PET in Oncology: Basics and Clinical Application PDF
Preview PET in Oncology: Basics and Clinical Application
J. Ruhlmann . P.Oehr . H.-J. Biersack (Eds.) PET in Oncology Springer Berlin Heidelberg New York Barcelona Hong Kong London Milan Paris Singapore Tokyo J. Ruhlmann . P. Oehr . H.-J. Biersack Editors PET in Oncology Basics and Clinical Application With 95 Figures, some in Color and 58 Tables Springer Dr. Dr. Jiirgen Ruhlmann PD Dr. Peter Oehr PET-Center Miinsterstra6e 20 53111 Bonn, Germany Prof. Dr. H.-J. Biersack University Clinic Bonn Clinic and Policlinic for Nuclear Medicine Rheinisch-Westfalische University Bonn Sigmund-Freud-Stra6e 25 53127 Bonn, Germany Translated from German by: Judith F. Lee, Ph.D. and Mary W. Tannert, Ph.D. ISBN -13: 978-3-642-64220-3 e-ISBN-13: 978-3-642-60010-4 DOl: 10.1007/978-3-642-60010-4 Library of Congress Cataloging-in-Publication Data PET in der Onkologie. English. PET in oncology: basics and clinical application 1 [edited by] J. Ruhl mann, P. Oehr, and H.-J. Biersack. p. cm. Includes bibliographical references and index. ISBN 3-540-65077-6 (hardcover: alk. paper) 1. Cancer-Tomography. 2. Tomography, Emission. I. Ruhlmann, J. (Jiirgen), 1955 - . II. Oehr, P. (Peter), 1942- . III. Biersack, H. J. IV. Title. [DNLM: 1. Neoplasms-radionuclide imaging. 2. Tomography, Emission-Computed-methods. QZ 241 P477P 1999a] RC270·3· T65P 4613 1999 616.99' 407575-dc21 DNLM/DLC for Library of Congress 99-26968 This work is subject to copyright. All rights are reserved, whether the whole or part of the materials is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broad casting, reproduction on microfilm or in any other way, and storage in data banks. Duplication of this publication or parts thereof is permitted only under the provisions of the German Copyright Law of September 9, 1965, in its current version, and permission for use must always be obtained from Springer-Verlag. Violations are liable for prosecution under the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1999 The use of general descriptive names, registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant pro tective laws and regulations and therefore free for general use. Product liability: The publisher cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature. Production: PRO EDIT GmbH, D-69126 Heidelberg Cover design: design & production, D-69121 Heidelberg Typesetting: Mitterweger Werksatz GmbH, D-68723 Plankstadt SPIN: 10693821 21/3135 - 5 4 3 2 1 0 - Printed on acid-free paper Preface Development of Positron -Emissiontomography respect to reimbursement, as well as the European (PET) dates back to the Mid-70ieS. However, this PET consensus conferences. Nowadays, PET is a imaging procedure gained clinical importance not well established routine procedure in lung and co before 1990. First clinical papers were published lorectal cancer as well as malignant melanoma, by US researchers. The patient populations were head and neck cancer and breast cancer. Other relatively small by that time, and European as indications are lymphoma and pancreatic cancer. well as German authors contributed results in larger Within the next years, the diagnostic spectrum of patient populations. These clinical papers led to a PET will be widened, especially in the field of therapy widespread application of PET in clinical routine. follow-up and proof of vitality after chemotherapy. The clinical relevance was documented by several The increased use of PET in oncology makes evi PET consensus conferences. However, the National dent, that it is necessary to train referring physians Health Service System is very reluctant to pay for in PET. The aim of this book is to summarize the PET studies. Even in Germany, PET is not yet a reg basics and the clinical results of PET and to bring ular part of the reimbursement system. On the other them of the attention of general medicine. hand, in solitary pulmonary nodules and brain tu mors third party payers in United States have accep Bonn, Spring 1999 J. Ruhlmann ted these indications. The high popularity of PET in P.Oehr US will certainly lead to an improved situation with H.