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PET/CT: Panacea, Redundancy, or Something in Between?

¹ Department of Nuclear Medicine, University Medical Center Nijmegen, Nijmegen, The Netherlands
² Department of Radiology, University Medical Center Nijmegen, Nijmegen, The Netherlands
³ Department of Radiotherapy, University Medical Center Nijmegen, Nijmegen, The Netherlands

View larger version (50K): [in a new window]   FIGURE 1. Example of software fusion of 18F-FDG PET and CT images for lesion localization. (A) 18F-FDG PET clearly showed pathologic lesion somewhere in upper thoracic aperture. More precise localization was not possible because of lack of anatomic information. (B) Lesion was not found retrospectively on diagnostic CT images. (C) Image fusion localized lesion in rib near costovertebral joint.

View larger version (30K): [in a new window]   FIGURE 2. Example of software fusion of 18F-FDG PET and CT images of primary laryngeal carcinoma for IMRT field planning. Patient was scanned for both 18F-FDG PET and CT on flat bed, in personalized rigid radiotherapy mask covering head and shoulders to prevent positioning differences. Lymph node in neck that was only marginally enlarged on CT proved pathologic on 18F-FDG PET and was included in the radiotherapy field. (A) Transverse slice through pathologic lymph node. (B) Coronal slice. (C) Sagittal slice.

View larger version (56K): [in a new window]   FIGURE 3. Example of software fusion of 18F-FDG PET and CT images of primary non–small cell lung cancer with lymph node metastasis in mediastinum for IMRT field planning. Patient was scanned for both 18F-FDG PET and CT on flat scanning bed, with arms up in rigid customized support system to minimize positioning differences. CT images were acquired during free tidal breathing, accounting for huge artifacts. 18F-FDG PET images were also acquired during free tidal breathing but show much more reliable delineation of tumor tissue. (A) Transverse slice. (B) Coronal slice.

View larger version (63K): [in a new window]   FIGURE 4. Sample IMRT field planning of oropharyngeal squamous cell carcinoma. Different levels of radiation dose are drawn in red in 3-dimensional space. Painted in blue is spinal cord that will be spared. Reverse planning was used to calculate optimal shape and intensity of 7 beams.

View larger version (76K): [in a new window]   FIGURE 5. Example of software fusion procedure for 18F-FDG PET and CT images. (A) After loading both scans in fusion software, large shift exists. PET transmission images in CT are displayed for easier recognition of body outlines. (B) Optimized fusion after automatic registration with mutual information algorithm. (C) Final result with 18F-FDG PET emission images displayed in CT.

View larger version (47K): [in a new window]   FIGURE 6. Example of failed software image fusion in patient with B-cell lymphoma. CT images were acquired during breath hold at deep inspiration with arms up. 18F-FDG PET images were acquired during free tidal breathing with arms down. Fusion images show major inaccuracies in upper thorax aperture and in region of diaphragm. (A) Transverse slice. (B) Coronal slice.