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FDG Extravasation in PET/CT Imaging: A Visual Grading Approach Based on Clinical Observations
1Department of Nuclear Medicine, Bursa Uludag University, Medical Faculty, Bursa, Turkey.
A new visual grading system for fluorodeoxyglucose (FDG) extravasation in PET/CT scans shows that even minor leakage can significantly impact standardized uptake value (SUV) measurements, affecting diagnostic accuracy.
Area of Science:
- Nuclear Medicine
- Radiology
- Oncologic Imaging
Background:
- Fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is crucial for cancer staging and monitoring.
- FDG extravasation during injection can degrade image quality and affect quantitative analysis.
- Standardized uptake value (SUV) measurements are key quantitative metrics in PET/CT, but their reliability can be compromised by artifacts like extravasation.
Purpose of the Study:
- To develop and validate a practical, visual grading system for FDG extravasation in PET/CT.
- To assess the impact of FDG extravasation on semi-quantitative SUV measurements in reference regions (liver and mediastinal blood pool).
- To provide a framework for improved clinical interpretation and reporting of PET/CT scans affected by extravasation.
Main Methods:
- Retrospective analysis of 235 oncologic PET/CT scans.
- Development of a 4-grade visual system (Grade 0-3) to classify FDG extravasation severity.
- Measurement of mean SUVmax and SUVmean in liver and mediastinal blood pool regions for each grade.
- Statistical analysis using ANOVA and post hoc testing to compare SUV values across grades.
Main Results:
- FDG extravasation was present in 31.9% of scans (75/235 patients).
- Statistically significant increases in liver and mediastinal SUV values were observed in patients with Grade 1 and Grade 2 extravasation compared to Grade 0 (p < 0.001).
- Liver SUVmax increased by up to 16.6% and mediastinal SUVmean by up to 20.6% in patients with low-to-moderate extravasation, potentially impacting interpretation.
Conclusions:
- Low-to-moderate FDG extravasation significantly alters reference SUV values in PET/CT.
- Implementing extravasation grading in clinical reports can enhance diagnostic consistency.
- Normalizing reference SUV values or accounting for extravasation may reduce the need for repeat imaging and improve diagnostic reliability.
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