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Research ArticleImaging

Characterizing and Mitigating Bladder Radioactivity on 18F-Fluciclovine PET/CT

Petra Lovrec, David M. Schuster, Robert H. Wagner, Medhat Gabriel and Bital Savir-Baruch
Journal of Nuclear Medicine Technology March 2020, 48 (1) 24-29; DOI: https://doi.org/10.2967/jnmt.119.230581
Petra Lovrec
1Department of Radiology, Loyola University Medical Center, Maywood, Illinois
2Department of Nuclear Medicine, University Hospital Center Zagreb, Zagreb, Croatia; and
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David M. Schuster
3Department of Radiology and Molecular Imaging, Emory University Hospital, Atlanta, Georgia
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Robert H. Wagner
1Department of Radiology, Loyola University Medical Center, Maywood, Illinois
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Medhat Gabriel
1Department of Radiology, Loyola University Medical Center, Maywood, Illinois
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Bital Savir-Baruch
1Department of Radiology, Loyola University Medical Center, Maywood, Illinois
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Article Figures & Data

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  • FIGURE 1.
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    FIGURE 1.

    Groups of bladder activity (encircles or arrowed). SUVmax threshold in all images is 7.0.

  • FIGURE 2.
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    FIGURE 2.

    Bladder radioactivity and volume scatterplot. Spearman ρ = −0.64 (P < 0.001).

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    FIGURE 3.

    (Top) Bladder SUVmax and SUVmean difference between protocols. (Bottom) Distribution of different bladder activity groups between protocols. *Statistically significant difference (P < 0.05). Mdn = median.

Tables

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    TABLE 1

    Demographics and Overall Bladder Activity and Volume

    ParameterData
    Age (y)69 (64–73)
    18F-fluciclovine dose (MBq)381.1 (362.6–392.2)
    Aorta SUVmean1.6 (1.4–1.8)
    Marrow SUVmean3.3 (2.7–3.9)
    Liver SUVmean8.6 (7.5–10.3)
    Bladder SUVmax3.1 (1.1–6.0)
    Bladder SUVmean1.6 (1.6–3.6)
    Bladder SUVmean/aorta SUVmean ratio1.1 (0.4–2.3)
    Bladder SUVmean/marrow SUVmean ratio0.5 (0.2–1.1)
    Bladder SUVmean/liver SUVmean ratio0.2 (0.1–0.5)
    Bladder radioactivity
     Bladder visualized on maximum-intensity projection53.5% (85/159)
     Quantitation
     Insignificant (bladder SUVmean < aorta SUVmean)48.4% (77/159)
     Mild (bladder SUVmean ≥ aorta SUVmean < marrow SUVmean)20.8% (33/159)
     Moderate (bladder SUVmean ≥ marrow SUVmean < liver SUVmean)22.0% (35/159)
     Intense (bladder SUVmean ≥ liver SUVmean)8.8% (14/159)
    Bladder volume (mL)
     Bladder volume (n = 159)34.4 (18.6–77.9)
     Insignificant (n = 77)64.9 (43.7–102.4), P < 0.001
     Mild (n = 33)26.4 (16.9–62.5), P = 0.004
     Moderate (n = 35)20.7 (14.2–30.9), P < 0.001
     Intense (n = 14)20.2 (14.1–26.3), P < 0.001
    • Data are median or percentage, with IQR or n in parentheses. Total n = 159.

    • View popup
    TABLE 2

    Quantification Differences and 18F-Fluciclovine Bladder Activity Comparison Between 2 Different Protocol Groups

    ParameterVoiding protocol (n = 36)Nonvoiding protocol (n = 123)P
    Age (y)67 (67, 63)69 (64, 74)0.21
    18F-fluciclovine dose (MBq)381.1 (362.6, 399.6)381.1 (362.6, 392.2)0.49
    Aorta SUVmean1.5 (1.3,1.6)1.6 (1.4, 1.8)0.003
    Marrow SUVmean3.2 (2.7,3.8)3.4 (2.7, 4.0)0.12
    Liver SUVmean8.4 (7.5, 9.5)8.7 (7.5, 10.3)0.31
    Bladder SUVmax4.9 (3.4, 8.1)2.1 (1.1, 5.6)0.001
    Bladder SUVmean2.8 (2.1, 6.0)1.3 (0.5, 2.8)<0.001
    Bladder SUVmean/aorta SUVmean ratio2.2 (1.5, 4.4)0.8 (0.4, 1.8)<0.001
    Bladder SUVmean/marrow SUVmean ratio1.1 (0.6, 2.2)0.4 (0.2, 0.9)<0.001
    Bladder SUVmean/liver SUVmean ratio0.4 (0.2, 0.7)0.2 (0.1, 0.3)<0.001
    Volume (mL)18.0 (12.6, 30.6)51.9 (25.4, 87.1)<0.001
    Bladder radioactivity (%)
     Bladder visualized on maximum-intensity projection77.8% (28/36)46.3% (57/123)<0.001
     Quantitation
      Insignificant (bladder SUVmean < aorta SUVmean)19.4% (7/36)56.9% (70/123)<0.001
      Mild (bladder SUVmean ≥ aorta SUVmean < marrow SUVmean)19.4% (7/36)21.1% (26/123)0.826
      Moderate (bladder SUVmean ≥ marrow SUVmean < liver SUVmean)38.9% (14/36)17.1% (21/123)0.005
      Intense (bladder SUVmean ≥ liver SUVmean)22.2% (8/36)4.9% (6/123)<0.001
    Bladder volume (mL)
     Insignificant36.5 (16.5, 66.0)71.2 (49.2, 104.8)0.039
     Mild15.4 (8.0, 18.1)31.1 (21.0, 73.9)0.015
     Moderate19.0 (12.60, 30.11)20.9 (15.5, 30.9)0.381
     Intense18.2 (12.6, 22.4)24.4 (17.7, 27.2)0.196
    • Data are median or percentage, with IQR or n in parentheses.

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Journal of Nuclear Medicine Technology: 48 (1)
Journal of Nuclear Medicine Technology
Vol. 48, Issue 1
March 1, 2020
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Characterizing and Mitigating Bladder Radioactivity on 18F-Fluciclovine PET/CT
Petra Lovrec, David M. Schuster, Robert H. Wagner, Medhat Gabriel, Bital Savir-Baruch
Journal of Nuclear Medicine Technology Mar 2020, 48 (1) 24-29; DOI: 10.2967/jnmt.119.230581
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Keywords

  • Fluciclovine
  • PET/CT
  • bladder
  • quantification
  • pharmacokinetics
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Characterizing and Mitigating Bladder Radioactivity on 18F-Fluciclovine PET/CT
Petra Lovrec, David M. Schuster, Robert H. Wagner, Medhat Gabriel, Bital Savir-Baruch
Journal of Nuclear Medicine Technology Mar 2020, 48 (1) 24-29; DOI: 10.2967/jnmt.119.230581

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