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Table 2 Comparison of CEST with closest nuclear medicine alternatives

From: An overview of CEST MRI for non-MR physicists

Target Method Contrast/mechanism Preparation Acquisition timea Resolutionb Field strength Status
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
  1. aPET acquisition times are provided per bed (i.e., anatomical station). The coverage of a PET bed varies with system geometry: PET/CT systems typically cover 70 × 70 × 15 cm, PET/MR systems 60 × 60 × 25 cm. Whole-body imaging (typically head-to-mid-thighs) requires between 6 and 8 beds
  2. bThe intrinsic resolution of PET systems decreases away from the center of the field-of-view (typically 1–2 mm). It is also dependent on the reconstruction algorithm. Standard measurements provided by manufacturers are performed using filtered backprojection, seldom used in clinical practice these days. The values provided here are approximations, representative of the average resolution that can be expected in state-of-the-art systems using iterative reconstruction methods. In the case of CEST, resolutions are not inherently limited but given by the scanner hardware, pulse sequence, and acquisition time. Typical values reported in recent literature are listed here as a reference