An Introduction to PET Imaging in Oncology

Size: px
Start display at page:

Download "An Introduction to PET Imaging in Oncology"

Transcription

1 January 2002 An Introduction to PET Imaging in Oncology Janet McLaren, Harvard Medical School Year III

2 Basics of PET Principle of Physiologic Imaging: Allows in vivo visualization of structures by their ability to concentrate specific labeled molecules Most commonly used compound: fluorodeoxyglucose (FDG) Past use had been limited due to cost of dedicated PET scanners and the difficulty in obtaining isotopes Recent advances have made PET more feasible: Modification of dual head gamma camera SPECT systems Increase in availability of isotopes 2

3 FDG: The Compound CH 2 OH O 2-deoxy-2-( 18 F)fluoro-D-glucose 18 F: positron-emitting isotope of fluorine Metabolically active cells utilize more glucose than other tissues and therefore uptake more FDG FDG is phosphorylated by hexokinase upon entry into the cell but cannot undergo further glycolytic reactions Dephosphorylation of the compound is slow, limiting transport out of the cell HO OH OH [ 18 F] FDG 3

4 FDG: The Isotope CH 2 OH O HO OH OH 18 F: emits positrons as it decays Positrons travel until they collide with an electron This collision produces two electromagnetic pulses of 511 kev that are detected by the PET detectors [ 18 F] FDG (+) Signal can be quantified: SUV (standardized uptake value) SUV > 2.5 generally used to indicate increased uptake 4

5 Applications Oncology Diagnosis: benign vs. malignant process Staging Post-therapy evaluation: response to tx or to identify recurrence PET is approved for imaging of lung, lymphoma, colon and melanoma cancers Assessment of Cardiac Viability Used to evaluate myocardial perfusion and viability CNS Functional analysis 5

6 Oncologic Imaging FDG identifies hypermetabolic cells: Malignancy Infection Inflammation FDG false (-)s, specific to malignancy: Small tumor size Relatively low tumor metabolic activity (i.e. welldifferentiated tumors, including bronchoalveolar) Hyperglycemia: dilutes uptake of FDG 6

7 PET and the SPN 130,000 new Solitary Pulmonary Nodules (SPN)/year 40% of non-calcified SPN seen on CXR are benign A significant number of these remain indeterminate after CT Transthoracic FNA: high false (-) rate, diagnosis obtained in less than 50% of patients PET: Sensitivity and specificity of 95% and 81% for detecting malignancy PET Imaging is for patients who will have treatment planned according to PET results, i.e. thoracotomy or f/u 7

8 PET and the DDx of a SPN DDx: Benign Tumor Malignant Tumor Metastatic Tumor Round pneumonia A/V malformation Rheumatoid Nodule SUV >2.5 Narrowed DDx: Cancer Cancer Cancer Granuloma Granuloma/Rheumatoid From BrighamRad Teaching Cases: From Metro Region PET Center: SPN Case Study 8

9 Oncologic Applications of PET: Diagnosis Staging Follow-up Post-surgical Response to chemo/rt Utility of PET in each of these areas varies among the different types of cancers From GE Medical Systems 9

10 Patient #1: SPN Nodule 84 year-old man with a solitary pulmonary nodule found on routine CXR. Nodule was followed by CT for 2 years and found to be stable. A few years later, PET became available for SPN evaluation. Courtesy of Dr. Vincent Chan, BIDMC 10

11 Patient #1: SPN A PET Scan showed the nodule to have increased activity The nodule was biopsied and found to be an adenocarcinoma Courtesy of Dr. Vincent Chan, BIDMC 11

12 Patient #1: SPN Lung CA Diagnosis PET can diagnose lesions deemed indeterminate by CT and thus is invaluable in the work-up of a SPN Staging In patients with known NSCLC, PET provides significant staging and prognostic information CT vs PET in assessment of nodal status 1999 Study: PET changed tx in 37% of cases Appropriate use of PET in the work-up of a SPN will prevent unnecessary operations and may prove to be cost effective 12

13 Patient #2: Breast Cancer 58 year-old woman presented with a breast mass after many years without clinical care This mammogram was obtained Diagnosed with inflammatory breast cancer The patient was referred to Nuclear Medicine for staging From Southern Illinois University School of Medicine ( 13

14 Patient #2: Breast Cancer PET Scan findings: Primary Left Breast Mass Mets to the Left Axilla LNs Met to the Liver movie Courtesy of Dr. Vincent Chan, BIDMC 14

15 Patient #2: Breast Cancer Diagnosis Most breast cancer is detected by mammo or PE PET can be used for equivocal lesions to avoid biopsy, or in patients with prior surgery or implants Staging Sentinel Node Biopsy remains the preferred method of detecting axillary node metastsis PET plays a useful role in identifying distant metastases Shown superior to bone scan in detecting osteolytic lesions Follow-Up Limited data show PET can be used to monitor response to chemo as early as 8 days into treatment 15

16 Patient #3: Melanoma 35 year-old man presented with a lesion on his back On excision, the lesion was found to be invasive melanoma Patient was referred to Nuclear Medicine for staging Courtesy of Dr. Vincent Chan, BIDMC 16

17 Patient #3: Melanoma PET Scan showed high activity in the left axilla and in a small area of the upper mediastinum Courtesy of Dr. Vincent Chan, BIDMC 17

