Quantitative FDG PET/CT in the community: Experience from interpretation of outside oncologic PET/CT exams in referred cancer patients

Abstract

Tertiary care institutions often deal with patients who have had a baseline positron emission tomography (PET)/computed tomography (CT) scan performed elsewhere. Little data exist regarding the quality of these PET/CT scans and whether they are fully suitable for qualitative or quantitative interpretation. We evaluated outside PET/CT scans from cancer patients referred to our institution and compared them with PET/CT scans acquired locally. This Health Insurance Portability and Accountability Act-compliant retrospective study was approved by our institutional review board. Informed consent requirements were waived. One hundred seventy recent whole-body outside PET/CT exams from many sites were digitally imported into our radiology imaging system and reviewed for key quality metrics including time from injection until imaging, availability of patient height and weight information, serum glucose level and [(18) F]fluoro-2-deoxy-D-glucose (FDG) dose. The standardised uptake value (SUV) and SUV based on lean body mass (SUL) in the liver were measured whenever possible. These were compared with 170 internal studies performed at our centre during the same period. Missing data were common in outside scans with height in 62%, weight 35%, uptake time 25%, FDG dose 28% and glucose levels in 64% of cases. In quantitatively evaluable cases, mean liver SUL, SUV, FDG dose and uptake time were much more variable in outside than in internal studies. Approximately one-third of the outside PET/CT studies submitted digitally for analysis lacked key information required to secure any quantitative imaging data. Only about a third of these studies had all necessary information available for accurate SUL determination and had acceptable quality that was comparable with locally acquired scans. This suggests that many of PET studies performed in the community cannot be relied upon to provide quantitative image data that can be applied in a different centre. Greater standardisation of oncologic PET/CT studies among different centres must still be pursued.