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Combined Functional and Structural Evaluation of Cancer Patients with a Hybrid Camera-Based PET/CT System Using ¹⁸F-FDG

¹ Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
² B. Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
³ Department of Diagnostic Radiology, Rambam Medical Center, Haifa, Israel
⁴ Department of Oncology, Rambam Medical Center, Haifa, Israel

Correct diagnosis and definition of the functional and anatomic status of lesions in cancer patients are of clinical importance. The value of hybrid imaging using a gamma camera-based PET/CT and ¹⁸F-FDG in determining the relationship between mass and cancer was assessed. Methods: Hybrid imaging was performed using a device combining low-dose CT and gamma camera-based PET. Ninety-one patients with histologically proven malignancy and 190 suspected sites of disease were evaluated. Camera-based PET was performed after the injection of 296–370 MBq ¹⁸F-FDG. The presence of organomegaly or an abnormal mass on CT and of abnormal uptake of ¹⁸F-FDG was assessed for each suspected lesion. The presence of malignancy at each site was determined by biopsy, imaging follow-up, or clinical outcome. Results: Five imaging patterns were found. Pattern 1 showed congruent abnormal ¹⁸F-FDG uptake and a mass on CT in 110 of the lesions. One hundred two sites (93%) had active cancer. Pattern 2 showed a mass on CT, larger than the area of abnormal ¹⁸F-FDG uptake, and was found in 5 lesions. Active malignancy was proven in 3 sites (60%). Pattern 3 showed an abnormal mass on CT with no ¹⁸F-FDG uptake and was found in 52 lesions. Thirteen of these lesions (25%) had active tumor. Pattern 4 showing abnormal ¹⁸F-FDG uptake with no mass on CT was found in 23 lesions. Sixteen of these sites (70%) were malignant. Pattern 5 showed normal CT findings and no abnormal ¹⁸F-FDG uptake in 11 patients. Two of these patients (18%) had active disease. Hybrid imaging was of value in establishing the correct relationship between CT and ¹⁸F-FDG findings in 98 of the 190 lesions (52%). Conclusion: A range of patterns presenting with or without abnormal ¹⁸F-FDG uptake on camera-based PET and a mass on CT may occur in suspected cancer sites. Both structural changes on CT and increased cell metabolism expressed by abnormal ¹⁸F-FDG uptake should be considered in oncologic imaging. Hybrid imaging, a combined physiologic and anatomic modality, appears to provide new diagnostic opportunities in characterizing function and morphology in malignancies.

Key Words: tumor cell metabolism • camera-based PET • hybrid imaging

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