A–C. Note 18F-FDG activity in contrast-enhanced right subclavian vein and heart is similar to A–C when unenhanced CT is used for attenuation correction. E, Attenuation-corrected PET with enhanced CT.

View larger version (86K): [in a new window]   Fig. 3F —56-year-old man with non–small cell lung cancer manifesting as left upper lobe mass. Attenuation correction performed using unenhanced CT (A–C) and IV contrast-enhanced CT (D–F). Coronal images show no perceived visual increase in 18F-FDG activity in mass (arrows) compared with A–C. Mean (maximum) SUV values of mass were 17.3 (24.6), an increase of 14.9% compared with A–C. Note 18F-FDG activity in contrast-enhanced right subclavian vein and heart is similar to A–C when unenhanced CT is used for attenuation correction. F, Coregistered PET/CT.

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