Optimization of BMI-Based Images for Overweight and Obese Patients — Implications on Image Quality, Quantification, and Radiation Dose in Whole Body 18F-FDG PET/CT Imaging

• Published in: Nuclear medicine and molecular imaging 2023-08, Vol.57 (4), p.180-193
• Main Authors: Bouchareb, Yassine, Tag, Naima, Sulaiman, Hajir, Al-Riyami, Khulood, Jawa, Zabah, Al-Dhuhli, Humoud
• Format: Article
• Language: English
• Subjects: Body mass index; Body size; Body weight; Cardiology; Computed tomography; Fluorine isotopes; Image contrast; Image filters; Image quality; Image reconstruction; Imaging; Medical imaging; Medicine; Medicine & Public Health; Nuclear Medicine; Obesity; Oncology; Optimization; Original; Original Article; Orthopedics; Overweight; Patients; Positron emission; Quality assessment; Radiation; Radiation dosage; Radiology
• ISSN: 1869-3474; 1869-3482
• DOI: 10.1007/s13139-023-00795-5

   Purpose In PET/CT imaging, the activity of the 18 F-FDG activity is injected either based on patient body weight (BW) or body mass index (BMI). The purpose of this study was to optimise BMI-based whole body 18 F-FDG PET images obtained from overweight and obese patients and assess their image quality, quantitative value and radiation dose in comparison to BW-based images. Methods The NEMA-IEC-body phantom was scanned using the mCT 128-slice scanner. The spheres and background were filed with F-18 activity. Spheres-to-background ratio was 4:1. Data was reconstructed using the OSEM-TOF-PSF routine reconstruction. The optimization was performed by varying number of iterations and subsets, filter’s size and type, and matrix size. The optimized reconstruction was applied to 17 patients’ datasets. The optimized BMI-, routine BMI- and the BW-based images were compared visually and using contrast-to-noise ratio (CNR) and standardized uptake values (SUV) measurements. Results The visual assessment of the optimized phantom images showed better image quality and contrast-recovery-coefficients (CRCs) values compared to the routine reconstruction. Using patient data, the optimized BMI-based images provided better image quality compared to BW-based images in 87.5% of the overweight cases and 66.7% for obese cases. The optimized BMI-based images resulted in more than 50% reduction of radiation dose. No significant differences were found between the three series of images in SUV measurements. Conclusion The optimized BMI-based approach using 1 iteration, 21 subsets, and 3 mm Hamming filter improves image quality, reduces radiation dose, and provides, at least, similar quantification compared to the BW-based approach for overweight and obese patients.