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Improvements in Cancer Staging with PET/CT: Literature-Based Evidence as of September 2006

Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Clinic/Nuclear Medicine, David Geffen School of Medicine, UCLA, Los Angeles, California

View larger version (57K): [in this window] [in a new window]   FIGURE 1.  Whole-body 123I (A) and PET/CT (B–E) images obtained in patient who had history of papillary thyroid cancer and who had been treated with surgery and radioiodine therapy. Patient presented with markedly elevated serum thyroglobulin levels. (A) Normal 123I whole-body scan. Green arrows denote physiologic activity in right submandibular region, stomach, and bladder. (B–E) Coronal whole-body PET/CT, axial PET/CT, axial CT, and axial PET images, respectively. PET/CT revealed intensely increased 18F-FDG uptake in left supraclavicular region, corresponding to lymphadenopathy on CT (yellow arrows). Subsequent surgical resection revealed metastasis from papillary carcinoma.

View larger version (97K): [in this window] [in a new window]   FIGURE 2.  Images obtained in patient with lung cancer after left upper lobectomy and chemotherapy. Study was performed for restaging. (A–D) Coronal whole-body PET/CT, axial PET/CT, axial CT, and axial PET images, respectively. Local recurrence in region of previous resection was evident. Unexpected metastases to left lobe of liver (yellow arrows) and to right iliac bone (red arrow) were identified, underscoring importance of whole-body staging of patients with lung cancer.

View larger version (56K): [in this window] [in a new window]   FIGURE 3.  Coronal PET/CT (A) and axial PET/CT (B), CT (C), and PET (D) images acquired in patient with breast cancer. White arrow on coronal image depicts primary tumor, which was infiltrating ductal carcinoma. Yellow arrows denote metastatic lesion in sternum.

View larger version (74K): [in this window] [in a new window]   FIGURE 4.  Coronal PET/CT (A) and axial PET/CT (B), CT (C), and PET (D) images acquired in patient with colorectal cancer. Increased 18F-FDG uptake in left axilla (yellow arrows), corresponding to lymphadenopathy on CT, was subsequently proven to represent metastatic disease.

View larger version (65K): [in this window] [in a new window]   FIGURE 5.  Coronal PET/CT (A) and axial PET/CT (B), CT (C), and PET (D) images acquired in patient with melanoma. Small focus of moderately increased 18F-FDG uptake corresponded to small soft-tissue nodule on CT (yellow arrows). Biopsy confirmed melanoma, and subsequent surgery for solitary metastasis was performed.