18 Patient #3: Melanoma The increased activity in the upper mediastinum was thought to be artifact The patient was treated with surgical excision of the left axillary lymph nodes Courtesy of Dr. Vincent Chan, BIDMC 18

19 Normal brain uptake Patient #3: Melanoma Healing tissue 6 months later the patient returned for follow-up The follow-up PET Scan revealed growth of the upper mediastinal mass The mass was excised and confirmed to be metastatic melanoma Courtesy of Dr. Vincent Chan, BIDMC 19

20 Patient #3: Melanoma Staging Sentinel Node Biopsy remains the preferred method of determining regional lymphatic spread PET is preferred and superior to CT and MRI for identifying distant metastatic lesions Data: sensitivity and specificity of 94% and 83% for PET vs. 55% and 84% for CT PET is very useful in identification and staging of cancers that metastasize widely or in an unpredictable manner (e.g. melanoma, lymphoma, head and neck cancer ) 20

21 Patient #4 78 year old female S/p colectomy and partial hepatectomy for metastatic colon CA seven years prior Rising CEA (10.0) Courtesy of Dr. Vincent Chan, BIDMC 21

22 Patient #4: Colon CA Abdominal CT findings: Courtesy of Dr. Vincent Chan, BIDMC Seroma Rib end? 22

23 Patient #4: Colon CA? Rib end 23 Courtesy of Dr. Vincent Chan, BIDMC

24 Patient #4: Colon CA As Abdominal CT was inconclusive, the patient was referred to Nuclear Medicine for a PET Scan. Courtesy of Dr. Vincent Chan, BIDMC 24

25 Patient #4: Colon CA PET Scan revealed uptake in the chest wall scar, consistent with seeding during removal of the liver metastasis and recurrence. Courtesy of Dr. Vincent Chan, BIDMC 25

26 Patient #4: Colon CA PET Imaging of the pelvis revealed another site of recurrence at the removal site of the primary tumor. Courtesy of Dr. Vincent Chan, BIDMC 26

27 Patient #4: Colon CA PET Imaging of the pelvis revealed another site of recurrence at the removal site of the primary tumor. Courtesy of Dr. Vincent Chan, BIDMC 27

28 Patient #4: Colon CA Diagnosis Highly sensitive in identifying colonic lesions, but not very specific (100% and 43%) Staging Good for evaluating distant metastases; lymph nodes to close to primary tumor to see Follow-up CTs are difficult to evaluate in the post-op patient due to fibrosis and distorted anatomy PET Scans are very useful in follow-up patients by identifying recurrent lesions in areas of scar tissue 28

29 Keeping a DDx FDG identifies hypermetabolic cells Malignancy Infection Inflammation 29

30 Lets review some positive PET scans that were NOT due to malignancy 30

31 Patient #5 60 year old female Referred for evaluation of a SPN in the right upper lobe? RV LV Cross-section at T9 level Courtesy of Dr. Vincent Chan, BIDMC 31

32 Patient #5 Courtesy of Dr. Vincent Chan, BIDMC 32

33 Patient #5 Hiatal Hernia Increased metabolic activity from inflammation Courtesy of Dr. Vincent Chan, BIDMC 33

34 Patient #6 41 year-old man History of hepatocellular carcinoma Chevron Incision Increased metabolic activity of healing tissue Courtesy of Dr. Vincent Chan, BIDMC 34

35 Summary PET is one of the most exciting fields in modern Nuclear Medicine When used in correlation with anatomic imaging, PET can provide important physiologic information The modality has become very useful in the diagnosis, staging, and follow-up of oncologic disease Great opportunity for advances in PET imaging: isotopes tailored for specific cancers new detectors to improve image resolution 35

36 Acknowledgements Vincent Chan, MD and the Nuclear Medicine Department of the BIDMC Pamela Lepkowski Larry Barbaras and Cara Lyn D amour, our Webmasters 36

37 References Bar-Shalom R, Valdivia AY, Blaufox MD. PET Imaging in Oncology. Sem Nuc Med 2000; 30(3): Bax JJ, Patton JA, Poldermans D, Elhendy A, and Sandler MP. 18- Fluorodeoxyglucose imaging with Positron Emission Tomography and Single Photon Emission Computed Tomography: Cardiac Applications. Sem Nuc Med 2000; 30(4): Delbeke D, Martin WH. Positron Emission Tomography Imaging in Oncology. RadClinNA2001 Sept; 39(5): Saunders CA, Dussek JE, O'Doherty MJ, Maisey MN. Evaluation of fluorine-18- fluorodeoxyglucose whole body positron emission tomography imaging in the staging of lung cancer. Annals of Thoracic Surgery1999 Mar; 67(3): Schwartz B and Udelson JE. Assessment of myocardial viability by nuclear imaging in coronary heart disease. Up-to-Date version 9.3, Stark P. Computed Tomography and Positron Emission Tomographic scanning of pulmonary nodules. Up-to-Date version 9.3,

Positron Emission Tomography in Lung Cancer

Positron Emission Tomography in Lung Cancer May 19, 2003 Positron Emission Tomography in Lung Cancer Andrew Wang, HMS III Patient DD 53 y/o gentleman presented with worsening dyspnea on exertion for the past two months 30 pack-year smoking Hx and

