title: The influence of different contrast medium concentrations and injection protocols on quantitative and clinical assessment of FDG-PET/CT in lung cancer.
abstract: OBJECTIVE
  To compare the effects of two different contrast medium concentrations for use in computed X-ray tomography (CT) employing two different injection protocols on positron emission tomography (PET) reconstruction in combined 2-(18)F-desoxyglucose (FDG) PET/CT in patients with a suspicion of lung cancer.
  
  
  METHODS
  120 patients with a suspicion of lung cancer were enrolled prospectively. PET images were reconstructed with the non-enhanced and venous phase contrast CT obtained after injection of iopromide 300 mg/ml or 370 mg/ml using either a fixed-dose or a body surface area adapted injection protocol. Maximum and mean standardized uptake values (SUV(max) and SUV(mean)) and contrast enhancement (HU) were determined in the subclavian vein, ascending aorta, abdominal aorta, inferior vena cava, portal vein, liver and kidney and in the suspicious lung lesion. PET data were evaluated visually for the presence of malignancy and image quality.
  
  
  RESULTS
  At none of the sites a significant difference in the extent of the contrast enhancement between the four different protocols was found. However, the variability of the contrast enhancement at several anatomical sites was significantly greater in the fixed dose groups than in the BSA groups for both contrast medium concentrations. At none of the sites a significant difference was found in the extent of the SUV(max) and SUV(mean) increase as a result of the use of the venous phase contrast enhanced CT for attenuation. Visual clinical evaluation of lesions showed no differences between contrast and non-contrast PET/CT (P=0.32).
  
  
  CONCLUSIONS
  Contrast enhanced CT for attenuation correction in combined PET/CT in lung cancer affects neither the clinical assessment nor image quality of the PET-images. A body surface adapted contrast medium protocol reduces the interpatient variability in contrast enhancement.
authors.affiliation: RWTH Aachen University Hospital, Department of Nuclear Medicine, Pauwelsstraße 30, 52074 Aachen, Germany. fverburg@ukaachen.de
authors.forename: Frederik A
authors.initials: FA
authors.lastname: Verburg
authors.forename: Christiane K
authors.initials: CK
authors.lastname: Kuhl
authors.forename: Hubertus
authors.initials: H
authors.lastname: Pietsch
authors.forename: Moritz
authors.initials: M
authors.lastname: Palmowski
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Florian F
authors.initials: FF
authors.lastname: Behrendt
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007275:Injections, Intravenous / Q000379:methods; D007472:Iohexol / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D007472:Iohexol; C038192:iopromide
keywords: Attenuation correction; Contrast medium; Lung cancer; PET/CT; SUV