Dynamic and Parametric Whole-Body FDG PET/CT Imaging in Oncology: Is it Feasible in Routine Clinical Practice?

Dynamic PET can probe a number of functional and biological processes in both the early vascular distribution phase and the later metabolic phase of study. The recent advances in PET-CT hardware and software algorithms have simplified dynamic whole body PET/CT imaging. There is a huge potential of the kinetic parameters in its ability to differentiate benign from malignant lesions, in the staging and treatment monitoring of tumors suggesting that dynamic PET imaging may become an essential part in clinical molecular imaging. However, the complexity and time consuming nature of the reconstruction and tracer kinetic modeling techniques have restricted parametric imaging thus far to drug development and clinical research applications. While the initial reported pilot results have been promising, the data is still in its nascent stage with lack of guidance on the recommendations for its clinical use. Prospective studies are therefore required on individual cancers to see how dynamic whole body parametric PET imaging could be used beyond clinical research and integrated into clinical practice. With the gaining importance of radiogenomics, a potential clinical interest for parametric imaging could be to correlate the kinetic parameters with molecular profiling of a tumor lesion such as some key oncogene mutational status and predicting their response to specific targeted therapy. This review discusses the parametric imaging and its scope with the recent technological advancement and a review of the available literature on its clinical applications