More information

The Role of PET / CT in Lung Cancer Staging

The Role of PET / CT in Lung Cancer Staging July 2004 The Role of PET / CT in Lung Cancer Staging Vlad Vinarsky, Harvard Medical School Year IV Patient AM HPI: 81 yo F p/w hemoptysis x 1 month LLL lesion on CXR, not responsive to Abx 35 pack-year

More information

PET/CT Frequently Asked Questions

PET/CT Frequently Asked Questions PET/CT Frequently Asked Questions General Q: Is FDG PET specific for cancer? A: No, it is a marker of metabolism. In general, any disease that causes increased metabolism can result in increased FDG uptake

More information

PET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET

PET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET Positron Emission Tomography (PET) When calling Anthem (1-800-533-1120) or using the Point of Care authorization system for a Health Service Review, the following clinical information may be needed to

More information

Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010

Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Self Assessment Module on Nuclear Medicine and PET/CT Case Review FDG PET/CT IN LYMPHOMA AND MELANOMA Submitted

More information

POSITRON EMISSION TOMOGRAPHY (PET)

POSITRON EMISSION TOMOGRAPHY (PET) Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should

More information

Molecular Imaging and Cancer

Molecular Imaging and Cancer Molecular Imaging and Cancer Cancer causes one in every four deaths in the United States, second only to heart disease. According to the U.S. Department of Health and Human Services, more than 512,000

More information

New Visions in PET: Surgical Decision Making and PET/CT

New Visions in PET: Surgical Decision Making and PET/CT New Visions in PET: Surgical Decision Making and PET/CT Stanley J. Goldsmith, MD Director, Nuclear Medicine Professor, Radiology & Medicine New York Presbyterian Hospital- Weill Cornell Medical Center

More information

objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University

objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University objectives Pitfalls and Pearls in PET/CT imaging Kevin Robinson, DO Assistant Professor Department of Radiology Michigan State University To determine the regions of physiologic activity To understand

More information

Molecular Imaging and Breast Cancer

Molecular Imaging and Breast Cancer Molecular Imaging and Breast Cancer Breast cancer forms in tissues of the breast usually in the ducts, tubes that carry milk to the nipple, and lobules, the glands that make milk. It occurs in both men

More information

Dr Sneha Shah Tata Memorial Hospital, Mumbai.

Dr Sneha Shah Tata Memorial Hospital, Mumbai. Dr Sneha Shah Tata Memorial Hospital, Mumbai. Topics covered Lymphomas including Burkitts Pediatric solid tumors (non CNS) Musculoskeletal Ewings & osteosarcoma. Neuroblastomas Nasopharyngeal carcinomas

More information

PET/CT in lung cancer

PET/CT in lung cancer PET/CT in lung cancer Andrei Šamarin North Estonia Medical Centre 3 rd Baltic Congress of Radiology 08.10.2010 Imaging in lung cancer Why do we need PET/CT? CT is routine imaging modality for staging of

More information

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management. Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician

More information

Radiological Manifestations of Metastatic Melanoma

Radiological Manifestations of Metastatic Melanoma Radiological Manifestations of Metastatic Melanoma Lia Hojman, Universidad de Chile Year VII Our patient: Clinical Presentation A 24 year old male. Former smoker. 8 months ago, he suffered a burn in his

More information

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type. Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic

More information

LYMPHATIC DRAINAGE IN THE HEAD & NECK

LYMPHATIC DRAINAGE IN THE HEAD & NECK LYMPHATIC DRAINAGE IN THE HEAD & NECK Like other parts of the body, the head and neck contains lymph nodes (commonly called glands). Which form part of the overall Lymphatic Drainage system of the body.

More information

FDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave

FDG PET/CT STAGING OF LUNG CANCER. Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER Dr Shakher Ramdave FDG PET/CT STAGING OF LUNG CANCER FDG PET/CT is used in all patients with lung cancer who are considered for curative treatment to exclude occult disease.

More information

PET/CT F-18 FDG. Objectives. Basics of PET/CT Imaging. Objectives. Basic PET imaging

PET/CT F-18 FDG. Objectives. Basics of PET/CT Imaging. Objectives. Basic PET imaging Basics of PET/CT Imaging Kevin Robinson, DO Department of Radiology Michigan State University Objectives Basic PET imaging Evaluating the therapeutic response Evaluating the big 5 Lymphoma Breast Lung

More information

Adam J. Hansen, MD UHC Thoracic Surgery

Adam J. Hansen, MD UHC Thoracic Surgery Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered

More information

CT PET SCANNING for GIT Malignancies A clinician s perspective

CT PET SCANNING for GIT Malignancies A clinician s perspective CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset

More information

Lung Cancer Imaging. Terence Z. Wong, MD,PhD. Department of Radiology Duke University Medical Center Durham, NC 9/9/09

Lung Cancer Imaging. Terence Z. Wong, MD,PhD. Department of Radiology Duke University Medical Center Durham, NC 9/9/09 Lung Cancer Imaging Terence Z. Wong, MD,PhD Department of Radiology Duke University Medical Center Durham, NC 9/9/09 Acknowledgements Edward F. Patz, Jr., MD Jenny Hoang, MD Ellen L. Jones, MD, PhD Lung

