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The Use of Breathing Synchronized PET/CT Imaging In the Detection and Quantification of FDG Uptake in Lung Nodules

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Trial Information

The Use of Breathing Synchronized PET/CT Imaging In the Detection and Quantification of FDG Uptake in Lung Nodules

Positron emission tomography is now a clinically accepted imaging modality for the
evaluation of pulmonary nodules as well as for the staging of patients with lung cancer. PET
imaging with the radiotracer 18 Fluoro-deoxy-glucose (FDG) has a high accuracy for the
differentiation between benign and malignant lung lesions and for the detection of nodal
metastases. This is because malignant tumors are characterized by an increase in glucose
metabolism as compared to most normal tissues. In clinical practice, PET images are
interpreted visually or semiquantitatively, using a standardized uptake value (SUV).
Previous studies have shown that SUV thresholds can be used with high accuracy to
distinguish between benign and malignant lesions that exhibit increased uptake of FDG. In
addition, the SUV is frequently used as a surrogate marker for the evaluation of a response
to chemo- or radiation therapy. Unfortunately, the accuracy of SUV measurements may be
affected by lesion motion during the image acquisition. This is a particular problem in PET
imaging of the lung. Normal respiratory motion, and hence lesion motion, causes a smearing
effect, whereby the concentration of radiotracer within a given lesion is spread out over a
larger area. For the same reason small lesions and lesions with relatively low uptake of
radiotracer may become undetectable during normal breathing (partial volume effect). PET
images are acquired for several minutes, image acquisition during breath hold is therefore
not an option for clinical scans. However recently published work from UCLA (Auerbach et al.
J Nucl Med., February 2006) shows that 3 lesions per patient on average can be missed on
shallow breathing scans compared to breath-hold CT scans. These lesions did not show any FDG
uptake on clinical PET scans. The goal of this pilot study is to evaluate whether
respiratory gating during PET image acquisition enables the detection of those lesions which
are identified during the breath-hold CT scan.

Inclusion Criteria:

- Age ≥ 18 years old

- Patients must have at least one lung lesion or lung cancer on prior chest Xray or
chest CT.

- Sign informed consent. Eligible patients should give their consent at the beginning
of the clinical PET scan. Following clinical CT and PET scans, breathhold CT should
follow. Then, these breath-hold CT images will be reviewed by one of the
investigating physicians to determine if the patient qualifies for the study. If
there is a small lesion (< 5 mm) gated PET images will be acquired.

Exclusion Criteria:

- Pregnant women are ineligible.

- Patients who are unable to follow breathing instructions either due to language
difficulties or hearing impairment This will be determined by one of the consenting
individuals when they approach the patient to ask for informed consent.

- Patients who are too ill to hold their breath.

Type of Study:


Study Design:

Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Diagnostic

Outcome Measure:

Pts w/suspected lung lesions will undergo more breath-hold CT scan & if visible lesion(s), gated-PET will be acquired plus clinical PET/CT. Scans will be used to compare how often additional lung lesions can be identified on breath-hold CT, if lesions

Outcome Time Frame:

5 years

Safety Issue:


Principal Investigator

Heiko Schoder, MD

Investigator Role:

Principal Investigator

Investigator Affiliation:

Memorial Sloan-Kettering Cancer Center


United States: Institutional Review Board

Study ID:




Start Date:

March 2004

Completion Date:

December 2009

Related Keywords:

  • Lung Cancer
  • lung
  • Lung Neoplasms



Memorial Sloan Kettering Cancer Center New York, New York  10021