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Hybrid PET/CT and SPECT/CT Imaging - A Teaching File
Delbeke, Israel
Editore
Springer
Anno
2010
Pagine
760
ISBN
9780387928197
170,00 €
I prezzi indicati possono subire variazioni poiché soggetti all'oscillazione dei cambi delle valute e/o agli aggiornamenti effettuati dagli Editori.
  • Edited by leading authorities in the field and includes internationally recognized contributors
  • Reinforces key teaching points with more than 250 full color images obtained on state-of-the art integrated hybrid imaging systems
  • Provides an in-depth reference source for both PET/CT and SPECT/CT systems

Hybrid PET/CT and SPECT/CT Imaging: A Teaching File presents a complete book on state-of-the-art integrated PET/CT and SPECT/CT imaging systems. Edited by Drs. Dominique Delbeke and Ora Israel, this practical guide includes in-depth cases that will advance the skills of nuclear physicians and radiologists while also preparing residents for the field of nuclear medicine and radiology. Internationally-recognized contributors provide the reader with chapters covering the technical and clinical aspects of hybrid imaging, including basic principles, physics and instrumentation, the normal distribution of radiopharmaceuticals, and protocols critical to the field. A comprehensive review of nuclear oncology cases found in everyday practice are addressed, including among other clinical applications head and neck tumors, breast cancer, lung neoplasms, colorectal cancer, pancreatic cancer, and genitourinary tumors. Additional chapters examine the use of these modalities in pediatric patients, benign bone diseases and infection, and cardiac hybrid imaging. A wealth of illustrations reinforces the key teaching points discussed throughout the book.

 

Contents
Part I General
I.1 History and Principles of Hybrid Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
James A. Patton
I.2 Normal Distribution, Variants, Pitfalls, and Artifacts. . . . . . . . . . . . . . . . . . . . 35
Ora Israel and Dominique Delbeke
Part II Clinical Applications in Oncology
II.1 Tumors of the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Aaron C. Jessop, Ronald C. Walker, and Dominique Delbeke
II.2 Hybrid Imaging of Head and Neck Malignancies. . . . . . . . . . . . . . . . . . . . . . . 137
Arie Gordin, Marcelo Daitzchman, and Ora Israel
II.3 Lung Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Ronald C. Walker, Laurie B. Jones-Jackson, Aaron C. Jessop,
and Dominique Delbeke
II.4 Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Simona Ben-Haim and Vineet Prakash
II.5 Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Dominique Delbeke and Ronald C. Walker
II.6 18F-FDG PET/CT in Tumors of the Gastrointestinal Tract: Esophageal and
Gastric Cancer and Gastrointestinal Stromal Tumors (GIST) . . . . . . . . . . . . . 293
Rachel Bar-Shalom and Ludmila Guralnik
II.7 Hepatobiliary and Pancreatic Malignancies. . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Dominique Delbeke and Ronald C. Walker
II.8 Gynecological Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Farrokh Dehdashti and Barry A. Siegel
xi
II.9 Hybrid Imaging in Malignancies of the Urinary Tract, Prostate,
and Testicular Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Martine Klein and Marina Orevi
II.10 Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Heather A. Jacene, Sibyll Goetze, and Richard L. Wahl
II.11 Endocrine Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Yodphat Krausz
II.12 Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Michal Weiler-Sagie and Ora Israel
II.13 Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Ronald C. Walker, Laurie B. Jones-Jackson, Aaron C. Jessop,
and Dominique Delbeke
II.14 Malignancy of the Bone: Primary Tumors, Lymphoma,
and Skeletal Metastases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583
Einat Even-Sapir, Gideon Flusser, and Arye Blachar
II.15 Pediatric Applications for PET/CT and SPECT/CT. . . . . . . . . . . . . . . . . . . . 621
Helen R. Nadel and Angela T. Byrne
Part III Other Clinical Applications
III.1 Cardiac Hybrid Imaging (PET/CT and SPECT/CT):
Assessment of CAD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 659
Gabriel Vorobiof, Zohar Keidar, Sharmila Dorbala,
and Marcelo F. Di Carli
III.2 Hybrid Imaging of Benign Skeletal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . 683
Einat Even-Sapir, Hedva Lerman, Gideon Flusser, and Arye Blachar
III.3 Infectious and Inflammatory Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 711
Christopher J. Palestro, Zohar Keidar, and Charito Love
Subject Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 747
xii Contents
Expanded Contents
Part I General
I.1 History and Principles of Hybrid Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Single Photon Emission Computed Tomography. . . . . . . . . . . . . . . . . . . . . . . 3
Data Acquisition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
SPECT Image Formation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Positron Emission Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
PET Detectors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2D Versus 3D Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Data Acquisition and Image Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . 16
