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KEY FACTS
Terminology
Imaging
TERMINOLOGY
Definitions
Principles of PET imaging
F-18 fluorodeoxyglucose (FDG) is taken up by glucose transporter (substrate for hexokinase), converted to FDG-6-phosphate, and trapped in cells
Positrons emitted with decay of radiotracer (e.g., F-18) hit electrons → two 511 keV gamma photons emitted at 180° from each other
Requires shielding of room, radiation safety
Cameras detect coincident gamma rays to create image
Functional imaging of metabolic activity
In-plane resolution 1.8 mm for all systems vs. ~ 6 mm for whole-body PET
Positron emission mammography (PEM): Dedicated device using breast stabilization → 12 tomographic "slice" images of breast
Reduced z-axis resolution of ~ 6 mm with PEM due to planar detectors and limited angle reconstruction; other systems use ring detectors and have < 2-mm resolution in all planes
Mammi-PET: Prone system with ring of detectors which rotate around breast; true PET
El Mammo: O-scanner prone position or C-PEM with patient semi-prone leaning into scanner with opening for arm
Half-life: Time required for 1/2 of nuclei of specific isotopic species to undergo radioactive decay
F-18: 110 minute half-life; positron emitter
Millicurie (mCi) = 3.7 x 10⁷ disintegrations per second [where 1 disintegration per second = 1 becquerel (Bq)]
Standardized uptake value (SUV) in whole-body PET: Tissue activity in mCi/mL divided by [injected FDG dose in mCi divided by body weight in kg]
PUV (PEM uptake value) max = maximum voxel uptake in region of interest on single PEM slice
LTB (lesion-to-background) ratio = ratio of maximum lesion uptake (PUV) to mean background uptake
IMAGING
Anatomy-Based Imaging Issues
Interpretive Criteria
Indications
New Horizons
Selected References
Narayanan D and Berg WA: Dedicated breast gamma camera imaging and breast PET: Current status and future directions. PET Clin N Am. 2018
Narayanan D and Berg WA: Use of breast-specific PET scanners and comparison with MR imaging. Magn Reson Imaging Clin N Am. 26(2):265-272, 2018
Teixeira SC et al: Evaluation of a hanging-breast PET system for primary tumor visualization in patients with stage I-III breast cancer: Comparison with standard PET/CT. AJR Am J Roentgenol. 206(6):1307-14, 2016
Yamamoto Y et al: A preliminary report of breast cancer screening by positron emission mammography. Ann Nucl Med. 30(2):130-7, 2016
Caldarella C et al: Diagnostic performance of dedicated positron emission mammography using fluorine-18-fluorodeoxyglucose in women with suspicious breast lesions: a meta-analysis. Clin Breast Cancer. 14(4):241-8, 2014
Koo HR et al: Background ¹⁸F-FDG uptake in positron emission mammography (PEM): correlation with mammographic density and background parenchymal enhancement in breast MRI. Eur J Radiol. 82(10):1738-42, 2013
Berg WA et al: Comparative effectiveness of positron emission mammography and MRI in the contralateral breast of women with newly diagnosed breast cancer. AJR Am J Roentgenol. 198(1):219-32, 2012
Eo JS et al: Imaging sensitivity of dedicated positron emission mammography in relation to tumor size. Breast. 21(1):66-71, 2012
Iima M et al: Clinical performance of 2 dedicated PET scanners for breast imaging: initial evaluation. J Nucl Med. 53(10):1534-42, 2012
Berg WA et al: Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 258(1):59-72, 2011
Kalinyak JE et al: PET-guided breast biopsy. Breast J. 17(2):143-51, 2011
Narayanan D et al: Interpretation of positron emission mammography and MRI by experienced breast imaging radiologists: performance and observer reproducibility. AJR Am J Roentgenol. 196(4):971-81, 2011
Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
Schilling K et al: Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging. Eur J Nucl Med Mol Imaging. 38(1):23-36, 2011
Hendrick RE: Radiation doses and cancer risks from breast imaging studies. Radiology. 257(1):246-53, 2010
MacDonald L et al: Clinical imaging characteristics of the positron emission mammography camera: PEM Flex Solo II. J Nucl Med. 50(10):1666-75, 2009
Adler LP et al: Quantitative improvement in breast lesion detectability on delayed images using high resolution positron emission mammography. J Nuc Med. 48 (suppl 2):369P, 2007
Berg WA et al: High-resolution fluorodeoxyglucose positron emission tomography with compression ("positron emission mammography") is highly accurate in depicting primary breast cancer. Breast J. 12(4):309-23, 2006
Tafra L et al: Pilot clinical trial of 18F-fluorodeoxyglucose positron-emission mammography in the surgical management of breast cancer. Am J Surg. 190(4):628-32, 2005
Vranjesevic D et al: Relationship between 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med. 44(8):1238-42, 2003
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
TERMINOLOGY
Definitions
Principles of PET imaging
