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PET/CT Technique and Imaging Issues
Marc S. Tubay, MD; Refky Nicola, MS, DO
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KEY FACTS

  • Terminology

    • Pre-Procedure

      • Procedure

        TERMINOLOGY

        • Abbreviations

          • Positron emission tomography (PET)
          • Computed tomography (CT)
        • Synonyms

          • 18-fluorodeoxyglucose (F-18 FDG) PET/CT
            • F-18 FDG is most widely used tracer in clinical practice; however, other tracers are available
        • Definitions

          • Imaging modality that combines functional/metabolic (PET) and anatomic (CT) information
            • PET relies on increased glucose uptake and metabolism by malignant cells although uptake can be seen in benign tissues as well

        PREPROCEDURE

        • Indications

          • Contraindications

            • Getting Started

              • Advantages

                • Disadvantages

                  • New Developments

                    • Patient Preparation

                      PROCEDURE

                      • Procedure Steps

                        • Findings and Reporting

                          POST PROCEDURE

                          • Things to Avoid

                            • Specific Interpretation Issues

                              • Pearls and Pitfalls

                                Selected References

                                1. Faria S et al: FDG-PET assessment of other gynecologic cancers. PET Clin. 13(2):203-23, 2018
                                2. Lakhani A et al: FDG PET/CT pitfalls in gynecologic and genitourinary oncologic imaging. Radiographics. 37(2):577-94, 2017
                                3. Prabhakar HB et al: FDG PET-CT of gynecologic cancers: pearls and pitfalls. Abdom Imaging. 40(7):2472-85, 2015
                                4. Mirpour S et al: The role of PET/CT in the management of cervical cancer. AJR Am J Roentgenol. 201(2):W192-205, 2013
                                5. Mitchell DG et al: ACR appropriateness criteria staging and follow-up of ovarian cancer. J Am Coll Radiol. 10(11):822-7, 2013
                                6. Navve D et al: Physiological (18)F-FDG uptake patterns in female reproductive organs before and after chemotherapy treatments: assessment by PET/CT. Med Oncol. 30(2):598, 2013
                                7. Viswanathan C et al: Positron emission tomography-computed tomography imaging for malignancies in women. Radiol Clin North Am. 51(6):1111-25, 2013
                                8. Antunovic L et al: Revisiting the clinical value of 18F-FDG PET/CT in detection of recurrent epithelial ovarian carcinomas: correlation with histology, serum CA-125 assay, and conventional radiological modalities. Clin Nucl Med. 37(8):e184-8, 2012
                                9. Crivellaro C et al: 18F-FDG PET/CT can predict nodal metastases but not recurrence in early stage uterine cervical cancer. Gynecol Oncol. 127(1):131-5, 2012
                                10. Langer JE et al: Imaging of the female pelvis through the life cycle. Radiographics. 32(6):1575-97, 2012
                                11. Rockall AG et al: The role of FDG-PET/CT in gynaecological cancers. Cancer Imaging. 12:49-65, 2012
                                12. Alt CD et al: Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: Part 2. Strahlenther Onkol. 187(11):705-14, 2011
                                13. Brocker KA et al: Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT : part 1. Strahlenther Onkol. 187(10):611-8, 2011
                                14. Patel CN et al: 18F-FDG PET/CT of cervical carcinoma. AJR Am J Roentgenol. 196(5):1225-33, 2011
                                15. Son H et al: Role of FDG PET/CT in staging of recurrent ovarian cancer. Radiographics. 31(2):569-83, 2011
                                16. Even-Sapir E: Imaging the normal and abnormal anatomy of the female pelvis using (18)F FDG-PET/CT, including pitfalls and artifacts. PET Clin. 5(4):425-34, 2010
                                17. Kitajima K et al: Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol. 195(3):737-43, 2010
                                18. Prakash P et al: Role of PET/CT in ovarian cancer. AJR Am J Roentgenol. 194(6):W464-70, 2010
                                19. Son H et al: PET/CT evaluation of cervical cancer: spectrum of disease. Radiographics. 30(5):1251-68, 2010
                                20. Brooks RA et al: Novel imaging modalities in gynecologic cancer. Curr Oncol Rep. 11(6):466-72, 2009
                                21. De Gaetano AM et al: Imaging of gynecologic malignancies with FDG PET-CT: case examples, physiologic activity, and pitfalls. Abdom Imaging. 34(6):696-711, 2009
                                22. Iyer RB et al: PET/CT and cross sectional imaging of gynecologic malignancy. Cancer Imaging. 7 Spec No A:S130-8, 2007
                                23. Suzuki R et al: Validity of positron emission tomography using fluoro-2-deoxyglucose for the preoperative evaluation of endometrial cancer. Int J Gynecol Cancer. 17(4):890-6, 2007
                                24. Unger JB et al: The prognostic value of pretreatment 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography scan in women with cervical cancer. Int J Gynecol Cancer. 17(5):1062-7, 2007
                                25. Blake MA et al: Pearls and pitfalls in interpretation of abdominal and pelvic PET-CT. Radiographics. 26(5):1335-53, 2006
                                26. von Schulthess GK et al: Integrated PET/CT: current applications and future directions. Radiology. 238(2):405-22, 2006
                                27. Kostakoglu L et al: PET-CT fusion imaging in differentiating physiologic from pathologic FDG uptake. Radiographics. 24(5):1411-31, 2004
                                28. Lerman H et al: Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med. 45(2):266-71, 2004
                                29. Sironi S et al: Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings. Radiology. 233(2):433-40, 2004
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Pre-Procedure

                                    • Procedure

                                      TERMINOLOGY

                                      • Abbreviations

                                        • Positron emission tomography (PET)
                                        • Computed tomography (CT)
                                      • Synonyms

