Types of PET tumor images :Types of PET tumor images Gipsy Morales


Objectives :Objectives Discuss methods for calculating Fluorodeoxyglucose Uptake Analyze the Quantitation of tumor metabolism Describe types of PET tumors imaging: Brain tumor , head and neck cancer, breast tumor, lung cancer, melanoma, endocrine tumors, musculoskeletal sarcomas, pancreatic cancer, colorectal cancer, hepatic tumors, esophageal cancer, prostate cancer, bladder cancer, renal tumors, ovarian and uterine cancer, testicular tumors, and lymphomas


PET Tumor ImagingIntroduction :PET Tumor ImagingIntroduction The first feature is PET radiotracer’s ability to closely mimic a natural biologic and physiologic chemical in the body The second feature is that after IV injection of the tracer and its accumulation in the target tissue Another feature is to acquire tomography whole body images (10 cm to 15 cm axial span) The most common used PET radiotracer is the glucose analog 2-F18 fluoro-2-deoxy-D-glucose (FDG)


PET Tumor ImagingIntroduction :PET Tumor ImagingIntroduction Method for calculating fluorodeoxyglucose uptake The quantification of FDG activity with PET help to distinguish a benign from malignant lesion, to measure a tumor’s response to therapy The more easily method for FDG quantitation is Patlak graphical method that allows rapid calculation of K in a region of tissue, but require multiple plasma samples of FDG activity The most commonly method is the SUV (standardize uptake value) also known as the dose uptake ratio (DUR) because avoids blood sampling


PET Tumor ImagingIntroduction :PET Tumor ImagingIntroduction Quantitation of tumor metabolism The effect of plasma glucose levels is an important factor in the quantitative assessment of FDG uptake in tumors Differences in FDG uptake also encouraged to fast prior to PET-FDG imaging to improve contrast between the lesion and background tissue To normalize the effects of plasma glucose, the SUV can be corrected by multiplication with the plasma glucose level


PET Tumor Imaging Brain Tumor :PET Tumor Imaging Brain Tumor Common brain tumors in adults: Gliomas (34%) Meningiomas (15%) Schwannomas (5%) Pituitary adenomas (4%) Matatatic lesions (32%) Common brain tumors in pediatrics; Astrocytomas of the cerebralhemispheres (20%) Pilocytic astrocytomas in the posterior fossa (10%) Brain stem gliomas (10 to 20%) Ependymonas (7 to 8%) Craniopharyngiomas (7%) Primitive neuroectodermal (15 to 25%)


PET Tumor Imaging Brain Tumor :PET Tumor Imaging Brain Tumor Fluorodeoxyglucose and C11 methionine are two agents that can be used for PET imaging of brain tumors to diagnose malignancy and tumor grade Pet images of the brain ca be analyzed visually or by semiquantitative methods Certain nonmalignant lesions can have relatively high FDG activity mimicking a malignant tumor PET offers a sensitive and noninvasive method for pretherapy and post therapy evaluation of patients with brain tumors


PET Tumor Imaging Brain Tumor :PET Tumor Imaging Brain Tumor PET is an useful tool: For identification of neoplastic masses within the brain parenchyma. To evaluate the grade of malignancy of gliomas and meningiomas To differentiate post surgical an post radiotherapy changes from recurrence or residual tumor To detect metastases to the brain from different cancers Prognosis and prediction of survival


PET Tumor Imaging Brain Tumor :PET Tumor Imaging Brain Tumor The positron emitting isotopes for brain tumor imaging are: F18-----------the most widely used C11----------measure blood brain barrier permeability O15----------measure tumor blood flow and blood volume Rb82-------- measure blood brain barrier permeability Ga68-------- measure blood brain barrier permeability


PET Tumor Imaging Brain Tumor :PET Tumor Imaging Brain Tumor The quantitative analysis of PET-FDG images are useful in evaluation of brain tumor Separate the areas of increased activity from the normal FDG uptake in the grey matter Grades: Moderate to high astrocytomas (I-IV) normal gray matter range Low astrocytomas (I-II) have uptake indices intermediate between gray and white matter Ratio of 1.4--------high grade gliomas Ratio less than 4.1-------low grade gliomas


