Clinical PET and PET/CT

Clinical PET and PET/CT

Clinical PET and PET/CT With 145 Figures H. JADVAR, MD, PhD, FACNM Assistant Professor of Radiology and Biomedical Engineering, Keck School of Medicine, University of Southern California, Loa Angeles, CA, USA, and Visiting Associate in Bioengineering, California Institute of Technology, Pasadena, CA, USA J.A. PARKER Associate Professor of Radiology, Department of Radiology, Harvard Medical School, Boston, Massachusetts, USA

H. Jadvar, MD, PhD Assistant Professor of Radiology and Biomedical Engineering, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA, and Visiting Associate in Bioengineering, California Institute of Technology, Pasadena, CA, USA J.A. Parker, MD, PhD Associate Professor of Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Cataloging-in-Publication Data Jadvar, H. Clinical PET and PET/CT / H. Jadvar and J.A. Parker. p. ; cm. Includes bibliographical references and index. ISBN 1-85233-838-5 (alk. paper) 1. Tomography. 2. Tomography, Emission. I. Parker, J. Anthony. II. Title. [DNLM: 1. Tomography, Emission-Computed methods. 2. Tomography, X-Ray Computed methods. WN 206 J21c 2005] RC78.7.T6.J346 2005 616.07 57 dc22 2004058913 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. ISBN 1-85233-838-5 Springer London Berlin Heidelberg Springer Science+Business Media springeronline.com Springer-Verlag London Limited 2005 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Typeset by EXPO Holdings Sdn Bhd Printed and bound in the United States of America 28/3830-543210 Printed on acid-free paper SPIN 10950500

Table of Contents Foreword...vii Preface...ix 1. PET Physics and Instrumentation...1 2. PET Radiotracers...45 3. Cardiology...69 4. Neurology and Psychiatry...87 5. Oncology Brain...97 6. Oncology Head, Neck and Thyroid...103 7. Oncology Lungs...117 8. Oncology Digestive Tract...137 9. Oncology Pancreas and Hepatobiliary System...153 10. Oncology Breast and Female Reproductive System...161 11. Oncology Male Reproductive System...181 12. Oncology Urology...189 13. Oncology Bone and Soft Tissue Tumors...195 14. Oncology Lymphoma...205 15. Oncology Melanoma...227 16. Infection and Inflammation...235 17. Pediatrics...243 18. Variants and Pitfalls...255 Index...269 Table of Contents v

Foreword: Imaging Marches Forward The field of molecular imaging/nuclear medicine continues to build excitement for the medical community as a whole. To be able to visualize fundamental molecular and biochemical processes in patients in a meaningful way has truly become reality. Of all the available molecular probes and tools it is clear that FDG with PET-CT is one of the true clinical success stories. Very few would have been able to predict the eventual impact of a simple glucose analog as a marker for imaging cancer, hibernating myocardium, Alzheimer s disease, epilepsy and many other important disease processes. Although relatively well entrenched in the imaging research community there is a growing need to better explain the use of FDG in everyday clinical applications. As more radiologists become involved in the daily interpretation of FDG PET-CT scans, it is important that they understand this technology. With the continued expansion of reimbursement for FDG PET it is important to point out both the advantages and limitations of this technology in the routine management of patients. This book is a concise summary of the use of FDG PET/PET-CT for the practicing Radiologist/Nuclear Medicine Physician. In this regard it fills an important void of being relevant to the clinical imaging community with an emphasis on the practical utility of FDG across many areas including oncology. The consistency between chapters and the highly relevant clinical examples make this book a true pleasure to read. The use of figures with both anatomical and functional information truly helps to make case presentations very clear. The specific attention to pediatric FDG PET-CT is also particularly a refreshing welcome. Drs. Jadvar and Parker have done a wonderful job in putting together a textbook that is clear, concise and timely. I hope the readers will find it a useful resource for becoming state-of-art practitioners in the rapidly growing and exciting field of FDG PET-CT. Sanjiv Sam Gambhir M.D., Ph.D. Director, Molecular Imaging Program at Stanford Head, Nuclear Medicine Professor of Radiology & Bio-X Stanford University Stanford, California, USA Foreword vii

