Hybrid PET/CT and SPECT/CT Imaging (eBook)

Preface 6
Acknowledgments 8
Contents 9
Expanded Chapter Contents 11
Contributors 24
Part 1: General 27
History and Principles of Hybrid Imaging 28
Introduction 28
Single Photon Emission Computed Tomography 28
Data Acquisition 29
Instrumentation 29
Acquisition Parameters 30
Collimation 30
Matrix Size 30
Arc of Rotation 31
Projections per Arc of Rotation 31
Time per Projection 31
SPECT Image Formation 31
Image Reconstruction 32
Filters 34
Iterative Reconstruction 36
Attenuation Correction 37
Positron Emission Tomography 38
PET Detectors 39
2D Versus 3D Imaging 41
Data Acquisition and Image Reconstruction 41
Time-of-Flight PET 43
Quantitative Techniques 43
X-Ray Computed Tomography 46
SPECT/CT and PET/CT 49
Clinical SPECT/CT Systems 51
Clinical PET/CT Systems 52
Contrast Agents 52
Beam-Hardening Artifacts 53
Physiological Motion 53
Radiation Dosimetry Considerations 53
Quality Assurance 54
Conclusions 56
References 57
Normal Distribution, Variants, Pitfalls, and Artifacts 59
PET/CT Imaging with 18F-Fluorodeoxyglucose 59
Normal 18F-FDG Distribution and Physiologic Variants 59
Pitfalls and Artifacts on 18F-FDG Imaging 61
Benign Processes Accumulating 18F-FDG 62
Treatment-Related Processes Accumulating 18F-FDG 62
Summary 63
Physiologic Distribution of Other PET Tracers 64
18F-Fluoride 64
18F-Fluorothymidine 64
18F-Fluorocholine and 11C-Choline 65
11C-Acetate 65
11C-Methionine 66
18F-Fluorodopamine 66
18F-Fluoromisonidazole 66
68Ga-Somatostatin Receptors 67
Physiologic Distribution of SPECT/CT Imaging Tracers 67
131I- and 123I-Iodine (131I and 123I) 67
131I- and 123I-MIBG 68
111In-DTPA-Octreotide 68
99mTc-Sestamibi 69
111In- and 99mTc-HMPAO-Leucocytes (WBC) 69
67Ga-Citrate 70
111In-ProstaScintreg 70
Case Presentations 72
Case I.2.1 (DICOM Images on DVD) 72
History 72
Findings 77
Discussion 77
Diagnosis 78
Clinical Report: Body 18F-FDG PET/CT Imaging (for DVD cases only) 78
Indication 78
History 78
Procedure 78
Findings 78
Disclaimers 78
Impression 79
Case I.2.2 80
History 80
Findings 80
Discussion 80
Diagnosis 81
Case I.2.3 82
History 82
Findings 83
Discussion 83
Diagnosis 84
Case I.2.4 85
History 85
Findings 85
Discussion 86
Diagnosis 86
Case I.2.5 87
History 87
Findings 88
Discussion 88
Diagnosis 89
Case I.2.6 90
History 90
Findings 92
Discussion 92
Diagnosis 93
Case I.2.7 94
History 94
Findings 96
Discussion 96
Diagnosis 96
Case I.2.8 97
History 97
Findings 97
Discussion 97
Diagnosis 98
Case I.2.9 99
History 99
Findings 102
Discussion 102
Diagnosis 103
Case I.2.10 104
History 104
Findings 104
Discussion 104
Diagnosis 105
Case I.2.11 106
History 106
Findings 106
Discussion 106
Diagnosis 107
Case I.2.12 108
History 108
Findings 109
Discussion 110
Diagnosis 110
Case I.2.13 111
History 111
Findings 113
Discussion 113
Diagnosis 114
Case I.2.14 115
History 115
Findings 116
Discussion 117
Diagnosis 117
References 118
Part 2: Clinical Applications in Oncology 121
Tumors of the Central Nervous System 122
Introduction 122
Physiologic Distribution of 18F-FDG in the CNS 123
Initial Evaluation and Staging of Primary Cerebral Tumors 124
Evaluation of Treated Primary Cerebral Tumors 125
Evaluation of Cerebral Metastases 125
Evaluation of Meningiomas 126
Summary 127
Guidelines and Recommendations for the use of 18F-FDG PET and PET/CT 127
Case Presentations 128
Case II.1.1 128
History 128
Findings 129
Discussion 129
Diagnosis 130
Case II.1.2 131
History 131
Findings 131
Discussion 132
Diagnosis 132
Case II.1.3 133
History 133
Findings 134