Time-of-Flight PET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Quantitative Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
X-Ray Computed Tomography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
SPECT/CT and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Clinical SPECT/CT Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Clinical PET/CT Systems. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Contrast Agents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Beam-Hardening Artifacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Physiological Motion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Radiation Dosimetry Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Quality Assurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
I.2 Normal Distribution, Variants, Pitfalls, and Artifacts. . . . . . . . . . . . . . . . . . . . . 35
PET/CT Imaging with 18F-Fluorodeoxyglucose. . . . . . . . . . . . . . . . . . . . . . . . 35
Normal 18F-FDG Distribution and Physiologic Variants. . . . . . . . . . . . . . . 35
Pitfalls and Artifacts on 18F-FDG Imaging. . . . . . . . . . . . . . . . . . . . . . . . . . 37
Benign Processes Accumulating 18F-FDG . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Treatment-Related Processes Accumulating 18F-FDG. . . . . . . . . . . . . . . . . 38
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Physiologic Distribution of Other PET Tracers . . . . . . . . . . . . . . . . . . . . . . . . 40
18F-Fluoride . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
18F-Fluorothymidine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
11C-Choline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Fluorocholine 11C-Acetate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
xiii
11C-Methionine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
18F-Fluorodopamine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
18F-Fluoromisonidazole. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
68Ga-Somatostatin Receptors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Physiologic Distribution of SPECT/CT Imaging Tracers. . . . . . . . . . . . . . . . . 43
131I- and 123I-Iodine (131I and 123I) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
131I- and 123I-MIBG. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
111In-DTPA-Octreotide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
99mTc-Sestamibi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
111In- and 99mTc-HMPAO-Leucocytes (WBC) . . . . . . . . . . . . . . . . . . . . . . . 45
67Ga-Citrate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
111In-Prostascint1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
I.2.1 Normal 18F-FDG Distribution (DICOM Images
on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
I.2.2 Physiologic 18F-FDG Uptake in aSymmetric Vocal Cord . . . . . . . . . 56
I.2.3 Rebound Thymic Hyperplasia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
I.2.4 Recurrent Hodgkin’s Disease and Abdominal Wall
Muscular Uptake in a Patient with Nausea and
Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
I.2.5 Diffuse Muscular Uptake in a Non-fasting Patient . . . . . . . . . . . . . . 63
I.2.6 Pericarditis and Crossed Ectopic Kidney . . . . . . . . . . . . . . . . . . . . . . 66
I.2.7 18F-FDG Uptake in Menstruating Uterus and Right Ovary
at Mid-Menstrual Cycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70
I.2.8 Hodgkin’s Disease and Lactating Breast . . . . . . . . . . . . . . . . . . . . . . 73
I.2.9 Brown Adipose Tissue Above and Below the Diaphragm . . . . . . . . . 75
I.2.10 Normal Distribution of 18F-FLT in a Patient with
Menetrier’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
I.2.11 131I-iodine: Remnant Left Lobe Thyroid Tissue
on Post-Ablation Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
I.2.12 131I-iodine: Physiological Uterine Uptake During Menstruation
on Post-Ablation Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
I.2.13 123I MIBG: Right Adrenal Pheochromocytoma and Dilated
Right Renal Pelvis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
I.2.14 99mTc-sestamibi: Left Parathyroid Adenoma. Atrophy of Right
Submandibular Gland and Slightly Enlarged Right Lobe of the
Thyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
Part II Clinical Applications in Oncology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
II.1 Tumors of the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Physiologic Distribution of 18F-FDG in the CNS . . . . . . . . . . . . . . . . . . . . . . 100
Initial Evaluation and Staging of Primary Cerebral Tumors . . . . . . . . . . . . . . 101
Evaluation of Treated Primary Cerebral Tumors . . . . . . . . . . . . . . . . . . . . . . . 102
Evaluation of Cerebral Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
Evaluation of Meningiomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
xiv Expanded Contents
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Guidelines and Recommendations for the use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
II.1.1 Low-grade Glioma (Oligodendroglioma, WHO
Grade II) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
II.1.2 Recurrent Glioma with Transformation from Low-Grade
to High-Grade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