-J. Biersack Contents Part I Principles l.3.3 NaI Detector Technology for Dedicated Pet-Systems ........ . 18 l.3.4 Post Injection CS-137 Singles Trans 1 Physical Principles ............. . 3 mission Improves Clinical Image H. Newiger, Y. Harnisch, P. Oehr, Quality, Quantitative Accuracy and J. Ruhlmann, B. Vollet, and S. Ziegler Enables Flexible Clinical Operation 19 1.1 PET Technology ............... . 3 1.4 Quality Control ............... . 26 H. Newiger B. Vollet l.1.1 The Physics of Positrons ......... . 3 l.4.1 Integrity Testing for PET Scanners l.1.2 Measurement of Positron or Gamma Cameras with Integrated Radiation .................... . 4 Coincidence Acquisition ......... . 28 l.1.3 Advantages of PET ............. . 4 l.4.2 Quality Assurance for l.l.4 Production of Positron Emitters ... . 5 Transmission Measurement ....... . 32 1.1.5 Detectors for PET .............. . 6 l.4.3 Integrity Testing for In Vitro l.l.6 Quantitative Imaging with PET 7 Analyzers and Activity Meters ..... . 32 l.l.7 Further Development l.4.4 Quality Assurance for Documentation of PET Technology of Findings ................... . 33 and Reconstruction Methods ...... . 9 2 Radiopharmaceutical Technology, 1.2 Dual Head Coincidence Camera 10 Toxicity and Radiation Dosages 35 S. Ziegler J. Ruhlmann and P. Oehr 1.2.1 Comparison of the 2.1 Introduction .................. . 35 Dual Head Coincidence Camera with Other Techniques .......... . 10 2.2 The Synthesis of 2-[18F1FDG ...... . 36 l.2.2 Measurement Problems .......... . 11 2.3 Purity of the 2-[18F1FDG Solution .. . 36 1.3 Design Considerations of NaI(Tl) Based PET Imaging Systems 2.4 2-[18F1FDG Activity Dosages ...... . 37 Adressing the Clinical and Technical Requirements of Wholebody PET ... 15 2.5 Radiation Exposure ............ . 38 Y. Harnisch 1.3.1 Introduction .................. . 15 2.6 Biochemical Toxicity ............ . 40 1.3.2 Digital Detectors Improve Countrate Capability .................... . 15 2.7 Conclusions .................. . 40 VIII Contents 3 Metabolism and Transport of Glucose 5.1.1 Epidemiology ................. . 67 and FDG .................... . 43 5.1.2 Histology and Staging ........... . 67 P.Oehr 5.1.3 Prognosis .................... . 67 5.1.4 Malignant Melanoma Therapy ..... . 68 3.1 Biological Functions 5.1.5 Staging and Follow-Up .......... . 68 of Carbohydrate Metabolism ...... . 43 5.1.6 Indications ................... . 69 5.1.7 Summary .................... . 69 3.1.1 Carbohydrate Requirements & Supply .................... . 43 5.2 Head and Neck Tumors ......... . 76 3.1.2 Regulation Mechanisms ......... . 43 C. Laubenbacher, R.J. Kau, e. Alexiou, 3.1.3 Factors in Glucose Homeostasis ... . 44 W. Arnold, and M. Schwaiger 3.2 Metabolism of Glucose, 2-DG, 2-FDG 5.2.1 Introduction .................. . 76 and 3-FDG ................... . 45 5.2.2 Significance of PET ............. . 78 5.2.3 Study Protocol and Interpretation 3.2.1 Glucose ..................... . 45 of PET ...................... . 85 3.2.2 Metabolism of 2-DG, 2-FDG 5.2.4 Summary .................... . 87 and 3-FDG ................... . 46 3.3 FDG Uptake .................. . 46 5.3 Thyroid Carcinomas ............ . 89 F. Grunwald 3.3.1 Glucose Transport Systems ....... . 46 3.3.2 Glucose Transporters 5.3.1 Clinical Background ............. 89 in Cancer Diseases ............. . 