More information

Page: 1 of 29. For this policy, PET scanning is discussed for the following 4 applications in oncology:

Page: 1 of 29. For this policy, PET scanning is discussed for the following 4 applications in oncology: Emission Tomography Scanning Page: 1 of 29 Last Review Status/Date: June 2015 Description Positron emission tomography (PET) scans are based on the use of positron-emitting radionuclide tracers coupled

More information

Radiology Pathology Conference

Radiology Pathology Conference Radiology Pathology Conference Sharlin Johnykutty,, MD, Cytopathology Fellow Sara Majewski, MD, Radiology Resident Friday, August 28, 2009 Presentation material is for education purposes only. All rights

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association PET Scanning: Oncologic Applications Page 1 of 42 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Positron Emission Tomography (PET) Scanning: Oncologic

More information

Clinical indications for positron emission tomography

Clinical indications for positron emission tomography Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will

More information

Subject: PET Scan With or Without CT Attenuation. Original Effective Date: 11/7/2017. Policy Number: MCR: 610. Revision Date(s): Review Date:

Subject: PET Scan With or Without CT Attenuation. Original Effective Date: 11/7/2017. Policy Number: MCR: 610. Revision Date(s): Review Date: Subject: PET Scan With or Without CT Attenuation Policy Number: MCR: 610 Revision Date(s): MHW Original Effective Date: 11/7/2017 Review Date: DISCLAIMER This Molina Clinical Review (MCR) is intended to

More information

Principles of nuclear metabolic imaging. Prof. Dr. Alex Maes AZ Groeninge Kortrijk and KULeuven Belgium

Principles of nuclear metabolic imaging. Prof. Dr. Alex Maes AZ Groeninge Kortrijk and KULeuven Belgium Principles of nuclear metabolic imaging Prof. Dr. Alex Maes AZ Groeninge Kortrijk and KULeuven Belgium I. Molecular imaging probes A. Introduction - Chemical disturbances will precede anatomical abnormalities

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association PET Scanning: Oncologic Applications Page 1 of 88 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Positron Emission Tomography (PET) Scanning: Oncologic Applications

More information

Nuclear Medicine in Oncology

Nuclear Medicine in Oncology Radiopharmaceuticals Nuclear Medicine in Oncology Practice Pharmaceutical Radionuc lide Function Tumor type Diphosphonates Tc-99m Osteoblast Bone tumor & metast. Ga-citrate Ga-67 Fe-analogue Bronchogenous

More information

Alison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD

Alison Douglass Gillian Lieberman, MD. November. Colon Cancer. Alison Douglass, Harvard Medical School Year III Gillian Lieberman, MD November Colon Cancer Alison Douglass, Harvard Medical School Year III Our Patient Mr. K. is a 67 year old man with no prior medical problems other than hemorrhoids which have caused occasional rectal

More information

PET/CT in oncology. Positron emission tomography

PET/CT in oncology. Positron emission tomography Clinical Medicine 2012, Vol 12, No 4: 368 72 PET/CT in oncology Fahim-Ul-Hassan, SpR Nuclear Medicine, Guy s Hospital, London; Gary J Cook, professor of Clinical PET, KCL Division of Imaging Sciences &

More information

Oncologic Applications of PET Scanning

Oncologic Applications of PET Scanning 6.01.26 Oncologic Applications of PET Scanning Section 6.0 Radiology Subsection Effective Date February 15, 2015 Original Policy Date January 26, 2009 Next Review Date December 2015 Description Positron

More information

Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.

Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,

More information

Nuclear medicine in oncology. 1. Diagnosis 2. Therapy

Nuclear medicine in oncology. 1. Diagnosis 2. Therapy Nuclear medicine in oncology 1. Diagnosis 2. Therapy Diagnosis - Conventional methods - Nonspecific radiopharmaceuticals cumulating in tumours - Specific radiopharmaceuticals (receptor- and immunoscintigraphy)

More information

Hybrid Imaging SPECT/CT PET/CT PET/MRI. SNMMI Southwest Chapter Aaron C. Jessop, MD

Hybrid Imaging SPECT/CT PET/CT PET/MRI. SNMMI Southwest Chapter Aaron C. Jessop, MD Hybrid Imaging SPECT/CT PET/CT PET/MRI SNMMI Southwest Chapter 2014 Aaron C. Jessop, MD Assistant Professor, Department of Nuclear Medicine UT MD Anderson Cancer Center, Houston, Texas Complimentary role

More information

Positron emission tomography Medicare Services Advisory Committee

Positron emission tomography Medicare Services Advisory Committee Positron emission tomography Medicare Services Advisory Committee Authors' objectives To assess the effectiveness of positron emission tomography (PET), the report addressed the following (truncated) six

More information

A Case of Pediatric Plasma Cell Granuloma

A Case of Pediatric Plasma Cell Granuloma August 2001 A Case of Pediatric Plasma Cell Granuloma Nii Tetteh, Harvard Medical School Year IV Our Patient 8 year old male with history of recurrent left lower lobe and lingular pneumonias since 1994.