II.1.3 Primary Lymphoma of CNS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
II.1.4 Toxoplasmosis (DICOM Images on DVD) . . . . . . . . . . . . . . . . . . . 113
II.1.5 Stage IV Non-small Cell Lung Cancer with Cerebral
Metastases and Poor FDG Uptake within the Brain due
to Hyperglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
II.1.6 Right Frontal Cerebral Arteriovenous Malformation . . . . . . . . . . . 119
II.1.7 Recurrent Glioblastoma Multiforme with Diminished Uptake
in the Right Temporal Region due to Post-therapy Changes
and Crossed Cerebellar Diaschisis (DICOM Images on DVD) . . . . 122
II.1.8 Meningioma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
II.1.9 Recurrent Low-grade Glioma Evaluated with 11C-methionine . . . . 131
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
II.2 Hybrid Imaging of Head and Neck Malignancies . . . . . . . . . . . . . . . . . . . . . . . 137
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Staging of Head and Neck Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Cervical Lymph Node Metastases of Unknown Tumors . . . . . . . . . . . . . . . . . 140
Monitoring Response to Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Diagnosis and Restaging of Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Planning of Radiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Guidelines and Recommendations for the Use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
II.2.1 Neck Metastasis of Unknown Origin . . . . . . . . . . . . . . . . . . . . . . . . 144
II.2.2 Cancer of the Larynx with Suspected Lung Metastases . . . . . . . . . . 146
II.2.3 Recurrent Cancer of the Nasopharynx: PET/CT Guided
Biopsy and Diagnosis (DICOM Images on DVD) . . . . . . . . . . . . . . 149
II.2.4 Second Primary Cancer of the Esophagus in Patient
with Suspected Recurrence of Laryngeal Tumor . . . . . . . . . . . . . . . 153
II.2.5 Recurrent Cancer of the Larynx: PET/CT Guided Biopsy
and Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
II.2.6 Assessment of the Post-Irradiated Edematous Larynx
with PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
II.2.7 Cancer of the Base of the Tongue with Normal Size Cervical
Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
II.2.8 Multiple Regional and Distant Metastases in Patient with
Advanced Laryngeal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
II.2.9 Benign FDG-avid Lesion: Warthin’s Tumor of Parotid Gland . . . . 166
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
Expanded Contents xv
II.3 Lung Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Indeterminate Pulmonary Nodules . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Non-surgical Evaluation of Pulmonary Nodules . . . . . . . . . . . . . . . . . . . . . 172
18F-FDG PET/CT for Evaluation of Pulmonary Nodules . . . . . . . . . . . . . . 173
Guidelines for Evaluation of Indeterminate Nodules . . . . . . . . . . . . . . . . . . 174
Non-Small-Cell Lung Carcinoma (NSCLC). . . . . . . . . . . . . . . . . . . . . . . . . . . 175
TNM Staging of NSCLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
18F-FDG Imaging for Staging of NSCLC at Presentation:
Comparison to CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Detection of Extra-Thoracic Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
Impact of 18F-FDG Imaging on Management of NSCLC at Presentation . . . 178
18F-FDG Imaging for Monitoring Therapy of NSCLC . . . . . . . . . . . . . . . . 178
Detection of Recurrence and Restaging with 18F-FDG PET or PET/CT . . 179
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Small-Cell Lung Carcinoma (SCLC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
18F-FDG PET and PET/CT for Staging, Restaging, and Assessment
of Treatment Response of SCLC. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Malignant Pleural Mesothelioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
18F-FDG Imaging of MPM. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Assessment of Metabolic Response to Treatment of MPM . . . . . . . . . . . . . 184
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
Guidelines and Recommendations for the Use of F-FDG PET and PET/CT . 184
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
II.3.1 Solitary Pulmonary Nodule with Moderate 18F-FDG Uptake:
Solitary Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
II.3.2 Solitary Pulmonary Mass with Moderate 18F-FDG Uptake:
Granuloma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
II.3.3 Solitary Pulmonary Nodule with Intense 18F-FDG Uptake:
Primary Lung Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190
II.3.4 Multi-focal Primary Lung Cancer: Bronchoalveaolar Cell
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
II.3.5 Restaging of Recurrent NSCLC: Recurrent TNM Stage IIA . . . . . 194
II.3.6 Pre-operative Staging of NSCLC with 18F-FDG PET/CT:
Stage IIIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
II.3.7 Pre-operative Staging of NSCLC with 18F-FDG PET/CT:
Stage IIIB and Adenomatous Polyp of the Transverse Colon . . . . . 199
II.3.8 Pre-operative Staging of NSCLC with 18F-FDG PET/CT:
Stage IV and Radiation Pneumonitis (DICOM Images on DVD). . 201
II.3.9 Pre-operative Staging of SCLC with 18F-FDG PET/CT:
Limited-Stage Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
II.3.10 Pre-treatment Staging of Malignant Pleural Mesothelioma with