Discussion 134
Diagnosis 135
Case II.1.4 (DICOM Images on DVD) 136
History 136
Findings 137
Discussion 137
Diagnosis 138
Clinical Report: Brain 18F-FDG PET/CT (for DVD cases only) 138
Indication 138
History 138
Procedure 138
Findings 138
Impression 139
Case II.1.5 140
History 140
Findings 140
Discussion 141
Diagnosis 141
Case II.1.6 142
History 142
Findings 143
Discussion 144
Diagnosis 144
Case II.1.7 (DICOM Images on DVD) 145
History 145
Findings 146
Discussion 146
Diagnosis 147
Clinical Report: Brain 18F-FDG PET/CT (for DVD cases only) 147
Indication 147
History 147
Procedure 147
Findings 147
Impression 148
Case II.1.8 149
History 149
Findings 150
Discussion 150
Diagnosis 153
Case II.1.9 154
History 154
Findings 155
Discussion 156
Diagnosis 156
Follow-Up 156
References 157
Hybrid Imaging of Head and Neck Malignancies 159
Introduction 159
Staging of Head and Neck Carcinoma 160
Cervical Lymph Node Metastases of Unknown Tumors 162
Monitoring Response to Therapy 163
Diagnosis and Restaging of Recurrence 164
Planning of Radiotherapy 164
Summary 165
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 165
Case Presentations 166
Case II.2.1 166
History 166
Findings 166
Discussion 166
Diagnosis 167
Case II.2.2 168
History 168
Findings 170
Discussion 170
Diagnosis 170
Case II.2.3 (DICOM Images on DVD) 171
History 171
Findings 172
Discussion 172
Diagnosis 173
Clinical Report Case II.2.3: Body 18F-FDG PET/CT (for DVD cases only) 173
Indication 173
History 173
Procedure 173
Findings 173
Impression 174
Case II.2.4 175
History 175
Findings 176
Discussion 176
Diagnosis 177
Case II.2.5 178
History 178
Findings 178
Discussion 178
Diagnosis 179
Case II.2.6 180
History 180
Findings 181
Discussion 181
Diagnosis 181
Case II.2.7 182
History 182
Findings 182
Discussion 183
Diagnosis 183
Case II.2.8 184
History 184
Findings 186
Discussion 186
Diagnosis 187
Case II.2.9 188
History 188
Findings 188
Discussion 189
Diagnosis 189
References 190
Lung Cancer 193
Introduction 193
Indeterminate Pulmonary Nodules 193
Non-surgical Evaluation of Pulmonary Nodules 194
18F-FDG PET/CT for Evaluation of Pulmonary Nodules 195
Guidelines for Evaluation of Indeterminate Nodules 196
Non-Small-Cell Lung Carcinoma (NSCLC) 197
TNM Staging of NSCLC 197
18F-FDG Imaging for Staging of NSCLC at Presentation: Comparison to CT 198
Detection of Extra-Thoracic Metastases 199
Impact of 18F-FDG Imaging on Management of NSCLC at Presentation 200
18F-FDG Imaging for Monitoring Therapy of NSCLC 200
Detection of Recurrence and Restaging with 18F-FDG PET or PET/CT 201
Summary 201
Small-Cell Lung Carcinoma (SCLC) 202
18F-FDG PET and PET/CT for Staging, Restaging, and Assessment of Treatment Response of SCLC 202
Summary 203
Malignant Pleural Mesothelioma 203
Introduction 203
18F-FDG Imaging of MPM 205
Assessment of Metabolic Response to Treatment of MPM 206
Summary 206
Guidelines and Recommendations for the Use of F-FDG PET and PET/CT 206
Case Presentations 208
Case II.3.1 208
History 208
Findings 208
Discussion 209
Diagnosis 209
Follow-up 209
Case II.3.2 210
History 210
Findings 211
Discussion 211
Diagnosis 211
Case II.3.3 212
History 212
Findings 213
Discussion 213
Diagnosis 213
Case II.3.4 214
History 214
Findings 214
Discussion 215
Diagnosis 215
Follow-up 215
Case II.3.5 216
History 216
Findings 217
Discussion 217
Diagnosis 218
Case II.3.6 219
History 219
Findings 220
Discussion 220
Diagnosis 220
Case II.3.7 221
History 221
Findings 222
Discussion 222
Diagnosis 222
Case II.3.8 (DICOM Images on DVD) 223
History 223
Findings 224