F-18 fluorodeoxyglucose (FDG) is taken up by glucose transporter (substrate for hexokinase), converted to FDG-6-phosphate, and trapped in cells
Positrons emitted with decay of radiotracer (e.g., F-18) hit electrons → two 511 keV gamma photons emitted at 180° from each other
Requires shielding of room, radiation safety
Cameras detect coincident gamma rays to create image
Functional imaging of metabolic activity
In-plane resolution 1.8 mm for all systems vs. ~ 6 mm for whole-body PET
Positron emission mammography (PEM): Dedicated device using breast stabilization → 12 tomographic "slice" images of breast
Reduced z-axis resolution of ~ 6 mm with PEM due to planar detectors and limited angle reconstruction; other systems use ring detectors and have < 2-mm resolution in all planes
Mammi-PET: Prone system with ring of detectors which rotate around breast; true PET
El Mammo: O-scanner prone position or C-PEM with patient semi-prone leaning into scanner with opening for arm
Half-life: Time required for 1/2 of nuclei of specific isotopic species to undergo radioactive decay
F-18: 110 minute half-life; positron emitter
Millicurie (mCi) = 3.7 x 10⁷ disintegrations per second [where 1 disintegration per second = 1 becquerel (Bq)]
Standardized uptake value (SUV) in whole-body PET: Tissue activity in mCi/mL divided by [injected FDG dose in mCi divided by body weight in kg]
PUV (PEM uptake value) max = maximum voxel uptake in region of interest on single PEM slice
LTB (lesion-to-background) ratio = ratio of maximum lesion uptake (PUV) to mean background uptake
IMAGING
Anatomy-Based Imaging Issues
Interpretive Criteria
Indications
New Horizons
Selected References
Narayanan D and Berg WA: Dedicated breast gamma camera imaging and breast PET: Current status and future directions. PET Clin N Am. 2018
Narayanan D and Berg WA: Use of breast-specific PET scanners and comparison with MR imaging. Magn Reson Imaging Clin N Am. 26(2):265-272, 2018
Teixeira SC et al: Evaluation of a hanging-breast PET system for primary tumor visualization in patients with stage I-III breast cancer: Comparison with standard PET/CT. AJR Am J Roentgenol. 206(6):1307-14, 2016
Yamamoto Y et al: A preliminary report of breast cancer screening by positron emission mammography. Ann Nucl Med. 30(2):130-7, 2016
Caldarella C et al: Diagnostic performance of dedicated positron emission mammography using fluorine-18-fluorodeoxyglucose in women with suspicious breast lesions: a meta-analysis. Clin Breast Cancer. 14(4):241-8, 2014
Koo HR et al: Background ¹⁸F-FDG uptake in positron emission mammography (PEM): correlation with mammographic density and background parenchymal enhancement in breast MRI. Eur J Radiol. 82(10):1738-42, 2013
Berg WA et al: Comparative effectiveness of positron emission mammography and MRI in the contralateral breast of women with newly diagnosed breast cancer. AJR Am J Roentgenol. 198(1):219-32, 2012
Eo JS et al: Imaging sensitivity of dedicated positron emission mammography in relation to tumor size. Breast. 21(1):66-71, 2012
Iima M et al: Clinical performance of 2 dedicated PET scanners for breast imaging: initial evaluation. J Nucl Med. 53(10):1534-42, 2012
Berg WA et al: Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 258(1):59-72, 2011
Kalinyak JE et al: PET-guided breast biopsy. Breast J. 17(2):143-51, 2011
Narayanan D et al: Interpretation of positron emission mammography and MRI by experienced breast imaging radiologists: performance and observer reproducibility. AJR Am J Roentgenol. 196(4):971-81, 2011
Narayanan D et al: Interpretation of positron emission mammography: feature analysis and rates of malignancy. AJR Am J Roentgenol. 196(4):956-70, 2011
Schilling K et al: Positron emission mammography in breast cancer presurgical planning: comparisons with magnetic resonance imaging. Eur J Nucl Med Mol Imaging. 38(1):23-36, 2011
Hendrick RE: Radiation doses and cancer risks from breast imaging studies. Radiology. 257(1):246-53, 2010
MacDonald L et al: Clinical imaging characteristics of the positron emission mammography camera: PEM Flex Solo II. J Nucl Med. 50(10):1666-75, 2009
Adler LP et al: Quantitative improvement in breast lesion detectability on delayed images using high resolution positron emission mammography. J Nuc Med. 48 (suppl 2):369P, 2007
Berg WA et al: High-resolution fluorodeoxyglucose positron emission tomography with compression ("positron emission mammography") is highly accurate in depicting primary breast cancer. Breast J. 12(4):309-23, 2006
Tafra L et al: Pilot clinical trial of 18F-fluorodeoxyglucose positron-emission mammography in the surgical management of breast cancer. Am J Surg. 190(4):628-32, 2005
Vranjesevic D et al: Relationship between 18F-FDG uptake and breast density in women with normal breast tissue. J Nucl Med. 44(8):1238-42, 2003
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