Emerging role of total-body PET/CT with artificial intelligence

The total-body PET/CT (TB PET/CT) system represents the state-of-the-art PET imaging technique. Recently, TB PET/CT has become commercially available and enables high-resolution whole-body imaging, even under extreme conditions. It provides a real-time picture of the tracers of all organs across the body. It may play critical role in other medical fields, including cancer imaging, drug development, and immunology.

Given its ultrahigh sensitivity, excellent temporal resolution, extended scan range, and the ability to provide dynamic total-body imaging, TB PET/CT technology offers a variety of opportunities to address currently unsolved clinical issues. In addition, the decreased injected activity and shorter acquisition duration of this technique increase its utility in certain patient populations. Small or low-FDG-avid tumor deposits can also be detected, and this technique can also image regions affected by respiratory motion. TB PET/CT scanning also provides dynamic quantitative analysis from head to toe, presenting great prospects in clinical practice, such as differentiating inflammation from tumoral lesions, drug development and toxicology, monitoring cell-based therapies, and personalized medicine.

Although this modality is more expensive than conventional PET/CT techniques, the lower radiation exposure allows physicians to repeat scans multiple times for the same radiation cost of one traditional scan. Hence, the total-body PET/CT will certainly push the existing boundaries of PET imaging, and make a greater contribution in many medical fields.

As one reflects on the advancements in TB-PET/CT and its clinical applications, it becomes evident that artificial intelligence (AI) stands at the forefront of enhancing this field. TB-PET/CT’s increased sensitivity and comprehensive diagnostic capabilities introduce the challenge of managing and interpreting vast amounts of complex data. Here, AI as a pivotal catalyst in transforming TB-PET from a diagnostic modality to a comprehensive solution for personalized medicine. AI-driven tools for segmentation and detection are becoming increasingly crucial. These tools not only streamline the processing of complex datasets but also enable the nuanced interpretation of diverse biomarkers, thus enhancing the overall utility of TB PET/CT.

It is essential to also consider the role of AI in enhancing the safety and efficiency of TB PET/CT imaging. This is particularly significant in scenarios like low-dose longitudinal studies, pediatric imaging, or screening, where optimizing the CT component of TB PET/CT imaging becomes crucial. While TB-PET/CT’s increased sensitivity enables inherently low-dose imaging, the radiation dose primarily stems from the CT component, necessitating careful consideration in repeated imaging scenarios. Advancements in AI offer potential solutions to reduce, or in some cases, eliminate the need for CT scans even though CT itself already has a role in some screening approaches and likely itself to provide complementary diagnostic information.

Hence, advancements in TB PET/CT analysis will pave the way for more personalized and effective patient care.