18F-FDG PET/CT (DICOM Images on DVD) . . . . . . . . . . . . . . . . 207
II.3.11 Use of 18F-FDG PET/CT for Radiation Treatment Planning of
NSCLC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
xvi Expanded Contents
II.4 Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
18F-FDG PET and PET/CT for the Detection and Staging of Breast
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
18F-FDG PET and PET/CT for the Detection of Metastatic Breast
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
18F-FDG PET and PET/CT for the Detection and Staging of Recurrent
Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
18F-FDG Imaging to Monitor Therapy of Breast Cancer . . . . . . . . . . . . . . . . 220
18F-FDG PET/CT for Radiation Therapy Planning in Breast Cancer. . . . . . . 221
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221
Guidelines and Recommendations for the Use of 18F-FDG PET and
PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223
II.4.1 Unsuspected Breast Primary Cancer . . . . . . . . . . . . . . . . . . . . . . . . . 223
II.4.2 Metastatic Breast Cancer to Omentum, Peritoneum, and
Ovaries with Partial Response to Treatment. . . . . . . . . . . . . . . . . . . 226
II.4.3 Metastatic Breast Cancer to Liver, T8 Vertebral Body, Right
Femur, and Acetabulum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232
II.4.4 Recurrent Left Breast Cancer with Regional Metastases
to Left Chest Wall and Synchronous Right Thyroid Papillary
Cancer (DICOM Images on DVD). . . . . . . . . . . . . . . . . . . . . . . . . . 236
II.4.5 Solitary Hepatic Metastasis, Right Chest Wall Breast Cancer
Recurrence, and Right Apical Lung Metastasis Causing
Brachial Plexopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242
II.4.6 Metastatic Breast Cancer to Bones, Left Lung, and Pleura:
Good Response to Therapy in Left Lung and Pleura; Partial
Response to Therapy in Bones (DICOM Images on DVD) . . . . . . 246
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259
II.5 Colorectal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
18F-FDG PET and PET/CT for Screening and Diagnosis of Colorectal
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
18F-FDG PET and PET/CT in the Initial Staging of Colorectal Carcinoma . . 262
18F-FDG PET and PET/CT for Assessment of Recurrent Colorectal
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Detection and Restaging of Recurrence . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262
Impact on Management and Cost Analysis in Patients with Recurrent
Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
18F-FDG Imaging for Monitoring Therapy Response of Colorectal
Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Systemic Chemotherapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Radiation Therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Regional Therapy to the Liver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Guidelines and Recommendations for the Use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266
Expanded Contents xvii
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
II.5.1 Incidental Primary Transverse Colon Carcinoma in a Patient
with Lung Cancer and Malignant Fibrohistiocytoma (DICOM
Images on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268
II.5.2 Primary Metastatic Rectal Carcinoma . . . . . . . . . . . . . . . . . . . . . . . 274
II.5.3 Colon Cancer with Hepatic Metastases . . . . . . . . . . . . . . . . . . . . . . 279
II.5.4 Local Recurrence and Metastatic Retroperitoneal Lymph Nodes
(DICOM Images on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
II.5.5 Colon Cancer with Pulmonary Metastases . . . . . . . . . . . . . . . . . . . . 286
II.5.6 Mucinous Adenocarcinoma of the Colon . . . . . . . . . . . . . . . . . . . . . 288
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 290
II.6 18F-FDG PET/CT in Tumors of the Gastrointestinal Tract:
Esophageal and Gastric Cancer and Gastrointestinal Stromal
Tumors (GIST) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
18F-FDG Imaging in Esophageal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
18F-FDG Imaging for Staging of Esophageal Cancer . . . . . . . . . . . . . . . . . . 294
18F-FDG Imaging for Monitoring Response to Treatment
of Esophageal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295
18F-FDG Imaging for Diagnosis of Recurrent Esophageal Cancer . . . . . . . 296
18F-FDG Imaging in Gastric Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
18F-FDG Imaging for Diagnosis and Staging of Gastric Cancer . . . . . . . . . 297
18F-FDG Imaging for Monitoring Response to Treatment of Gastric
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298
18F-FDG Imaging for Diagnosis of Recurrent Gastric Cancer. . . . . . . . . . . 298
18F-FDG Imaging in Gastrointestinal Stromal Tumors . . . . . . . . . . . . . . . . . . 299
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299
18F-FDG Imaging at Initial Diagnosis of GIST . . . . . . . . . . . . . . . . . . . . . . 300
18F-FDG Imaging for Monitoring Response to Treatment
of GIST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Guidelines and Recommendations for the Use of 18F-FDG PET and
PET/CT in Esophageal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
II.6.1 Distal Esophageal Cancer at Staging: Loco-regional