Slide 11:FDG-PET-MRI Image Fusion Brain Tumor Brain tumor as seen using PET scan


PET Tumor Imaging Head and Neck Cancer :PET Tumor Imaging Head and Neck Cancer Head and Neck cancer constitute 4% of all newly diagnosed cancers An increased incident is seen in cigarette smokers and alcoholics, also people with breast cancer, salivary gland cancer, esophageal cancer, and pharyngeal cancer PET-FDG is useful to locating an unknown primary, for assessing response to therapy and for identifying recurrences in regions distorted by surgery or scarring and edema after radiotherapy PET scanning is able to distinguish tumor activity from fluid-filled sinuses


PET Tumor Imaging Head and Neck Cancer :PET Tumor Imaging Head and Neck Cancer FDG and C11 methionine are tracers that can be used for PET imaging of head and neck cancers Prognosis is dependent on the extent of lymph nodal involment, and PET can assist in mapping the extent of these nodes Image registration with MRI or CT can improve the anatomical localization of the PET lesion C11 methionine is used as an imaging agent for a better performed with the patient in a fasting state


PET Tumor Imaging Head and Neck Cancer :PET Tumor Imaging Head and Neck Cancer Assessment of Head and Neck Cancer after treatment: Response to therapy in most series of patients studied so far has been found to be associated with a decreased FDG uptake. An increased of FDG activity after radiotherapy indicates a current or persistent disease A decreased by tumor seen immediately after radiotherapy may be due to a combination of radiotherapy effects on glucose transport mechanism, radiation-induced vascular damage resulting in decreased perfusion to the tumor and cell death


Slide 15:Patients with head and neck cancer


PET Tumor Imaging Breast Tumors :PET Tumor Imaging Breast Tumors The incidence in the United States is around one in every nine women Only one third of mammograpgically initiated biopsies are diagnosed as cancer Other modalities use for early breast cancer detection include digital mammography, MRI, CT, scintimammography, and PET


PET Tumor Imaging Breast Tumors :PET Tumor Imaging Breast Tumors Breast primary tumors are FDG avid and have shown a tumor to background ratio of 8:1. Cysts are often photopenic, and solid benign masses consistently have show low FDG uptake Owning to its high specificity of between 90% and 100% for axillary's node metastases, PET-FDG can serve as a useful in the staging of patient prior to therapy


PET Tumor Imaging Breast Tumors :PET Tumor Imaging Breast Tumors Evaluation of breast masses with PET imaging Tracer used for PET imaging include FDG, C11 methionine, C11 tyrosine and O15 labeled tracer as well as FES PET-FDG scans have shown high focal uptake in the primary cancerous lesions compared with normal tissue PET imaging is able to identify unsuspected multifocal carcinoma in the breast


PET Tumor Imaging Breast Tumors :PET Tumor Imaging Breast Tumors Staging Primary tumor Invasive breast cancer of diameters of 1cm or less The presence or absence of axillary's lymph node metastases


PET Tumor Imaging Breast Tumors :PET Tumor Imaging Breast Tumors Evaluation of response to therapy There are parameters ( size of the lesion, the histopathology of primary tumor…) that are take into consideration including the presence of estrogen and progesterone status of the women Treatment modalities include different combinations of surgery, chemotherapy and radiotherapy


PET Tumor Imaging Breast Tumors :PET Tumor Imaging Breast Tumors By using serial PET scan, demonstrated that follow-up scan6-13 days after the first chemotherapy showed a decreased uptake of FDG in primary breast mass C11 methionine uptake showed a better target-to-background ratio that FDG images A median interval of 8 days following the initiation of chemohormonal therapy is the optimum time for assessment of tumor response by PET-FDG


Slide 22:Post-processed images of a breast tumor


PET Tumor Imaging Lung cancer :PET Tumor Imaging Lung cancer Lung cancer is the must frequently diagnosed cancer in the world and the must frequently visceral malignancy PET-FDG imaging has help in the evaluation of patients with lung masses, allowing a better selection of patients for more invasive procedures


PET Tumor Imaging Lung cancer :PET Tumor Imaging Lung cancer SUR (Standard Uptake Ratio) of 2.5 is an accurate threshold in differentiating benign from malignant lung lesions. SUR is obtained by the equation: SUV= mean ROI activity (mCi/ml) / injected dose (mCi) X body weight (g) There are some benign lesions that also take up FDG avidly, and these include active tuberculosis, histoplasmosis, and rheumatoid nodules


