Lymphoma: Patient Study Using Low Injected Dose and Fast Acquisition Protocol

Restaging evaluation of patient with lymphoma

Partha Ghosh, MD

Case data provided by National University Hospital Singapore, Republic of Singapore

 |  Oct 11, 2012


A 45-year-old female patient (64 kg) with lymphoma was evaluated with fludeoxyglucose F 18* (18F FDG) PET•CT for restaging.


*Siemens' PETNET Solutions is a manufacturer of fludeoxyglucose F 18 injection (18F FDG). Indication and important safety information as approved by the US Food and Drug Administration can be found at the bottom of the page for 18F FDG, adult dose 5-10 mCi, administered by intravenous injection.


The study was performed on a Biograph™ mCT with TrueV extended field of view 60 minutes after intravenous injection of 6 mCi of 18F FDG. Study was performed with very fast acquisition time of one minute per bed position. The whole-body PET evaluation with 12 bed positions required to scan head to foot took just 12 minutes. PET•CT study shows multiple hypermetabolic lymph node lesions in the left supraclavicular and axillary nodal groups. A small involved lymph node also was delineated in the right supraclavicular region. Increase bone marrow uptake reflects previous chemotherapy. Mediastinal and para-aortic nodes appear uninvolved. No evidence of disease in liver or spleen. The supraclavicular and axillary nodal involvement in spite of previous chemotherapy suggests lymphoma recurrence requiring major change in therapy approach.



The high image quality, high lesion contrast and sharp delineation of small lymph node lesions in the ultraHD•PET study with 1 minute per bed acquisition time and an injected dose of only 6 mCi reflects the performance of the Biograph mCT. The system combines increased count rate capability and ultraHD•PET combining Time of Flight acquisition and PSF reconstruction to deliver high resolution and increased lesion contrast for delineation of small lesions with low FDG uptake even with very low injected dose and fast acquisition time as demonstrated in this clinical example. Use of FDG PET•CT in lymphoma for primary staging, therapy follow up and restaging has been widely accepted. The trend towards maximizing patient throughput and minimizing radiation burden by incorporating low injected dose protocol can be optimally performed on the Biograph mCT due to the combination of LSO crystal technology, TrueV extended field of view and ultraHD•PET which provides optimal lesion contrast and resolution and high count rate capability even at low dose and fast acquisition protocols.


*Fludeoxyglucose F 18 Injection

Fludeoxyglucose F 18 injection (18F FDG) is indicated for positron emission tomography (PET) imaging in the following setting:
Oncology: For assessment of abnormal glucose metabolism to assist in the evaluation of malignancy in patients with known or suspected abnormalities found by other testing modalities, or in patients with an existing diagnosis of cancer.

Radiation Risks

Radiation-emitting products, including fludeoxyglucose F 18 injection, may increase the risk for cancer, especially in pediatric patients. Use the smallest dose necessary for imaging and ensure safe handling to protect the patient and health care worker.

Blood Glucose Abnormalities
In the oncology and neurology setting, suboptimal imaging may occur in patients with inadequately regulated blood glucose levels. In these patients, consider medical therapy and laboratory testing to assure at least two days of normoglycemia prior to fludeoxyglucose F18 injection administration.

Adverse Reactions
Hypersensitivity reactions with pruritus, edema and rash have been reported; have emergency resuscitation equipment and personnel immediately available.


Full Prescribing Information for Fludeoxyglucose F 18 Injection


Fludeoxyglucose F 18 injection is manufactured by Siemens' PETNET Solutions, 810 Innovation Drive, Knoxville, TN 39732

The statements by Siemens customers described herein are based on results that were achieved in the customer's unique setting. Since there is no "typical" hospital and many variables exist (e.g., hospital size, case mix, level of IT adoption) there can be no guarantee that other customers will achieve the same results.