Metastatic Adenopathy at the Level of the Gastro-hepatic
Ligament and Distant Non-regional Metastasis in Left
Pre-tracheal Lymph Node (DICOM Images on DVD) . . . . . . . . . . 302
II.6.2 Increase Focal 18F-FDG Gastric Uptake at Site of Upper
Anastomosis, Most Probably due to Physiologic Uptake
or a Mild Inflammatory Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
II.6.3 Primary Gastric Cancer with no Evidence of Metastases;
Degenerative Changes in Cervical Spine (DICOM Images
on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309
II.6.4 Adenocarcinoma of Gastro-esophgeal Junction with Nodal
Metastasis in Porta-hepatic Region and Inflammatory Lung
Infiltrate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315
xviii Expanded Contents
II.6.5 Para-rectal GIST with no Evidence for Metastases: Complete
Metabolic Response to treatment with Gleevec on 18F-FDG-PET
and Partial Response with Residual Para-rectal Mass on CT . . . . . 319
II.6.6 Recurrent GIST within Multiple Omental and Peritoneal
Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
II.7 Hepatobiliary and Pancreatic Malignancies. . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Hepatobiliary Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Pancreatic Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332
Imaging of Hepatobiliary and Pancreatic Neoplasms . . . . . . . . . . . . . . . . . . . 332
Hepatic Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
18F-FDG PET/CT Imaging of Hepatic Metastases. . . . . . . . . . . . . . . . . . . . 334
Hepatocellular Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
18F-FDG PET/CT for Diagnosis and Staging of HCC. . . . . . . . . . . . . . . . . 335
11C-Acetate Imaging of HCC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336
18F-FDG PET/CT for Diagnosis and Staging of Cholangiocarcinoma . . . . 336
Gallbladder Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337
18F-FDG PET/CT for Diagnosis and Staging of Gallbladder Carcinoma . . 337
18F-FDG PET/CT Monitoring Therapy of Hepatic Tumors . . . . . . . . . . . . 337
Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
18F-FDG PET/CT for Preoperative Diagnosis of Pancreatic Carcinoma. . . 339
18F-FDG PET/CT for Staging of Pancreatic Carcinoma . . . . . . . . . . . . . . . 340
18F-FDG PET/CT in the Post-therapy Setting . . . . . . . . . . . . . . . . . . . . . . . 340
Impact of 18F-FDG PET/CT on Management of Patients with
Pancreatic Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
Limitations of 18F-FDG Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Guidelines and Recommendations for the Use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343
II.7.1 Hepatocellular Carcinoma (DICOM Images on DVD) . . . . . . . . . . 343
II.7.2 Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 350
II.7.3 Gallbladder Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
II.7.4 Pancreatic Carcinoma (DICOM Images on DVD). . . . . . . . . . . . . . 360
II.7.5 Klatskin’s Tumor and Acute Pancreatitis . . . . . . . . . . . . . . . . . . . . . 366
II.7.6 Cavernous Hemangioma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
II.7.7 Focal Nodular Hyperplasia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
II.7.8 Monitoring Therapy of Hepatic Metastases Treated with
90Y-microspheres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379
II.8 Gynecological Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383
18F-FDG PET/CT in Staging Cervical Cancer . . . . . . . . . . . . . . . . . . . . . . . 383
18F-FDG PET/CT in Directing Therapy in Cervical Cancer . . . . . . . . . . . . 384
Expanded Contents xix
18F-FDG PET/CT in Predicting Prognosis in Cervical Cancer. . . . . . . . . . . 384
18F-FDG PET/CT in Post-therapy Monitoring of Cervical Cancer . . . . . . . 385
Ovarian Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 385
18F-FDG PET/CT in Diagnosis and Staging of Ovarian Cancer . . . . . . . . . 385
18F-FDG PET/CT in Assessment of Response to Therapy in Ovarian
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386
18F-FDG PET/CT in Detection of Recurrent Ovarian Cancer. . . . . . . . . . . 386
Endometrial Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Guidelines and Recommendations for the Use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
II.8.1 Cervical cancer, Staging: Regional and Distant Metastases
(DICOM Images on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
II.8.2 Cervical cancer, Staging: Regional Metastases and Benign
Axillary Node Uptake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394
II.8.3 Cervical Cancer, Staging: Regional Metastases; Metabolic
Response to Chemoradiation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
II.8.4 Ovarian Cancer, Recurrence: Diffuse Abdominal
Carcinomatosis (DICOM Images on DVD) . . . . . . . . . . . . . . . . . . . 400
II.8.5 Endometrial Cancer, Recurrence in Abdominal Wall, and Pelvic
Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407
II.9 Hybrid Imaging in Malignancies of the Urinary Tract, Prostate,
and Testicular Cancers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
Renal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409
PET/CT Imaging for Diagnosis and Staging of RCC. . . . . . . . . . . . . . . . . . 410
PET/CT Imaging During Follow-Up and Recurrent RCC. . . . . . . . . . . . . . 410