                                        • 18-fluorodeoxyglucose (F-18 FDG) PET/CT
                                          • F-18 FDG is most widely used tracer in clinical practice; however, other tracers are available
                                      • Definitions

                                        • Imaging modality that combines functional/metabolic (PET) and anatomic (CT) information
                                          • PET relies on increased glucose uptake and metabolism by malignant cells although uptake can be seen in benign tissues as well

                                      PREPROCEDURE

                                      • Indications

                                        • Contraindications

                                          • Getting Started

                                            • Advantages

                                              • Disadvantages

                                                • New Developments

                                                  • Patient Preparation

                                                    PROCEDURE

                                                    • Procedure Steps

                                                      • Findings and Reporting

                                                        POST PROCEDURE

                                                        • Things to Avoid

                                                          • Specific Interpretation Issues

                                                            • Pearls and Pitfalls

                                                              Selected References

                                                              1. Faria S et al: FDG-PET assessment of other gynecologic cancers. PET Clin. 13(2):203-23, 2018
                                                              2. Lakhani A et al: FDG PET/CT pitfalls in gynecologic and genitourinary oncologic imaging. Radiographics. 37(2):577-94, 2017
                                                              3. Prabhakar HB et al: FDG PET-CT of gynecologic cancers: pearls and pitfalls. Abdom Imaging. 40(7):2472-85, 2015
                                                              4. Mirpour S et al: The role of PET/CT in the management of cervical cancer. AJR Am J Roentgenol. 201(2):W192-205, 2013
                                                              5. Mitchell DG et al: ACR appropriateness criteria staging and follow-up of ovarian cancer. J Am Coll Radiol. 10(11):822-7, 2013
                                                              6. Navve D et al: Physiological (18)F-FDG uptake patterns in female reproductive organs before and after chemotherapy treatments: assessment by PET/CT. Med Oncol. 30(2):598, 2013
                                                              7. Viswanathan C et al: Positron emission tomography-computed tomography imaging for malignancies in women. Radiol Clin North Am. 51(6):1111-25, 2013
                                                              8. Antunovic L et al: Revisiting the clinical value of 18F-FDG PET/CT in detection of recurrent epithelial ovarian carcinomas: correlation with histology, serum CA-125 assay, and conventional radiological modalities. Clin Nucl Med. 37(8):e184-8, 2012
                                                              9. Crivellaro C et al: 18F-FDG PET/CT can predict nodal metastases but not recurrence in early stage uterine cervical cancer. Gynecol Oncol. 127(1):131-5, 2012
                                                              10. Langer JE et al: Imaging of the female pelvis through the life cycle. Radiographics. 32(6):1575-97, 2012
                                                              11. Rockall AG et al: The role of FDG-PET/CT in gynaecological cancers. Cancer Imaging. 12:49-65, 2012
                                                              12. Alt CD et al: Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT: Part 2. Strahlenther Onkol. 187(11):705-14, 2011
                                                              13. Brocker KA et al: Imaging of female pelvic malignancies regarding MRI, CT, and PET/CT : part 1. Strahlenther Onkol. 187(10):611-8, 2011
                                                              14. Patel CN et al: 18F-FDG PET/CT of cervical carcinoma. AJR Am J Roentgenol. 196(5):1225-33, 2011
                                                              15. Son H et al: Role of FDG PET/CT in staging of recurrent ovarian cancer. Radiographics. 31(2):569-83, 2011
                                                              16. Even-Sapir E: Imaging the normal and abnormal anatomy of the female pelvis using (18)F FDG-PET/CT, including pitfalls and artifacts. PET Clin. 5(4):425-34, 2010
                                                              17. Kitajima K et al: Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol. 195(3):737-43, 2010
                                                              18. Prakash P et al: Role of PET/CT in ovarian cancer. AJR Am J Roentgenol. 194(6):W464-70, 2010
                                                              19. Son H et al: PET/CT evaluation of cervical cancer: spectrum of disease. Radiographics. 30(5):1251-68, 2010
                                                              20. Brooks RA et al: Novel imaging modalities in gynecologic cancer. Curr Oncol Rep. 11(6):466-72, 2009
                                                              21. De Gaetano AM et al: Imaging of gynecologic malignancies with FDG PET-CT: case examples, physiologic activity, and pitfalls. Abdom Imaging. 34(6):696-711, 2009
                                                              22. Iyer RB et al: PET/CT and cross sectional imaging of gynecologic malignancy. Cancer Imaging. 7 Spec No A:S130-8, 2007
                                                              23. Suzuki R et al: Validity of positron emission tomography using fluoro-2-deoxyglucose for the preoperative evaluation of endometrial cancer. Int J Gynecol Cancer. 17(4):890-6, 2007
                                                              24. Unger JB et al: The prognostic value of pretreatment 2-[18F]-fluoro-2-deoxy-D-glucose positron emission tomography scan in women with cervical cancer. Int J Gynecol Cancer. 17(5):1062-7, 2007
                                                              25. Blake MA et al: Pearls and pitfalls in interpretation of abdominal and pelvic PET-CT. Radiographics. 26(5):1335-53, 2006
                                                              26. von Schulthess GK et al: Integrated PET/CT: current applications and future directions. Radiology. 238(2):405-22, 2006
                                                              27. Kostakoglu L et al: PET-CT fusion imaging in differentiating physiologic from pathologic FDG uptake. Radiographics. 24(5):1411-31, 2004
                                                              28. Lerman H et al: Normal and abnormal 18F-FDG endometrial and ovarian uptake in pre- and postmenopausal patients: assessment by PET/CT. J Nucl Med. 45(2):266-71, 2004
                                                              29. Sironi S et al: Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings. Radiology. 233(2):433-40, 2004