Discussion 224
Diagnosis 225
Clinical Report: Body 18F-FDG PET/CT Imaging (for DVD cases only) 225
Indication 225
History 225
Procedure 225
Findings 225
Case II.3.9 227
History 227
Findings 227
Discussion 228
Diagnosis 228
Case II.3.10 (DICOM Images on DVD) 229
History 229
Findings 230
Discussion 230
Diagnosis 231
Clinical Report (Body 18F-FDG PET/CT for DVD cases only) 231
Indication 231
History 231
Procedure 231
Findings 231
Case II.3.11 233
History 233
Findings 234
Discussion 234
Diagnosis 234
References 235
Breast Cancer 238
Introduction 238
18F-FDG PET and PET/CT for the Detection and Staging of Breast Cancer 239
18F-FDG PET and PET/CT for the Detection of Metastatic Breast Cancer 240
18F-FDG PET and PET/CT for the Detection and Staging of Recurrent Breast Cancer 240
18F-FDG Imaging to Monitor Therapy of Breast Cancer 241
18F-FDG PET/CT for Radiation Therapy Planning in Breast Cancer 242
Summary 242
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 243
Case Presentations 244
Case II.4.1 244
History 244
Findings 245
Discussion 245
Diagnosis 246
Case II.4.2 247
History 247
Findings 251
Discussion 251
Diagnosis 252
Case II.4.3 253
History 253
Findings 255
Discussion 255
Diagnosis 256
Case II.4.4 (DICOM Images on DVD) 257
History 257
Findings 260
Discussion 260
Diagnosis 261
Follow-Up 261
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 261
Indication 261
History 261
Procedure 261
Findings 261
Impression 262
Case II.4.5 263
History 263
Findings 265
Discussion 265
Diagnosis 266
Case II.4.6 (DICOM Images on DVD) 267
History 267
Findings 276
Discussion 277
Diagnosis 277
Follow-Up 277
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 278
Indication 278
History 278
Procedure 278
Findings 278
Impression 278
References 280
Colorectal Cancer 282
Introduction 282
18F-FDG PET and PET/CT for Screening and Diagnosis of Colorectal Carcinoma 282
18F-FDG PET and PET/CT in the Initial Staging of Colorectal Carcinoma 283
18F-FDG PET and PET/CT for Assessment of Recurrent Colorectal Carcinoma 283
Detection and Restaging of Recurrence 283
Impact on Management and Cost Analysis in Patients with Recurrent Disease 284
18F-FDG Imaging for Monitoring Therapy Response of Colorectal Carcinoma 286
Systemic Chemotherapy 286
Radiation Therapy 286
Regional Therapy to the Liver 287
Summary 287
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 287
Case Presentations 289
Case II.5.1(DICOM Images on DVD) 289
History 289
Findings 292
Discussion 292
Diagnosis 293
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 293
Indication 293
History 293
Procedure 293
Findings 294
Impression 294
Case II.5.2 295
History 295
Findings 298
Discussion 298
Diagnosis 299
Case II.5.3 300
History 300
Findings 300
Discussion 301
Diagnosis 301
Case II.5.4 (DICOM Images on DVD) 302
History 302
Findings 304
Discussion 304
Diagnosis 305
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 305
Indication 305
History 305
Procedure 305
Findings 306
Impression 306
Case II.5.5 307
History 307
Findings 307
Discussion 307
Diagnosis 308
Case II.5.6 309
History 309
Findings 309
Discussion 309
Diagnosis 310
References 311
18F-FDG PET/CT in Tumors of the Gastrointestinal Tract: Esophageal and Gastric Cancer and Gastrointestinal Stromal Tumors (GIST) 314
18F-FDG Imaging in Esophageal Cancer 314
Introduction 314
18F-FDG Imaging for Staging of Esophageal Cancer 315
18F-FDG Imaging for Monitoring Response to Treatment of Esophageal Cancer 316
18F-FDG Imaging for Diagnosis of Recurrent Esophageal Cancer 317
