Influence of PET/CT-introduction on PET scanning frequency and indications

H. Stergar; A. Bockisch; S. M. Eschmann; B. J. Krause; R. Rödel; R. Tiling; M. Weckesser

doi:10.1055/s-0037-1621024

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2007; 46(02): 57-64
DOI: 10.1055/s-0037-1621024

Grußwort

Schattauer GmbH

Influence of PET/CT-introduction on PET scanning frequency and indications

Results of a multicenter studyEinfluss der Einführung von PET/CT auf das PETUntersuchungsspektrum und die UntersuchungszahlenErgebnisse einer Multizenterstudie

H. Stergar

¹Departments of Nuclear Medicine, University Hospital Essen

,

A. Bockisch

¹Departments of Nuclear Medicine, University Hospital Essen

,

S. M. Eschmann

²Departments of Nuclear Medicine, University Hospital Tübingen

,

B. J. Krause

³Departments of Nuclear Medicine, Technical University Munich

,

R. Rödel

⁴Departments of Nuclear Medicine, University Hospital Bonn

,

R. Tiling

⁵Departments of Nuclear Medicine, University of Munich

,

M. Weckesser

⁶Departments of Nuclear Medicine, University Hospital Münster, Germany

› Author Affiliations

Abstract

Summary

Aim: To evaluate the influence of the introduction of combined PET/CT scanners into clinical routine. This investigation addresses the quantitative changes between PET/CT and stand alone PET. Methods: The study included all examinations performed on stand alone PET- or PET/CTscanners within 12 month prior to and after implementation of PET/CT. The final data analysis included five university hospitals and a total number of 15 497 exams. We distinguished exams on stand alone tomographs prior to and after installation of the combined device as well as PET/CT scans particularly with regard to disease entities. Various further parameters were investigated. Results: The overall number of PET scans (PET and PET/CT) rose by 146% while the number of scans performed on stand alone scanners declined by 22%. Only one site registered an increase in stand alone PET. The number of exams for staging in oncology increased by 196% while that of cardiac scans decreased by 35% and the number of scans in neurology rose by 47%. The use of scans for radiotherapy planning increased to 7% of all PET/CT studies. The increase of procedures for so-called classic PET oncology indications was moderate compared to the more common tumors. An even greater increase was observed in some rare entities. Conclusions: The introduction of PET/CT led to more than a doubling of overall PET procedures with a main focus on oncology. Some of the observed changes in scanning frequency may be caused by a rising availability of new radiotracers and advancements of competing imaging methods. Nevertheless the evident increase in the use of PET/CT for the most common tumour types demonstrates its expanding role in cancer staging. The combination of molecular and morphologic imaging has not only found its place but is still gaining greater importance with new developments in technology and radiochemistry.

Zusammenfassung

Ziel: In dieser multizentrischen Studie wurde die Auswirkung der Einführung von PET/CT-Geräten auf das Untersuchungsspektrum und die absolute Anzahl von PET-Untersuchungen analysiert. Methoden: In jeweils den 12 Monaten direkt vor und nach Einführung der PET/CT wurden alle Patienten erfasst, die mit dedizierter PET oder mit PET/CT untersucht worden waren. Bei insgesamt 15 497 Untersuchungen wurden die Zuweisungsdiagnosen erfasst für: Untersuchung am dedizierten PET vor bzw. nach Installation des PET/CT sowie am PET/CT selbst. Verschiedene weitere Parameter wurden berücksichtigt. Ergebnisse: Die Gesamtzahl an PET-Untersuchungen (PET + PET/CT) stieg um 146% während die Zahl der Studien an dedizierten Geräten um 22% sank. Nur ein Zentrum verzeichnete einen Anstieg an PET-Untersuchungen am dedizierten Scanner. Die Anzahl onkologischer Untersuchungen stieg um 196% an, während die Zahl kardiologischer Indikationen um 35% fiel und bei neurologischen Untersuchungen ein Anstieg um 47% festgestellt wurde. Der Anteil der Studien zur Bestrahlungsplanung stieg auf 7% der PET/CT-Untersuchungen. Die so genannten klassischen PET-Indikationen waren hinsichtlich des Anstiegs der Untersuchungszahlen unterproportional vertreten, wohingegen die häufigen Tumorentitäten überproportionale Anstiege aufwiesen. Ein noch höherer Anstieg fand sich bei selteneren Entitäten. Schlussfolgerungen: Die Einführung der PET/CT führte zu mehr als einer Verdoppelung der Gesamtzahl an PET-Untersuchungen. Der Anstieg resultiert in erster Linie aus onkologischen Fragestellungen, was zu einer Schwerpunktverschiebung führt. Auch fest etablierte PET-Indikationen zeigen eine deutliche Steigerung der Untersuchungsfrequenz. Dies zeigt, dass die Kombination der PET mit der Morphologie den Bedürfnissen des klinischen Umfeldes entspricht und dadurch auch neue Felder (z. B. Strahlentherapieplanung) erschlossen werden. Die beobachteten Veränderungen lassen sich teilweise auf die bessere Verfügbarkeit neuer Radiopharmaka und auf Fortschritte konkurrierender bildgebender Verfahren zurückführen. Die große Zahl unterschiedlicher Radiotracer spricht dafür, dass der Erfolg der PET/CT nicht nur auf die Verwendung von FDG beschränkt ist.