PET Tumor Imaging Lung cancer :PET Tumor Imaging Lung cancer PET-FDG is useful in evaluating and staging of non-small-cell and small-cell lung cancer, lymphomas and mesotheliomas The T, N, and M subsets are combined to form stages 0-IV The primary role of PET in the staging of lung cancer is in distinguishing between the NO or from N2 or N3 disease False positive uptake include granulomatous disease involving hilar and mediastial lymph nodes and radiation pneumonitis


Slide 26:70 year old woman with newly diagnosed cavitary lesion of the left lung referred for staging PET•CT. 73-year-old male with a 1.3 centimeter left upper lobe lung mass with mediastinal adenopathy. Patient is status post right nephrectomy


PET Tumor Imaging Melanoma :PET Tumor Imaging Melanoma Melanoma has increased in incidence attributed to increasing recreational exposure to sun and the increase amount of ultraviolet B rays in the sunlight Stages: I and II consist of localized melanoma with variable penetration into dermal layers III is limited nodal metastases involving one regional nodal basin or less than 5 in transit metastases IV consist of advanced regional metastases or any patient with distant metastases


PET Tumor Imaging Melanoma :PET Tumor Imaging Melanoma Treatment: Includes excision of the primary lesion, lymph node dissection, radiation therapy, chemotherapy , and immunologic agents including interleukin-2 and immunotherapy A variety of tracer can be used for visualizing melanoma and these include FDG, C11 alpha aminousobutyric acid, C11 methionine, and C11 dihydroxyphenyllalanine Fluorodeoxyglucose is the most widely used radiopharmaceutical to date for melanoma


Slide 29:59 year old with a history of melanoma who has had multiple recurrences and several different therapies for follow up after therapy.


PET Tumor Imaging Endocrine tumors :PET Tumor Imaging Endocrine tumors Endocrine cancer includes thyroid gland, parathyroid glands cancer, carcinoid and neuroendocrine tumors of the pancreas, pituitary tumor, pineal tumor, and testicular and ovarian tumors.


PET Tumor Imaging Endocrine tumors :PET Tumor Imaging Endocrine tumors For pancreatic neuroendocrine tumors, accurate localization is extremely important Gastrinomas, about 52% of all patients are found to have metastatic diseases at surgery Liver is the most extrapancreatic Best suited for confirming pituitary adenomas are CT and MRI Thyroid and parathyroid tumors, ultrasound and scintigraphy have been the conventional imaging modalities Mediastial lesions and adrenal masses have been used CT and MRI


PET Tumor Imaging Endocrine tumors :PET Tumor Imaging Endocrine tumors Targeted radiopharmaceutical such as C11 radiolebeled hydroxytryptamine (5-HTP) and 5-DOPA have considerable potential for imaging the neuroendocrine tumors of the pancreas and carcinoid tumors There appears to be a definite potential role for the use of C11 L methionine in the pretreatment and post-treatment evaluation of pituitary adenomas PET FDG is useful for identifying metastases from medullary carcinoma of the thyroid


Slide 33:A 40-year-old female with multiple endocrine syndrome (MEN-1) and history of malignant pheochromocytoma.


PET Tumor Imaging Musculoskeletal Sarcomas :PET Tumor Imaging Musculoskeletal Sarcomas Include a variety of tumors arising from the soft tissues and bone. Osteogenic and Ewing's sarcoma and the soft tissue sarcomas Soft tissue sarcoma 2 per 100.000 annually, the overall in children under 15 is higher that adults Visceral sarcomas are less common than the somatic sarcomas


PET Tumor Imaging Musculoskeletal Sarcomas :PET Tumor Imaging Musculoskeletal Sarcomas Stages: I comprises low-grade histology with no metastases II comprises high-grade histology with no metastases III compromises either grade with regional or distant metastases Several tracers can be used for PET imaging of musculoskeletal sarcomas; however, the two main tracers are FDG and N13 L-glutamate Work with FDG and N13 L-glutamate has revealed that there is considerable potential for these imaging agents in the follow-up of musculoskeletal sarcomas and the response to therapy


Slide 36:A 68-year-old female with Ewing’s sarcoma dx 1999. Abnormal bone scan at T8-T9, biopsy consistent with ES. Chemotherapy. Tumor and T9 excised. RT due to positive residual disease. Laminectomy and C-plate fusion. Complained about serious back pain one month post surgery.


