Research ArticleIMAGING

Impact of Obesity on Nuclear Medicine Imaging

Mohammad A. Ghanem, Nafeesa A. Kazim and Abdelhamid H. Elgazzar
Journal of Nuclear Medicine Technology March 2011, 39 (1) 40-50; DOI: https://doi.org/10.2967/jnmt.110.078881

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    Whole-body PET/CT scan of 48-y-old woman (body mass index, 39; blood glucose level, 101 mg/dL, or 5.6 mmol/L) with history of breast cancer whose body contour exceeds PET and CT field of view, causing cropping and reconstruction artifact at left-breast region.

  • FIGURE 2.
    FIGURE 2.

    Whole-body PET/CT scan of 49-y-old woman (body mass index, 42; blood glucose level, 104 mg/dL, or 5.6 mmol/L) with history of breast cancer who was not able to complete emission part of study because of discomfort during acquisition.

  • FIGURE 3.
    FIGURE 3.

    Lung perfusion images of overweight female patient who was unable to lift arms over head during acquisition, causing attenuation defects (arrows) on lateral, right anterior oblique, and left anterior oblique images.

  • FIGURE 4.
    FIGURE 4.

    Whole-body bone scintigraphy image shows that peripheral parts of body are outside field of view of γ-camera because of patient's obesity. Most parts of upper limbs are not included in field of view.

  • FIGURE 5.
    FIGURE 5.

    Multislice views (A) and raw images (B) show large-breast-attenuation artifact (arrows) involving anterolateral myocardial wall of obese female patient.

  • FIGURE 6.
    FIGURE 6.

    Myocardial perfusion imaging using supine and prone stress technique clearly demonstrates that inferior wall artifact (arrows) caused by diaphragmatic attenuation in obese male patient is corrected on prone images (middle row).

  • FIGURE 7.
    FIGURE 7.

    Myocardial perfusion imaging using stress technique and breast taping (middle-row images and second-from-left bull's-eye) clearly demonstrates that anterolateral wall artifact caused by large-breast attenuation in obese female patient is corrected with breast-lifting technique.

  • FIGURE 8.
    FIGURE 8.

    Whole-body sulfur colloid scintigraphy image shows right-breast attenuation over dome of right lobe of liver in overweight female patient.

  • FIGURE 9.
    FIGURE 9.

    Photon attenuation caused by massive abdominal fat, which renders interpretation of lumbar spine and pelvis difficult on anterior view of this male subject.

  • FIGURE 10.
    FIGURE 10.

    Fat tissue over lower abdomen and buttocks on gallium scan causes soft-tissue attenuation of detected photons on anterior and posterior views.

  • FIGURE 11.
    FIGURE 11.

    Whole-body bone scan of obese patient illustrates effect of body build on images. Attenuation is seen in region of lower lumbar spine and pelvis, in addition to edge artifact caused by fat crease in mid posterior lumbar spine and, to lesser extent, in anterior ribs.

Tables

  • TABLE 1

    Main Effects of Obesity on Nuclear Medicine Imaging and Possible Remedies

    Obesity-related difficultyImpact on imagingPossible remedy
    Body configurationAttenuationProper preparation such as adequate hydration (higher amount)
    Increase of injected activity
    Delayed acquisition in some studies
    Increased time of acquisition
    Access to veinsPossible infiltrationUse of more experienced nuclear medicine technologist
    Patient discomfortUse of intravenous team
    Help from an anesthesiologist
    Use of ultrasound-guided peripheral intravenous access injection method
    Patient mobilityPossible fall injuriesUse of greater caution
    Use of accessory gadgets
    Imaging of patient on stretcher (mobile camera may be needed)
    Adequate communication with patient
    Positioning for acquisitionDifficulty in achieving proper positionsAttention to proper and secured positioning
    Use of pillow, splints, or other means to ensure patient's comfort and thus minimize motion
    Body contouringVariable distances from camera at different parts of bodyManual adjustment of camera head to obtain adequate images
    Patient girthCompton scatterUse of narrower or asymmetric energy window
    Insufficient count statisticsIncrease of acquisition time
    Beam-hardening artifact on CT.Use of caution during reading and quantification
    Reduced sensitivity to peripheral lesionsComparison with non–attenuation-corrected images
    Acquisition of additional spot image studies
    Diaphragmatic attenuation (cardiac)Masking of underlying organ activity (inferior wall artifact)Use of prone acquisition in myocardial perfusion
    Use of attenuation correction
    Breast attenuation (cardiac)Masking of underlying organ activity (anteroseptal-lateral wall defect)Breast lifting and binding
    Use of attenuation correction
    Fat crease and steatopygiaEdge effect/attenuationManipulation of crease and reimaging, or addition of SPECT
    Masking of bone details and creation of false findingsAddition of extra views or SPECT
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