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Prone position PET/CT is useful in reducing gravity-dependent opacity-related [18F]fluorodeoxyglucose uptake

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Abstract

Objectives

This study aimed to investigate whether performing [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) in the prone position could reduce [18F]FDG uptake in dependent lungs.

Methods

Patients who underwent [18F]FDG PET/CT in both supine and prone positions from October 2018 to September 2021 were reviewed retrospectively. [18F]FDG uptake of dependent and nondependent lungs was analysed visually and semi-quantitatively. A linear regression analysis was performed to examine the association between the mean standardised uptake value (SUVmean) and the Hounsfield unit (HU).

Results

A total of 135 patients (median age, 66 years [interquartile range: 58–75 years]; 80 men) were included. Dependent lungs showed significantly higher SUVmean and HU than nondependent lungs on supine position PET/CT (sPET/CT, 0.59 ± 0.14 vs. 0.36 ± 0.09, p < 0.001; − 671 ± 66 vs. − 802 ± 43, p < 0.001, respectively) and prone position PET/CT (pPET/CT, 0.45 ± 0.12 vs. 0.42 ± 0.08, p < 0.001; − 731 ± 67 vs. − 790 ± 40, p < 0.001, respectively). Linear regression analysis revealed a strong association between the SUVmean and HU in sPET/CT (R = 0.86, p < 0.001) and moderate association in pPET/CT (R = 0.65, p < 0.001). One hundred and fifteen patients (85.2%) had visually discernible [18F]FDG uptake in the posterior lung on sPET/CT, which disappeared on pPET/CT in all but one patient (0.7%, p < 0.001).

Conclusions

[18F]FDG uptake of the lung had moderate-to-strong associations with HU. Gravity-dependent opacity-related [18F]FDG uptake can be effectively reduced on prone position PET/CT.

Clinical relevance statement

Prone position PET/CT effectively reduces gravity-dependent opacity-related [18F]fluorodeoxyglucose uptake in the lung, potentially improving diagnostic accuracy in evaluating nodules in dependent lungs and offering a more accurate assessment of lung inflammation parameters in interstitial lung disease evaluations.

Key Points

• The study evaluated whether performing [18F]fluorodeoxyglucose ([18F]FDG) PET/CT could reduce [18F]FDG uptake in lungs.

• In prone and supine position PET/CT, the [18F]FDG uptake and Hounsfield unit were moderately to strongly associated.

• Prone position PET/CT can reduce gravity-dependent opacity-related [18F]FDG uptake by the posterior lung.

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Abbreviations

[18F]FDG:

[18F]Fluorodeoxyglucose

CT:

Computed tomography

HU:

Hounsfield unit

PET/CT:

Positron emission tomography/computed tomography

pPET/CT:

Prone position PET/CT

ROI:

Region of interest

sPET/CT:

Supine position PET/CT

SUVmean :

Mean standardised uptake value

SUV-TFmean :

Tissue fraction corrected SUVmean

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Funding

This study has received funding from Hallym University Research Fund, 2021 (HURF-2021–30).

Author information

Author notes

  1. Yun Hye Song and Jung Won Moon contributed equally to this work as first authors.

Authors and Affiliations

  1. Department of Radiology, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, Republic of Korea

    Yun Hye Song, Jung Won Moon, Yoo Na Kim, Ji Young Woo & Suk Hyun Lee

  2. Department of Nuclear Medicine, Dankook University Medical Center, Cheonan, Chungnam, Republic of Korea

    Hye Joo Son

Authors
  1. Yun Hye Song
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Corresponding author

Correspondence to Suk Hyun Lee.

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Guarantor

The scientific guarantor of this publication is Suk Hyun Lee.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported in our previous article (Eur Radiol (2021) 31:4606–4614). This study included 135 patients who underwent PET/CT scans in both supine and prone positions from October 2018 to September 2021 at Kangnam Sacred Heart Hospital. Our previously published study included 28 patients who underwent PET/CT scans in both supine and prone positions from November 2018 to April 2020. Therefore, a significant number of patients overlap. However, the previous study was to find out whether prone position PET/CT could reduce the respiratory motion artefact of the lung nodule, and the current study was to find out if it could reduce the gravity-dependent opacity-related [18F]FDG uptake of the normal lung. Therefore, the two studies have completely different study designs.

Methodology

• retrospective

• observational

• performed at one institution

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Song, Y.H., Moon, J.W., Kim, Y.N. et al. Prone position PET/CT is useful in reducing gravity-dependent opacity-related [18F]fluorodeoxyglucose uptake. Eur Radiol 33, 8270–8278 (2023). https://doi.org/10.1007/s00330-023-09831-6

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  • DOI: https://doi.org/10.1007/s00330-023-09831-6

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