PET Tumor Imaging Pancreatic Cancer :PET Tumor Imaging Pancreatic Cancer Is the fourth leading cause of cancer-related deaths PET is used in the work-up of patients with elevated tumor markers and equivocal findings by CT or MRI Pancreatic tumors have been imaged with FDG, C11 -5-HTP, and C11 L-DOPA Investigation of GLUT (glucose transporter) proteins make the issue of sensitivity and specify of PET with FDG for benign versus malignant masses more complex


Slide 38:Fig. 1FDG PET image of the abdomen showing high uptake in the head of the pancreas


PET Tumor Imaging Colorectal Cancer :PET Tumor Imaging Colorectal Cancer Ranks as the second most common cancer in US PET –FDG imaging plays a major role in the follow-up of these biochemical changes that are exploited by metabolic imaging There is a 20% recurrence of colorectal cancer within the first 2 yr after diagnosis and treatment PET-FDG imaging has a role in identifying local and distant metastases An important application of PET-FDG is the differentiation of post-operative scar and recurrence


Slide 40:A 70 year old man with a history of colorectal cancer, status post resection, with rising CEA level was scheduled for a restaging PET•CT scan.The PET•CT scan revealed a focal area of intense increased uptake of FDG in the presacral space corresponding to small presacral node or soft tissue mass in that area on the CT portion of the exam. This area of increased uptake was very suspicious for recurrent malignancy.


PET Tumor Imaging Hepatic tumors :PET Tumor Imaging Hepatic tumors Subclassified as benign or malignant Benign include focal nodular hyperplasia, bile-duct adenomas and cystanomas, nodular hyperplasia, hemangiomas, hemangioendotheliomas, mesenchymal hamartomas, and peliosis hepatis Malignant include hepatoblastomas, hepatocellular carcinoma and cholangiocarcinoma


PET Tumor Imaging Hepatic tumors :PET Tumor Imaging Hepatic tumors Fluorodeoxyglucose shows persistent accumulation within hapatomas beyond 1 hour, whereas it decreases by 1 hour in normal liver Therapies for hepatomas include surgery, chemotherapy, radiotherapy, transcatheter embolization and hyperthermia PET-FDG imaging offers a good alternative to anatomic imaging modalities PET imaging ca be used for evaluating the uptake of F18 labeled 5 FU within hapatic metastases and following the response to chemotherapy


PET Tumor Imaging Esophageal Cancer :PET Tumor Imaging Esophageal Cancer In US the incident is low, male preponderance Associated risk factors include tobacco use and alcohol consumption Staging of esophageal cancer is based on the length of esophageal involment and the propensity for spread to the adjacent organs The primary role of PET-FDG imaging is esophageal cancer appears to be in the presurgical evaluation of patient


Slide 45:A 69 year old man with a history of esophageal cancer and esophagectomy was referred for a 6 month follow-up PET•CT scan.


PET Tumor Imaging Prostate Cancer :PET Tumor Imaging Prostate Cancer One of the few cancers that exhibits a low proliferative activity that may explain the relatively low FDG uptake indices Adenocarcinoma of the prostate is most malignancy males in US and the second leading cause related death in men over the age of 50 yr The annual incident in the US is 58 per 100,000 white men and 95 per 100,000 black men Most of these cancers arise in the peripheral zone of the gland, which constitutes 70% of the bulk of the prostate gland Benign prostate hypertrophy arise in the central portion of the gland


PET Tumor Imaging Prostate Cancer :PET Tumor Imaging Prostate Cancer Various treatment option offered for prostate cancer include: Observation Radical prostatectomy Interstitial irradiation with staging lymphadenectomy External irradiation Hormonal manipulation Chemotherapy


PET Tumor Imaging Prostate Cancer :PET Tumor Imaging Prostate Cancer The radiotracers used have include O15 labeled water used for measurements of blood flow and blood volume in prostatic cancer N3 F18 FDG used to demonstrate high target to nontarget ratios C11 5 HTP used for the identification of skeletal metastases in hormone refractory prostatic Adenocarcinoma


Slide 49:This is an 82 year old male with prostate cancer diagnosed 17 years ago, status post TURP, radiation therapy, orchiectomy in 1995. He has recent rising PSA.


