PET/CT-guided percutaneous liver biopsies or ablations using 20-second PET acquisitions.
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Purpose: To determine the targeting accuracy of 20-second breath-hold PET scans versus up to 180-second summed, breath-hold PET scans during PET/CT- guided IR procedures for FOG-avid liver lesions. If feasible, single breath-hold PET scans may decrease scan times during PET/CT-guided procedures and improve PET/CT image co-registration for targets subject to respiratory motion. Materials and Methods: Ten patients with 13 liver lesions visible on FOG PET and unenhanced CT underwent PET/CT-guided liver biopsy or tumor ablation using respiratory-bellows-monitored, breath-hold PET and CT acquisitions. Nine 20-second, breath-hold PET scans and one breath-hold CT scan were obtained for each planning PET/CT scan. 20, 40, 60, and 180-second PET scans were reconstructed for each patient. Four interventional radiology readers reviewed 40 PET datasets followed by 10 CT datasets, both in random order, and marked the epicenter of the tumors using OsiriX PACS DICOM Viewer. 3-dimensional differences (distance errors) in target localization for each PET dataset compared to 180-second PET or CT, as gold standards, were analyzed with multiple regression models. Tumor sizes and FOG-avidities were correlated with magnitudes of targeting errors using Pearson correlation analysis. Statistical tests were two-sided; P < .05 was considered significant. Results: 20-second PET targeting errors compared to 180-second PET ranged from .7 - 153 mm (mean 19.2 mm) and were not significantly different than 40 or 60-second PET (P= .83 &.60). 20-second PET targeting errors compared to CT ranged from 1.4-468 mm (mean 37.3 mm) and were not statistically different than 40, 60, or 3 minute PET (P= .88 , .88, & .61 ). Overall, PET targeting errors were inversely correlated with tumor size (P< .001) and FOG avidity (P< .001 ). Conclusion: Targeting accuracy using 20-second breath-hold PET is comparable to longer PET acquisitions up to 180-seconds. PET targeting errors are larger for small tumors or tumors with low FOG avidity regardless of PET acquisition time. PET/CT scans for guiding percutaneous liver procedures are feasible in two breath-holds, one for CT and one for PET acquisitions, without compromising accuracy.
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