More information

The Use of PET Scanning in Urologic Oncology

The Use of PET Scanning in Urologic Oncology The Use of PET Scanning in Urologic Oncology Dr Nicholas C. Buchan Uro-oncology Fellow 1 2 Aims To understand the basic concepts underlying PET scanning. Understand the emerging role of PET Scanning for

More information

PET CT for Staging Lung Cancer

PET CT for Staging Lung Cancer PET CT for Staging Lung Cancer Rohit Kochhar Consultant Radiologist Disclosures Neither I nor my immediate family members have financial relationships with commercial organizations that may have a direct

More information

Radiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh

Radiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Radiological staging of lung cancer Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Bronchogenic Carcinoma Accounts for 14% of new cancer diagnoses in 2012. Estimated to kill ~150,000

More information

Nuclear Medicine and PET. D. J. McMahon rev cewood

Nuclear Medicine and PET. D. J. McMahon rev cewood Nuclear Medicine and PET D. J. McMahon 150504 rev cewood 2018-02-15 Key Points Nuclear Medicine and PET: Imaging: Understand how Nuc Med & PET differ from Radiography & CT by the source of radiation. Be

More information

Ryan Niederkohr, M.D. Slides are not to be reproduced without permission of author

Ryan Niederkohr, M.D. Slides are not to be reproduced without permission of author Ryan Niederkohr, M.D. CMS: PET/CT CPT CODES 78814 Limited Area (e.g., head/neck only; chest only) 78815 78816 Regional (skull base to mid-thighs) True Whole Body (skull vertex to feet) SELECTING FIELD

More information

Cardiac Imaging Tests

Cardiac Imaging Tests Cardiac Imaging Tests http://www.medpagetoday.com/upload/2010/11/15/23347.jpg Standard imaging tests include echocardiography, chest x-ray, CT, MRI, and various radionuclide techniques. Standard CT and

More information

Lung Cancer-a primer. Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo

Lung Cancer-a primer. Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo Lung Cancer-a primer Sai Yendamuri, MD Professor and Chair, Dept of Thoracic Surgery,RPCI,Buffalo CLINICAL CATEGORIES THE SOLITARY PULMONARY NODULE MULTIPLE PULMONARY NODULES Differential Diagnosis Malignant

More information

THORACIK RICK. Lungs. Outline and objectives Richard A. Malthaner MD MSc FRCSC FACS

THORACIK RICK. Lungs. Outline and objectives Richard A. Malthaner MD MSc FRCSC FACS THORACIK RICK Outline and objectives Lungs Management of a solitary lung nodule Mediastinum Management of a mediastinal mass Pleura Management of a pleural fluid & pneumothorax Esophagus & Stomach Management

More information

Imaging Decisions Start Here SM

Imaging Decisions Start Here SM Owing to its high resolution and wide anatomic coverage, dynamic first-pass perfusion 320-detector-row CT outperforms PET/CT for distinguishing benign from malignant lung nodules, researchers from Japan

More information

Radiologic Assessment of Myocardial Viability

Radiologic Assessment of Myocardial Viability November 2001 Radiologic Assessment of Myocardial Viability Joshua Moss, Harvard Medical School Year III Patient EF 66yo female with a 3-year history of intermittent chest pain previously relieved by sublingual

More information

María del Pilar Garrido Ruiz Teresa Mendoza Dobaño Cristian Jesús Lucena Morales

María del Pilar Garrido Ruiz Teresa Mendoza Dobaño Cristian Jesús Lucena Morales María del Pilar Garrido Ruiz Teresa Mendoza Dobaño Cristian Jesús Lucena Morales Index 1. Introduction. 2. Physical principles: annihilation reaction. 3. PET image creation. 4. Advantages of PET use. 5.

More information

FieldStrength. Leuven research is finetuning. whole body staging

FieldStrength. Leuven research is finetuning. whole body staging FieldStrength Publication for the Philips MRI Community Issue 40 May 2010 Leuven research is finetuning 3.0T DWIBS for whole body staging The University Hospital of Leuven is researching 3.0T whole body

More information

PET/CT in Breast Cancer

PET/CT in Breast Cancer PET/CT in Breast Cancer Rodolfo Núñez Miller, M.D. Nuclear Medicine and Diagnostic Imaging Section Division of Human Health International Atomic Energy Agency Vienna, Austria Overview Introduction Locorregional

More information

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior

More information

Thoracic Surgery; An Overview

Thoracic Surgery; An Overview Thoracic Surgery What we see Thoracic Surgery; An Overview James P. Locher, Jr, MD Methodist Cardiovascular and Thoracic Surgery Lung cancer Mets Fungus and TB Lung abcess and empyema Pleural based disease

More information

ROLE OF PET-CT IN BREAST CANCER, GUIDELINES AND BEYOND. Prof Jamshed B. Bomanji Institute of Nuclear Medicine UCL Hospitals London

ROLE OF PET-CT IN BREAST CANCER, GUIDELINES AND BEYOND. Prof Jamshed B. Bomanji Institute of Nuclear Medicine UCL Hospitals London ROLE OF PET-CT IN BREAST CANCER, GUIDELINES AND BEYOND Prof Jamshed B. Bomanji Institute of Nuclear Medicine UCL Hospitals London CANCER Key facts Estimated 15.2 million new cases per year in 2015 worldwide

More information

I. Cancer staging problem

I. Cancer staging problem Instrumentation Lab (Craig Levin) Angela Craig Peter Jin Frezghi Guillem Billie Garry Research interests (by imaging modality) I. High resolution radionuclide imaging : positron emission tomography (PET)