PET Tumor Imaging Bladder Cancer :PET Tumor Imaging Bladder Cancer 90% of bladder cancer are traditional cell cancers, following the pattern of most urothelial tumors The remaining 10% of the bladder cancers are either squamous cell or adenocarcinomas , with a greater preponderance of the squamous cell variety


PET Tumor Imaging Bladder Cancer :PET Tumor Imaging Bladder Cancer Stages: O is the lowest stage with the cancer confined to the mucosa A includes lesions invading the lamina propria B and C lesions are those invading the muscle, with B representing no palpable mass or induration by bimanual examination and stage C representing the presence of either of these features D is Subclassified into D1 and D2 depending on the presence of lymphnode involment within and outside the pelvis


PET Tumor Imaging Bladder Cancer :PET Tumor Imaging Bladder Cancer Treatment of bladder cancer is guided by the staging and varies from transurethral resections or fulguration to intravesical chemotherapy to partial or radical cystectomies In following-up care, PET has the potential for distinguishing scar from recurrence. In fact, PET scan with FDG may be more sensitive than levels of bladder tumor antigen for the confirmation or exclusion of recurrence of bladder cancer


Slide 53:Fig. 1. Images of bladder carcinoma. Helical CT arterial-phase axial (A), SSD (B), RaySum (C) and CTVC (D) images could clearly demonstrate a cauliflower-like tumor protruding into the bladder.Fig. 2. Helical CT arterial-phase axial image shows the bladder tumor as a cauliflower-like mass, with the surrounding wall thickened (white arrow point) and the inferior segment of the right ureter encased (white arrow). The margin between the tumor and the neck of cervix (black arrow) is blurred. Fig. 3. The coronal MPR image clearly displays the relation of the bladder tumor to the inferior segment of the right ureter.Fig. 4. RaySum image clearly displays the relation of the bladder tumor to the inferior segment of the right ureter.Fig. 5. CTVC image clearly demonstrates the relation of the bladder tumor (black arrow) to the ureteric orifices (white arrow).


PET Tumor Imaging Renal Tumor :PET Tumor Imaging Renal Tumor The incidence is approximately 3% of all malignancies. 3 types of renal cell cancer: The clear cell Granular cell Spindle cell Stages: I is confined to the kidney II branches the renal capsule IIIA has tumor thrombus in the renal vein IIIB includes involment of the local hilar lymph node IV tumor has spread to local


Slide 55:renal tumor


PET Tumor Imaging Ovarian and Uterine Cancer :PET Tumor Imaging Ovarian and Uterine Cancer In US ovarian cancer is 7 per 100,000 women More common in highly industrialized societies Incidence is in the 40 to 70 yr rage 5 yr survival rates for patients with malignant ovarian tumor is 34% 5 yr survival rage is 74-98% for the low malignant tumors


PET Tumor Imaging Ovarian and Uterine Cancer :PET Tumor Imaging Ovarian and Uterine Cancer The tumor markers associates with ovarian cancer include: Alpha fetoprotein is useful for the evaluation of post-therapy patient with endodermal sinus tumor CEA is associated with epithelial ovarian cancer CA-125 in the post menopausal patient, a markedly elevated CA-125 levels (greater than 95U/ml) distinguishes malignant from benign disease with a positive predictive value of 96%


PET Tumor Imaging Ovarian and Uterine Cancer :PET Tumor Imaging Ovarian and Uterine Cancer Stages: I disease includes growth limited to the ovaries II disease is growth involving one or both ovaries with pelvic extension III disease is tumor involving one or both ovaries with extra pelvic peritoneal implants with or without retroperitoneal lymphnode metastases and superficial liver metastases IV disease is cancer involving one or both ovaries with distant metastases and parenchymal liver disease


PET Tumor Imaging Ovarian and Uterine Cancer :PET Tumor Imaging Ovarian and Uterine Cancer Tracers used for PET imaging of ovarian tumor include FDG and C11 methionine The most common female genital cancer is endometrial cancer, and it constitutes 6-9% of all the cancers occurring in women One of the drawbacks of PET imaging for gynecologic malignancies is the physiologic activity in the bowel and bladder that interferes with visualization of lymph-node metastases within the pelvis


Slide 60:46 year old female, 143 lbs., Stage III Ovarian Cancer, evaluate for restaging post-surgery & chemotherapy.


