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Effects of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 (HBED-CC) PET/MRI

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

PSMA ligand imaging with hybrid PET/MRI scanners could be an integral part of the clinical routine in the future. However, the first study about this novel method revealed a severe photopenic artifact (“halo artifact”) around the urinary bladder causing significantly reduced tumor visibility. The aim of this evaluation was to analyze the role of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 PET/MRI hypothesizing that this influences the appearance.

Methods

Twenty-seven consecutive patients were subjected to 68Ga-PSMA-11 PET/CT (1 h p.i.) followed by PET/MRI (3 h p.i.). PET/MRI was first started with scans of the abdomen to pelvis with arms positioned up above the head. Immediately thereafter, additional scans from the pelvis to abdomen were conducted with arms positioned down beside the trunk. All investigations were first analyzed separately and then compared with respect to tumor detection and tumor uptake (SUV) as well as the presence and intensity of the halo artifact. The Wilcoxon signed rank test was used to determine statistical differences including Bonferroni correction.

Results

The halo was significantly reduced if the arms were elevated. Lesions inside the halo artifact (n = 16) demonstrated significantly increased SUVmean (p = 0.0007) and SUVmax (p = 0.0024) with arms positioned up. The halo appearance and intensity was not dependent on the total activity and activity concentration of the urinary bladder.

Conclusion

Positioning the arms down was shown to be significantly associated with the appearance of the halo artifact in PET/MRI. Positioning the arms up above the head can significantly reduce the halo artifact, thereby detecting more tumor lesions.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Heidelberg University Hospital, INF 400, 69120, Heidelberg, Germany

    Ali Afshar-Oromieh & Uwe Haberkorn

  2. Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany

    Ali Afshar-Oromieh & Uwe Haberkorn

  3. Department of Radiology, German Cancer Research Center, Heidelberg, Germany

    Maya Wolf, Regula Gnirs, Heinz-Peter Schlemmer & Martin T. Freitag

  4. Department of Medical Physics in Radiology, German Cancer Research Center, Heidelberg, Germany

    Marc Kachelrieß

  5. Division of Radiopharmaceutical Chemistry, German Cancer Research Center, Heidelberg, Germany

    Klaus Kopka

Authors
  1. Ali Afshar-Oromieh
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  2. Maya Wolf
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  3. Uwe Haberkorn
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  4. Marc Kachelrieß
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  5. Regula Gnirs
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  6. Klaus Kopka
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  7. Heinz-Peter Schlemmer
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  8. Martin T. Freitag
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Corresponding author

Correspondence to Ali Afshar-Oromieh.

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Conflicts of interest

Ali Afshar-Oromieh has received honoraria from Siemens Healthcare for one educational talk. All other authors declare that they have no conflicts of interest.

Ethical approval

This retrospective study was approved by the local ethics committee (S-485/2012, S-638/2013) and was conducted in agreement with the Declaration of Helsinki. All patients gave written informed consent.

Electronic supplementary material

Supplementary Figure 1

The volume of the urinary bladder was measured by drawing a 90% isocontour VOI around the urinary bladder. The software automatically calculated the activity concentration as well. (GIF 77 kb)

High-resolution image (TIFF 621 kb)

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Afshar-Oromieh, A., Wolf, M., Haberkorn, U. et al. Effects of arm truncation on the appearance of the halo artifact in 68Ga-PSMA-11 (HBED-CC) PET/MRI. Eur J Nucl Med Mol Imaging 44, 1636–1646 (2017). https://doi.org/10.1007/s00259-017-3718-0

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  • DOI: https://doi.org/10.1007/s00259-017-3718-0

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