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

2020 ◽  
Vol 13 (3) ◽  
pp. 218-227
Author(s):  
Cinzia Crivellaro ◽  
Luca Guerra
Keyword(s):  
Lung Cancer ◽  
New Technologies ◽  
Respiratory Gating ◽  
Motion Artifacts ◽  
Radiotherapy Planning ◽  
Acquisition Time ◽  
Lung Lesions ◽  
Gated Pet ◽  
Pet Ct ◽  
The Impact

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.

scholarly journals Systematic endobronchial ultrasound-guided transbronchial needle aspiration improves radiotherapy planning in non-small cell lung cancer

2019 ◽  
Vol 5 (3) ◽  
pp. 00004-2019 ◽  
Author(s):  
Aidan Joseph Cole ◽  
Nicholas Hardcastle ◽  
Guy-Anne Turgeon ◽  
Roshini Thomas ◽  
Louis B. Irving ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Needle Aspiration ◽  
Small Cell ◽  
Radiotherapy Planning ◽  
Endobronchial Ultrasound ◽  
Small Cell Lung ◽  
Transbronchial Needle Aspiration ◽  
Pet Ct ◽  
The Impact

ObjectivesPatients suitable for radical chemoradiotherapy for lung cancer routinely have radiotherapy (planning) volumes based on positron emission tomography (PET)-computed tomography (CT) imaging alone. Endobronchial ultrasound (EBUS)-guided transbronchial needle aspiration (TBNA) can identify PET-occult malignancy and benign PET-avid regions. We investigated the impact of EBUS-TBNA on curative-intent radiotherapy in non-small cell lung cancer (NSCLC).MethodsA prospective multicentre trial was undertaken, investigating the impact of systematic EBUS-TBNA in addition to PET-CT for patients considered for radical chemoradiotherapy with NSCLC. A subset analysis of patients with discordant findings between PET-CT and EBUS-TBNA was performed. Radiotherapy plans investigated tumour coverage and dose to critical organs at risk (OARs) using PET-CT alone in comparison to PET-CT and EBUS-TBNA.ResultsOf 30 patients enrolled, 10 had discordant findings between PET-CT and EBUS-TBNA. EBUS-TBNA-derived plans allowed for reduction in dose to OARs in patients downstaged by EBUS-TBNA, and reduced the risk of geographic miss in treating PET-occult disease in four patients where EBUS-TBNA identified malignant involvement of PET-negative lymphadenopathy. With the addition of EBUS-TBNA to radiotherapy planning, reductions were noted of 5.7%, 3.7% and 12.5% for the risks of symptomatic pneumonitis, mean heart dose and mean oesophageal dose, respectively.ConclusionsThis study demonstrates for the first time that systematic EBUS-TBNA prior to radical-intent radiotherapy significantly improves coverage of subclinical disease through detection of PET-occult metastases. Identification of false-positive lymph node involvement in highly selected cases may reduce radiation dose to critical structures, and risk of organ toxicity.

The effect of 18F-FDG-PET/CT respiratory gating on detected metabolic activity in lung lesions

2009 ◽  
Vol 23 (2) ◽  
pp. 191-196 ◽  
Author(s):  
Andrea Lupi ◽  
Marta Zaroccolo ◽  
Matteo Salgarello ◽  
Veronica Malfatti ◽  
Pierluigi Zanco
Keyword(s):  
Metabolic Activity ◽  
Fdg Pet ◽  
Respiratory Gating ◽  
Lung Lesions ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

INTRA-ACQUISITION VARIABILITY DURING PET/CT IN LUNG CANCER PATIENTS – IMPLICATIONS FOR RADIOTHERAPY-PLANNING

2009 ◽  
Vol 92 ◽  
pp. S41
Author(s):  
N. Marmouk ◽  
E. Van Mierlo ◽  
B. Verhoeven ◽  
A. Arens ◽  
M. van de Pol
Keyword(s):  
Lung Cancer ◽  
Cancer Patients ◽  
Radiotherapy Planning ◽  
Lung Cancer Patients ◽  
Pet Ct

The impact of [68Ga]PSMA I&T PET/CT on radiotherapy planning in patients with prostate cancer

2018 ◽  
Vol 194 (7) ◽  
pp. 646-654 ◽  
Author(s):  
Thorsten Frenzel ◽  
Milena Tienken ◽  
Merve Abel ◽  
Christoph Berliner ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiotherapy Planning ◽  
Pet Ct ◽  
The Impact

Etiology of Solitary Extrapulmonary Positron Emission Tomography and Computed Tomography Findings in Patients With Lung Cancer

2005 ◽  
Vol 23 (28) ◽  
pp. 6846-6853 ◽  
Author(s):  
Didier Lardinois ◽  
Walter Weder ◽  
Marina Roudas ◽  
Gustav K. von Schulthess ◽  
Michaela Tutic ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Lung Cancer ◽  
Positron Emission Tomography ◽  
Ct Imaging ◽  
Emission Tomography ◽  
Whole Body ◽  
Benign Tumors ◽  
Positron Emission ◽  
Pet Ct ◽  
The Impact

