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FDG-PET/CT imaging in lung malignancy: The effect of respiratory gating on the Standardised Uptake Values of lung lesions. Lasitha Naveen Wickramaratne, Geogre Larcos Background: FDG-PET/CT has gained widespread acceptance as an invaluable tool in the management of oncology patients, in which, the Standardised Uptake Values (SUV) are used to provide a simplistic measure oi the lesion metabolic activity. However, in the evaluation of lung malignancy, respiratory motion results in smearing (partial volume) artefact, that leads to underestimation of the lesion SUV. Respiratory gating has been employed as a potential solution. However, literature regarding the effect of respiratory gating on the Standardised Uptake Values in lung malignancy is mostly limited to pilot studies with small sample sizes. Objective: To assess the effect of respiratory gating on the SUV of lung lesions, in the FDG-PET/CT evaluation of lung malignancy, in the clinical setting. Thereby we aim to provide proof of principle to the effectiveness of respiratory gating in reducing the smearing (partial volume) artefact created by respiratory motion and to its ability in providing a more accurate estimation of the SUV in the evaluation of patients with lung malignancy. Method: Retrospective cohort study was conducted on 49 consecutive patients with biopsy proven lung malignancy, that underwent both conventional (non gated) and respiratory gated FDG-PET/CT imaging, from December 2018 to June 2019. The maximum Standardised Uptake Values (SUVmax) of the lung lesions was recorded from both series of images. A paired-samples t-test was performed to compare the SUVmax values between the two groups. Results: There was a statistically significant difference in the SUVmax value for the non gated (M=9.6284, SD=5.13304) and the gated (M =10.4651, SD=5.51711) series; t(48)= -3.755, p = 0.000. These results suggest that respiratory gating does influence the SUVmax of lung lesions. Specifically, our results suggest that when respiratory gating is employed the SUVmax of lung lesions increase compared to the non gated series. Conclusion: Respiratory gating is effective in reducing the smearing (partial volume) artefact created by respiratory motion and provides a more accurate estimation of the Standardised Uptake Values for lung lesions in the PET/CT evaluation of lung malignancy.