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

This Article Abstract Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend 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 Hicks, R. J. Search for Related Content PubMed PubMed Citation Articles by Hicks, R. J.

Role of ¹⁸F-FDG PET in Assessment of Response in Non–Small Cell Lung Cancer

Centre for Molecular Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; and University of Melbourne, Parkville, Victoria, Australia

View larger version (124K): [in this window] [in a new window]   FIGURE 1.  Volume rendering of staging 18F-FDG PET demonstrates difficulties posed in defining primary lesion dimensions on CT in presence of atelectasis. Extensive loss of aerated lung was apparent in relationship to right lower-lobe primary tumor that partially obstructed bronchus. Nonenlarged lymph nodes (arrows) with high 18F-FDG uptake, indicating likely involvement, were not amenable to response assessment by RECIST but could be monitored on serial 18F-FDG PET scans. High right paratracheal and aortopulmonary nodal involvement significantly increased radiation volume required to achieve coverage of macroscopic disease.

View larger version (57K): [in this window] [in a new window]   FIGURE 2.  Influence of respiratory motion is greatest for lesions near base of lung. Although CT component of hybrid 18F-FDG PET/CT was acquired rapidly enough to stop respiratory motion, PET images were acquired over several minutes and demonstrated blurring. Combination of movement and assignment of inappropriate attenuation map created appearance of liver metastasis on PET and fused PET/CT images (left). Close relationship of this abnormality to known lung lesion and absence of structural abnormality led to acquisition of additional respiratory gated study over diaphragm. Resulting image showed good registration of CT, which was not respiratory gated, with end-expiratory frame of gated 18F-FDG PET; however, on end-inspiratory frame, this abnormality projected partially over lung lesion, lung (arrow), and liver (right). When attenuation correction was applied on basis of assumption that lesion arose from lung, apparent counts (and, hence, measured SUVs) were significantly reduced. This situation must be considered when serial SUV measurements of lung lesions are obtained.

View larger version (107K): [in this window] [in a new window]   FIGURE 3.  Presence of inflammatory changes in distal consolidation and collapse can significantly compromise evaluation of extent of residual tumor on both CT and PET. Although pattern recognition can help to improve positive predictive value, reactive lymphadenopathy can also mimic metastatic involvement. In this case, collapse with associated infection of right upper lobe was apparent. Hilar and subcarinal abnormality was also apparent on PET. Volume rendering (bottom right) demonstrated high uptake in subcarinal node that was close to both bronchus and esophagus (crosshairs). Accordingly, this node could be noninvasively accessed for biopsy via either endoscopic bronchoscopic ultrasound or endoscopic ultrasound to pathologically characterize this abnormality.

View larger version (68K): [in this window] [in a new window]   FIGURE 4.  High uptake of 18F-FDG in primary lesion, multiple lymph nodes, and multiple upper thoracic vertebrae indicates stage IV disease (top), not suitable for curative surgery or radiotherapy. Repeat 18F-FDG PET after 14 d of molecularly targeted therapy with epithelial growth factor receptor inhibitor revealed dramatic decreases in both qualitative 18F-FDG uptake and SUV (–62%) at target sites of previous disease (bottom).