Purpose The aim of this prospective study was to assess the incidence and the nature of solitary extrapulmonary [18F] fluorodeoxyglucose (FDG) accumulations in patients with non–small-cell lung cancer (NSCLC) staged with integrated positron emission tomography and computed tomography (PET/CT) and to evaluate the impact on management. Patients and Methods A total of 350 patients with NSCLC underwent whole-body PET/CT imaging. All solitary extrapulmonary FDG accumulations were evaluated by histopathology, further imaging, or clinical follow-up. Results PET/CT imaging revealed extrapulmonary lesions in 110 patients. In 72 patients (21%), solitary lesions were present. A diagnosis was obtained in 69 of these patients, including 37 (54%) with solitary metastases and 32 (46%) with lesions unrelated to the lung primary. Histopathologic examinations of these 32 lesions revealed a second clinically unsuspected malignancy or a recurrence of a previous diagnosed carcinoma in six patients (19%) and a benign tumor or inflammatory lesion in 26 patients (81%). The six malignancies consisted of carcinoma of the breast in two patients, and carcinoma of the orbit, esophagus, prostate, and non-Hodgkin's lymphoma in one patient each. Benign tumors and inflammatory lesions included eight colon adenomas, four Warthin's tumors, one granuloma of the lower jaw, one adenoma of the thyroid gland, one compensatory muscle activity due to vocal chord palsy, two occurrences of arthritis, three occurrences of reflux esophagitis, two occurrences of pancreatitis, two occurrences of diverticulitis, one hemorrhoidal inflammation, and one rib fracture. Conclusion Solitary extrapulmonary FDG accumulations in patients with newly diagnosed lung cancer should be analyzed critically for correct staging and optimal therapy, given that up to half of the lesions may represent unrelated malignancies or benign disease.

The impact of respiratory gating on lung dosimetry in stereotactic body radiotherapy for lung cancer

2014 ◽  
Vol 30 (6) ◽  
pp. 682-689 ◽  
Author(s):  
Seong Soon Jang ◽  
Gil Ja Huh ◽  
Suk Young Park ◽  
Po Song Yang ◽  
Eun Youn Cho
Keyword(s):  
Lung Cancer ◽  
Stereotactic Body Radiotherapy ◽  
Respiratory Gating ◽  
The Impact

Abstract B32: The impact of PET-CT on staging, management, and prognostication of small cell lung cancer.

2014 ◽  
Vol 20 (2 Supplement) ◽  
pp. B32-B32
Author(s):  
Alona Zer ◽  
Yael Rapson ◽  
Meital Nadam ◽  
Dov Flex ◽  
Aaron M. Allen ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Small Cell Lung Cancer ◽  
Cell Lung Cancer ◽  
Small Cell ◽  
Small Cell Lung ◽  
Pet Ct ◽  
The Impact

Impact of 18F-fluorodeoxyglucose position emission tomography/computed tomography on radiotherapy treatment planning and outcomes in esophageal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 67-67
Author(s):  
Sweet Ping Ng ◽  
Jennifer Tan ◽  
Glen Osbourne ◽  
Luke Williams ◽  
Mathias Bressel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rates ◽  
Ct Scanning ◽  
Radiotherapy Planning ◽  
Position Emission Tomography ◽  
Pet Ct ◽  
Ct Data ◽  
The Impact ◽  
Radiotherapy Treatment

67 Background: Currently there is no universally accepted method to accurately delineate the gross tumor volume (GTV) of primary esophageal cancer in patients undergoing radiotherapy. This prospective study aims to determine the impact of PET/CT on radiotherapy planning and outcomes in patients with localized esophageal cancer. Methods: 54 patients were recruited between June 2003 - May 2008. All underwent PET/CT scanning in the radiotherapy treatment position and received treatment planned using the PET/CT dataset. Of these, 13 (24.1%) had metastatic disease detected on PET and 3 patients had no radical radiotherapy, while another 3 patients had missing planning PET/CT data (excluded from planning component analysis). GTV was defined separately on PET/CT (GTV-PET) and CT (GTV-CT) data sets. A corresponding planning target volume (PTV) was generated for each patient. Volumetric and spatial analysis quantified the proportion of FDG-avid disease not included in CT-based volumes. Clinical data was collected for 38 patients treated radically to determine locoregional control and overall survival rates. Results: Mean age was 67 years (range:32 - 88). Median follow up was 4 years (range:2.7 – 6.8). FDG-avid disease would have been excluded from GTV-CT in 29 patients (79%) with a mean volume of 17% (range:1-100%). In 5 patients, FDG-avid disease would have been completely excluded from the PTV-CT (median volume missed = 6%, range:2-92%). For 8 patients, less than 95% of PTV-PET would have received at least 95% of prescription dose based on the CT-based plan. GTV-CT underestimated the cranial and caudal extent of FDG-avid tumor in 14 (36%) and 10 (26%) patients respectively. There were no significant differences in radiation doses to the lungs and liver. 5-year overall survival and locoregional failure free survival were 24%, and 42% respectively. Conclusions: PET/CT prevented futile radiotherapy for 1 in 4 patients and avoided geographic misses without significant impact on normal tissues in apparently localized esophageal cancer. However, survival remains suboptimal and indicates the need for further improvement in planning and therapeutic paradigms.

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