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Review
. 2020;13(3):218-227.
doi: 10.2174/1874471013666200317144629.

Respiratory Gating and the Performance of PET/CT in Pulmonary Lesions

Cinzia Crivellaro  1 , Luca Guerra  1   2
Affiliations
Review

Respiratory Gating and the Performance of PET/CT in Pulmonary Lesions

Cinzia Crivellaro et al. Curr Radiopharm. 2020.

Abstract

Background: Motion artifacts related to the patient's breathing can be the cause of underestimation of the lesion uptake and can lead to missing of small lung lesions. The respiratory gating (RG) technology has demonstrated a significant increase in image quality.

Objective: The aim of this paper was to evaluate the advantages of RG technique on PET/CT performance in lung lesions. The impact of 4D-PET/CT on diagnosis (metabolic characterization), staging and re-staging lung cancer was also assessed, including its application for radiotherapy planning. Finally, new technologies for respiratory motion management were also discussed.

Methods: A comprehensive electronic search of the literature was performed by using Medline database (PubMed) searching "PET/CT", "gated" and "lung". Original articles, review articles, and editorials published in the last 10 years were selected, included and critically reviewed in order to select relevant articles.

Results: Many papers compared Standardized Uptake Value (SUV) in gated and ungated PET studies showing an increase in SUV of gated images, particularly for the small lesions located in medium and lower lung. In addition, other features as Metabolic Tumor Volume (MTV), Total Lesion Glycolysis (TLG) and textural-features presented differences when obtained from gated and ungated PET acquisitions. Besides the increase in quantification, gating techniques can determine an increase in the diagnostic accuracy of PET/CT. Gated PET/CT was evaluated for lung cancer staging, therapy response assessment and for radiation therapy planning.

Conclusion: New technologies able to track the motion of organs lesion directly from raw PET data, can reduce or definitively solve problems (i.e.: extended acquisition time, radiation exposure) currently limiting the use of gated PET/CT in clinical routine.

Keywords: 4D-PET/TC; PET/CT; lung cancer; pulmonary lesions; radiomics; respiratory gating.

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Figures

Fig. (1)
Fig. (1)
WB 18F-FDG PET /CT study (A) conducted to characterize 2 lung nodules in an oncologic patient. Sagittal (B) and axial (C) CT images confirmed the presence of two nodules in the upper lobe of the left lung. The PET data on the chest (1 FOV) were acquired in LIST mode and then reconstructed with and without respiratory-gated synchronization. The WB ungated study (D) shows only one focal uptake of the tracer, whereas the gated PET axial image (E) clearly demonstrates that both nodules have metabolic activity. (A higher resolution / colour version of this figure is available in the electronic copy of the article).
See this image and copyright information in PMC

References

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