18F-FDG Imaging in Gastric Cancer 317
Introduction 317
18F-FDG Imaging for Diagnosis and Staging of Gastric Cancer 318
18F-FDG Imaging for Monitoring Response to Treatment of Gastric Cancer 319
18F-FDG Imaging for Diagnosis of Recurrent Gastric Cancer 319
18F-FDG Imaging in Gastrointestinal Stromal Tumors 320
Introduction 320
18F-FDG Imaging at Initial Diagnosis of GIST 321
18F-FDG Imaging for Monitoring Response to Treatment of GIST 321
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT in Esophageal Cancer 322
Case Presentations 323
Case II.6.1 (DICOM Images on DVD) 323
History 323
Findings 325
Discussion 325
Diagnosis 326
Clinical Report: Body FDG-PET/CT (for DVD cases only) 326
Indication 326
History 326
Procedure 327
Findings 327
Impression 327
Case II.6.2 328
History 328
Findings 328
Discussion 328
Diagnosis 329
Case II.6.3 (DICOM Images on DVD) 330
History 330
Findings 333
Discussion 333
Diagnosis 334
Clinical Report: Body FDG-PET/CT (for DVD cases only) 334
Indication 334
History 334
Procedure 335
Findings 335
Impression 335
Case II.6.4 336
History 336
Findings 338
Discussion 338
Diagnosis 339
Case II.6.5 340
History 340
Findings 341
Discussion 341
Diagnosis 342
Case II.6.6 343
History 343
Findings 346
Discussion 347
Diagnosis 347
References 348
Hepatobiliary and Pancreatic Malignancies 351
Hepatobiliary Neoplasms 351
Pancreatic Neoplasms 352
Imaging of Hepatobiliary and Pancreatic Neoplasms 352
Hepatic Metastases 354
18F-FDG PET/CT Imaging of Hepatic Metastases 354
Hepatocellular Carcinoma 354
18F-FDG PET/CT for Diagnosis and Staging of HCC 355
11C-Acetate Imaging of HCC 355
Cholangiocarcinoma 356
18F-FDG PET/CT for Diagnosis and Staging of Cholangiocarcinoma 356
Gallbladder Carcinoma 357
18F-FDG PET/CT for Diagnosis and Staging of Gallbladder Carcinoma 357
18F-FDG PET/CT Monitoring Therapy of Hepatic Tumors 357
Pancreatic Cancer 358
18F-FDG PET/CT for Preoperative Diagnosis of Pancreatic Carcinoma 359
18F-FDG PET/CT for Staging of Pancreatic Carcinoma 360
18F-FDG PET/CT in the Post-therapy Setting 360
Impact of 18F-FDG PET/CT on Management of Patients with Pancreatic Carcinoma 360
Limitations of 18F-FDG Imaging 361
Summary 361
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 362
Case Presentations 363
Case II.7.1 (DICOM Images on DVD) 363
History 363
Findings 366
Discussion 367
Diagnosis 367
Clinical Report: Body 18F-FDG and 11C-Acetate PET/CT (for DVD cases only) 367
Indication 367
History 367
Procedure 368
Findings 368
Disclaimers 369
Impression 369
Case II.7.2 370
History 370
Findings 373
Discussion 373
Diagnosis 374
Case II.7.3 375
History 375
Findings 378
Discussion 378
Diagnosis 379
Case II.7.4 (DICOM Images on DVD) 380
History 380
Findings 383
Discussion 383
Diagnosis 384
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 384
Indication 384
History 384
Procedure 384
Findings 384
Impression 385
Case II.7.5 386
History 386
Findings 389
Discussion 389
Diagnosis 390
Case II.7.6 391
History 391
Findings 391
Discussion 391
Diagnosis 392
Case II.7.7 393
History 393
Findings 395
Discussion 395
Diagnosis 396
Case II.7.8 397
History 397
Findings 397
Discussion 398
Diagnosis 398
References 399
Gynecological Tumors 403
Introduction 403
Cervical Cancer 403
18F-FDG PET/CT in Staging Cervical Cancer 403
18F-FDG PET/CT in Directing Therapy in Cervical Cancer 404
18F-FDG PET/CT in Predicting Prognosis in Cervical Cancer 404
18F-FDG PET/CT in Post-therapy Monitoring of Cervical Cancer 405
Ovarian Cancer 405
18F-FDG PET/CT in Diagnosis and Staging of Ovarian Cancer 405
