Limits for reduction of acquisition time and administered activity in 18F-FDG PET studies of Alzheimer dementia and frontotemporal dementia

Abstract

We evaluated the effect of a reduced acquisition time for 18F-FDG PET studies of Alzheimer dementia (AD) and frontotemporal dementia (FTD) to derive a limit for reductions of acquisition time (improving patient compliance) and administered activity (lowering the radiation dose) with uncompromised diagnostic outcome. Methods: We included patients with a clinical diagnosis of AD (n 5 13) or FTD (n 5 12) who were examined with 18F-FDG PET/CT after injection of 210 ± 9 MBq of 18F-FDG. List-mode data were reconstructed over various time intervals simulating reduced acquisition times or administered activities. Volume-of-interest-based and voxelwise statistical analyses including group contrasts were performed for 15 different acquisition times ranging from 10 min to 2 s. In addition, masked visual reads were obtained from 3 readers independently for 7 different acquisition times down to 30 s, providing a diagnosis of either AD or FTD and the individual diagnostic certainty. Results: Regional mean uptake changed by less than 5% at a reduced acquisition time down to 1 min in all regions and patients except for the posterior cingulate cortex of 1 patient. Voxelwise group contrasts suggest a sufficient measurement time of only 2 min, for which the number of significant voxels decreased by merely 5% while maintaining their spatial pattern. In 450 visual reads at reduced times, no change in the original diagnosis was observed. The diagnostic certainty showed only a very slow and mild decline, with small effect sizes (Cohen's d) of 0.3, at acquisition times of 3 and 2 min compared with the original results at 10 min. Conclusion: Statistical results at a region and voxel level, as well as single-subject visual reads, reveal a considerable potential to reduce the typical 10-min acquisition time (by a factor of 4) without compromising diagnostic quality. Conversely, our data suggest that for a given acquisition time of 10 min and a similar effect size, the administered activity may be reduced to 50 MBq, resulting in an effective dose of less than 1 mSv for the PET examination.