HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Supplemental Videos Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Related articles in JNM Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Quon, A. Articles by Gambhir, S. S. Search for Related Content PubMed PubMed Citation Articles by Quon, A. Articles by Gambhir, S. S.

"Flying Through" and "Flying Around" a PET/CT Scan: Pilot Study and Development of 3D Integrated ¹⁸F-FDG PET/CT for Virtual Bronchoscopy and Colonoscopy

Molecular Imaging Program at Stanford, Departments of Radiology and Bioengineering, Stanford University, Stanford, California

View larger version (42K): [in a new window]   FIGURE 1.  Flowchart of software-processing steps to produce 3D PET/CT images.

View larger version (52K): [in a new window]   FIGURE 2.  Schematic of 3D rendering of PET/CT images. Standard 2D tomographic CT and PET images, which contain scaling and alignment parameters calculated by software on PET/CT scanner, are simultaneously rendered (28) into single image that combines CT anatomy and PET activity in correct anatomic relationship. Bone, soft-tissue, and airway windows can be selected when using 3D rendering of CT to emphasize a particular anatomic perspective. Similar process is used to create 3D-rendered virtual endoscopy images.

View larger version (78K): [in a new window]   FIGURE 3.  CT virtual colonoscopy compared with PET/CT virtual colonoscopy for detection of a potentially malignant lesion. (A) CT-based virtual colonoscopy showing several areas of stool that are difficult to distinguish from potential malignant polyp. (B) PET/CT virtual colonoscopy showing intense 18F-FDG uptake that highlights suspected polyp relative to surrounding stool and greatly aids in differentiation of lesion from stool. (C and D) Retrospective review of standard 2D PET/CT tomographic slices reveals abnormal focus in colon that was missed on original interpretation (C) and would not have been detected without 3D fusion rendering (D). p = polyp; s = stool.

View larger version (93K): [in a new window]   FIGURE 4.  CT virtual bronchoscopy compared with PET/CT virtual bronchoscopy. (A, C, and E) Standard 2D PET/CT tomographs illustrating patient with highly 18F-FDG–avid malignant subcarinal/paratracheal mass that extends along right tracheal sidewall and right bronchus. (B) CT virtual bronchoscopy illustrating that tracheal sidewall and carina appear normal, without indication of large tumors that abut central airways. (D) PET/CT virtual bronchoscopy showing abnormal 18F-FDG uptake along right paratracheal wall, carina, and proximal right bronchus consistent with regions of malignant tissue that were not evident on CT virtual bronchoscopy. Images and video fly-through provided excellent preview of region before surgical bronchoscopy. t = tumor.

View larger version (43K): [in a new window]   FIGURE 5.  3D-rendered PET/CT fly-around aiding spatial localization of metastatic lymph nodes. (A, B, and D) Standard 2D tomographic 18F-FDG PET/CT images illustrating abnormal focus in left side of mediastinum, posterior to left bronchus (demarcated by red cross-hairs). Despite coregistration of focus to contrast-enhanced thin-slice CT, it was difficult to detect and spatially localize lesion. (C) External 3D-rendered PET/CT fly-around showing abnormal 18F-FDG PET focus hidden behind left mainstem bronchus, as well as several additional perihilar 18F-FDG–avid lymph nodes. This image allowed clear spatial localization of lesion and guided mediastinoscopy biopsy. LN = lymph node.

View larger version (70K): [in a new window]   FIGURE 6.  Virtual colonoscopy using supine and prone PET/CT with air insufflation. (A) Supine PET/CT without air insufflation showing abnormal focus (arrows) in rectosigmoid colon on PET. (B) Prone PET and CT with air insufflation providing excellent definition of same lesion shown in A on both PET and CT images. (C) PET/CT without air insufflation illustrating good image and lesion (arrow) coregistration. (D) 3D-rendered PET/CT colonography demonstrating lesion in its entirety.