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Can PET/CT Replace Separate Diagnostic CT for Cancer Imaging? Optimizing CT Protocols for Imaging Cancers of the Chest and Abdomen

¹ Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany; and ² Department of Nuclear Medicine, University Hospital Essen, Essen, Germany

View larger version (81K): [in this window] [in a new window]   FIGURE 1.  Patient supported with different positioning aids on PET/CT table. (A) For whole-body PET/CT, arms are raised above head and supported by foam cushion to avoid truncation artifacts during scanning of thorax and abdomen (arrow). Furthermore, head is placed within foam cushion and may be additionally supported with vacuum-lock bag to prevent head motion (blue vacuum-lock bag). (B) Legs are supported by another foam mold to inflect patient's knees and to ensure comfortable positioning during scanning. (C) For head and neck scanning, vacuum-lock bag is deflated to fix head and neck within foam cushion (arrows). Thus, possible moving artifacts can be avoided. (D) Additionally, arms are placed on or beside patient's trunk to avoid truncation artifacts in head and neck area.

View larger version (72K): [in this window] [in a new window]   FIGURE 2.  Comparison of chest scanning during shallow breathing (A) and chest scanning with additional low-dose CT during maximal inspiration (B). (A) Lung metastasis from colorectal cancer is only barely visible during shallow breathing (arrow). Also note blurred lung vessels and congested lung parenchyma in this image. (B) Metastasis can be clearly detected by low-dose CT during maximal inspiration (arrow). Additionally, lung parenchyma is well inflated, and lung vessels are displayed sharply.

View larger version (78K): [in this window] [in a new window]   FIGURE 3.  Patient with NSCLC, positioned for radiotherapy planning, and wearing combined chest–neck–head mask. Patient rests on flat radiotherapy planning table, and mask is fixed at both sides of table (arrows). Arms are raised above head to avoid truncation artifacts on chest images. Arms are supported by triangular cushion to avoid motion artifacts.

View larger version (39K): [in this window] [in a new window]   FIGURE 4.  (A) Foam mold for dedicated PET/CT breast imaging with 2 breast cups. (B) For greater patient comfort, breast imaging device is covered with cotton drapery during examination. (C) Patient positioned for breast PET/CT in prone position with arms raised above head. (D) Corresponding 18F-FDG PET/CT image of patient with suspected breast cancer revealed elevated glucose metabolism in left breast; finding was verified during surgery to be breast cancer. (E) Corresponding MRI showing mass (arrow).

View larger version (102K): [in this window] [in a new window]   FIGURE 5.  Male patient with GIST 1 y after initiation of imatinib treatment. CT image shows newly developed, round, contrast-enhancing nodules (arrows) within liquefied metastatic remnants. This nodule-within-a-mass pattern is typical CT appearance of GIST recurrence during imatinib treatment.