Keywords

Diagnostic imaging - positron emission tomography - computed tomography - PET/CT

Schlüsselwörter

Diagnostische Bildgebung - Positronenemisstionstomographie - Computertomographie - PET/CT

Full Text

References

References
1 Antoch G, Freudenberg LS, Stattaus J. et al. Whole-body positron emission tomography-CT: optimized CT using oral and IV contrast materials. AJRAmJRoentgenol 2002; 179: 1555-1560.
2 Antoch G, Kanja J, Bauer S. et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med 2004; 45: 357-365.
3 Antoch G, Saoudi N, Kuehl H. et al. Accuracy of whole-body dual-modality fluorine-18-2-flu- oro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/ CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004; 22: 4357-4368.
4 Antoch G, Stattaus J, Nemat AT. et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 2003; 229: 526-533.
5 Baks T, Cademartiri F, Moelker AD. et al. Multi- slice computed tomography and magnetic resonance imaging for the assessment of reperfused acute myocardial infarction. J Am Coll Cardiol 2006; 48: 144-152.
6 Bar-Sever Z, Keidar Z, Ben-Barak A. et al. The incremental value of (18)F-FDG PET/CT in paedia- tric malignancies. Eur J Nucl Med Mol Imaging. 2006 Epub ahead of print.
7 Bar-Shalom R, Guralnik Tsalic ML. et al. The additional value of PET/CT over PET in FDG imaging of oesophageal cancer. Eur J Nucl Med Mol Imaging 2005; 32: 918-924.
8 Bar-Shalom R, Yefremov N, Guralnik L. et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 2003; 44: 1200-1209.
9 Beyer T, Antoch G, Bockisch A. et al. Optimized intravenous contrast administration for diagnostic whole-body 18F-FDG PET/CT. J Nucl Med 2005; 46: 429-435.
10 Beyer T, Bockisch A, Kühl H. et al. Whole-Body 18F-FDG PET/CT in the presence oftruncation artifacts. J Nucl Med 2006; 47: 91-99.
11 Beyer T, Rosenbaum S, Veit P. et al. Respiration artifacts in whole-body 18F-FDG PET/CT studies with combined PET/CT tomographs employing spiral CT technology with 1 to 16 detector rows. Eur J Nucl Med Mol Imaging 2005; 32: 1429-1439.
12 Beyer T, Townsend DW, Brun T. et al. A combined PET/CT scanner for clinical oncology. J Nucl Med 2000; 41: 1369-1379.
13 Bockisch A, Beyer T, Antoch G. et al. Positron emission tomography/computed tomography-imaging protocols, artifacts, and pitfalls. Mol Imaging Biol 2004; 6: 188-199.
14 Branstetter 4th BF, Blodgett TM, Zimmer LA. et al. Head and neck malignancy: is PET/CT more accurate than PET or CT alone?. Radiology 2005; 235: 580-586.
15 Cohade C, Osman M, Leal J. et al. Direct comparison of 18F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003; 44: 1797-1803.
16 Franzius C, Bielack S, Flege S. et al. Prognostic significance of 18F-FDG and 99mTc-methylene diphosphonate uptake in primary osteosarcoma. J Nucl Med 2002; 43: 1012-1017.
17 Franzius C, Hermann K, Weckesser M. et al. Whole-body PET/CT with uC-meta-hydroxyep- hedrine in tumors of the sympathetic nervous system: feasibility study and comparison with 123I-MIBG SPECT/CT. J Nucl Med 2006; 47: 1635-1642.
