PET/CT for Referring Physician

42
Headline PET/CT for Today ELITE IMAGING

description

PET /CT presentation

Transcript of PET/CT for Referring Physician

Page 1: PET/CT for Referring Physician

Headline

PET/CT for Today

ELITE IMAGING

Page 2: PET/CT for Referring Physician

PET + CT = More Information

CT only PET only

PET/ CT

Page 3: PET/CT for Referring Physician

• 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

Page 4: PET/CT for Referring Physician

• 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

Page 5: PET/CT for Referring Physician

Diagnostic Power of PET

Source: The Journal of Nuclear Medicine Supplement, Volume 42, 2001 and UCLA.

Page 6: PET/CT for Referring Physician

The Power of Two

Page 7: PET/CT for Referring Physician

Where would you position the treatment port for Radiation Therapy? Would it change now?

The Power of Two

Page 8: PET/CT for Referring Physician

• 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:

Page 9: PET/CT for Referring Physician

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

Page 10: PET/CT for Referring Physician

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

Page 11: PET/CT for Referring Physician

• 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:

Page 12: PET/CT for Referring Physician

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

Page 13: PET/CT for Referring Physician

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

Page 14: PET/CT for Referring Physician

• 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:

Page 15: PET/CT for Referring Physician

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

Page 16: PET/CT for Referring Physician

Headline

Clinical Cases

Page 17: PET/CT for Referring Physician

Pre-Therapy

Post-Therapy

Fast accurate monitoring for therapy !

Therapy F/U

Page 18: PET/CT for Referring Physician

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

Page 19: PET/CT for Referring Physician

Rectum CA

Page 20: PET/CT for Referring Physician

•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

Page 21: PET/CT for Referring Physician

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

Page 22: PET/CT for Referring Physician
Page 23: PET/CT for Referring Physician

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

Page 24: PET/CT for Referring Physician

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

Page 25: PET/CT for Referring Physician

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

Page 26: PET/CT for Referring Physician
Page 27: PET/CT for Referring Physician

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

Page 28: PET/CT for Referring Physician

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

Page 29: PET/CT for Referring Physician

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

Page 30: PET/CT for Referring Physician

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

Page 31: PET/CT for Referring Physician

Lesion Detection

Alzheimer’s

Neuro Imaging

Page 32: PET/CT for Referring Physician

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

Page 33: PET/CT for Referring Physician

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

Page 34: PET/CT for Referring Physician

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

Page 35: PET/CT for Referring Physician

• Lung Cancer–SPN–Diagnosis NSCLC & SCLC–Initial Staging–Restaging

• Colorectal Cancer–Diagnosis–Initial Staging–Restaging

• Ovarian Cancer

PET/CT Usage

Page 36: PET/CT for Referring Physician

• Melanoma–Diagnosis–Initial Staging–Restaging

• Lymphoma–Diagnosis–Initial Staging–Restaging

• Pancreatic Cancer

PET/CT Usage

Page 37: PET/CT for Referring Physician

• Head and Neck Cancer–Diagnosis–Initial Staging–Restaging

• Esophageal Cancer–Diagnosis–Initial Staging–Restaging

• Soft tissue sarcoma

PET/CT Usage

Page 38: PET/CT for Referring Physician

• 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

Page 39: PET/CT for Referring Physician

• Testicular Cancer• Thyroid Cancer

– Diagnosis– Staging– Restaging

• Cardiology– Myocardial Perfusion Imaging– Myocardial Viability Study

PET/CT Usage

Page 40: PET/CT for Referring Physician

• 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

Page 41: PET/CT for Referring Physician

• 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

Page 42: PET/CT for Referring Physician

Headline

ELITE IMAGING

CONCORDE CENTRE II

2999 NE 191ST STREET

SUITE 103

AVENTURA, FL 33180

Thank You for your Attention