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Discussing the future of PET/CT at ECR 2016

by Gus Iversen, Editor in Chief | March 02, 2016
CT Molecular Imaging Rad Oncology X-Ray
Dr. Christian Rimny
As radiology professionals converged on Vienna over the last few days, there has been mounting anticipation for this year's meeting of the European Congress of Radiology (ECR). HCB News was there to see and hear the opening day announcements and presentations as they happened, and some of the most interesting items pertained to molecular imaging.

In a scientific session dedicated to PET/CT and MR in oncology, researchers from around the world showcased their findings with relation to the prospects and limitations of molecular imaging. Many of the presentations focused on FDG but Dr. Christian Uprimny from Austria's Medical University Innsbruck, Department of Nuclear Medicine, showcased promising research on Gallium-68 as a PET/CT agent for primary staging of prostate cancer.

He described a retrospective study in which 60 out of 63 patients with biopsy-proven prostate cancer showed increased prostate specific membrane antigen (PSMA) expression at primary staging, while detecting small-size PSMA-positive lymph nodes and bone lesion visualization consistent with bone metastases.
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"Median uptake was higher but in some cases it was low," said Uprimny. "Correlation with Gleason scores lower than 10 had lower median than those with higher, but there were outliers."

Since it was a retrospective study, more research is needed but the research contributes to growing evidence for — and interest in — Gallium-68 as an imaging agent.

A team from Ohio State University discussed research conducted using a pre-commercial Vereos Digital PET/CT system from Philips. They cited improved sensitivity and time of flight as benefits, but discussed the challenges pertaining to reconstruction protocols on the new, HD-capable system.

The team determined that directly applying reconstruction protocols that are used in conventional PET/CT leads to degraded image quality, so defining new protocols is necessary — and the voxels of the image are a big factor in selecting how to reconstruct.

Using the exams of 35 patients who received FDG, they tried to determine the right number of subsets to maximize the quality of the diagnostic image. To accomplish this, three expert reviewers judged image quality and determined that at a voxel volume of 4mm, 13 and 9 subsets images became too smooth and exceeding 17 subsets resulted in too much image noise. When looking at 2mm voxel volumes they discovered comparable findings, but the ideal number of subsets was determined to be slightly less than with the larger volume sets, (13 and 15, respectively).

Reaching convergence much earlier in reconstruction than with conventional PET imaging — as is accomplished with the digital system — could yield benefits for low-dose imaging, ultra fast acquisitions, and possibly allow for an ultra HD 1mm whole body image, according to the Ohio State presenters.

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