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¹⁸F-FDG PET and PET/CT in the Evaluation of Cancer Treatment Response^*

Institute of Nuclear Medicine University College London, London, United Kingdom

View larger version (51K): [in this window] [in a new window]   FIGURE 1.  A 15-y-old boy with newly diagnosed HD. On baseline pretherapy 18F-FDG PET/CT (top), maximum-intensity-projection image (top right) and selected transaxial fused PET/CT slice (top left) show 18F-FDG–avid lymphadenopathy in both cervical and supraclavicular regions, extending into mediastinum, both axillae, and right internal mammary chain. 18F-FDG PET/CT was repeated after 3 chemotherapy courses (bottom). CT images (not shown) showed large residual mediastinal lymphadenopathy and cervical and supraclavicular residual disease. MIP image (bottom right) and selected transaxial fused PET/CT slice (bottom left) show no 18F-FDG–avid disease, consistent with complete metabolic response. New focus in mid-abdomen is due to focal inflammation, unrelated to primary tumor. MIP = maximum-intensity projection.

View larger version (48K): [in this window] [in a new window]   FIGURE 2.  A 31-y-old woman was diagnosed with primary mediastinal B-cell NHL and received 8 courses of R-CHOP (rituximab, cyclophosphamide, hydroxydaunomycin, vincristine [Oncovin; Eli Lilly and Co.], and prednisone). 18F-FDG PET/CT scan obtained after 6 cycles of therapy (not shown) showed residual mass with minimal 18F-FDG activity. Patient was referred for repeated 18F-FDG PET/CT after 8 cycles of chemotherapy and before planned radiotherapy (top). Maximum-intensity-projection image (top right) and selected transaxial fused PET/CT slice (top left) show an 18F-FDG–avid anterior mediastinal mass, compatible with active lymphoma. Further therapy with 2 cycles of ESHAP (etoposide, methylprednisolone, cytarabine, and cisplatin) and consolidation radiotherapy was administered, and repeated PET/CT after 3 mo (bottom) shows no evidence of 18F-FDG–avid disease, consistent with complete metabolic response. MIP = maximum-intensity projection.

View larger version (61K): [in this window] [in a new window]   FIGURE 3.  A 50-y-old woman with T4 left breast cancer was treated with adjuvant chemotherapy and radiotherapy to chest wall, followed by modified left mastectomy. 18F-FDG PET/CT was performed after 5 y for assessment of elevated Ca-15.3 serum marker (top). Maximum-intensity-projection image (top right) shows 18F-FDG–avid mediastinal and right hilar lymphadenopathy and 18F-FDG–avid lesions in both lobes of liver. Selected transaxial fused PET/CT slice (top left) shows largest 18F-FDG–avid liver lesion. Further chemotherapy was given, and 18F-FDG PET/CT repeated 3 wk after completion of 6 courses of docetaxel (bottom) shows no evidence of 18F-FDG–avid disease, compatible with excellent response to therapy. MIP = maximum-intensity projection.

View larger version (61K): [in this window] [in a new window]   FIGURE 4.  A 67-y-old man with newly diagnosed esophageal cancer. 18F-FDG PET/CT scan was obtained at presentation (top). Maximum-intensity-projection image (top right) and selected transaxial fused PET/CT slice (top left) show 18F-FDG–avid primary (SUVmax, 9) and no evidence of spread. 18F-FDG PET/CT was repeated after 3 mo of neoadjuvant chemotherapy for presurgical assessment (bottom). MIP image (bottom right) and selected transaxial fused PET/CT slice (bottom left) show reduced 18F-FDG uptake in distal esophagus (SUVmax, 5.6) and no 18F-FDG–avid disease elsewhere, indicating good response and favorable prognosis. Patient was therefore referred for surgery. MIP = maximum-intensity projection.