The Efficacy of NButylscopolamine BuscopanTM in FDG PET scanning Ppt Powerpoint Presentation slides Jennifer Emmott MSc DCR(R) Medical Slideshow RTOG 0522: Assess the role of FDG PET/CT scans in determining the overall c

The Efficacy of NButylscopolamine BuscopanTM in FDG PET scanning

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Slide 1 :

The Efficacy of N-Butylscopolamine (BuscopanTM) in FDG PET scanning Jennifer Emmott* Bal Sanghera*, Jane Chambers* Sue Huggett** Wai-Lup Wong* * Paul Strickland Scanner Centre, Mount Vernon Hospital, UK ** City University, London, UK.

Slide 2 :

FDG uptake in the bowel can cause a diagnostic dilemma Reduction of bowel motility can potentially reduce FDG uptake in bowel BuscopanTM is used in X-ray departments to reduce bowel motility Introduction

Slide 3 :

Aim To investigate the effect of BuscopanTM on reducing artefacts due to physiological bowel uptake in FDG PET Objectives To assess The visual difference of bowel uptake with and without BuscopanTM The semi-quantitative (SUV) difference of bowel uptake with and without BuscopanTM

Slide 4 :

Local Ethical approval granted 102 prospective patients 66 male 36 female Mean age 60 years No patients had bowel or liver pathology Lung lesions (isolated, SPN etc) 45 Head & neck cancer 29 Oesophagus cancer (isolated) 23 Lymphoma (excluding intrabdominal disease) 3 Haemoptysis, axillary nodal disease 2 Subjects and Methods

Slide 5 :

Informed written consent obtained 20mg/1ml BuscopanTM injected 1min later 300-400MBqs F-FDG injected Scan 1hour p.i PET scan performed using a Siemens ECAT EXACT 47, 2D, OSEM, approx 1hr Scans anonymised prior to observer scoring Subjects and Methods

Slide 6 :

A random mixture of patients with and without BuscopanTM was included in each reporting session 2 experienced PET radiologists (JC/WLW) Blind to each others results Blind to category of patient Grading system Ability to distinguish uptake bowel from other uptake no confusion = 0 to maximum confusion = 3 Degree of bowel uptake no uptake = 0 mild = 1 moderate =2 intense = 3 Visual Analysis

Slide 7 :

Bowel/Liver Ratios ROIs were drawn over areas of highest uptake in the gastro-intestinal tract and in an area of uniform uptake in the liver Mean SUVs were recorded The liver SUV was used as an estimate for general background uptake Semi-Quantitative Analysis

Slide 8 :

Areas of high uptake on visual analysis Descending Colon 31 17 14 Gastro-oesophageal jct 27 14 13 Ascending Colon 21 12 9 Rectum/Anus 9 3 6 Transverse Colon 8 3 5 Others 6 2 4 Results With Without Total BuscopanTM BuscopanTM

Slide 9 :

Patient injected with 20mg/1ml BuscopanTM No BuscopanTM injection Patient with mediastinal disease (HD) 6months apart Higher uptake areas Patient with / without BuscopanTM

Slide 10 :

Less confusion and uptake was identified in subjects with BuscopanTM No difference in results between the two observers (Mann Whitney Observer 1 p=0.0001, 0.002; Observer 2 0.0001, 0.001 respectively) Bowel/liver ratio values were lower in BuscopanTM subjects (unrelated t-test, p=0.001) These results are strongly in favour for administering BuscopanTM Summary of Results

Slide 11 :

This study has demonstrated that the use of BuscopanTM can significantly reduce uncertainty with respect to FDG uptake in the bowel Conclusions

Slide 12 :

Acknowledgements Staff at Paul Strickland Scanner Centre for all their time and effort in supporting this study

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