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¹⁸F-FDG PET Evaluation of the Response to Therapy for Lymphoma and for Breast, Lung, and Colorectal Carcinoma^*

Division of Nuclear Medicine, Department of Radiology, New York Presbyterian Hospital, Weill Medical College of Cornell University, New York, New York

View larger version (44K): [in a new window]   FIGURE 1. A 45-y-old man with NHL (diffuse large cell) underwent 18F-FDG PET simultaneously with CT using dual-head system (Millennium VG, Hawkeye [inbuilt CT scanner]; General Electric Medical Systems, Milwaukee, WI) before and after completion of chemotherapy (cyclophosphamide, hydroxydaunomycin, vincristine sulfate, and prednisone). Pretherapy 18F-FDG PET/CT images reveal intense 18F-FDG uptake in right supraclavicular region and right anterior mediastinum. Note physiologic uptake in myocardium.

View larger version (43K): [in a new window]   FIGURE 2. Post-therapy 18F-FDG PET/CT study of same patient as in Figure 1, acquired using same system. There is no appreciable 18F-FDG uptake in mediastinum (especially in transverse and sagittal images) to suggest residual lymphoma. Note intense 18F-FDG uptake in bone marrow in shoulder joints, sternum, and thoracic vertebrae, consistent with post-therapy reactive bone marrow changes. Patient is still in remission after progression-free survival of 18 mo.

View larger version (76K): [in a new window]   FIGURE 3. A 55-y-old man with NHL (diffuse large cell) underwent 18F-FDG PET using dual-head gamma camera with attenuation correction (MCD-AC; ADAC Laboratories, Milpitas, CA) before, after first cycle of, and at completion of chemotherapy. Pretherapy 18F-FDG PET image reveals extensive radiotracer uptake in anterior mediastinum. Note physiologic uptake in supraclavicular cervical muscles. Patient underwent chemotherapy with cyclophosphamide, hydroxydaunomycin, vincristine sulfate, and prednisone. After first cycle, residual disease was seen in anterior mediastinum (not shown). 18F-FDG PET image after last cycle (middle image) demonstrates no residual mass in mediastinum, consistent with complete resolution of disease. 18F-FDG PET image 8 mo after completion of therapy, however, reveals recurrence of disease in anterior mediastinum. Note physiologic uptake in heart in all images.

View larger version (106K): [in a new window]   FIGURE 4. A 46-y-old man with NSCLC of right upper lobe. Patient underwent 18F-FDG PET using dual-head gamma camera with attenuation correction (MCD-AC; ADAC Laboratories, Milpitas, CA) before and after completion of chemotherapy. Pretherapy 18F-FDG PET image (left) demonstrates distinct focus of increased 18F-FDG uptake in right upper lung. Post-therapy 18F-FDG PET image (right) reveals almost complete resolution of 18F-FDG uptake in corresponding region. Patient underwent resection of right upper lobe and was free of disease at 10-mo follow-up.

View larger version (106K): [in a new window]   FIGURE 5. A 50-y-old woman with NSCLC of right upper lobe underwent 18F-FDG PET using dual-head gamma camera with attenuation correction (MCD-AC; ADAC Laboratories, Milpitas, CA) before and after completion of chemotherapy. Pretherapy 18F-FDG PET image (left) demonstrates distinct focus of increased 18F-FDG uptake in right upper lung. Post-therapy 18F-FDG PET image (right) reveals no interval change in extent of 18F-FDG uptake. Patient underwent resection of right upper lobe but, 8 mo after completion of therapy, presented with bone metastases detected on bone scan (not shown) obtained at another institution.