More information

THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC)

THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) THE ROLE OF CONTEMPORARY IMAGING AND HYBRID METHODS IN THE DIAGNOSIS OF CUTANEOUS MALIGNANT MELANOMA(CMM) AND MERKEL CELL CARCINOMA (MCC) I.Kostadinova, Sofia, Bulgaria CMM some clinical facts The incidence

More information

Radionuclide detection of sentinel lymph node

Radionuclide detection of sentinel lymph node Radionuclide detection of sentinel lymph node Sophia I. Koukouraki Assoc. Professor Department of Nuclear Medicine Medicine School, University of Crete 1 BACKGROUND The prognosis of malignant disease is

More information

Lymphoma Read with the experts

Lymphoma Read with the experts Lymphoma Read with the experts Marc Seltzer, MD Associate Professor of Radiology Geisel School of Medicine at Dartmouth Director, PET-CT Course American College of Radiology Learning Objectives Recognize

More information

PET in Rectal Carcinoma

PET in Rectal Carcinoma Case Report PET in Rectal Carcinoma Josefina Jofré M 1, Paulina Sierralta C 1, José Canessa G 1,2, Pamela Humeres A 3, Gabriel Castro M 4, Teresa Massardo V 1,4 1 Centro PET de Imágenes Moleculares, Hospital

More information

Appendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer

Appendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer Appendix 1: Regional Lymph Node Stations for Staging Esophageal Cancer Locoregional (N stage) disease was redefined in the seventh edition of the AJCC Cancer Staging Manual as any periesophageal lymph

More information

Medical imaging X-ray, CT, MRI, scintigraphy, SPECT, PET Györgyi Műzes

Medical imaging X-ray, CT, MRI, scintigraphy, SPECT, PET Györgyi Műzes Medical imaging X-ray, CT, MRI, scintigraphy, SPECT, PET Györgyi Műzes Semmelweis University, 2nd Dept. of Medicine Medical imaging: definition technical process of creating visual representations about

More information

Radiology Pathology Conference

Radiology Pathology Conference Radiology Pathology Conference Nadia F. Yusaf, M.D. PGY-3 1/29/2010 Presentation material is for education purposes only. All rights reserved. 2010 URMC Radiology Page 1 of 90 Case 1 60 year- old man presents

More information

PET/CT in breast cancer staging

PET/CT in breast cancer staging PET/CT in breast cancer staging Anni Morsing Consultant, PhD, DMSc Rigshospitalet 1 18F- FDG PET/CT for breastcancer staging Where is the clinical impact? To which women should 18F- FDG PET/CT be offered?

More information

Indications of PET/CT in oncology

Indications of PET/CT in oncology Monday, August 27, 2012 Session 1, 10:00-10:40 Indications of PET/CT in oncology Helle Westergren Hendel MD, PhD, assistant professor Bacelor in Leadership & Health Ecomomics Head of Clinical PET, Herlev

More information

Cigna - Prior Authorization Procedure List: Radiology & Cardiology

Cigna - Prior Authorization Procedure List: Radiology & Cardiology Cigna - Prior Authorization Procedure List: Radiology & Cardiology Product Category CPT Code CPT Code Description Radiology MR 70336 MRI Temporomandibular Joint(s), (TMJ) Radiology CT 70450 CT Head or

More information

Charles Mulligan, MD, FACS, FCCP 26 March 2015

Charles Mulligan, MD, FACS, FCCP 26 March 2015 Charles Mulligan, MD, FACS, FCCP 26 March 2015 Review lung cancer statistics Review the risk factors Discuss presentation and staging Discuss treatment options and outcomes Discuss the status of screening

More information

Positron emission tomography/computer tomography in the evaluation of head and neck cancer treatment

Positron emission tomography/computer tomography in the evaluation of head and neck cancer treatment Positron emission tomography/computer tomography in the evaluation of head and neck cancer treatment Severina Šedienė 1, Ilona Kulakienė 1, Viktoras Rudžianskas 2 1 Lithuanian University of Health Sciences,

More information

Breast Cancer Staging. Physiology Trumps Anatomy Author: Maxine Jochelson, MD, FSBI

Breast Cancer Staging. Physiology Trumps Anatomy Author: Maxine Jochelson, MD, FSBI Breast Cancer Staging. Physiology Trumps Anatomy Author: Maxine Jochelson, MD, FSBI The purpose of this paper is to address the importance of physiologic imaging for the staging and follow up of patients

More information

Imaging in Metastatic Melanoma. Nilanthi Gunawardane Gillian Lieberman, MD March 2008

Imaging in Metastatic Melanoma. Nilanthi Gunawardane Gillian Lieberman, MD March 2008 Imaging in Metastatic Melanoma Nilanthi Gunawardane Gillian Lieberman, MD March 2008 Malignant Melanoma Neoplasm of pigment-forming cells, melanocytes,, and nevus cells Types of melanoma Superficial spreading

More information

INTERACTIVE SESSION 2

INTERACTIVE SESSION 2 INTERACTIVE SESSION 2 2 patients with lung metastases, with complete response after oncologic treatment - Clinical Case Presentation: Dr. Esther Casado Dr. Sergi Call - Expert Opinion: Dr. Raúl Embún Dr.

