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Research ArticleImaging

Blanching Defects at Pressure Points: Observations from Dynamic Total-Body PET/CT Studies

Yasser G. Abdelhafez, Kristin McBride, Edwin K. Leung, Heather Hunt, Benjamin A. Spencer, Javier E. Lopez, Kwame Atsina, Elizabeth J. Li, Guobao Wang, Simon R. Cherry, Ramsey D. Badawi, Fatma Sen and Lorenzo Nardo
Journal of Nuclear Medicine Technology December 2022, 50 (4) 327-334; DOI: https://doi.org/10.2967/jnmt.122.263905
Yasser G. Abdelhafez
1Department of Radiology, University of California, Davis, California;
2Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt;
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Kristin McBride
1Department of Radiology, University of California, Davis, California;
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Edwin K. Leung
1Department of Radiology, University of California, Davis, California;
3Biomedical Engineering, University of California, Davis, California;
4UIH America, Inc., Houston, Texas;
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Heather Hunt
1Department of Radiology, University of California, Davis, California;
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Benjamin A. Spencer
1Department of Radiology, University of California, Davis, California;
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Javier E. Lopez
5Department of Internal Medicine, University of California, Davis, California; and
6Cardiovascular Research Institute, University of California, Davis, California
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Kwame Atsina
5Department of Internal Medicine, University of California, Davis, California; and
6Cardiovascular Research Institute, University of California, Davis, California
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Elizabeth J. Li
3Biomedical Engineering, University of California, Davis, California;
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Guobao Wang
1Department of Radiology, University of California, Davis, California;
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Simon R. Cherry
1Department of Radiology, University of California, Davis, California;
3Biomedical Engineering, University of California, Davis, California;
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Ramsey D. Badawi
1Department of Radiology, University of California, Davis, California;
3Biomedical Engineering, University of California, Davis, California;
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Fatma Sen
1Department of Radiology, University of California, Davis, California;
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Lorenzo Nardo
1Department of Radiology, University of California, Davis, California;
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Abstract

Total-body PET/CT allows simultaneous acquisition of all body parts at a single bed position during the radiotracer uptake phase. Dynamic imaging protocols using total-body PET might demonstrate findings that may not have been previously visualized or described using conventional PET/CT scanners. We examined the characteristics of blanching defects—areas of markedly reduced (partial defect) or absent (complete defect) radiotracer uptake seen at the skin and subcutaneous tissues opposite the bony prominences at pressure points. Methods: In this observational study, 77 participants underwent dynamic total-body PET/CT imaging using 18F-FDG (group 1, n = 47, 60-min dynamic, arms down, divided into 3 subgroups according to the injected dose) or 18F-fluciclovine (group 2, n = 30, 25-min dynamic, arms up). Forty of the 47 participants in group 1 were reimaged at 90 min after being allowed off the scanning table. Blanching defects, partial or complete, were characterized opposite the bony prominences at 7 pressure points (the skull, scapula, and calcaneus bilaterally, as well as the sacrum). The association of the blanching defects with different clinical and technical characteristics was analyzed using uni- and multivariate analyses. Results: In total, 124 blanching defects were seen in 68 of the 77 (88%) participants at one or more pressure points. Blanching defects were higher, on average, in group 2 (3.5 ± 1.7) than in group 1 (2.1 ± 1.4; P < 0.001) but did not vary within group 1 for different 18F-FDG dose subgroups. All defects resumed a normal pattern on delayed static (90-min) images, except for 14 partial defects. No complete blanching defects were seen on the 90-min images. By multivariate analysis, arm positioning above the head was associated with skull defects; scapular and sacral defects were significantly more common in men and in those with a lower body mass index, whereas calcaneal defects were not associated with any factor. Conclusion: Blanching defects opposite the bony pressure points are common on dynamic total-body PET/CT images using different radiopharmaceuticals and injection doses. Their appearance should not be immediately interpreted as an abnormality. The current findings warrant further exploration in a prospective setting and may be used to study various mechanopathologic conditions, such as pressure ulcers.

  • total-body PET/CT
  • dynamic scans
  • pressure points
  • blanching defects
  • skin and subcutaneous tissue

Footnotes

  • Published online Apr. 19, 2022.

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Journal of Nuclear Medicine Technology: 50 (4)
Journal of Nuclear Medicine Technology
Vol. 50, Issue 4
December 1, 2022
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Blanching Defects at Pressure Points: Observations from Dynamic Total-Body PET/CT Studies
Yasser G. Abdelhafez, Kristin McBride, Edwin K. Leung, Heather Hunt, Benjamin A. Spencer, Javier E. Lopez, Kwame Atsina, Elizabeth J. Li, Guobao Wang, Simon R. Cherry, Ramsey D. Badawi, Fatma Sen, Lorenzo Nardo
Journal of Nuclear Medicine Technology Dec 2022, 50 (4) 327-334; DOI: 10.2967/jnmt.122.263905

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Blanching Defects at Pressure Points: Observations from Dynamic Total-Body PET/CT Studies
Yasser G. Abdelhafez, Kristin McBride, Edwin K. Leung, Heather Hunt, Benjamin A. Spencer, Javier E. Lopez, Kwame Atsina, Elizabeth J. Li, Guobao Wang, Simon R. Cherry, Ramsey D. Badawi, Fatma Sen, Lorenzo Nardo
Journal of Nuclear Medicine Technology Dec 2022, 50 (4) 327-334; DOI: 10.2967/jnmt.122.263905
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Keywords

  • total-body PET/CT
  • dynamic scans
  • pressure points
  • blanching defects
  • skin and subcutaneous tissue
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