PET/CT for Referring Physician
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Headline
PET/CT for Today
ELITE IMAGING
PET + CT = More Information
CT only PET only
PET/ CT
• One-Stop-Shop for Anatomical and Functional information.
• Greater Patient Comfort– One trip to the doctors office for everything– Shorter overall PET exam time– Better treatment planning– More satisfied Patient experience
Why PET + CT
• Improved Treatment Planning for Therapy
• Anatomical and Functional Cardiac Information
• Higher Confidence with Diagnosis
• Accurate Registration of Patient Images
• Easier to Manage your patient
Why PET + CT
Diagnostic Power of PET
Source: The Journal of Nuclear Medicine Supplement, Volume 42, 2001 and UCLA.
The Power of Two
Where would you position the treatment port for Radiation Therapy? Would it change now?
The Power of Two
• Diagnose malignant tumors
• Select and monitor therapy
• Detect recurrent tumors before they can be seen on CT or other imaging modalities
• Find out if the tumor has metastasized (spread)
PET is used in oncology to:
HISTORYA 47-year-old male with recurrent colorectal cancer. Patient had a resection of part of his colon 8 months prior to his initial PET scan.
ORIGINAL DIAGNOSISCT scans at both 5 and 8 months post-resection were reported as normal. The patient still complained of abdominal pain, and at the patient’s request, a PET scan was ordered.
PET FINDINGSThe whole-body FDG PET scan at 8 months post-resection revealed extensive lesions in both the liver and bowel.
CHANGE IN TREATMENTBased on the findings of the PET scan, the patient underwent chemotherapy and returned five months after the initial PET scan for a follow-up PET scan. The follow-up scan showed remission in all known tumor sites.
PRE-THERAPY
POST-THERAPY
Colorectal Cancer
Courtesy of University of Kansas Medical Center • Kansas City, Kansas
HISTORY
A 57-year-old female with non-Hodgkin’s lymphoma.
ORIGINAL DIAGNOSISCT scan read as negative.
PET FINDINGS
Multiple foci of increased activity in the abdomen are noted. There is increased uptake in a retroperitoneal node at the T11-12 level. In addition, focus of abnormal uptake is present superior to the left kidney. Another large focus of abnormal activity is present between the anterior pole of the left kidney in the left lobe of the liver. Small focus of abnormal activity is present just posterior to the superior left lobe of the liver.
CHANGE IN TREATMENT
PET enabled the physician to diagnosis the disease and begin treatment immediately.
Non-Hodgkin‘s Lymphoma
Courtesy of the University of Colorado, Gloria Cook PET Center, Denver, Colorado
• Localize seizure focus in patients with
seizure disorders
• Differentiate Alzheimer’s disease from
multi-infarct dementia or depression
• Analyze Parkinson’s disease
• Evaluate extent of stroke and recovery
following therapy
PET is used in neurology to:
HISTORY
A 3-year-old male epilepsy
ORIGINAL DIAGNOSISPatient suffered from intractable drop seizures since the age of 18 months. MRI showed no abnormalities. Interictal scalp EEG demonstrated epileptiform activity emanating from the right parietal region.
PET FINDINGS
The PET abnormality guided the subdural grid placement with very good correlation.
CHANGE IN TREATMENT
The patient was submitted to surgery and is seizure-free.
Courtesy of Children’s Hospital, Detroit, Michigan
Epilepsy
HISTORY
An 86-year-old male with history of suspected Alzheimer’s.
PET FINDINGSPET shows hypo-metabolism temporoparietal and reduced glucose uptake in cranial portion of both frontal lobes consistent with Alzheimer’s disease
CHANGE IN TREATMENTConventional treatment would be watchful waiting and annual imaging, clinical, and behavior tests for up to five years before diagnosis is confirmed.
Institut für Medizin Forschungszentrum Jülich, Germany
Alzheimer’s Disease
• Detect presence of coronary artery disease
• Assess the extent of damage from heart disease (is the patient a bypass candidate?)
• Determine which patients will benefit from cardiac transplantation
PET is used in cardiology:
HISTORY
A 50-year-old female with history of heart disease waiting for possible cardiac transplant.
ORIGINAL DIAGNOSIS
Thallium scintigraphy found large non-reversible defect; myocardium judged non-viable.
PET FINDINGS
FDG PET scan found good viability throughout the myocardium except for a small part of the apex.