PET Tumor Imaging Testicular tumor :PET Tumor Imaging Testicular tumor Accounts for 1% of all cancers in men Most common cancer occurring in the 15-35 yr age group Can be called curable because of modern aggressive management The germinal neoplasm are again subdivided into seminomas that constitute about 40% of testicular tumors


PET Tumor Imaging Testicular tumor :PET Tumor Imaging Testicular tumor Stages: I is tumor confined to the testis II being metastatic disease in the node bearing areas III being disease above the diaphragm or other viscera IV is tumor with extranodal metastases


Slide 63:The capsule of the testis appeared to be adherent at the lower pole. Cut section showed a well circumscribed nonencapsulated, firm, homogenous grey white tumor measuring 4 x 3.5cms. Focal areas of hemorrhage were seen. Normal testicular parenchyma was seen above the tumor. The spermatic cord and the epididymis appeared uninvolved


PET Tumor Imaging Lymphomas :PET Tumor Imaging Lymphomas More common in men with an incidence of 8.1 per 100,000 In women the incidence is 5.7 per 100,000 A viral etiology has been hypothesized for Hodgkin’s and non- Hodgkin’s lymphomas Positron emitting tracers that can be used for imaging lymphomas include F18 FDG, C11 thymidine and C11 methionine


PET Tumor Imaging Lymphomas :PET Tumor Imaging Lymphomas Stages: I is involvement of a single lymph-nodal region or a single extralymphatic organs II is involvement of two or more lymph-node groups on the same side of the diaphragm III is involvement of lymph –node groups on both sides of the diaphragm IV is disseminated involment of one or more extralymphatic organs with or without lymph-node involment The stages are further subdivided into A and B depending on the presence or absence of systemic symptoms


Slide 66:79-year-old nonimmunocompromised woman with primary central nervous system lymphoma who presented with disorientation. Axial T1-weighted MR image shows hypointense lesion (arrow) in deep left parieto—occipital white matter extending into splenium of corpus callosum. 79-year-old nonimmunocompromised woman with primary central nervous system lymphoma who presented with disorientation. Axial T2-weighted MR image shows hyperintense lesion involving corpus callosum surrounded by high-signal-intensity edema.


Conclusions :Conclusions The first feature is PET radiotracer’s ability to closely mimic a natural biologic and physiologic chemical in the body The second feature is that after IV injection of the tracer and its accumulation in the target tissue Another feature is to acquire tomography whole body images (10 cm to 15 cm axial span) The most common used PET radiotracer is the glucose analog 2-F18 fluoro-2-deoxy-D-glucose (FDG)


Conclusions :Conclusions PET is an useful tool in brain tumor: For identification of neoplastic masses within the brain parenchyma. To evaluate the grade of malignancy of gliomas and meningiomas To differentiate post surgical an post radiotherapy changes from recurrence or residual tumor To detect metastases to the brain from different cancers Prognosis and prediction of survival


Conclusions :Conclusions PET-FDG in head and neck cancers is useful to locating an unknown primary, for assessing response to therapy and for identifying recurrences in regions distorted by surgery or scarring and edema after radiotherapy Evaluation of response to therapy in breast tumor There are parameters ( size of the lesion, the histopathology of primary tumor…) that are take into consideration including the presence of estrogen and progesterone status of the women Treatment modalities include different combinations of surgery, chemotherapy and radiotherapy


Conclusions :Conclusions Positron emitting tracers that can be used for imaging lymphomas include F18 FDG, C11 thymidine and C11 methionine PET-FDG in lung cancer is useful in evaluating and staging of non-small-cell and small-cell lung cancer, lymphomas and mesotheliomas The primary role of PET in the staging of lung cancer is in distinguishing between the NO or from N2 or N3 disease A variety of tracer can be used for visualizing melanoma and these include FDG, C11 alpha aminousobutyric acid, C11 methionine, and C11 dihydroxyphenyllalanine