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
Bladder Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
18F-FDG Imaging of Bladder Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411
11C-Choline Imaging of Bladder Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412
11C-Acetate and 11C-Methionine Imaging of Bladder Cancer . . . . . . . . . . . 412
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
Prostate Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413
PET/CT and SPECT/CT of Primary Prostate Cancer . . . . . . . . . . . . . . . . . 413
PET/CT and SPECT/CT of Metastatic Prostate Cancer . . . . . . . . . . . . . . . 414
PET/CT and SPECT/CT in Recurrent Prostate Cancer . . . . . . . . . . . . . . . . 415
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
Testicular Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416
18F-FDG Imaging for Staging of Testicular Tumors . . . . . . . . . . . . . . . . . . 417
18F-FDG Imaging of Residual and Recurrent Testicular Tumors . . . . . . . . 417
18F-FDG Imaging in Follow-up of NSGCT . . . . . . . . . . . . . . . . . . . . . . . . . 418
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Guidelines and Recommendations for the use of 18F-FDG PET
and PET/CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
xx Expanded Contents
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419
II.9.1 Renal Cell Carcinoma with Left Pulmonary Metastasis. . . . . . . . . . 419
II.9.2 RCC with Recurrent Skeletal Metastasis (DICOM Images
on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422
II.9.3 Muscle Invasive TCC of Bladder with Single Nodal Metastasis . . . 426
II.9.4 Muscle Invasive TCC of Bladder with Bilateral Pelvic Lymph
Nodes Metastases (DICOM Images on DVD) . . . . . . . . . . . . . . . . . 429
II.9.5 Primary Prostate Cancer with Right Obturator Nodal
Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434
II.9.6 Local Recurrence of Prostate Cancer and Paget’s Disease
of Right Iliac Bone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 436
II.9.7 Metastatic Seminoma Achieving a Complete Remission . . . . . . . . . 438
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 441
II.10 Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445
Differentiated Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446
Radioiodine Whole-Body Scintigraphy with SPECT/CT . . . . . . . . . . . . . . . 446
18F-FDGPET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446
Hu¨ rthle Cell Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
Anaplastic Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448
Medullary Thyroid Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448
Thyroid Incidentalomas on 18F-FDG PET/CT . . . . . . . . . . . . . . . . . . . . . . . . 449
Guidelines and Recommendations for the Use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 450
II.10.1 Recurrent Papillary Thyroid Carcinoma in Right Upper
Paratracheal Lymph Nodes (DICOM Images on DVD) . . . . . . . . 450
II.10.2 Metastatic Papillary Thyroid Cancer, Bilateral Central and
Right lateral Neck Lymph Nodes (DICOM Images on DVD). . . . 453
II.10.3 Persistent, Iodine-avid Hu¨ rthle Cell Carcinoma in Left
Iliac/Sacral Metastasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458
II.10.4 Anaplastic Thyroid Carcinoma in the Thyroid Gland
and Possible Metastasis in a Left Parotid Lymph Node . . . . . . . . . 460
II.10.5 Medullary Thyroid Cancer with Metastatic Left Neck
Lymphadenopathy, Active and Treated Skeletal Metastases,
and Treated Hepatic Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . 463
II.10.6 Recurrent Medullary Thyroid Cancer with Right Paratracheal
and Left Level II Lymph Nodes, Skeletal Metastases, and
Physiologic Scalene Muscle 18F-FDG Uptake . . . . . . . . . . . . . . . . 465
II.10.7 Recurrent Melanoma of the Right Nasal Cavity Mucosa
and Papillary Thyroid Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . 468
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471
II.11 Endocrine Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 475
Imaging Protocols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
SPECT/CT and PET/CT Tracers for Imaging of NE Tumors . . . . . . . . . . . . . 476
Expanded Contents xxi
SPECT/CT and PET/CT of GEP Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . 478
SPECT/CT and PET/CT of Neural Crest Tumors . . . . . . . . . . . . . . . . . . . . . . 479
SPECT/CT of Parathyroid Adenoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 481
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
II.11.1 Well-differentiated Small Intestine Neuroendocrine
Tumor with Mesenteric Metastasis (DICOM Images
on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
II.11.2 VIPoma in Body of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . 488
II.11.3 Pancreatic Neuroendocrine Carcinoma with Disseminated
Hepatic and Skeletal Metastases Expressing High Density
of Somatostatin Receptors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491
II.11.4 Suspected Recurrence of Pheochromocytoma in Left
Adrenal Bed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494
II.11.5 123I-MIBG Avid Pheochromocytoma Metastatic to Lungs
and Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498
II.11.6 Left Upper Parathyroid Adenoma in Posterior Location
between the Trachea and Esophagus. . . . . . . . . . . . . . . . . . . . . . . . 503