18 Franzius C, Juergens KU, Schober O. Is PET/CT necessary in paediatric oncology? For. Eur J Nucl Med Mol Imaging 2006; 33: 960-965.
19 Freudenberg LS, Antoch G, Schutt P. et al. FDG- PET/CT in re-staging of patients with lymphoma. Eur J Nucl Med Mol Imaging 2004; 31: 325-329.
20 Freudenberg LS, Antoch G, Jentzen W. et al. Value of 124I-PET/CT in staging of patients with differentiated thyroid cancer. Eur Radiol 2004; 14: 2092-2098.
21 Groves AM, Kayani I, Dickson JC. et al. Oral contrast medium in PET/CT: should you or shouldn't you?. Eur J Nucl Med Mol Imaging 2005; 32: 1160-1166.
22 Hermann S, Wormanns D, Pixberg M. et al. Staging in childhood lymphoma: differences between FDG-PET and CT. Nuklearmedizin 2005; 44: 1-7.
23 Hunold P, Brandt-Mainz K, Freudenberg L. et al. Evaluation of myocardial viability with contrast- enhancedmagnetic resonance imaging-compari- son of the late enhancement technique with positron emission tomography. Röfo 2002; 174: 867-873.
24 Juergens KU, Weckesser M, Stegger L. et al. Tumor staging using whole-body high-resolution 16-channel PET-CT: does additional low-dose chest CT in inspiration improve the detection of solitarypulmonarynodules?. Eur Radiol 2006; 16: 1131-1137.
25 Khan MA, Combs CS, Brunt EM. et al. Positron emission tomography scanning in the evaluation of hepatocellular carcinoma. J Hepatol 2000; 32: 792-797.
26 Kim YJ, Yun M, Lee WJ. et al. Usefulness of 18F-FDG PET in intrahepatic cholangiocarcino- ma. Eur J Nucl Med Mol Imaging 2003; 30: 1467-1472.
27 Kuhl HP, Beek AM, van der Weerdt AP. et al. Myocardial viability in chronic ischemic heart disease: comparison of contrast-enhanced magnetic resonance imaging with 18F-fluorodeoxy- glucose positron emission tomography. J Am Coll Cardiol 2003; 41: 1341-1348.
28 Leber AW, Knez A, von Ziegler F. et al. Quantification of obstructive and nonobstructive coronary lesions by 64-slice computed tomography: a comparative study with quantitative coronary angiography and intravascular ultrasound. J Am Coll Cardiol 2005; 46: 147-154.
29 Löffler M, Weckesser M, Franzius C. et al. High diagnostic value of 18F-FDG-PET in pediatric patients with chronic inflammatory bowel disease. Ann NY Acad Sci 2006; 1072: 379-385.
30 Nakamoto Y, Chin BB, Kraitchman DL. et al. Effects of nonionic intravenous contrast agents at PET/CT imaging: phantom and canine studies. Radiology 2003; 227: 817-824.
31 Namdar M, HanyT F, Koepfli P. et al. Integrated PET/ CT for the assessment of coronary artery disease: a feasibility study. J Nucl Med 2005; 46: 930-935.
32 Petrowsky H, Wildbrett P, Husarik DB. et al. Impact of integrated positron emission tomography and computed tomography on staging and management of gallbladder cancer and cholangioc- arcinoma. J Hepatol 2006; 45: 43-50.
33 Reske SN, Kotzerke J. FDG-PET for clinical use. Results of the 3rd German Interdisciplinary Consensus Conference, “Onko-PET III”, 21 July and 19 September 2000. Eur J Nucl Med 2001; 28: 1707-1723.
34 Shim SS, Lee KS, Kim BT. et al. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology 2005; 236: 1011-1019.