More information

Cigna - Prior Authorization Procedure List: Radiology & Cardiology

Cigna - Prior Authorization Procedure List: Radiology & Cardiology Cigna - Prior Authorization Procedure List: Radiology & Cardiology Category CPT Code CPT Code Description 93451 Right heart catheterization 93452 Left heart catheterization 93453 Combined right and left

More information

Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors

Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors Lars Stegger, Benjamin Noto Department of Nuclear Medicine University Hospital Münster, Germany Content From PET to

More information

Lung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded.

Lung. 10/24/13 Chest X-ray: 2.9 cm mass like density in the inferior lingular segment worrisome for neoplasm. Malignancy cannot be excluded. Lung Case Scenario 1 A 54 year white male presents with a recent abnormal CT of the chest. The patient has a history of melanoma, kidney, and prostate cancers. 10/24/13 Chest X-ray: 2.9 cm mass like density

More information

FDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D.

FDG PET/CT in Lung Cancer Read with the experts. Homer A. Macapinlac, M.D. FDG PET/CT in Lung Cancer Read with the experts Homer A. Macapinlac, M.D. Patient with suspected lung cancer presents with left sided chest pain T3 What is the T stage of this patient? A) T2a B) T2b C)

More information

Imaging: When to get MRI, CT or PET-CT?

Imaging: When to get MRI, CT or PET-CT? Imaging: When to get MRI, CT or PET-CT? Alina Uzelac, D.O. Assistant Clinical Professor Neuroradiology UCSF Department of Radiology and Biomedical Imaging San Francisco General Hospital Overview CT MRI

More information

Nuclear Sciences and Medicine

Nuclear Sciences and Medicine Nuclear Sciences and Medicine Rethy Chhem, MD, PhD (Edu), PhD (His), FRCPC Division of Human Health Guest Professor, Medical University of Vienna International Atomic Energy Agency Medical Imaging X-rays

More information

The Spectrum of Management of Pulmonary Ground Glass Nodules

The Spectrum of Management of Pulmonary Ground Glass Nodules The Spectrum of Management of Pulmonary Ground Glass Nodules Stanley S Siegelman CT Society 10/26/2011 No financial disclosures. Noguchi M et al. Cancer 75: 2844-2852, 1995. 236 surgically resected peripheral

More information

Molecular Imaging and the Brain

Molecular Imaging and the Brain Molecular imaging technologies are playing an important role in neuroimaging, a branch of medical imaging, by providing a window into the living brain. Where CT and conventional MR imaging provide important

More information

PET-MRI in malignant bone tumours. Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany

PET-MRI in malignant bone tumours. Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany PET-MRI in malignant bone tumours Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany Content From PET to PET/MRI General considerations Bone metastases Primary bone tumours

More information

Oncology General Principles L A U R I E S I M A R D B R E A S T S U R G I C A L O N C O L O G Y F E L L O W D E C E M B E R

Oncology General Principles L A U R I E S I M A R D B R E A S T S U R G I C A L O N C O L O G Y F E L L O W D E C E M B E R Oncology General Principles L A U R I E S I M A R D B R E A S T S U R G I C A L O N C O L O G Y F E L L O W D E C E M B E R 2 0 1 2 Objectives Discuss Diagnostic and staging strategies in oncology Know

More information

High Tech Imaging Quick Reference Guide

High Tech Imaging Quick Reference Guide High Tech Imaging Quick Reference Guide 1 High Tech Imaging Authorizations may now be requested through our secure provider portal, BlueAccess. Getting Started Step 1: Log into BlueAccess from www.bcbst.com

More information

Nuclear Perfusion Imaging of Angina

Nuclear Perfusion Imaging of Angina January 2002 Nuclear Perfusion Imaging of Angina Davin Quinn HMS III Beth Israel Deaconess Medical Center Radiology Department Goals of Presentation Understand what a perfusion scan is Understand what

More information

Bone and CT Scans Are Complementary for Diagnoses of Bone Metastases in Breast Cancer When PET Scans Findings Are Equivocal: A Case Report

Bone and CT Scans Are Complementary for Diagnoses of Bone Metastases in Breast Cancer When PET Scans Findings Are Equivocal: A Case Report Bone and CT Scans Are Complementary for Diagnoses of Bone Metastases in Breast Cancer When Scans Findings Are Equivocal: A Case Report Yuk-Wah Tsang 1, Jyh-Gang Leu 2, Yen-Kung Chen 3, Kwan-Hwa Chi 1,4

More information

FDG-PET/CT in Gynaecologic Cancers

FDG-PET/CT in Gynaecologic Cancers Friday, August 31, 2012 Session 6, 9:00-9:30 FDG-PET/CT in Gynaecologic Cancers (Uterine) cervical cancer Endometrial cancer & Uterine sarcomas Ovarian cancer Little mermaid (Edvard Eriksen 1913) honoring

More information

BlueAdvantage SM. & BlueChoice SM Radiology Prior Authorization Program Code List CPT /HCPS

BlueAdvantage SM. & BlueChoice SM Radiology Prior Authorization Program Code List CPT /HCPS BlueAdvantage SM & BlueChoice SM Radiology Prior Authorization Program Code List CPT /HCPS 70336 MRI TMJ 70450 CT Head Without Contrast 70460 CT Head With Contrast 70470 CT Head Without & With Contrast

More information

SEER Summary Stage Still Here!