II.11.7 Ectopic Parathyroid Adenoma in Mid-anterior Lower Neck . . . . . 506
II.11.8 68Ga-DOTATOC-avid Neuroendocrine Tumor in Tail
of Pancreas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509
II.12 Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Non-Hodgkin’s Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 513
Hodgkin’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
18F-FDG Imaging for Diagnosis of NHL and HD. . . . . . . . . . . . . . . . . . . . . . 516
18F-FDG Imaging at Initial Staging of Lymphoma . . . . . . . . . . . . . . . . . . . . . 516
18F-FDG Avidity of HD and NHL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516
Comparative Performance of 18F-FDG Imaging and CT. . . . . . . . . . . . . . . 516
Diagnosis of Bone Marrow Involvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
18F-FDG Staging Criteria in HD and NHL . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
18F-FDG Imaging for Monitoring Therapy Response in Lymphoma . . . . . . . 517
Definition of Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517
Timing of 18F-FDG Imaging in Assessing Response to Treatment
in Lymphoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518
During and End-of-Treatment 18F-FDG Imaging in Lymphoma . . . . . . . . 518
18F-FDG Imaging of a Residual Mass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
Pitfalls in Interpretation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519
18F-FDG Imaging for Diagnosis and Restaging of Lymphoma Recurrence . . . 520
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520
Guidelines and Recommendations for the Use of 18F-FDG-PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
II.12.1 NHL-DLCL of the Spleen (with local invasion to LN in
splenic hilum and to tail of pancreas) (DICOM Images
on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523
xxii Expanded Contents
II.12.2 NHL-DLCL Stage IV: Good Response to Treatment. . . . . . . . . . 529
II.12.3 HD, Nodular Sclerosis Type Stage III: Good Early Response
at Mid-treatment (DICOM Images on DVD). . . . . . . . . . . . . . . . . 532
II.12.4 Recurrent Small Lymphocytic NHL and Infection in Right
Groin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 536
II.12.5 HD, Refractory to First Line Chemotherapy: CR after
Salvage Therapy and AHCT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 540
II.12.6 Recurrent Follicular Grade II NHL and Gastritis . . . . . . . . . . . . . 542
II.12.7 Early Relapse of HD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 544
II.12.8 Recurrent Follicular Grade II NHL . . . . . . . . . . . . . . . . . . . . . . . . 547
II.12.9 HD in Complete Remission: Transient Foci of Increased
18F-FDG Activity due to Inflammation . . . . . . . . . . . . . . . . . . . . . 550
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 552
II.13 Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Cutaneous Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 555
Staging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556
Detection of Recurrence and Restaging with 18F-FDG PET
and PET/CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 559
Choroidal Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 561
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562
Guidelines and Recommendations for the Use of 18F-FDG PET
and PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 562
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
II.13.1 Metastatic Melanoma with Cerebral Metastases Seen
on CT Only . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
II.13.2 Metastatic Melanoma s/p Regional Lymph Node
Dissection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565
II.13.3 Metastatic Melanoma to the Right Ventricle and Pulmonary
Emboli (DICOM Images on DVD). . . . . . . . . . . . . . . . . . . . . . . . . 567
II.13.4 Choroidal Melanoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 570
II.13.5 No Evidence of Recurrence in a Patient Treated with
Vaccine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573
II.13.6 Widely Metastatic Melanoma including the Mesentery
(DICOM Images on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 575
II.13.7 SPECT/CT of a Cervical Sentinel Lymph Node. . . . . . . . . . . . . . . 579
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
II.14 Malignancy of the Bone: Primary Tumors, Lymphoma, and Skeletal
Metastases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 583
Skeletal Metastases, Bone Lymphoma, and Multiple Myeloma. . . . . . . . . . . . 583
18F-FDG PET/CT for Diagnosis of Malignant Skeletal Lesions . . . . . . . . . 583
18F-FDG PET/CT for Monitoring Response to Therapy. . . . . . . . . . . . . . . 584
Advantages of 18F-FDG PET/CT in Malignant Skeletal
Involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 584
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 584
Expanded Contents xxiii
Primary Skeletal Malignancies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585
18F-FDG PET/CT for Diagnosis of Primary Skeletal Tumors . . . . . . . . . . . 585
18F-FDG PET/CT for Staging Primary Skeletal Tumors . . . . . . . . . . . . . . . 585
18F-FDG PET/CT for Monitoring Response to Therapy. . . . . . . . . . . . . . . 586
Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 586
