Table 2 Comparison of CEST with closest nuclear medicine alternatives

Body tumors

Hydroxyl CEST

d-Glucose/glucose concentration

6 h fasting

(for control)

N/A (preclinical)

N/A (preclinical)

9.4 T

Human studies

FDG PET

[¹⁸F]Fluorodeoxyglucose/glucose metabolism

~350 MBq

4 h fasting

60 min uptake

~2 min/bed

~4 × 4 × 5 mm³

N/A

Clinical use

Choline PET

[¹⁸F]Fluorocholine/cell membrane synthesis

~200 MBq

24 h diet

6 h fasting

2 min uptake

~2 min/bed

2 passes

~4 × 4 × 5 mm³

N/A

Clinical use

PSMA PET

[⁶⁸Ga]PSMA/prostate-specific membrane antigen

~150 MBq

60 min uptake

~4 min/bed

~4 × 4 × 5 mm³

N/A

Human studies

DOTATATE PET

DOTATOC PET

DOTANOC PET

[⁶⁸Ga]DOTA-conjugated peptides/somatostatin receptors

~150 MBq

60 min uptake

~2 min/bed

~4 × 4 × 5 mm³

N/A

Human studies

FMISO PET

[¹⁸F]Fluoromisonidazole/macromolecules, hypoxia

~400 MBq

90 min uptake

~10 min/bed

~4 × 4 × 5 mm³

N/A

Human studies

Brain tumors

Amide CEST

None/protein concentration

Not needed

~40 s/slice

~2.2 × 2.2 × 4.4 mm³

3 T

Human studies

Amine CEST

None/pH

Not needed

~1 min/slice

~2.3 × 2.3 × 6.0 mm³

3 T

Human studies

FET PET

[¹⁸F]Fluoroethyltyrosine/amino acid

~130 MBq

4 h fasting

20 min uptake

~20 min dynamic

~4 × 4 × 5 mm³

N/A

Clinical use

FLT PET

[¹⁸F]Fluorothymidine/DNA synthesis, proliferation

~250 MBq

45 min uptake

~60 min dynamic

~4 × 4 × 5 mm³

N/A

Human studies

FDOPA PET

[¹⁸F]Fluoro-L-DOPA/dopamine receptors

~300 MBq

15 min uptake

~30 min dynamic

~4 × 4 × 5 mm³

N/A

Human studies

FMISO PET

[¹⁸F]Fluoromisonidazole/macromolecules, hypoxia

~400 MBq

90 min uptake

~10 min

~4 × 4 × 5 mm³

N/A

Human studies

Stroke

Amide CEST

None/pH

Not needed

~13 s/slice

2.5 × 2.5 × 5.0 mm³

3 T

Human studies

H₂O/O₂/CO PET

H₂[15O]-O, [15O]-O₂, C[15O]O/cerebral blood flow, oxygen consumption, blood volume (combined: oxygen extraction fraction)

~500 MBq

Not needed

~3 min dynamic

~4 × 4 × 5 mm³

N/A

Human studies

NH₃ PET

[¹³N]Ammonia/cerebral blood flow

~150 MBq

Not needed

~10 min dynamic

~4 × 4 × 5 mm³

N/A

Human studies

FMISO PET

[¹⁸F]Fluoromisonidazole/macromolecules, hypoxia

~400 MBq

90 min uptake

~10 min

~4 × 4 × 5 mm³

N/A

Human studies

Neurological state

Amine CEST

None/glutamate concentration

Not needed

~10 min/slice

~1 × 1 × 5 mm³

7 T

Human studies

Hydroxyl CEST

None/myo-inositol concentration

Proposed marker of glial function/density

Not needed

N/A (preclinical)

N/A (preclinical)

9.4 T

Animal studies

mGluR5 PET

[¹¹C]-ABP, [¹⁸F]-PSS232/mGluR5 receptor density

~250 MBq

Not needed

~2 min/bed dynamic

~4 × 4 × 5 mm³

N/A

Human studies

FDOPA PET

[¹⁸F]Fluoro-L-DOPA/dopamine receptors

~300 MBq

15 min uptake

~30 min dynamic

~4 × 4 × 5 mm³

N/A

Human studies

Raclopride PET

[¹¹C]Raclopride/dopamine receptors

~350 MBq

Not needed

~60 min dynamic

~4 × 4 × 5 mm³

N/A

Human studies

FDG PET

[¹⁸F]Fluorodeoxyglucose/glucose metabolism

~350 MBq

4 h fasting

60 min uptake

~2 min/bed

~4 × 4 × 5 mm³

N/A

Clinical use

Neurotransmitter transporter PET

Various/dopamine transporter, serotonin transporter

Various

Various

N/A

N/A

Animal studies

SV2A PET

[¹⁸F]UCB-H, [¹¹C]LEV/synaptic vesicle protein 2A

(proposed marker of synaptic density)

Various

Various

N/A

N/A

Animal studies

Energetics

Amine CEST

None/creatine concentration

Not needed

~48 s/slice

~1 × 1 × 4 mm³

7 T

Human studies

FDG PET

[¹⁸F]Fluorodeoxyglucose/glucose metabolism

~350 MBq

4 h fasting

60 min uptake

~2 min/bed

~4 × 4 × 5 mm³

N/A

Clinical use

Cartilage

Hydroxyl CEST

None/GAG concentration

Not needed

~30 s/slice

~0.7 × 0.7 × 3.0 mm³

7 T

Human studies

FDG PET

[¹⁸F]Fluorodeoxyglucose/glucose metabolism

~350 MBq

4 h fasting

60 min uptake

~2 min/bed

~4 × 4 × 5 mm³

N/A

Clinical use