The Efficiency of Respiratorygated 18FFDG PET/CT in Lung Adenocarcinoma: Amplitudegating Versus Phasegating Methods

Objective(s): In positron emission tomography (PET) studies, thoracic movement under freebreathing conditions is a cause of image degradation. Respiratory gating (RG) is commonly used to solve this problem. Two different methods, i.e., phasegating (PG) and amplitudegating (AG) PET, are available for respiratory gating. It is important to know the strengths and weaknesses of both methods when selecting an RG methodfor a given patient. We conducted this study to clarify whether AG or PG is preferable for measuring fluorodeoxyglucose (FDG) accumulation in lung adenocarcinoma and to investigate patient conditions which are most suitable for AG and PG methods.Methods: A total of 31 patients (11 males, 20 females; average age: 11.6±70.1 yrs) with 44 lung lesions, diagnosed as lung adenocarcinoma between April 2012 and March 2013, were investigated. Wholebody FDGPET/CT scan was performed with both PG and AG methods in all patients. The maximum standardized uptake value (SUVmax) of PG, AG, and the control data of these two methods were measured, and the increase ratio (IR), calculated as IR(%)= (Post – Pre)/Pre × 100, was calculated. The diameter and positionof lung lesions were also analyzed. We defined an ‘effective lesion’ of PG (or AG) as a lesion which showed a higher IR compared to AG (or PG). 8 (25.8%)Results: The average SUVmax and average IR were 7.94±8.99 and 25.6±21.4% in PG and 6.70±7.60 and 14.4±4.0% in AG, respectively. Although there was no significant difference between the average SUVmax of PG and AG (P=0.09), the average IR of PG was significantly higher than that of AG (P lt;0.01). The number of PG and AGeffective lesions was 32 (72.7%) and 12 (28.3%) , respectively. There was no significant difference in the average diameter or position of the lesions between the PG and AGeffective lesions.There were 23 (74.2%) PGeffective and 8 (25.8%) AGeffective patients. No significant difference was observed in sex or age between PG and AGeffective patients.Conclusion: The PG method was more effective for measuring FDG accumulation of lung lesions under freebreathing conditions in comparison with the AG method.