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Quantification of 18F-FDG Delivery Rate for Liver Inflammation Using Shortened Dynamic PET Imaging Protocols
Xiaoyu Duan1, Souvik Sarkar1,2, Victoria Lyo3
1Department of Radiology, University of California Davis Health, Sacramento, California.
Abstract:
Liver inflammation is a diagnostic hallmark of metabolic dysfunction-associated steatohepatitis (MASH), a severe form of chronic metabolic dysfunction-associated steatotic liver disease. 18F-FDG delivery rate (K 1) in the liver, measured by dynamic PET with tracer kinetic modeling, has the potential to assess liver inflammation and diagnose MASH noninvasively. However, a 1-h scan protocol is typically used to generate the liver [Formula: see text], which is less practical for clinical use. In this study, we aimed to investigate shortened scan protocols for quantification of liver 18F-FDG [Formula: see text] in patients with MASH. Methods: Eighty-two subjects, including 68 patients with metabolic dysfunction-associated steatotic liver disease and 14 healthy volunteers, were scanned on either a short-axial-field-of-view PET/CT scanner or a total-body PET/CT system following a full 1-h dynamic scan protocol. Two shortened scan protocols were proposed with appropriate tracer kinetic models: a 15-min dynamic scan with a 2-tissue reversible model and a 10-min dynamic scan with a 2-tissue irreversible model. Liver [Formula: see text] values generated from the shortened scan protocols were compared with those generated from the full 1-h scan and used to assess biopsy-determined liver inflammation and MASH using receiver-operating-characteristic analysis. Results: Liver 18F-FDG [Formula: see text] values generated from the shortened scan protocols were approximately equal to [Formula: see text] values generated from the full 1-h scan. Such [Formula: see text] showed equivalent capability to differentiate between healthy, low-inflammation, and high-inflammation groups (P < 0.0005), similar to the [Formula: see text] obtained from a full 1-h scan. When combined with liver CT that assesses steatosis, the 2 shortened scan protocols achieved an area under the curve of 0.95 for receiver-operating-characteristic analysis when differentiating MASH and non-MASH with both scanners. Conclusion: It is feasible to develop a liver PET/CT parametric imaging approach using a dynamic scan of 15 min or less with an appropriate tracer kinetic model for evaluating liver inflammation and diagnosing MASH on both total-body and conventional PET scanners. The 2 proposed shortened scan protocols are more practical than the 1-h protocol for measuring liver 18F-FDG [Formula: see text].
Insights
Shortened 18F-FDG PET scan protocols can accurately assess liver inflammation and diagnose metabolic dysfunction-associated steatopathy (MASH). These faster methods are more practical for clinical use than the standard 1-hour scan.
Area of Science:
- Nuclear Medicine
- Radiochemistry
- Medical Imaging
Background:
- Liver inflammation is a key indicator of metabolic dysfunction-associated steatohepatitis (MASH).
- Dynamic PET imaging with 18F-FDG tracer kinetic modeling can noninvasively assess liver inflammation and MASH.
- Current 1-hour scan protocols for liver 18F-FDG K1 quantification are not clinically practical.
Purpose of the Study:
- To investigate shortened dynamic PET scan protocols for quantifying liver 18F-FDG K1 in MASH patients.
- To evaluate the feasibility of using reduced scan times for MASH diagnosis.
Main Methods:
- Eighty-two subjects (68 MASH patients, 14 healthy volunteers) underwent a 1-hour dynamic PET scan.
- Two shortened protocols were tested: 15-min (2-tissue reversible model) and 10-min (2-tissue irreversible model).
- Liver 18F-FDG K1 values from shortened protocols were compared to the full 1-hour scan and correlated with biopsy data.
Main Results:
- Shortened protocols yielded liver 18F-FDG K1 values comparable to the full 1-hour scan.
- K1 values from shortened protocols effectively differentiated between healthy, low-, and high-inflammation groups (P < 0.0005).
- Combined with CT for steatosis assessment, shortened protocols achieved an AUC of 0.95 for MASH differentiation.
Conclusions:
- Feasible liver PET/CT parametric imaging for MASH evaluation using dynamic scans of 15 minutes or less.
- Shortened protocols are more practical and clinically applicable than the 1-hour protocol for liver 18F-FDG K1 measurement.
- This approach enables noninvasive assessment of liver inflammation and MASH diagnosis using total-body and conventional PET scanners.
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