title: Towards real-time topical detection and characterization of FDG dose infiltration prior to PET imaging.
abstract: OBJECTIVE
  To dynamically detect and characterize18F-fluorodeoxyglucose (FDG) dose infiltrations and evaluate their effects on positron emission tomography (PET) standardized uptake values (SUV) at the injection site and in control tissue.
  
  
  METHODS
  Investigational gamma scintillation sensors were topically applied to patients with locally advanced breast cancer scheduled to undergo limited whole-body FDG-PET as part of an ongoing clinical study. Relative to the affected breast, sensors were placed on the contralateral injection arm and ipsilateral control arm during the resting uptake phase prior to each patient's PET scan. Time-activity curves (TACs) from the sensors were integrated at varying intervals (0-10, 0-20, 0-30, 0-40, and 30-40 min) post-FDG and the resulting areas under the curve (AUCs) were compared to SUVs obtained from PET.
  
  
  RESULTS
  In cases of infiltration, observed in three sensor recordings (30 %), the injection arm TAC shape varied depending on the extent and severity of infiltration. In two of these cases, TAC characteristics suggested the infiltration was partially resolving prior to image acquisition, although it was still apparent on subsequent PET. Areas under the TAC 0-10 and 0-20 min post-FDG were significantly different in infiltrated versus non-infiltrated cases (Mann-Whitney, p < 0.05). When normalized to control, all TAC integration intervals from the injection arm were significantly correlated with SUVpeakand SUVmaxmeasured over the infiltration site (Spearman ρ ≥ 0.77, p < 0.05). Receiver operating characteristic (ROC) analyses, testing the ability of the first 10 min of post-FDG sensor data to predict infiltration visibility on the ensuing PET, yielded an area under the ROC curve of 0.92.
  
  
  CONCLUSIONS
  Topical sensors applied near the injection site provide dynamic information from the time of FDG administration through the uptake period and may be useful in detecting infiltrations regardless of PET image field of view. This dynamic information may also complement the static PET image to better characterize the true extent of infiltrations.
authors.affiliation: Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, AA-1105 Medical Center North, Nashville, TN, 37232-2310, USA. jason.m.williams@vanderbilt.edu.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Williams
authors.affiliation: Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, AA-1105 Medical Center North, Nashville, TN, 37232-2310, USA.
authors.forename: Lori R
authors.initials: LR
authors.lastname: Arlinghaus
authors.affiliation: Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, AA-1105 Medical Center North, Nashville, TN, 37232-2310, USA.|Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Sudheer D
authors.initials: SD
authors.lastname: Rani
authors.affiliation: Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Martha D
authors.initials: MD
authors.lastname: Shone
authors.affiliation: Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
authors.forename: Vandana G
authors.initials: VG
authors.lastname: Abramson
authors.affiliation: Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: Praveen
authors.initials: P
authors.lastname: Pendyala
authors.affiliation: Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.|Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: A Bapsi
authors.initials: AB
authors.lastname: Chakravarthy
authors.affiliation: Lucerno Dynamics, LLC, Morrisville, NC, USA.
authors.forename: William J
authors.initials: WJ
authors.lastname: Gorge
authors.affiliation: Lucerno Dynamics, LLC, Morrisville, NC, USA.
authors.forename: Joshua G
authors.initials: JG
authors.lastname: Knowland
authors.affiliation: Lucerno Dynamics, LLC, Morrisville, NC, USA.
authors.forename: Ronald K
authors.initials: RK
authors.lastname: Lattanze
authors.affiliation: Lucerno Dynamics, LLC, Morrisville, NC, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Perrin
authors.affiliation: Lucerno Dynamics, LLC, Morrisville, NC, USA.|Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Scarantino
authors.affiliation: Lucerno Dynamics, LLC, Morrisville, NC, USA.|Clinical Imaging Research Centre, Agency for Science, Technology and Research-National University of Singapore, Singapore, Singapore.
authors.forename: David W
authors.initials: DW
authors.lastname: Townsend
authors.affiliation: Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, 1161 21st Avenue South, AA-1105 Medical Center North, Nashville, TN, 37232-2310, USA.|Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt-Ingram Cancer Center, Nashville, TN, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Abramson
authors.affiliation: Institute for Computational and Engineering Sciences, and Departments of Biomedical Engineering and Internal Medicine, The University of Texas at Austin, Austin, TX, USA.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Yankeelov
mesh_terms: D065567:Absorption, Physiological; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000378:metabolism*; D003199:Computer Systems; D016903:Drug Monitoring / Q000295:instrumentation; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D006801:Humans; D007267:Injections; D008657:Metabolic Clearance Rate; D011829:Radiation Dosage; D019275:Radiopharmaceuticals / Q000008:administration & dosage / Q000493:pharmacokinetics*; D015203:Reproducibility of Results; D012588:Scintillation Counting / Q000295:instrumentation* / Q000379:methods; D012680:Sensitivity and Specificity; D014018:Tissue Distribution
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Extravasation; Infiltration; Radiotracer injection; Standardized uptake value accuracy; Time-activity curve; Topical scintillation device