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 587
II.14.1 Lung Cancer with Direct Extension to Bone and Distant
Skeletal Metastases (DICOM Images on DVD). . . . . . . . . . . . . . . 587
II.14.2 Marrow-based and Cortical Skeletal Metastases before and
with Partial Response after Treatment, and Hepatic Metastases . . 592
II.14.3 Lung Cancer with Extensive Skeletal Metastatic Spread
and Invasion of the Epidural Space at T11 . . . . . . . . . . . . . . . . . . . 598
II.14.4 Lymphoma with Skeletal Involvement and Suspected
Involvement of the Left S1 Neural Foramen, in addition
to Nodal Pleural and Muscular Disease . . . . . . . . . . . . . . . . . . . . . 600
II.14.5 Primary Lymphoma of the Bone. . . . . . . . . . . . . . . . . . . . . . . . . . . 604
II.14.6 Multiple Myeloma with Active Disease in Rib and
Post-radiotherapy Inactive Disease in Vertebra . . . . . . . . . . . . . . . 610
II.14.7 Ewing Sarcoma of the Proximal Femur with Muscular
Involvement, Pulmonary Metastases, and Suspected Additional
Distant Sites of Disease in Bone and Lymph Nodes (DICOM
Images on DVD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 612
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 618
II.15 Pediatric Applications for PET/CT and SPECT/CT. . . . . . . . . . . . . . . . . . . . 621
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
Neuroblastoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
Sarcoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 622
Lymphoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 623
Considerations on Radiation Exposure from PET/CT. . . . . . . . . . . . . . . . . . . 624
PET/CT Procedure and Preparation of the Pediatric Patient. . . . . . . . . . . . . . 625
SPECT/CT Procedure and Preparation of the Pediatric Patient . . . . . . . . . . . 625
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 627
II.15.1 B-Cell Lymphoblastic Lymphoma, Stage IV Disease with Left and
Right Face/Neck Disease and Bilateral Skeletal Involvement of the
Lower Extremities (DICOM Images on DVD). . . . . . . . . . . . . . . . 627
II.15.2 Multiple GIST Tumors Metastatic to the Liver and
Unconfirmed Pulmonary Chondromas. . . . . . . . . . . . . . . . . . . . . . 633
II.15.3 Ewing Sarcoma with Solitary Skeletal Metastasis. . . . . . . . . . . . . . 637
II.15.4 ALL with Diffuse Skeletal Involvement, Renal and GIT
Involvement; Post-surgical Changes Related to Previous
Rotationplasty for Osteogenic Sarcoma . . . . . . . . . . . . . . . . . . . . . 640
II.15.5 Stage IV Neuroblastoma with Residual Retrocrural Soft Tissue
Disease and Skeletal Metastasis in the Sacrum after Treatment and
Post-surgical Changes Left Upper Quadrant (DICOM Images on
DVD). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 645
II.15.6 Occult Calcaneal Stress Fracture. . . . . . . . . . . . . . . . . . . . . . . . . . . 651
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 655
xxiv Expanded Contents
Part II Other Clinical Applications. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 657
III.1 Cardiac Hybrid Imaging (PET/CT and SPECT/CT): Assessment of CAD . . . 659
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 659
Imaging Protocols for Hybrid Cardiac Imaging . . . . . . . . . . . . . . . . . . . . . . . . 659
CT Imaging for Hybrid Cardiac SPECT/CT and PET/CT. . . . . . . . . . . . . . 659
Cardiac SPECT/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661
Cardiac PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 661
Quality Control of Cardiac Hybrid Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . 662
Clinical Applications of Cardiac Hybrid Imaging . . . . . . . . . . . . . . . . . . . . . . 662
Diagnosis of CAD Using Cardiac Hybrid Imaging. . . . . . . . . . . . . . . . . . . . 662
Risk Assessment Using Cardiac Hybrid Imaging . . . . . . . . . . . . . . . . . . . . . 663
Guiding Management of CAD Using Cardiac Hybrid Imaging . . . . . . . . . . 664
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 665
Case Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 666
III.1.1 Cardiac SPECT/Low Dose CT for Attenuation Correction:
Normal Patient with Misregistration. . . . . . . . . . . . . . . . . . . . . . . . 666
III.1.2 Cardiac PET/Low Dose CT for Attenuation Correction:
Normal Patient with Misregistration. . . . . . . . . . . . . . . . . . . . . . . . 668
III.1.3 Cardiac SPECT/CCTA: Hemodynamically Significant
Lesion in the Territory of the RCA Related to Stenosis
in SVGto RCA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 670
III.I.4 Cardiac SPECT/CCTA: Ischemia in the Inferior Wall Indicating
the Hemodynamically Significant Lesion in theRCA. . . . . . . . . . . . 673
III.1.5 Normal PET MPS with High Calcium Score (> 1,000) . . . . . . . . . 676
III.1.6 Moderate Stenosis in the RCA with Normal PET MPS . . . . . . . . . 679
Protocol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 679
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 681
III.2 Hybrid Imaging of Benign Skeletal Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . 683
99mTc-MDP SPECT/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683
18F-Fluoride PET/CT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 685
18FDG PET/CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686
Summary . . . . . . . . . . . . . . . . . . .

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