EJNMMI Physics (May 2023)

Safety injections of nuclear medicine radiotracers: towards a new modality for a real-time detection of extravasation events and 18F-FDG SUV data correction

  • Mauro Iori,
  • Elisa Grassi,
  • Lorenzo Piergallini,
  • Greta Meglioli,
  • Andrea Botti,
  • Giada Sceni,
  • Noemi Cucurachi,
  • Laura Verzellesi,
  • Domenico Finocchiaro,
  • Annibale Versari,
  • Beatrice Fraboni,
  • Federica Fioroni

DOI
https://doi.org/10.1186/s40658-023-00556-5
Journal volume & issue
Vol. 10, no. 1
pp. 1 – 16

Abstract

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Abstract Background 18F-FDG PET/CT imaging allows to study oncological patients and their relative diagnosis through the standardised uptake value (SUV) evaluation. During radiopharmaceutical injection, an extravasation event may occur, making the SUV value less accurate and possibly leading to severe tissue damage. The study aimed to propose a new technique to monitor and manage these events, to provide an early evaluation and correction to the estimated SUV value through a SUV correction coefficient. Methods A cohort of 70 patients undergoing 18F- FDG PET/CT examinations was enrolled. Two portable detectors were secured on the patients' arms. The dose-rate (DR) time curves on the injected DRin and contralateral DRcon arm were acquired during the first 10 min of injection. Such data were processed to calculate the parameters Δpin NOR = (DRin max- DRin mean)/DRin max and ΔRt = (DRin(t) − DRcon(t)), where DRin max is the maximum DR value, DRin mean is the average DR value in the injected arm. OLINDA software allowed dosimetric estimation of the dose in the extravasation region. The estimated residual activity in the extravasation site allowed the evaluation of the SUV's correction value and to define an SUV correction coefficient. Results Four cases of extravasations were identified for which ΔRt [(390 ± 26) µSv/h], while ΔRt [(150 ± 22) µSv/h] for abnormal and ΔRt [(24 ± 11) µSv/h] for normal cases. The Δpin NOR showed an average value of (0.44 ± 0.05) for extravasation cases and an average value of (0.91 ± 0.06) and (0.77 ± 0.23) in normal and abnormal classes, respectively. The percentage of SUV reduction (SUV%CR) ranges between 0.3% and 6%. The calculated self-tissue dose values range from 0.027 to 0.573 Gy, according to the segmentation modality. A similar correlation between the inverse of Δpin NOR and the normalised ΔRt with the SUV correction coefficient was found. Conclusions The proposed metrics allowed to characterised the extravasation events in the first few minutes after the injection, providing an early SUV correction when necessary. We also assume that the characterisation of the DR-time curve of the injection arm is sufficient for the detection of extravasation events. Further validation of these hypotheses and key metrics is recommended in larger cohorts.

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