Advantages of SiPM-based digital PET/CT technology in nuclear medicine clinical practice: a systematic review—Part 1 oncological setting

• Published in: Clinical and translational imaging : reviews in nuclear medicine and molecular imaging 2024, Vol.12 (6), p.769-785
• Main Authors: Rovera, Guido, Urso, Luca, Stracuzzi, Federica, Laudicella, Riccardo, Frantellizzi, Viviana, Cottignoli, Chiara, Gazzilli, Maria, Guglielmo, Priscilla, Panareo, Stefano, Evangelista, Laura, Filice, Angelina, Burroni, Luca
• Format: Article
• Language: English
• Subjects: Cancer; Computed tomography; Diagnostic Radiology; Heterogeneity; Image quality; Imaging; Interventional Radiology; Lesions; Literature reviews; Localization; Medical and Radiation Physics; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Radiology; Radiotherapy; Review
• ISSN: 2281-7565; 2281-5872; 2281-7565
• DOI: 10.1007/s40336-024-00653-0

Purpose New-generation fully-digital PET/CT (dPET) scanners offer several technical advantages compared to analog (aPET) systems. This review aimed to summarize the current literature evidence about dPET technology clinical advantages. Methods A systematic literature search of PubMed/MEDLINE and Embase databases was performed following PRISMA guidelines. The full-text articles methodological quality was independently assessed by four authors using the CASP-diagnostic study checklist. Results Out of 510 articles, 81 were selected of which 42 related to oncology. In early-recurrent prostate cancer (PSA range ≤ 0.5 and 0.5–2.0 ng/ml), PSMA-dPET has shown a significantly higher detection rate compared to aPET especially for smaller lesions. A higher image quality and lesion detectability was reported in [ 18 F]FDG studies on lung cancer and on mixed oncological cohorts, where metabolic TNM upstaging occurred in up to 32% of cases compared to aPET. dPET technology was also found to improve the localization of in-transit metastases in melanoma, the staging of early oral squamous cell carcinoma, as well as the accuracy of [ 68  Ga]Ga-DOTA-TATE and 124 I imaging in neuroendocrine tumors and thyroid cancer respectively. Although dPET sensitivity can provide better image quality in diagnostic and therapeutic ( 90 Y-SIRT) applications, the possible higher rate of false positive findings (e.g., unspecific bone uptake at PSMA-1007), and SUV max /radiomic-features variability should be considered. Main studies limitations included their retrospective nature, heterogeneity, and matched pair comparison design. Conclusions dPET has shown a diagnostic advantage over aPET in a variety of oncological settings, where the earlier and more accurate lesion localization and quantification could have relevant implications for optimal patient management.