Clinical Performance of PET/CT in Evaluation of Cancer: Additional Value for Diagnostic Imaging and Patient Management
Rachel Bar-Shalom, MD1,
Nikolai Yefremov, MD1,
Ludmila Guralnik, MD2,
Diana Gaitini, MD2,3,
Alex Frenkel, DSc1,
Abraham Kuten, MD3,4,
Hernan Altman, MBA5,
Zohar Keidar, MD, PhD1 and
Ora Israel, MD1,3
1 Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
2 Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel
3 School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
4 Department of Oncology, Rambam Medical Center, Haifa, Israel
5 Elgems, Tirat Hacarmel, Israel
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FIGURE 1. Summary of data: additional value of PET/CT for single-step detection of malignancy, definition of its location and extent, and improved management.
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FIGURE 2. Precise localization of increased 18F-FDG uptake and exclusion of malignancy, after PET/CT. A 68-y-old man, 3 y after partial gastrectomy for adenocarcinoma of stomach, was referred for 18F-FDG PET/CT for further evaluation of polypoid mass in gastric stump detected on routine follow-up gastroscopy, with equivocal biopsy results. (A) 18F-FDG PET coronal images (top) and axial images (bottom) show increased 18F-FDG uptake in region of stomach (arrow). (B) Hybrid PET/CT axial image (top) precisely localizes and defines uptake as physiologic activity at gastric stump (arrowhead). Suspicious polypoid mass in anastomotic region (arrow), seen on corresponding hybrid and CT slices (bottom) obtained during same acquisition, shows no uptake of 18F-FDG. Findings on PET/CT were interpreted as physiologic 18F-FDG uptake in stomach and nonviable residual mass. Patient showed no evidence of disease for follow-up of 7 mo.
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FIGURE 3. Precise characterization of increased 18F-FDG uptake and retrospective lesion detection on CT, after PET/CT. A 35-y-old man, 22 mo after treatment for colon cancer, with negative high-resolution contrast-enhanced CT and normal levels of serum tumor markers, was referred for 18F-FDG PET for further assessment of pelvic pain. (A) Coronal PET images show area of increased 18F-FDG uptake in left pelvic region (arrow), interpreted as equivocal for malignancy, possibly related to inflammatory changes associated with ureteral stent or to physiologic bowel uptake. (B) Hybrid PET/CT axial image (top) precisely localizes uptake to soft-tissue mass adjacent to left ureter, anterior to left iliac vessels. Mass (arrow) was detected only retrospectively on both diagnostic CT and CT component of hybrid imaging study (bottom). Patient received chemotherapy, resulting in pain relief and decrease in size of pelvic mass on follow-up CT.
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FIGURE 4. Precise anatomic localization of malignant 18F-FDG uptake and retrospective lesion detection on CT, after PET/CT. A 33-y-old man with Hodgkin’s disease in left cervical region was referred for 18F-FDG PET for staging. No other sites of disease were reported on CT. (A) PET images show infradiaphragmatic focus of abnormal 18F-FDG uptake in medial border of liver, consistent with either liver involvement (stage IV disease?) or nodal disease in porta hepatis (stage III disease?). (B) Hybrid PET/CT axial image (top) precisely localizes 18F-FDG uptake to adenopathy at porta hepatis, only retrospectively detected on corresponding CT image (bottom) (arrow). Patient was treated as having stage III disease and achieved complete response, showing no evidence of disease for follow-up of 12 mo.
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Copyright © 2003 by the Society of Nuclear Medicine.
