Metabolic imaging with fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) is increasing rapidly worldwide because of superior accuracy compared with conventional non-invasive techniques used for evaluating cancer.
Limited anatomical information from FDG-PET images alone dictates that complementary use with structural imaging is required to optimise benefit.
Recently, combined positron emission tomography/computed tomography (PET/CT) scanners have overtaken standalone PET scanners as the most commonly purchased PET devices.
We describe our experience of over 5500 scans performed since the first PET/CT scanner in Australia was commissioned at the Peter MacCallum Cancer Centre (PMCC), Melbourne, in January 2002.
Clinical indications for PET/CT scans performed at PMCC largely reflect current Medicare reimbursement policy.
Advantages of PET/CT include greater patient comfort and higher throughput, greater diagnostic certainty and accuracy, improved biopsy methods, and better treatment planning.
We believe PET/CT will underpin more effective and efficient imaging paradigms for many common tumours, and lead to a decrease in imaging costs.
- 1. Bomanji JB, Costa DC, Ell PJ. Clinical role of positron emission tomography in oncology. Lancet Oncology 2001; 3: 157-164.
- 2. Flamen P, Stroobants S, Van Cutsem E, et al. Additional value of whole body positron emission tomography with fluorine-18-2-fluoro-2-deoxy-D-glucose in recurrent colorectal cancer. J Clin Oncol 1999; 17: 894-901.
- 3. MacManus MR, Hicks R, Fisher R, et al. FDG-PET-detected extracranial metastasis in patients with non-small cell lung cancer undergoing staging for surgery or radical radiotherapy — survival correlates with metastatic disease burden. Acta Oncol 2003; 42: 48-54.
- 4. Shreve PD, Anzai Y, Wahl RL. Pitfalls in oncologic diagnosis with FDG PET imaging; physiologic and benign variants. Radiology 1999; 19: 61-77.
- 5. Gary JR, Wegner EA, Fogelman I. Pitfalls and artifacts in FDG PET and PET/CT oncologic imaging. Semin Nucl Med 2004; 34: 122-133.
- 6. Schoder H, Larson SM, Yeung WD. PET/CT in oncology: integration into clinical management of lymphoma, melanoma and gastrointestinal malignancies. J Nucl Med 2004; 45: 72S-81S.
- 7. Czermin J, Schelbert H. PET/CT Imaging: facts, opinions, hopes, and questions. J Nucl Med 2004; 45: 1S-3S.
- 8. Wu TH, Huang YH, Lee JJS, et al. Radiation exposure during transmission measurements: comparison between CT and germanium-based techniques with a current PET scanner. Eur J Nucl Med Mol Imaging 2004; 31: 38-42.
- 9. MacManus MM, Peters L, Duchesne G, et al. How should we introduce clinical PET in UK? Oncologists need to have a clearer view [editorial]. Clin Oncol 2004; 16: 492-493.
- 10. Kamel E, Hany TF, Burger C, et al. CT vs 68Ge attenuation correction in a combined PET/CT system: evaluation of the effect of lowering the CT tube current. Eur J Nucl Med 2002; 29: 346-350.
- 11. Keith CJ, Miles KA, Griffiths MR, et al. Solitary pulmonary nodules: accuracy and cost-effectiveness of sodium iodide FDG-PET using Australian data. Eur J Nucl Med Mol Imaging 2002; 29: 1016-1023.
- 12. Cohade C, Osman M, Pannu HK, Wahl RL. Uptake in supraclavicular area (“USA-fat”): description on 18F-FDG PET/CT. J Nucl Med 2003; 44: 170-176.
- 13. Yeung HWD, Grewal RK, Gonen M, et al. Patterns of F18 FDG uptake in adipose tissue and muscle: a potential source of false-positives for PET. J Nucl Med 2003; 44: 1789-1796.
- 14. Bar-Shalom R, Yefremov N, Guralnik L, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 2003; 44: 1200-1209.
- 15. Bradley JD, Perez CA, Dehdashti F, Siegel BA. Implementing biologic target volumes in radiation treatment planning for non-small cell lung cancer. J Nucl Med 2004; 45: 96S-101S.
- 16. Beggs AD, Hain SF, Curran KM, O’Doherty MJ. FDG-PET as a “metabolic biopsy” tool in non-lung lesions with indeterminate biopsy. Eur J Nucl Med 2002; 29: 542-546.
- 17. Hain SF, O’Doherty MJ, Bingham J, et al. Can FDG PET be used to successfully direct preoperative biopsy of soft tissue tumours? Nucl Med Commun 2004; 24: 1139-1143.
- 18. Di Chiro G. PET using FDG in brain tumours. A powerful diagnostic and prognostic tool. Invest Radiol 1987; 22(5): 360-371.
- 19. MacManus MP, Hicks RJ, Matthews JP, et al. High rate of detection of unsuspected distant metastases in apparent-stage III non-small cell lung cancer: implications for radical radiation therapy. Int J Radiat Oncol Biol Phys 2001; 50: 287-293.
- 20. Ciernick IF, Dizendorf E, Baumert BG, et al. Radiation treatment planning with an integrated positron emission and computer tomography (PET/CT): a feasibility study. Int J Radiat Oncol Biol Phys 2003; 57: 853-863.
- 21. Osman MM, Cohade C, Nakamoto Y, et al. Clinically significant inaccurate localization of lesions with PET/CT: frequency in 300 patients. J Nucl Med 2003; 44: 240-243.
- 22. Goerres GW, Hany TF, Kamel E, et al. Head and neck imaging with PET and PET/CT: artefacts from dental metallic implants. Eur J Nucl Med 2002; 29: 367-370.
- 23. Cohade C, Osman M, Nakamoto Y, et al. Initial experience with oral contrast in PET/CT: phantom and clinical studies. J Nucl Med 2003; 44: 412-416.
- 24. Wahl RL. Why nearly all PET of abdominal and pelvic cancers will be performed as PET/CT. J Nucl Med 2004; 45: 82S-95S.
- 25. Goerres GW, Von Schulthess GK, Steinert HC. Why most PET of lung and head-and-neck cancer will be PET/CT. J Nucl Med 2004; 45: 66S-71S.
- 26. Townsend DW, Carney JPJ, Yap JT, Hall NC. PET/CT today and tomorrow. J Nucl Med 2004; 45: 4S-14S.
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