18F-FDG PET/CT in Assessment of Response to Therapy in Ovarian Cancer 406
18F-FDG PET/CT in Detection of Recurrent Ovarian Cancer 406
Endometrial Cancer 407
Summary 407
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 408
Case Presentations 409
Case II.8.1 (DICOM Images on DVD) 409
History 409
Findings 411
Discussion 411
Diagnosis 412
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 412
Indication 412
History 412
Procedure 412
Findings 413
Impression 413
Case II.8.2 414
History 414
Findings 415
Discussion 415
Diagnosis 416
Case II.8.3 417
History 417
Findings 419
Discussion 419
Diagnosis 419
Case II.8.4 (DICOM Images on DVD) 420
History 420
Findings 422
Discussion 422
Diagnosis 423
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 423
Indication 423
History 423
Procedure 423
Findings 424
Impression 424
Case II.8.5 425
History 425
Findings 426
Discussion 426
Diagnosis 426
References 427
Hybrid Imaging in Malignancies of the Urinary Tract, Prostate, and Testicular Cancers 429
Introduction 429
Renal Cancer 429
PET/CT Imaging for Diagnosis and Staging of RCC 430
PET/CT Imaging During Follow-Up and Recurrent RCC 430
Conclusions 431
Bladder Cancer 431
18F-FDG Imaging of Bladder Cancer 431
11C-Choline Imaging of Bladder Cancer 432
11C-Acetate and 11C-Methionine Imaging of Bladder Cancer 432
Conclusions 433
Prostate Cancer 433
PET/CT and SPECT/CT of Primary Prostate Cancer 433
PET/CT and SPECT/CT of Metastatic Prostate Cancer 434
PET/CT and SPECT/CT in Recurrent Prostate Cancer 435
Conclusions 436
Testicular Cancer 436
18F-FDG Imaging for Staging of Testicular Tumors 437
18F-FDG Imaging of Residual and Recurrent Testicular Tumors 437
18F-FDG Imaging in Follow-up of NSGCT 438
Conclusions 438
Guidelines and Recommendations for the use of 18F-FDG PET and PET/CT 438
Case Presentations 439
Case II.9.1 439
History 439
Findings 440
Discussion 440
Diagnosis 441
Case II.9.2 (DICOM Images on DVD) 442
History 442
Findings 443
Discussion 443
Diagnosis 444
Follow-up 444
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only Corresponds to Fig. II.9.2C)
Indication 444
History 444
Procedure 444
Findings 445
Impression 445
Case II.9.3 446
History 446
Findings 447
Discussion 447
Diagnosis 448
Case II.9.4 (DICOM Images on DVD) 449
History 449
Findings 450
Discussion 450
Diagnosis 451
Follow-up 451
Clinical Report: Body 11C-choline PET/CT and 11C-acetate PET/CT (for DVD cases only) 451
Indication 451
History 451
Procedure for 11C-choline PET/CT 451
Findings for 11C-choline PET/CT 451
Procedure for 11C-acetate PET/CT (Performed the day after the 11C-choline PET/CT) 452
Findings for 11C-acetate PET/CT 452
Impression for 11C-choline and 11C-acetate PET/CT 452
Case II.9.5 454
History 454
Findings 454
Discussion 454
Diagnosis 455
Case II.9.6 456
History 456
Findings 457
Discussion 457
Diagnosis 457
Case II.9.7 458
History 458
Findings 459
Discussion 459
Diagnosis 460
References 461
Thyroid Cancer 464
Introduction 464
Differentiated Thyroid Cancer 465
Radioiodine Whole-Body Scintigraphy with SPECT/CT 465
18F-FDG PET/CT 465
H•rthle Cell Carcinoma 466
Anaplastic Thyroid Cancer 467
Medullary Thyroid Cancer 467
Thyroid Incidentalomas on 18F-FDG PET/CT 468
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 468
Case Presentations 469
Case II.10.1 (DICOM Images on DVD) 469
History 469
Findings 470
Discussion 470
Diagnosis 470
Clinical Report: 123I Metastatic Survey with SPECT/CT (for DVD cases only) 471
Indication 471
History 471
Procedure 471
Findings 471
Impression 471
