Advantages of SiPM-based digital PET/CT technology in nuclear medicine clinical practice: a systematic review—Part 1 oncological setting

Purpose

New-generation fully-digital PET/CT (dPET) scanners offer several technical advantages compared to analog (aPET) systems. This review aimed to summarize the current literature evidence about dPET technology clinical advantages.

Methods

A systematic literature search of PubMed/MEDLINE and Embase databases was performed following PRISMA guidelines. The full-text articles methodological quality was independently assessed by four authors using the CASP-diagnostic study checklist.

Results

Out of 510 articles, 81 were selected of which 42 related to oncology. In early-recurrent prostate cancer (PSA range ≤ 0.5 and 0.5–2.0 ng/ml), PSMA-dPET has shown a significantly higher detection rate compared to aPET especially for smaller lesions. A higher image quality and lesion detectability was reported in [¹⁸F]FDG studies on lung cancer and on mixed oncological cohorts, where metabolic TNM upstaging occurred in up to 32% of cases compared to aPET. dPET technology was also found to improve the localization of in-transit metastases in melanoma, the staging of early oral squamous cell carcinoma, as well as the accuracy of [⁶⁸ Ga]Ga-DOTA-TATE and ¹²⁴I imaging in neuroendocrine tumors and thyroid cancer respectively. Although dPET sensitivity can provide better image quality in diagnostic and therapeutic (⁹⁰Y-SIRT) applications, the possible higher rate of false positive findings (e.g., unspecific bone uptake at PSMA-1007), and SUV_max/radiomic-features variability should be considered. Main studies limitations included their retrospective nature, heterogeneity, and matched pair comparison design.

Conclusions

dPET has shown a diagnostic advantage over aPET in a variety of oncological settings, where the earlier and more accurate lesion localization and quantification could have relevant implications for optimal patient management.