Conclusions :Conclusions Fluorodeoxyglucose is the most widely used radiopharmaceutical to date for melanoma PET FDG is useful for identifying metastases from medullary carcinoma of the thyroid Several tracers can be used for PET imaging of musculoskeletal sarcomas; however, the two main tracers are FDG and N13 L-glutamate Work with FDG and N13 L-glutamate has revealed that there is considerable potential for these imaging agents in the follow-up of musculoskeletal sarcomas and the response to therapy


Conclusions :Conclusions PET in pancreatic tumors is used in the work-up of patients with elevated tumor markers and equivocal findings by CT or MRI Pancreatic tumors have been imaged with FDG, C11 -5-HTP, and C11 L-DOPA In colorectal cancers, PET-FDG imaging has a role in identifying local and distant metastases An important application of PET-FDG is the differentiation of post-operative scar and recurrence PET imaging ca be used for evaluating the uptake of F18 labeled 5 FU within hapatic metastases and following the response to chemotherapy


Conclusions :Conclusions Staging of esophageal cancer is based on the length of esophageal involment and the propensity for spread to the adjacent organs The primary role of PET-FDG imaging is esophageal cancer appears to be in the presurgical evaluation of patientPET has the potential for distinguishing scar from recurrence. In fact, PET scan with FDG may be more sensitive than levels of bladder tumor antigen for the confirmation or exclusion of recurrence of bladder cancer 3 types of renal cell cancer: The clear cell Granular cell Spindle cell One of the drawbacks of PET imaging for gynecologic malignancies is the physiologic activity in the bowel and bladder that interferes with visualization of lymph-node metastases within the pelvis


Conclusions :Conclusions Testicular cancer can be called curable because of modern aggressive management. The germinal neoplasm are again subdivided into seminomas that constitute about 40% of testicular tumors


References :References Strauss LC, Conti PS. The applications of PET in clinical oncology. J Nucl Med 1991;32:623-648 Sudha Challa, Carl K Hoh, Gry R Caputo, Randall A Hawkins. Nuclear Medicine: Oncology. Society of Nuclear Medicine 1999 Inoue T, Kim EE, Komaki R, et al. detecting recurrent or residual lung cancer with FDG-PET. J Nucl med 1995;36:788-793 Hoffman JM, Waskin HA, Schifter T, etal.FDG PET in differentiating lymphoma from non malignant CNS lesion. J Nucl Med 1993;34:567-575


Questions :Questions 1. Regarding PET-FDG imaging of breast masses, which of the following are true? A-sensitivity for primary breast cancer averages more than 95% B-benign solid lesions demonstrate low grade FDG uptake C- it is not efficacious in women with breast implant D- lesions less than 1 cm are detectable 2. Tracers used in PET of soft tissue and skeletal sarcomas include which of the following? A- Nitrogen 13 glutamate B- Carbon 11 L-DOPA C- Carbon 11 5-HTP D- Fluorodeoxyglucose 3. Positron emitting radionuclides useful for brain tumor imaging include which of the following? A- Carbon 11 B- Fluorine 18 C- Oxygen 15 D- Gallium 67 E- Krypton 81


Questions :Questions True or false 4. ___In breast cancer false positives are rare and not a problem 5. ___ Staging of esophageal cancer is based on the length of esophageal involment and the propensity for spread to the adjacent organs 6. ___ respect to response of PET-FDG to therapy of head and neck cancer, the activity increase after radiotherapy associated with recurrent tumor


Questions :Questions 7. Name the 3 types of renal cell cancer 8. The stages of the lymphomas are further subdivided into A and B depending on the ______or ______ of systemic symptoms 9. Which one is the most common female genital cancer 10. Describe the stages of testicular tumors


Answers :Answers 1. A-C 2. A-C-E 3. A-C 4. F 5. T 6. T 7. The clear cell, Granular cell, Spindle cell 8. the presence or absence 9. endometrial cancer 10. Stages: I is tumor confined to the testis II being metastatic disease in the node bearing areas III being disease above the diaphragm or other viscera IV is tumor with extranodal metastases