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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

View larger version (34K): [in a new window]   FIGURE 1. Pattern 1: congruent findings of abnormal 18F-FDG uptake and mass on CT in recurrent colon cancer. A 31-y-old male patient with adenocarcinoma of cecum, Duke’s stage C2, state after right hemicolectomy. There is thickening of intestinal wall at level of anastomosis on CT (left) with abnormal 18F-FDG uptake (center) of similar size and location as confirmed by hybrid TET (right) images. Red markers are used for exact localization of lesion on all components of hybrid study. Surgery confirmed recurrence at site of anastomosis.

View larger version (29K): [in a new window]   FIGURE 2. Pattern 2: incongruent findings of abnormal 18F-FDG uptake representing residual cancer inside larger residual mass seen on CT after treatment. A 34-y-old male patient with leiomyosarcoma of left chest wall. There was decrease in size of tumor on repeated CT studies after chemo- and radiotherapy, suggesting response to treatment. However, CT (left), 18F-FDG (center), and hybrid TET (right) images indicate presence of viable cancer inside residual tumor mass. Patient died with tumor progression 6 wk later.

View larger version (33K): [in a new window]   FIGURE 3. Pattern 3: incongruent findings of residual mass on CT with no 18F-FDG uptake indicating no viable cancer. A 49-y-old female patient with recurrent abdominal low-grade non-Hodgkin’s lymphoma, state after chemo- and radiotherapy. CT image (left) shows mild-to-moderate mesenterial lymphadenopathy (arrow). There is no abnormal 18F-FDG uptake (center) in same localization as shown on hybrid TET image (right). TET also localizes increased 18F-FDG uptake in left abdomen to physiologic colon excretion. Patient has been in continuous clinical remission for >14 mo.

View larger version (90K): [in a new window]   FIGURE 4. Pattern 4: incongruent findings of abnormal 18F-FDG uptake indicating presence of active cancer with no mass on CT. A 59-y-old male patient, 4 y after abdominoperineal resection for well-differentiated cancer of rectum, stage C2, and elevated levels of tumor serum markers. 18F-FDG images (center) show abnormal uptake localized by hybrid TET images (right) to prostate, which is of normal size on CT image (left). Studies are presented in transaxial (top row), coronal (middle row), and sagittal (bottom row) planes. Red markers are used to allow for exact localization of lesion on CT. Biopsy was guided by precise localization provided by hybrid imaging. It revealed metastasis from rectal cancer to prostate, detected by abnormal 18F-FDG uptake but not by CT.