50 5.3.2 Therapy. . . . . . . . . . . . . . . . . . . . .. 91 3.3.3 Kinetics of Glucose Transport ..... . 51 5.3.3 Use of FDG PET. . . . . . . . . . . . . . .. 92 3.3.4 Quantification of PET 5.3.4 Indications . . . . . . . . . . . . . . . . . . .. 98 Measurements ................ . 52 5.3.5 Results and Interpretation . . . . . . . .. 99 5.3.6 Limits of Interpretation .......... 100 5.4 Pulmonary Nodules and Non-Small- Part II Clinical Applications Cell Bronchial Carcinoma . . . . . . . .. 102 R.P. Baum, N. Presselt, and R. Bonnet 4 Patient Preparation ............. . 61 5.4.1 Epidemiology and Etiology B. Kozak of Lung Cancer. . . . . . . . . . . . . . . .. 102 5.4.2 Prognosis, Histology and Staging . . .. 103 4.1 PET Scanning Technique 61 5.4.3 Diagnosis of Lung Cancer. . . . . . . .. 103 5.4.4 Therapy for Non-Small-Cell Bronchial 5 Clinical Indications ............. . 67 Carcinoma ...... . . . . . . . . . . . . .. 104 e. Alexiou, R. An, W. Arnold, 5.4.5 Positron Emission Tomography. . . .. 106 M. Bangard, R.P. Baum, H.-J. Biersack, 5.4.6 Clinical Indications for Positron R. Bonnet, U. Bull, U. Cremerius, Emission Tomography ........... 108 e.G. Diederichs, F. Grunwald, R.J. Kau, 5.4.7 Positron Emission Tomography: R. Kaufmann, C. Laubenbacher, Limitations and Pitfalls . . . . . . . . . .. 115 C. Menzel, P. Oehr, H. Palmedo, N. Presselt, J. Reul, D. Rinne, 5.5 Breast Cancer . . . . . . . . . . . . . . . . .. 119 J. Ruhlmann, M. Schwaiger, P. Willkomm, H. Palmedo, P. Willkomm, and M. Zimny M. Bangard, P. Oehr, and H.-J. Biersack 5.1 Malignant Melanoma ........... . 67 5.5.1 Introduction, Clinical Background, D. Rinne, R. Kaufmann, Prognosis . . . . . . . . . . . . . . . . . . . .. 119 and R.P. Baum 5.5.2 Technical Aspects. . . . . . . . . . . . . .. 120 Contents IX 5.5.3 Indications . . . . . . . . . . . . . . . . . . .. 121 5.11 PET and Neuro-Imaging: 5.5.4 Summary . . . . . . . . . . . . . . . . . . . .. 126 Diagnostic and Therapeutic Value, Current Applications 5.6 Pancreatic Cancer . . . . . . . . . . . . . .. 128 and Future Perspective ........... 165 C.G. Diederichs J. Reul 5.6.1 Clinical Principles . . . . . . . . . . . . . .. 128 5.11.1 Introduction................... 165 5.6.2 Current Therapy . . . . . . . . . . . . . . .. 129 5.11.2 Diagnostic N euroimaging 5.6.3 PET ......................... 129 and Tumour Classification ........ 166 5.6.4 Other Diagnostic Methods . . . . . . . .. 133 5.11.3 Diagnostic Imaging with PET ...... 169 5.6.5 Indications . . . . . . . . . . . . . . . . . . .. 134 5.11.4 Conclusion .................... 170 5.7 Colorectal Cancer . . . . . . . . . . . . . .. 135 5.12 Miscellaneous Tumors ........... 171 J. Ruhlmann and P. Oehr H.-J. Biersack, P. Willkomm, R. An, and J. Ruhlmann 5.7.1 Incidence, Etiology and Risk Factors . . . . . . . . . . . . . . .. 135 5.12.1 Brain Tumors .................. 171 5.7.2 Diagnostics . . . . . . . . . . . . . . . . . . .. 137 5.12.2 Musculoskeletal Tumors .......... 171 5.7.3 Prognosis, Staging 5.12.3 Prostate Cancer ................ 172 and Tumor Spread .............. 138 5.12.4 Bladder Cancer. . . . . . . . . . . . . . . .. 173 5.7.4 Therapy ...................... 138 5.12.5 Kidney Tumors ................ 173 5.7.5 Positron Emission Tomography. . . .. 139 5.12.6 Esophageal Cancer .............. 174 5.12.7 Gastric Cancer ................. 175 5.8 Ovarian Cancer ................ 144 5.12.8 Liver Cancer ................. " 175 M. Zimny, U. Cremerius, and U. Biill 5.8.1 Epidemiology .................. 144 6 Cancer Screening with Whole-Body 5.8.2 Pathophysiology FDG PET ..................... 179 and Tumor Spread .. . . . . . . . . . . .. 145 S. Yasuda, M. Ide, and A. Shohtsu 5.8.3 Histology .................... , 145 5.8.4 Tumor Staging ................. 