Effects of nonionic intravenous contrast agents at PET/CT imaging: Phantom and canine studies

PURPOSE: To investigate the effects of intravenous contrast agents on quantitative values obtained with a combined positron emission tomographic (PET) and computed tomographic (CT) scanner by using several phantoms and a dog. MATERIALS AND METHODS: Fluorine 18 fluorodeoxyglucose (FDG) was mixed with different concentrations of contrast agent with the same syringe (phantom 1), and the phantom was scanned. After image reconstruction with various attenuation maps, radioactivity concentrations were compared. Then, FDG solutions with (phantom 2) or surrounded by (phantom 3) various concentrations of contrast agent were scanned repeatedly, and radioactivity concentration was compared. Finally, PET and CT with and without contrast agent were performed in a dog. PET images were reconstructed by using different attenuation maps, and radioactivity concentrations were compared. The radioactivity concentration on germanium 68 (⁶⁸Ge)-based corrected images was regarded as standard, and percentage bias, defined as difference divided by measured activity of ⁶⁸Ge-based corrected images, was assessed. The relationship between the concentration of contrast agent and the percentage bias was assessed with the Pearson coefficient r, and the significance of correlations was evaluated with the Fisher z test. RESULTS: All phantom studies demonstrated that presence of a contrast agent resulted in overestimation of emission data. CT numbers showed a strong positive correlation with the percentage bias in phantoms 2 (r = 0.999) and 3 (r = 0.987); the maximum percentage bias at 1,360 HU reached approximately 45%. These effects were independent of FDG concentration. In a canine model, presence of a contrast agent also increased emission activity, but the percentage bias was less than 15% in the liver and smaller in all other organs except the kidney (26%). CONCLUSION: High concentrations of a contrast agent caused considerable overestimation of apparent tracer activity in phantom studies; however, the emission bias was relatively modest in vivo, except in areas with very high contrast agent concentrations.