SEER Summary Stage Still Here! SEER Summary Stage Still Here! CCRA NORTHERN REGION STAGING SYMPOSIUM SEPTEMBER 20, 2017 SEER Summary Stage Timeframe: includes all information available through completion of surgery(ies) in the first

More information

Respiratory Interactive Session. Elaine Borg

Respiratory Interactive Session. Elaine Borg Respiratory Interactive Session Elaine Borg Case 1 Respiratory Cytology 55 year old gentleman Anterior mediastinal mass EBUS FNA Case 1 Respiratory Cytology 55 year old gentleman with anterior mediastinal

More information

Disclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None

Disclosure. Acknowledgement. What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Rectal cancer imaging. None What is the Best Workup for Rectal Cancer Staging: US/MRI/PET? Zhen Jane Wang, MD Assistant Professor in Residence UC SF Department of Radiology Disclosure None Acknowledgement Hueylan Chern, MD, Department

More information

Breast Cancer PET/CT Imaging Protocol

Breast Cancer PET/CT Imaging Protocol Breast Cancer PET/CT Imaging Protocol Scanning Protocol: Patients are scanned from the top of the neck through the pelvis. Arms-up position is used to avoid beam-hardening artifact in the chest and abdomen.

More information

Breast Cancer Diagnosis, Treatment and Follow-up

Breast Cancer Diagnosis, Treatment and Follow-up Breast Cancer Diagnosis, Treatment and Follow-up What is breast cancer? Each of the body s organs, including the breast, is made up of many types of cells. Normally, healthy cells grow and divide to produce

More information

Positron emission tomography scanning is coming to a hospital near you soon!

Positron emission tomography scanning is coming to a hospital near you soon! PROFESSIONAL ISSUES Positron emission tomography scanning is coming to a hospital near you soon! Humayun Bashir, Gregory Shabo and TO Nunan Humayun Bashir MB BS FCPS, Specialist Registrar in Nuclear Medicine

More information

VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy

VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy CYRIC Annual Report 2003 VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy Yamaura G., Yoshioka T., Yamaguchi K. *, Fukuda

More information

Nuclear Medicine in Thyroid Cancer. Phillip J. Koo, MD Division Chief of Diagnostic Imaging

Nuclear Medicine in Thyroid Cancer. Phillip J. Koo, MD Division Chief of Diagnostic Imaging Nuclear Medicine in Thyroid Cancer Phillip J. Koo, MD Division Chief of Diagnostic Imaging Financial Disclosures Bayer Janssen Learning Objectives To learn the advantages and disadvantages of SPECT/CT

More information

F NaF PET/CT in the Evaluation of Skeletal Malignancy

F NaF PET/CT in the Evaluation of Skeletal Malignancy F NaF PET/CT in the Evaluation of Skeletal Malignancy Andrei Iagaru, MD September 26, 2013 School of of Medicine Ø Introduction Ø F NaF PET/CT in Primary Bone Cancers Ø F NaF PET/CT in Bone Metastases

More information

Original Policy Date

Original Policy Date MP 6.01.17 Oncologic Applications of PET Scanning Medical Policy Section Radiology Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature/12:2013 Return to Medical

More information

Nuclear pulmonology. Katalin Zámbó Department of Nuclear Medicine

Nuclear pulmonology. Katalin Zámbó Department of Nuclear Medicine Nuclear pulmonology Katalin Zámbó Department of Nuclear Medicine Imaging techniques Morphology Physiology Metabolism Molecules X-ray / CT MRI NM - SPECT/ PET MR spectroscopy fmri Ultrasound Hybrid imaging:

More information

Management of Neck Metastasis from Unknown Primary

Management of Neck Metastasis from Unknown Primary Management of Neck Metastasis from Unknown Primary.. Definition Histologic evidence of malignancy in the cervical lymph node (s) with no apparent primary site of original tumour Diagnosis after a thorough

More information

Use of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer

Use of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer November 2010 Use of Integrated PET CT in the Clinical Staging of Non Small Cell Lung Cancer Laura Myers, Harvard Medical School, Year III Clinical Presentation 79yo woman with cough productive of green

More information

Maximizing the Utility of Integrated PET/MRI in Clinical Applications

Maximizing the Utility of Integrated PET/MRI in Clinical Applications Maximizing the Utility of Integrated PET/MRI in Clinical Applications Spencer Behr, MD Department of Nuclear Medicine & Abdominal Imaging University of California, San Francisco PET/MR at UCSF Device:

More information

Typical PET Image. Elevated uptake of FDG (related to metabolism) Lung cancer example: But where exactly is it located?

Typical PET Image. Elevated uptake of FDG (related to metabolism) Lung cancer example: But where exactly is it located? Typical PET Image Elevated uptake of FDG (related to metabolism) Lung cancer example: But where exactly is it located? PET/CT Oncology Imaging Anatometabolic fusion images are useful in the management

More information

Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer

Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer Endobronchial Ultrasound in the Diagnosis & Staging of Lung Cancer Dr Richard Booton PhD FRCP Lead Lung Cancer Clinician, Consultant Respiratory Physician & Speciality Director Manchester University NHS

More information