Case II.10.2 (DICOM Images on DVD) 472
History 472
Findings 474
Discussion 474
Diagnosis 475
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 475
Indication 475
History 475
Procedure 475
Findings 476
Impression 476
Case II.10.3 477
History 477
Findings 478
Discussion 478
Diagnosis 478
Case II.10.4 479
History 479
Findings 480
Discussion 480
Diagnosis 481
Case II.10.5 482
History 482
Findings 483
Discussion 483
Diagnosis 483
Case II.10.6 484
History 484
Findings 485
Discussion 485
Diagnosis 486
Case II.10.7 487
History 487
Findings 488
Discussion 488
Diagnosis 489
References 490
Endocrine Tumors 493
Introduction 493
Imaging Protocols 494
SPECT/CT and PET/CT Tracers for Imaging of NE Tumors 494
SPECT/CT and PET/CT of GEP Tumors 496
SPECT/CT and PET/CT of Neural Crest Tumors 497
SPECT/CT of Parathyroid Adenoma 499
Summary 500
Case Presentations 501
Case II.11.1 (DICOM Images on DVD) 501
History 501
Findings 503
Discussion 503
Diagnosis 504
Follow-up 504
Clinical Report: Body 18F-FDG PET/CT, and 111In-Pentetreotide SPECT/CT (for DVD cases only) 504
Indication 504
History 504
Procedure: PET/CT 504
Procedure: 111In-Pentetreotide SRS 504
Findings: PET/CT 504
Findings: 111In-Pentetreotide SRS 505
Impression 505
Case II.11.2 506
History 506
Findings 507
Discussion 507
Diagnosis 508
Case II.11.3 509
History 509
Findings 510
Discussion 510
Diagnosis 511
Case II.11.4 512
History 512
Findings 514
Discussion 514
Diagnosis 515
Case II.11.5 516
History 516
Findings 519
Discussion 519
Diagnosis 520
Case II.11.6 521
History 521
Findings 523
Discussion 523
Diagnosis 523
Case II.11.7 524
History 524
Findings 525
Discussion 525
Diagnosis 525
Case II.11.8 526
History 526
Findings 526
Diagnosis 526
Follow-up 526
References 527
Lymphoma 530
Introduction 530
Non-Hodgkin’s Lymphoma 530
Hodgkin’s Disease 532
18F-FDG Imaging for Diagnosis of NHL and HD 533
18F-FDG Imaging at Initial Staging of Lymphoma 533
18F-FDG Avidity of HD and NHL 533
Comparative Performance of 18F-FDG Imaging and CT 533
Diagnosis of Bone Marrow Involvement 534
18F-FDG Staging Criteria in HD and NHL 534
18F-FDG Imaging for Monitoring Therapy Response in Lymphoma 534
Definition of Response 534
Timing of 18F-FDG Imaging in Assessing Response to Treatment in Lymphoma 535
During and End-of-Treatment 18F-FDG Imaging in Lymphoma 535
18F-FDG Imaging of a Residual Mass 536
Pitfalls in Interpretation 536
18F-FDG Imaging for Diagnosis and Restaging of Lymphoma Recurrence 537
Summary 537
Guidelines and Recommendations for the Use of 18F-FDG-PET and PET/CT 538
Case Presentations 540
Case II.12.1 (DICOM Images on DVD) 540
History 540
Findings 543
Discussion 543
Diagnosis 544
Follow-Up 544
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 544
Indication 544
History 544
Procedure 544
Findings 545
Impression 545
Case II.12.2 546
History 546
Findings 547
Discussion 547
Diagnosis 548
Case II.12.3(DICOM Images on DVD) 549
History 549
Findings 550
Discussion 550
Diagnosis 551
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 551
Indication 551
History 551
Procedure 551
Findings 551
Impression 552
Case II.12.4 553
History 553
Findings 555
Discussion 555
Diagnosis 556
Case II.12.5 557
History 557
Findings 557
Discussion 558
Diagnosis 558
Case II.12.6 559
History 559
Findings 559
Discussion 560
Diagnosis 560
Case II.12.7 561
History 561
Findings 562
Discussion 562
Diagnosis 563
Case II.12.8 564
History 564
Findings 565
Discussion 565
Diagnosis 566
Case II.12.9 567
History 567
Findings 567
Discussion 567
Diagnosis 568
References 569
