Breath-hold and free-breathing F-18-FDG-PET/CT in malignant melanoma—detection of additional tumoral foci and effects on quantitative parameters

During PET/CT acquisition, respiratory motion generates artifacts in the form of breath-related blurring, which may impair lesion detectability and diagnostic accuracy. This observational study was undertaken to verify whether breath-hold F-18-FDG-PET/CT (bhPET) detects additional foci compared to free-breathing PET/CT (fbPET) in cases of malignant melanoma, and to assess the impact of breath-holding on standard uptake values (SUV) and metabolic isocontoured volume (mV(ic40)). Thirty-four patients with melanoma were examined. BhPET and fbPET findings of 117 lesions were compared and correlated with standard contrast-enhanced (ce) CT and MRI for lesion verification. Quantitative parameters (SUV(max), SUV(mean), and mV(ic40)) were assessed for both methods and evaluated by linear regression and Spearman correlation. The impact of lesion size and time interval between investigations was analyzed. In 1 patient, a CT-confirmed liver metastasis was seen only on bhPET but not on fbPET. At bhPET, SUV(max), and SUV(mean) proved significantly higher and mV(ic40) significantly lower than at fbPET. The positive effect on SUV(max) and SUV(mean) was more pronounced in smaller lesions, whereas the time interval between bhPET and fbPET did not influence SUV or mV(ic40). In our patient cohort, bhPET yielded significantly higher SUV and provided improved volumetric lesion definition, particularly of smaller lesions. Also one additional liver lesion was identified. Breath-hold PET/CT is technically feasible, and may become clinically useful when fine quantitative evaluations are needed.