Preface Medical imaging has undergone remarkable evolution over the past century. Since the discovery of the x-rays by Wilhelm Röntgen, for which he received the Nobel Prize in 1901, there have been many other important discoveries and technical developments that have culminated in our current sophisticated multi-modality imaging systems. Nobel Prizes have been given for the discoveries of radioactivity (Marie Curie, Pierre Curie, and Henri Becquerel in 1903) and the positron (Carl Anderson in 1936) and for technical developments such as the radiotracer concept (George De Hevesy in 1943), computed tomography (Godfrey Hounsfield and Alan Cormack in 1979), and magnetic resonance imaging (Paul Lauterbur and Peter Mansfield in 2003). In keeping pace with these milestones in the evolution of medical imaging, positron emission tomography (PET), and more recently integrated positron emission tomography-computed tomography (PET-CT), have now emerged not only as important research tools but also as significant diagnostic imaging systems in clinical medicine. There is little doubt that in the near future PET and PET-CT will become even more important as clinical imaging tools for the evaluation of many disease processes. PET and PET-CT will also aid in the evolution from the current nonspecific imaging methods toward patient-specific imaging evaluation based on morphologic, physiologic, molecular, and genetic markers of disease. Ultimately, the use of multi-modality imaging systems and smart specific imaging agents will achieve the key tasks of accurate diagnosis, treatment evaluation, surveillance, and prognosis in individual patients. Toward this goal, we have attempted to compile a relatively short book that reviews the current state of affairs for PET and PET-CT. Each chapter of the book is intended to be independent, so that a reader may refer to any particular chapter of interest without loss of continuity. Therefore, some repetitions of concepts may be noted. Another difference from other books is that instead of referring to various sources by a reference number in the text, we list all the references alphabetically in the bibliography of each chapter and no specific referrals are made in the text. We preferred this format as we intended to consolidate and summarize the information from various sources for the reader. The book is nearly entirely based on the use of [F-18]fluorodeoxyglucose (FDG) as the radiotracer, but in some cases the uses of other relevant PET radiotracers in specific clinical situations are also included. The book is organized into 18 chapters. Chapters 1 and 2 review PET physics, instrumentation, and radiotracers. The clinical chapters, 3 17, emphasize the oncology applications of FDG for various organ systems or disease processes (5 through 15) but also review cardiac applications (chapter 3), neurology and psychiatry applications (chapter 4), and the emerging role of PET in infection and inflammation imaging (chapter 16) and in pediatrics (chapter 17). The book concludes with a brief discussion of variants and pitfalls. It is important to note that although many third-party payers continue to cover PET for various conditions in individual cases but the current list of Preface ix

indications approved by the Centers for Medicare and Medicaid Services include myocardial perfusion studies, myocardial viability assessment, presurgical evaluation of seizure disorders, evaluation of some patients suspected of having Alzheimer s disease or fronto-temporal dementia, characterization of solitary pulmonary nodule, and evaluations of breast cancer, colorectal cancer, esophageal cancer, head and neck cancer, non-small cell lung cancer, lymphoma, and melanoma. We hope that the book will appeal to all those who would like to learn about PET and PET-CT quickly and concisely. We regret any potential errors and omissions, and we will make certain to remedy the shortcomings in any future editions. Both authors would like to thank the Springer-Verlag staff, including Melissa Morton, Eva Senior, and Lesley Poliner, for their expert work in the design, editing, and production of this book. H. Jadvar dedicates this book to his very understanding and patient wife, Mojgan, and his lovely infant daughter, Donya. J.A. Parker dedicates this book to the great joy of his life, his children, Scott, Meg, and Bidget. October 2004 H. Jadvar Keck School of Medicine University of Southern California J.A. Parker Beth Israel Deaconess Medical Center Harvard Medical School x Preface