Melanoma 572
Introduction 572
Cutaneous Melanoma 572
Diagnosis 572
Staging 573
TNM Staging 573
Early Stage Melanoma: Role of SPECT/CT for SLN Localization and Biopsy 575
High-Risk Melanoma: Role of 18F-FDG Imaging 576
Detection of Recurrence and Restaging with 18F-FDG PET and PET/CT 576
Choroidal Melanoma 578
Summary 579
Guidelines and Recommendations for the Use of 18F-FDG PET and PET/CT 579
Case Presentations 580
Case II.13.1 580
History 580
Findings 580
Discussion 581
Diagnosis 581
Case II.13.2 582
History 582
Findings 582
Discussion 583
Diagnosis 583
Case II.13.3 (DICOM Images on DVD) 584
History 584
Findings 585
Discussion 585
Diagnosis 585
Follow-up 585
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 585
Indication 585
History 586
Procedure 586
Findings 586
Impression 586
Case II.13.4 587
History 587
Findings 588
Discussion 588
Diagnosis 589
Case II.13.5 590
History 590
Findings 591
Discussion 591
Diagnosis 591
Case II.13.6 (DICOM Images on DVD) 592
History 592
Findings 594
Discussion 594
Diagnosis 594
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 594
Indication 594
History 594
Procedure 594
Findings 594
Impression 595
Case II.13.7 596
History 596
Findings 596
Discussion 597
Diagnosis 597
References 598
Malignancy of the Bone: Primary Tumors, Lymphoma, and Skeletal Metastases 600
Skeletal Metastases, Bone Lymphoma, and Multiple Myeloma 600
18F-FDG PET/CT for Diagnosis of Malignant Skeletal Lesions 600
18F-FDG PET/CT for Monitoring Response to Therapy 601
Advantages of 18F-FDG PET/CT in Malignant Skeletal Involvement 601
Summary 601
Primary Skeletal Malignancies 602
18F-FDG PET/CT for Diagnosis of Primary Skeletal Tumors 602
18F-FDG PET/CT for Staging Primary Skeletal Tumors 602
18F-FDG PET/CT for Monitoring Response to Therapy 603
Summary 603
Case Presentations 604
Case II.14.1 (DICOM Images on DVD) 604
History 604
Findings 606
Discussion 606
Diagnosis 607
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 607
Indication 607
History 607
Procedure 607
Findings 607
Impression 608
Case II.14.2 609
History 609
Findings 612
Discussion 613
Diagnosis 614
Baseline study 614
Follow-Up Study 614
Case II.14.3 615
History 615
Findings 615
Discussion 616
Diagnosis 616
Case II.14.4 617
History 617
Findings 619
Discussion 620
Diagnosis 620
Case II.14.5 621
History 621
Findings 625
Discussion 626
Diagnosis 626
Case II.14.6 627
History 627
Findings 628
Discussion 628
Diagnosis 628
Case II.14.7 (DICOM Images on DVD) 629
History 629
Findings 632
Discussion 633
Diagnosis 633
Clinical Report: Whole Body 18F-FDG PET/CT (for DVD cases only) 633
Indication 633
History 633
Procedure 633
Findings 633
Impression 634
References 635
Pediatric Applications for PET/CT and SPECT/CT 637
Introduction 637
Neuroblastoma 637
Sarcoma 638
Lymphoma 639
Considerations on Radiation Exposure from PET/CT 640
PET/CT Procedure and Preparation of the Pediatric Patient 641
SPECT/CT Procedure and Preparation of the Pediatric Patient 641
Case Presentations 643
Case II.15.1 (DICOM Images on DVD) 643
Findings 646
Discussion 647
Diagnosis 647
Follow-up 647
Clinical Report: Whole Body 18F-FDG PET/CT (for DVD cases only) 647
Indication 647
History 647
Procedure 647
Findings 648
Impression 648
Case II.15.2 649
History 649
Findings 651
Discussion 651
Diagnosis 652
Case II.15.3 653
History 653
Findings 654
Discussion 654
Diagnosis 655
Case II.15.4 656
History 656
Findings 659
Discussion 659
Diagnosis 660
Case II.15.5 (DICOM Images on DVD) 661
History 661
Findings 664
Discussion 664
Diagnosis 665
Follow-up 665
