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Radiology
Positron Emission Tomography
Built from Fundamentals of Diagnostic Radiology
What’s inside
9 sections · 149 slides
Overview
- What this topic covers
How PET works
Positron decay, annihilation photons, detectors, and hybrid systems
- What positron emission tomography detects
- Positron-emitting radionuclides
- Positron travel and image sharpness
- From positron to image
- PET cameras and coincidence detection
- Time-of-flight PET
- Hybrid scanners: PET/CT
- PET/MR
- Attenuation and its correction
- Reading corrected and uncorrected images
Performing and interpreting PET/CT
Patient preparation, acquisition, and FDG biology
- Preparing the patient for FDG PET
- Limiting bladder activity
- How the scan is acquired
- Contrast and PET
- Interpreting a PET/CT
- FDG: the workhorse tracer
- How FDG is trapped in cells
- What drives FDG accumulation
- Normal and variant FDG activity
Normal FDG distribution
Organ-by-organ physiologic uptake
- Skeletal muscle uptake
- Whole-body FDG PET biodistribution
- Physiologic FDG uptake in muscle
- Brain uptake
- Physiologic FDG uptake in the brain
- Cardiac muscle uptake
- Physiologic FDG uptake in the heart
- Liver and gallbladder uptake
- Physiologic FDG uptake in the liver
- Spleen and bone marrow uptake
- Stomach uptake
- Colon uptake
- Massive physiologic colon activity
- Metformin and bowel activity
- Urinary tract activity
- Normal urinary tract FDG activity
- Uterus and ovaries
- Corpus luteum cyst on FDG PET
- Salivary and thyroid glands
- Brown fat
- Brown fat hypermetabolism
Standard uptake values (SUV)
Semiquantifying tracer uptake
- What the SUV measures
- Interpreting SUV numbers
Oncologic PET imaging
Staging, response, and recurrence across tumor types
- Three core oncology indications
- Lung cancer overview
- Solitary pulmonary nodule (SPN)
- Hot pulmonary nodule: incidental carcinoma
- Warm pulmonary nodule: bronchoalveolar carcinoma
- SPN false results and SUV cutoff
- Reading a solitary pulmonary nodule
- Lung cancer staging
- Lung cancer staging on PET/CT
- Lung cancer recurrence and response
- Postradiation pneumonitis
- Lymphoma staging principles
- Lymphoma staging
- Lymphoma false results
- Lymphoma initial staging
- Splenic lymphoma
- Lymphoma bone marrow
- Lymphoma early treatment response
- Lymphoma: early treatment response
- Lymphoma posttherapy residual mass
- Lymphoma recurrence
- Melanoma
- Melanoma recurrence
- Esophageal cancer
- Esophageal recurrence
- Gastric cancer
- Pancreatic cancer
- Colorectal cancer staging
- Colon cancer staging
- Colorectal false positives and technique
- Colorectal nodes and liver
- Hepatic metastasis from colon cancer
- Colorectal recurrence
- Colon anastomosis activity
- Hepatocellular carcinoma
- Cholangiocarcinoma
- Hepatic metastases
- Necrotic hepatic metastasis
- Gallbladder cancer
- Cholecystitis on PET/CT
- Breast cancer on PET
- Breast cancer on PET/CT
- Breast cancer limits and sentinel nodes
- Lactational breast uptake
- Breast PET technique
- Axillary node metastasis in breast cancer
- Internal mammary node metastases
- Breast pitfalls
- Cervical cancer
- Uterine cancer
- Uterine cancer recurrence
- Ovarian cancer
- Stage 1 ovarian cancer
- Renal and bladder malignancies
- Transitional cell carcinoma of the bladder
- Adrenal lesions
- Adrenal metastasis
- Benign adrenal adenoma
- Testicular cancer
- Prostate cancer
- Head and neck cancers
- Squamous cell carcinoma of the tongue
- Head and neck challenges
- Metastatic nasopharyngeal carcinoma: axial views
- Metastatic nasopharyngeal carcinoma: coronal views
- Sarcomas and osseous malignancies
- Facet joint inflammation, not metastasis
- Bone marrow stimulation versus metastases
- Benign hypermetabolic bone marrow
- Diffuse metastases with hypermetabolic marrow
- Hot and cold osseous metastases
- Hot and cold osseous metastases
- FDG-avid osseous metastasis
- Neuroendocrine tumors
- Somatostatin receptor avid metastases
Infection and inflammation
Fever of unknown origin and sarcoidosis
- PET in inflammation and infection
- Fever of unknown origin (FUO)
- Sarcoidosis
- Cardiac sarcoidosis
Pitfalls in PET/CT
Physiologic, inflammatory, and technical traps
- The core pitfall: physiologic activity
- Brown fat revisited
- Inflammatory processes
- Shoulder arthritis
- Immunotherapy-related activity
- Immunotherapy-associated colitis
- Benign tumors and recent surgery
- Fractures
- Rib fracture on PET/CT
- Low-uptake malignancies
- Attenuation-correction artifacts
- Misregistration
- CT truncation and injection leakage
- Thymic rebound
- Thymic rebound
- Osteophytes and medications
Emerging tracers
Beyond FDG: fluciclovine and PSMA
- Limits of FDG
- Fluciclovine (FACBC)
- F-18 fluciclovine PET/CT
- PSMA PET
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Brant and Helms' Fundamentals of Diagnostic Radiology