Article Figures & Data
Figures
- FIGURE 1.
Summary of data: additional value of PET/CT for single-step detection of malignancy, definition of its location and extent, and improved management.
- FIGURE 2.
Precise localization of increased 18F-FDG uptake and exclusion of malignancy, after PET/CT. A 68-y-old man, 3 y after partial gastrectomy for adenocarcinoma of stomach, was referred for 18F-FDG PET/CT for further evaluation of polypoid mass in gastric stump detected on routine follow-up gastroscopy, with equivocal biopsy results. (A) 18F-FDG PET coronal images (top) and axial images (bottom) show increased 18F-FDG uptake in region of stomach (arrow). (B) Hybrid PET/CT axial image (top) precisely localizes and defines uptake as physiologic activity at gastric stump (arrowhead). Suspicious polypoid mass in anastomotic region (arrow), seen on corresponding hybrid and CT slices (bottom) obtained during same acquisition, shows no uptake of 18F-FDG. Findings on PET/CT were interpreted as physiologic 18F-FDG uptake in stomach and nonviable residual mass. Patient showed no evidence of disease for follow-up of 7 mo.
- FIGURE 3.
Precise characterization of increased 18F-FDG uptake and retrospective lesion detection on CT, after PET/CT. A 35-y-old man, 22 mo after treatment for colon cancer, with negative high-resolution contrast-enhanced CT and normal levels of serum tumor markers, was referred for 18F-FDG PET for further assessment of pelvic pain. (A) Coronal PET images show area of increased 18F-FDG uptake in left pelvic region (arrow), interpreted as equivocal for malignancy, possibly related to inflammatory changes associated with ureteral stent or to physiologic bowel uptake. (B) Hybrid PET/CT axial image (top) precisely localizes uptake to soft-tissue mass adjacent to left ureter, anterior to left iliac vessels. Mass (arrow) was detected only retrospectively on both diagnostic CT and CT component of hybrid imaging study (bottom). Patient received chemotherapy, resulting in pain relief and decrease in size of pelvic mass on follow-up CT.
- FIGURE 4.
Precise anatomic localization of malignant 18F-FDG uptake and retrospective lesion detection on CT, after PET/CT. A 33-y-old man with Hodgkin’s disease in left cervical region was referred for 18F-FDG PET for staging. No other sites of disease were reported on CT. (A) PET images show infradiaphragmatic focus of abnormal 18F-FDG uptake in medial border of liver, consistent with either liver involvement (stage IV disease?) or nodal disease in porta hepatis (stage III disease?). (B) Hybrid PET/CT axial image (top) precisely localizes 18F-FDG uptake to adenopathy at porta hepatis, only retrospectively detected on corresponding CT image (bottom) (arrow). Patient was treated as having stage III disease and achieved complete response, showing no evidence of disease for follow-up of 12 mo.
Tables
Criteria Head and neck Chest Abdominopelvic Soft tissue and bone Total Precise lesion characterization and localization on PET after PET/CT As benign 2 34 16 8 60 As malignant 5 10 14 2 31 Precise localization of malignant lesion — 12 17 8 37 Retrospective lesion detection after PET/CT On PET 2 4 1 — 7 On CT* 6 19 21 17 63 Total† (%) 12 71 61 34 178 (32) (24) (41) (31) (30) Patient no. Diagnosis PET/CT additional value* Lesion definition after PET/CT Impact and follow-up 1 Lung cancer, treatment response a Vascular structure Exclusion of cancer, NED on 7-mo follow-up 2 Lung cancer, suspected recurrence a Vascular structure Exclusion of cancer, NED on 7-mo follow-up 3 Lung cancer, suspected recurrence a Vascular structure Exclusion of cancer, NED on 7-mo follow-up 4 Stomach cancer, suspected recurrence a Physiologic uptake in gastric lumen Exclusion of cancer, NED on 7-mo follow-up 5 Lung cancer, suspected recurrence a Vascular structure Exclusion of hilar metastasis, radiotherapy of single bone metastasis 6 Melanoma, staging b, e Thyroid lesion Guiding biopsy, benign nodule 7 Lung cancer, staging c Lesion in ischium Guiding biopsy, tendinitis 8 Breast cancer, suspected recurrence b Mediastinal LN Guiding mediastinoscopy, antracotic LN 9 Colon cancer, suspected recurrence c Lesion in colon Guiding colonoscopy and biopsy, recurrence 10 SPN, diagnosis c Lesion in colon Guiding biopsy, primary colon cancer and lung metastasis 11 Colon cancer, suspected recurrence b, e Supraclavicular LN Guiding biopsy, metastatic adenopathy 12 Renal tumor, suspected recurrence b Mass in pancreas Guiding biopsy, metastasis in pancreas 13 SPN, diagnosis d Lesion in lung Guiding curative surgery, bronchoalveolar cancer 14 Colon cancer, suspected recurrence c Abdominal mass Guiding surgery, omental metastases 15 Colon cancer, suspected recurrence c Parasplenic LN Guiding surgery, LN metastases 16 Colon cancer, suspected recurrence b, e Pelvic LN Guiding surgery, LN metastases 17 Recurrent colon cancer, restaging e Hepatic lesion Planning surgical approach, liver wedge resection 18 Colon cancer, suspected recurrence b, e Mesenteric LN Referred to chemotherapy 19 Colon cancer, suspected recurrence b, e Parailiac LN Referred to chemotherapy 20 Recurrent ovary cancer, restaging b, e Parasplenic LN Referred to chemotherapy, surgery canceled 21 Recurrent lung cancer, restaging c, e Lung lesion Referred to chemotherapy, surgery canceled 22 Lung cancer, suspected recurrence c, e Retrocrural LN Referred to chemotherapy in addition to surgery and radiotherapy 23 Lung cancer, suspected recurrence b, e Lesion in left ilium Referred to radiotherapy 24 Lymphoma, treatment response d Nasopharynx Referred to radiotherapy 25 Lung cancer, suspected recurrence e Mediastinal LN Change in radiation fields 26 Bladder cancer, suspected recurrence b, e Pelvic LN Change in radiation fields 27 Cervical cancer, staging c Retroperitoneal LN Change in radiation fields 28 Lung cancer, suspected recurrence a Vascular structure Exclusion of additional malignant site, change in radiation fields ↵* PET/CT additional value: Categories by which PET/CT induced changes in image interpretation of suspected sites were classified as follows: a = characterization as definitely benign (exclusion of malignancy); b = characterization as definitely malignant; c = precise anatomic localization of malignant site; d = retrospective detection on PET; e = retrospective detection on high-resolution contrast-enhanced CT and on CT of PET/CT.
NED = no evidence of disease; LN = lymph node.
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