Are lesion features reproducible between 18F-FDG PET/CT images when acquired on analog or digital PET/CT scanners?

Eur Radiol. 2021 May;31(5):3071-3079. doi: 10.1007/s00330-020-07390-8. Epub 2020 Oct 30.


Objectives: To compare lesion features extracted from 18F-FDG PET/CT images acquired on analog and digital scanners, on consecutive imaging data from the same subjects.

Methods: Whole-body 18F-FDG PET/CT images from 55 oncological patients were acquired twice after a single 18F-FDG injection, with a digital and an analog PET/CT scanner, alternately. Twenty-nine subjects were examined first on the digital, and 26 first on the analog equipment. Image reconstruction was performed using manufacturer standard clinical protocols and protocols that fulfilled EARL1 specifications. Twenty-five features based on lesion standardized uptake value (SUV) and geometry were assessed. To compare these features, intraclass correlation coefficient (ICC), relative difference (RD), absolute value of RD (|RD|), and repeatability coefficient (RC) were used.

Results: In total, 323 18F-FDG avid lesions were identified. High agreement (ICC > 0.75) was obtained for most of the lesion features pulled out from both scanners' imaging data, especially when reconstruction protocols fulfilled EARL1 specifications. For EARL1 reconstruction images, the features frequently used in clinics, SUVmax, SUVpeak, SUVmean, metabolic tumor volume, and total lesion glycolysis, reached an ICC of 0.92, 0.95, 0.87, 0.98, and 0.98, and a median RD (digital-analog) of 3%, 5%, 4%, - 3% and 1%, respectively. Using standard reconstruction protocols, the ICC were 0.84, 0.93, 0.80, 0.98, and 0.98, and the RD were 20%, 11%, 13%, - 7%, and 7%, respectively.

Conclusion: Under controlled acquisition and reconstruction parameters, most of the features studied can be used for research and clinical work. This is especially important for multicenter studies and patient follow-ups.

Key points: • Using manufacturer standard clinical reconstruction protocols, lesions SUV was significantly higher when using the digital scanner, especially the SUVmax that was approximately 20% higher. • High agreement was obtained for the majority of the lesion features when using reconstruction protocols that fulfilled EARL1 specifications. • Longitudinal patient studies can be performed interchangeably between digital and analog scanners when both fulfill EARL1 specifications.

Keywords: 18F-FDG PET/CT; Computer-assisted image analysis; Diagnostic imaging; Image reconstruction; Reproducibility of results.

MeSH terms

  • Fluorodeoxyglucose F18*
  • Glycolysis
  • Humans
  • Image Processing, Computer-Assisted
  • Positron Emission Tomography Computed Tomography*
  • Positron-Emission Tomography
  • Radiopharmaceuticals
  • Tomography Scanners, X-Ray Computed
  • Tumor Burden


  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18