CHANGE IN TREATMENT
Conventional treatment plan based on single photon nuclear medicine study would have been placing the patient on transplant waiting list. After PET, coronary artery bypass graft was performed resulting in improved cardiac function. Patient had significant improvement in quality of life.
SHORT AXIS
H LONG AXIS
V LONG AXIS
Myocardial Viability
Courtesy of Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois
Headline
Clinical Cases
Pre-Therapy
Post-Therapy
Fast accurate monitoring for therapy !
Therapy F/U
Ovarian Cancer•46 year old female,143 lbs.
•History: Stage IIIA Ovarian Cancer, evaluate for restaging post-surgery & chemotherapy.
•Two pericaval nodes, one approximately 10 mm and one 4 mm found in the lumbar region, posterior to the right kidney. Findings are consistent with metastatic disease.
•Scan protocol: CT 152 mAs, 120 kV, 0.75 mm acquired slice width, 5 mm reconstruction increment
• PET 11.9 mCi 18F-FDG 75 min. post-injection, AW-OSEM (4i8s), 7 beds at 4 min/bed
4 mm lesion
10 mm lesion
Lesion Detectability with HI-REZ Technology
HI-REZ
Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
Rectum CA
•68 year old male, 80.5 kg (177 lbs.)•Scan protocol: CT 95 reference mAs CAREDose4D, 130 kV, 5 mm slices, 2.5 reconstruction increment • PET 12.3 mCi 18F-FDG, 50 minute uptake, AW-OSEM (4i8s), 6 beds
Data Courtesy of Long Beach PET Imaging Center, Long Beach, CA, Dr. Jeff Dobkin
1 min/bed HI-REZ Wholebody Scan
Gallbladder Cancer•57 y.o. Female,125 lb. History: Cholangiocarcinoma evaluated for restaging.•Reccurrence at original site of diagnosis.•Scan protocol: CT 160 mAs, 120 kV, 3 mm reconstruction increment •PET 10.5 mCi 18F-FDG 160 min. post-injection, AW-OSEM (2i8s), 7 beds at 2 min/bed
Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
HI-REZ
Lung Cancer•68 year old Female, 116 lbs. History of non small cell lung carcinoma, Referred to restage following therapy.•Compared to prior exam a large cavitary mass in the right lower lobe continues, exhibiting moderately intense FDG accumulation peripherally, extending medially and posteriorly. Additionally, a slight interval increase in the intensity and the size is noted when compared to prior exam.•Scan protocol:
– CT 95 reference mAs CAREDose4D, 130 kV, 5 mm slices, 2.5 reconstruction increment– PET 113.1 mCi 18F-FDG, 60 min. uptake, AW-OSEM (4i6s), 3 min/bed
Data Courtesy of Long Beach PET Imaging Center, Long Beach, CA, Dr. Jeff Dobkin,
HI-REZ
52 yearold male, 62 kg (135 lbs.) Pre- and post-therapy follow-up Squamous cell tonsillar cancer with a 4 cm positive node; pre-surgery chemo; right tonsillectomy and radical neck dissection; removal of positive node and 45 others, all negative. Post-surgical infectious complications; follow-up PET showed diffuse band of activity; PET/CT with LSO, Pico-3D and HI-REZ resolved individual nodes. Patient scheduled for biopsy.Scan protocol: CT: 140 mAs, 120 kV, 5 mm slices at 0.75 mm
PET: 11.3 mCi 18F-FDG, 129 min p.i, 5 min/bed, 7 beds; 4i/8s
Tonsillar Cancer
Standard PET
PRE-THERAPY POST-THERAPY
HI-REZ
Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
Wholebody Scan•61 y.o. Female, 165 lb. Patient has history of cancer•Scan protocol: CT 149 mAs, 120 kV•PET 10 mCi 18F-FDG, 60 minute uptake, AW-OSEM (4i8s), 3 min/bed
Data Courtesy of Alegent Health Bergan Mercy Medical Center, Omaha, NE
HI-REZ
Lung Cancer with Liver Metastasis•54 year old male, 68.2 kg (150 lbs.) – Recurrent carcinoma of the lung•There are six separate areas of focal hypermetabolism localized to the left lung, the most medial of these is adjacent to the mediastinum but does not appear to include mediastinal lymph nodes. Also noted are at least three focal hypermetabolic abnormalities localized to the parenchyma of the liver. In addition, there is a focal hypermetabolism localized to a right inguinal lymph node, and in the right ischium and the right ilium. Hypermetabolic abnormalities are consistent with malignancy.