Clinical Report: 123I-MIBG SPECT/CT (for DVD cases only) 665
Indication 665
History 665
Procedure 665
Findings 665
Impression 666
Case II.15.6 667
History 667
Findings 670
Discussion 670
Diagnosis 670
References 671
Part 3: Other Clinical Applications 673
Cardiac Hybrid Imaging (PET/CT and SPECT/CT): Assessment of CAD 674
Introduction 674
Imaging Protocols for Hybrid Cardiac Imaging 674
CT Imaging for Hybrid Cardiac SPECT/CT and PET/CT 674
Attenuation Correction 674
Diagnostic CT 675
Cardiac SPECT/CT 676
Cardiac PET/CT 676
Emission Imaging 676
Quality Control of Cardiac Hybrid Imaging 677
Clinical Applications of Cardiac Hybrid Imaging 677
Diagnosis of CAD Using Cardiac Hybrid Imaging 677
Risk Assessment Using Cardiac Hybrid Imaging 678
Guiding Management of CAD Using Cardiac Hybrid Imaging 679
Conclusions 680
Case Presentations 681
Case III.1.1 681
History 681
Protocol 681
Findings 682
Discussion 682
Diagnosis 682
Case III.1.2 683
History 683
Protocol 683
Findings 683
Discussion 684
Diagnosis 684
Case III.1.3 685
History 685
Protocol 686
Findings 686
Discussion 686
Diagnosis 687
Follow-Up 687
Case III.I.4 688
History 688
Protocol 689
Findings 689
Discussion 689
Diagnosis 689
Follow-Up 690
Case III.1.5 691
History 691
Protocol 692
Findings 692
Discussion 693
Diagnosis 693
Case III.1.6 694
History 694
Protocol 694
Findings 694
Discussion 695
Diagnosis 695
References 696
Hybrid Imaging of Benign Skeletal Diseases 698
99mTc-MDP SPECT/CT 698
18F-Fluoride PET/CT 700
18FDG PET/CT 701
Summary 702
Case Presentations 703
Case III.2.1 703
History 703
Findings 704
Discussion 704
Diagnosis 705
Case III.2.2 706
History 706
Findings 707
Discussion 707
Diagnosis 708
Case III.2.3 (DICOM Images on DVD) 709
History 709
Findings 711
Discussion 712
Diagnosis 712
Clinical Report: Whole-Body Planar 99mTc-MDP and SPECT/Low-Dose CT of the Pelvis (for DVD cases only) 712
Indication 712
History 712
Procedure 712
Findings 712
Impression 713
Case III.2.4 (DICOM Images on DVD) 714
History 714
Findings 717
Discussion 717
Diagnosis 718
Clinical Report: Whole-Body 18F-Fluoride-PET/CT 718
Indication 718
History 718
Procedure 718
Findings 718
Impression 719
Case III.2.5 720
History 720
Findings 721
Discussion 721
Diagnosis 722
References 723
Infectious and Inflammatory Diseases 725
Introduction 725
Radionuclide Procedures 725
Skeletal Scintigraphy 725
67Gallium Scintigraphy 726
Labeled Leukocyte Scintigraphy 726
18F-FDG Imaging 727
Case Presentations 728
Case III.3.1 728
History 728
Findings 729
Discussion 729
Diagnosis 730
Case III.3.2 731
History 731
Findings 732
Discussion 732
Diagnosis 733
Case III.3.3 734
History 734
Findings 736
Discussion 736
Diagnosis 737
Case III.3.4 738
History 738
Findings 739
Discussion 739
Diagnosis 739
Case III.3.5 740
History 740
Findings 740
Discussion 741
Diagnosis 741
Case III.3.6 742
History 742
Findings 743
Discussion 744
Diagnosis 744
Case III.3.7A (DICOM Images on DVD) 745
History 745
Findings 746
Diagnosis 746
Clinical Report: Body 18F-FDG PET/CT (for DVD cases only) 746
History 746
Procedure 746
Findings 747
Impression 747
Case III.3.7B 748
History 748
Findings 749
Diagnosis 749
Follow-Up 749
Case III.3.7C 750
History 750
Findings 751
Diagnosis 751
Follow-Up 749
Discussion for Cases III.3.7A, B, and C 751
Case III.3.8 (DICOM Images on DVD) 753
History 753
Findings 755
Discussion 755
Diagnosis 756
Clinical Report: Body 18F-FDG PET/CT and 99mTc-MDP SPECT/CT (for DVD cases only) 756
Protocol 756
Findings 757
Impression 757
References 758
Subject Index 760