145 6.1 Background ................... 179 5.8.5 Therapy ... . . . . . . . . . . . . . . . . . .. 146 5.8.6 Diagnosis ..................... 146 6.2 Cancer Screening with Whole-Body 5.8.7 Positron Emission Tomography. . . .. 146 FDG PET ..................... 179 5.8.8 Results . . . . . . . . . . . . . . . . . . . . . .. 148 6.2.1 Subjects and Methods . . . . . . . . . . .. 179 6.2.2 Results . . . . . . . . . . . . . . . . . . . . . .. 181 5.9 Testicular Tumors .............. 151 6.2.3 Cancer Screening ............... 183 U. Cremerius, M. Zimny, and U. Bull 5.9.1 Clinical Principles 6.3 Conclusions ................... 187 and Current Therapy ............ 151 5.9.2 Performing PET Scans ........... 153 7 PET and Radiotherapy 189 5.9.3 Results of PET Scans ............ 153 Val J. Lowe 5.9.4 Indications . . . . . . . . . . . . . . . . . . .. 156 7.1 Introduction . . . . . . . . . . . . . . . . . .. 189 5.10 Hodgkin's Disease and Non-Hodgkin's Lymphomas 158 7.2 PET Before Radiation Therapy 189 C. Menzel 5.10.1 Hodgkin's Disease .............. 158 7.3 PET During Radiation Therapy 190 5.10.2 Malignant Lymphomas - Non-Hodgkin's Lymphomas ....... 159 7.4 Reoxygenation and PET .......... 190 X Contents 7.5 PET Imaging After Completion 8 Cost Effectiveness of PET of Radiation Therapy ............ 191 in Oncology 195 P.E. Valk 7.6 Diagnosing Recurrent Disease with PET ..................... 191 8.1 Diagnosis and Staging of Non-Small Cell Lung Cancer ............... 195 7.7 Timing of PET After Radiation Therapy . . . . . . . . . . . . . . . . . . . . .. 192 8.2 Staging of Recurrent Colorectal Cancer ...................... , 196 7.8 Summary. . . . . . . . . . . . . . . . . . . .. 193 8.3 Staging of Metastatic Melanoma .... 197 Subject Index ....................... 199 List of Contributors Alexiou, e. Cremerius, U. Department of Otorhinolaryngology Clinic for Nuclear Medicine Head and Neck Surgery RWTH Aachen Isar Right Bank Clinic, Technical University Munich PauwelsstraBe 30, 52074 Aachen, Germany Ismaninger StraBe 22, 81675 Munchen, Germany Diederichs, e.G. An, R. Department of Nuclear Medicine Clinic and Policlinic for Nuclear Medicine Ulm University Clinic University of Bonn Robert-Koch-StraBe 8, 89070 Ulm, Germany Sigmund-Freud-StraBe 25, 53127 Bonn Grunwald, F. Germany Clinic and Policlinic for Nuclear Medicine Arnold, W. University of Bonn Department of Otorhinolaryngology Sigmund-Freud-StraBe 25, 53127 Bonn, Germany Head and Neck Surgery Harnisch, Y. Isar Right Bank Clinic, Technical University Munich ADAC, Europe Ismaninger StraBe 22, 81675 Munchen, Germany GroBenbaumer Weg 6, 40472 Dusseldorf, Germany Bangard, M. Ide, M. Clinic and Policlinic for Nuclear Medicine HIMEDIC Imaging Center at Lake Yamanaka University of Bonn Yanagihara 562-12 Sigmund-Freud-StraBe 25, 53127 Bonn Hirano, Yamanashi, 401-0502, Japan Germany Kau, R.J. Baum, R. P. Department of Otorhinolaryngology PET Center, Central Clinic Bad Berka GmbH Head and Neck Surgery 99437 Bad Berka, Germany Isar Right Bank Clinic, Technical University Munich Ismaninger StraBe 22, 81675 Munchen, Germany Biersack, H.-J. Clinic and Policlinic for Nuclear Medicine Kaufmann, R. University of Bonn Department of Dermatology, Medical Center Sigmund-Freud-StraBe 25, 53127 Bonn University of Frankfurt Germany Theodor-Stern-Kai 7, 60590 Frankfurt, Germany Bonnet, R. Kozak, B. PET Center, Central Clinic Bad Berka GmbH Nuclear Medicine and Radiology Practice 99437 Bad Berka, Germany MunsterstraBe 20, 53111 Bonn, Germany Bull, U. Laubenbacher, C. Clinic for Nuclear Medicine Clinic and Policlinic for Nuclear Medicine RWTH Aachen Isar Right Bank Clinic, Technical University Munich PauwelsstraBe 30, 52074 Aachen, Germany Ismaninger StraBe 22, 81675 Munchen, Germany
The list of books you might like
