Review ArticleContinuing Education

Best Practices for 18F-Fluciclovine PET/CT Imaging of Recurrent Prostate Cancer: A Guide for Technologists

Funmilayo I. Tade, Rebecca A. Sajdak, Mehdat Gabriel, Robert H. Wagner and Bital Savir-Baruch
Journal of Nuclear Medicine Technology December 2019, 47 (4) 282-287; DOI: https://doi.org/10.2967/jnmt.119.227116

Article Figures & Data

Figures

  • FIGURE 1.
    FIGURE 1.

    (A) 18F-fluciclovine intravenous injection via right antecubital vein demonstrates increased uptake in right axillary vein on maximum-intensity projection (arrow). (B) Focal uptake in subclavian space may mimic or mask metastatic lymph node uptake on PET/CT transaxial image (arrow). (C and D) In patient injected via right antecubital vein, focus of increased 18F-fluciclovine uptake in left supraclavicular space correlates with enlarged suggestive lymph node on PET/CT transaxial image (C) and maximum-intensity projection (D) (blue arrows). Additional diffuse retroperitoneal metastatic lymph nodes are noted (black arrow).

  • FIGURE 2.
    FIGURE 2.

    CT scout images demonstrating recommended positioning of patient with arms up (A) and alternative, less preferred, position with arms down (B).

  • FIGURE 3.
    FIGURE 3.

    Respiration artifact from rapid breathing pattern on 18F-fluciclovine PET maximum-intensity projection appears as artificially decreased tracer uptake (arrow) by liver dome.

  • FIGURE 4.
    FIGURE 4.

    Normal biodistribution of 18F-fluciclovine on PET maximum-intensity projection shows highest uptake within liver and pancreas.

  • FIGURE 5.
    FIGURE 5.

    18F-fluciclovine PET/CT image demonstrating moderate uptake bilaterally in reactive inguinal lymph nodes (arrows).

  • FIGURE 6.
    FIGURE 6.

    18F-fluciclovine PET/CT coronal images demonstrating mild (SUVmean > blood pool) (A) and moderate (SUVmean > marrow < liver) (B) urine radioactivity in patients who did not void before injection of 18F-fluciclovine, compared with intense urine radioactivity (SUVmean > liver) (C) in patient who voided.

Tables

  • TABLE 1

    Differences Between Imaging Protocols for 18F-Fluciclovine PET/CT and 18F-FDG PET/CT

    Parameter18F-fluciclovine PET/CT18F-FDG PET/CT
    Patient preparationAsk patients to fast for at least 4 h, including water restrictionAsk patients to fast for at least 4 h, with no water restriction
    Ask patients not to void for 1 h before 18F-fluciclovine injection and imagingAsk patients to void immediately before imaging starts
    Injection siteRight armRight or left arm (if applicable, arm contralateral to cancer side)
    Image acquisitionStart PET imaging 4 min after injectionStart PET imaging 30–90 min after injection
    Image caudocranially, from mid thighs to skull baseImage craniocaudally (field of image is cancer-specific)
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