Data Courtesy of Alegent Health Bergen Mercy Medical Center, Omaha, NE, Dr. Samual Mehr
Lymphoma•58 year old male, 75 kg (165 lbs.) – History of non-Hodgkin’s Lymphoma•Significant hypermetabolism localized to multiple discrete regions of the left neck; left pharyngeal tonsil is mildly hypermetabolic when compared to right; no additional abnormalities. These findings are consistent with lymphoma. After a round of chemotherapy, the 3 month follow-up exam showed no intense abnormal activity in the left neck.
Data Courtesy of Alegent Health Bergen Mercy Medical Center, Omaha, NE, Dr. Samual Mehr
Alzheimer’s Disease•54 year old female, 68.2 kg (150 lbs)•Decreased glucose metabolism in posterior parietal association cortex in patient with memory problems.
Data Courtesy of PET Medical Imaging Center, Grand Rapids, MI, Dr. Paul Shreve
Brain Scan•41 y.o. Female, 165 lb. – Normal Volunteer•Scan protocol: CT 426 mAs, 120kV•PET 15 mCi18F-FDG, 98 minute uptake, AW-OSEM (4i8s), 15 minutes
Data Courtesy of Alegent Health Bergan Mercy Medical Center, Omaha, NE
HI-REZ
Lesion Detection
Alzheimer’s
Neuro Imaging
PET/CT 82Rb Stress/Rest Cardiac Scan•43 y.o. Female, 158 lb. Volunteer Patient•Scan protocol: CT 30 mAs, 120 kV•PET Rest: 50 mCi RbCl, 2 minute uptake, AW-OSEM (4i8s), 5 min. acq.•PET Stress: 50 mCi RbCl, 2 minute uptake, AW-OSEM (4i8s), 5 min. acq.
Data Courtesy of Alegent Health Bergan Mercy Medical Center, Omaha, NE
16 Gate 82Rb Cardiac PET/CT•33 year old Male, 175 lbs.•Cardiac Stress, Rest and Gated PET slices.
Data Courtesy of Cleveland Clinic Foundation, Cleveland, OH
Stress
Rest
Gated
Stress
Rest
Gated
Stress
Rest
Gated
Stress
Rest
Gated
Bone Scan•42 year old Female, 136 lbs.•HI-REZ technology demonstrates the finest resolution and exceptional image quality.
•Scan protocol: CT 154 mAs, 120 kV, 1.5 mm acquired slice width, 3 mm reconstruction increment
•PET 11.1 mCi 18F-NaF 60 min. post-injection, AW-OSEM (4i8s), 4 min/bed
Anterior Posterior SaggitalHI-REZ
Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
• Lung Cancer–SPN–Diagnosis NSCLC & SCLC–Initial Staging–Restaging
• Colorectal Cancer–Diagnosis–Initial Staging–Restaging
• Ovarian Cancer
PET/CT Usage
• Melanoma–Diagnosis–Initial Staging–Restaging
• Lymphoma–Diagnosis–Initial Staging–Restaging
• Pancreatic Cancer
PET/CT Usage
• Head and Neck Cancer–Diagnosis–Initial Staging–Restaging
• Esophageal Cancer–Diagnosis–Initial Staging–Restaging
• Soft tissue sarcoma
PET/CT Usage
• Breast Cancer– Diagnosis / Surgical Planning
– Initial Staging
– Restaging
– Evaluation to Response to
Treatment
• Neurology– Brain Cancer
– Pre-surgery planning for Seizures
– Alzheimer’s Disease
PET/CT Usage
• Testicular Cancer• Thyroid Cancer
– Diagnosis– Staging– Restaging
• Cardiology– Myocardial Perfusion Imaging– Myocardial Viability Study
PET/CT Usage
• 50% of all PET patients had a CT, or needs a CT• 63% of all positive PET scans need a new CT
because of the results.• It is easier for the patient to have it performed all
at once• The power of the combined unit improves
confidence in interpretation• Over 50% of all cancer treatment is altered as a
result of the PET findings on the patient
Why PET/CT with use
• Medical Journal Articles supporting PET/CT
• Cutting Edge Medical Practice
• Better Patient Management
• Retain Patients by Offering the Best
Patient Care Solutions for them
• Fast Report Turnaround
• Personal Consultations
Why PET/CT with use
Headline
ELITE IMAGING
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