FDG PET and Split-Bolus Multi-Detector Row CT Fusion Imaging in Oncologic Patients: Preliminary Results

To assess the incremental value of split-bolus multidetector computed tomography (CT) combined with fluorine 18 fluorodeoxyglucose (FDG) positron emission tomography (PET) for follow-up of oncologic patients.

The institutional ethics committee approved the use of this protocol. Thirty-eight oncologic patients who underwent FDG PET/unenhanced multidetector CT and split-bolus multidetector CT for restaging were investigated retrospectively. The split-bolus CT protocol included imaging during the hepatic arterial and portal venous phases in one scan. Software was used for fusion of the independently acquired FDG PET and split-bolus CT data, and fused datasets were compared with FDG PET/unenhanced CT data. The standard of reference for diagnosis of lesions in all patients was a combination of histologic results (if available), clinical results (medical history, physical examination, and laboratory test results), and the results of follow-up imaging (conventional CT, magnetic resonance imaging, and/or ultrasonography) for at least 6 months. Descriptive statistics were used.

Fifty-nine true-positive lesions were identified with fused FDG PET/split-bolus CT; 41 were concordant and detected with both split-bolus CT and PET/unenhanced CT, 16 with split-bolus CT only, and two with PET/unenhanced CT. Two different false-positive lesions were identified with PET/unenhanced CT and PET/split-bolus CT. Furthermore, in 20 of 38 (53%) patients, FDG PET/split-bolus CT allowed detection of important additional findings (n = 40) not detected at FDG PET/unenhanced CT. Both the tumor-related findings (n = 13, 32.5%) and the non-tumor-related findings (n = 27, 67.5%) were important to the clinical treatment of these patients.

Fused FDG PET/split-bolus multidetector CT provides additional information compared with FDG PET/unenhanced multidetector CT in oncologic patients.