Practical FDG Imaging: A Teaching File PDF
Preview Practical FDG Imaging: A Teaching File
Practical FDG Imaging Springer New York Berlin Heidelberg Barcelona Hong Kong London Milan Paris Singapore Tokyo Dominique Delbeke, MD, PhD William H. Martin, MD James A. Patton, PhD Martin P. Sandler, MD Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center,Nashville,Tennessee Editors Practical FDG Imaging A Teaching File With a Foreword by R. Edward Coleman,MD With 146 Illustrations in 316 Parts 1 3 Dominique Delbeke,MD,PhD William H.Martin,MD James A.Patton,PhD Martin P.Sandler,MD Department of Radiology and Radiological Sciences Vanderbilt University Medical Center Nashville,TN 37232 USA Library of Congress Cataloging-in-Publication Data Practical FDG imaging :a teaching file / Dominique Delbeke...[et al.]. p.;cm. Includes bibliographical references and index. ISBN 0-387-95292-6 (h/c :alk.paper) 1. Tomography,Emission. I. Delbeke,Dominique. [DNLM: 1. Tomography,Emission-Computed—methods. 2. Fludeoxyglucose F 18—diagnostic use. 3. Fluorine Radioisotopes—diagnostic use.WN 206 P895 2001] RC78.7.T62 P733 2001 616.07¢575—dc21 2001032004 Printed on acid-free paper. © 2002 Springer-Verlag New York,Inc. All rights reserved.This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer-Verlag New York,Inc.,175 Fifth Avenue, New York,NY 10010,USA),except for brief excerpts in connection with reviews or schol- arly analysis.Use in connection with any form of information storage and retrieval,elec- tronic adaptation,computer software,or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names,trademarks,service marks,and similar terms, even if they are not identified as such,is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press,neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made.The publisher makes no warranty,express or implied,with respect to the material contained herein. Production coordinated by Chernow Editorial Services,Inc.,and managed by MaryAnn Brickner;manufacturing supervised by Jerome Basma. Typeset by SNP Best-set Typesetter Ltd.,Hong Kong. Printed and bound by Maple-Vail Book Manufacturing Group,York,PA. Printed in the United States of America. 9 8 7 6 5 4 3 2 1 ISBN 0-387-95292-6 SPIN 10838552 Springer-Verlag New York Berlin Heidelberg A member of BertelsmannSpringer Science+Business Media GmbH To our families Philippe,Cerine,and Cedric Jeanty Cynthia,Lauren,and David Martin Beverly,Jimmy,and David Patton Glynis,Kim,and Carla Sandler Foreword FDG imaging is one of the most rapidly growing techniques in radiol- ogy.Even though the technology that has led to modern day PET scan- ning was developed in the early 1970s, PET scanning was only used clinically in any significant numbers starting in the late 1990s.It took so long for PET to be used clinically simply because of the absence of policy for reimbursement until 1998. One limitation for reimbursement was related to absence of approval of FDG by the Food and Drug Adminis- tration (FDA). In 1997,Congress passed the Food and Drug Adminis- tration Modernization Act that gave PET radiopharmaceuticals the equivalence of FDA approval. In January 1998,following the approval of FDG,the Health Care Financing Administration (HCFA) developed a policy to cover PET scans for evaluation of solitary pulmonary nodules and the initial staging of lung cancer. This policy was followed by an expansion of the policy in July 1999,when the following indications were covered:detection of recurrent colorectal cancer with rising CEA,detec- tion of recurrent malignant melanoma and initial staging and restaging of lymphoma.Other third parties developed coverage policies similar to those of the HCFA,and many third-party payers covered more than the indications approved by the HCFA. As the number of indications covered by third-party payers increased, the use of PET scanning increased. This increase in usage resulted in more investment going into PET imaging,and the instrumentation indus- try made major efforts to improve PET instrumentation.These improve- ments have been in both camera-based and dedicated systems. Marked improvements have occurred in the camera-based systems with thicker crystals which result in studies that have more counts in the images, better methods of attenuation correction including CT-based attenua- tion correction,and fusion imaging of the PET scan with the CT scan. The dedicated systems have improvements consisting of being able to acquire the studies in a shorter time period because of the use of itera- tive reconstruction algorithms and segmented attenuation correction. There are combined CT-dedicated PET scanners,and the images are dra- matically improved because of the noise-free attenuation correction. Furthermore,the ability to have fusion imaging of the PET and CT scans makes these studies more useful diagnostically. vii viii Foreword The rapid increase in the availability of PET imaging has resulted in the need for more training in FDG imaging.This training is being per- formed at regional and national meetings and at a few academic medical centers that provide CME courses on PET imaging. Books devoted to current techniques for performing and interpreting FDG PET studies are now being widely sought. This book provides information necessary for performing FDG imaging and interpreting the studies. The book is unique for several reasons:It is current;it has both camera-based and dedicated PET scans; it is authored by individuals with extensive experience in clinical PET imaging;it covers both the technical and clinical aspects of FDG imaging; and it presents cases of all the malignancies that one is likely to see in a clinical PET practice. The authors provide examples of normal variants and frequently found imaging artifacts. The characteristic findings in disorders of the central nervous system,cardiac disease,and oncology are included. Dr.Delbeke and her colleagues are to be congratulated for providing this important information in a timely fashion.Individuals who are start- ing to do PET imaging will find the information in this book helpful in their practice and will find it worthwhile to have this as a reference book. R. Edward Coleman,MD Professor of Radiology Vice-Chairman of Department of Radiology Duke University Medical Center Durham,North Carolina Preface Practical FDG Imaging:A Teaching File is intended to provide a refer- ence source of cases with FDG images obtained both on dedicated PET tomographs and hybrid scintillation gamma cameras.The cases are pre- sented in depth so that they will be of value to both the specialist physi- cian and resident in training who need to learn the indications and interpretation of FDG images and the advantages and limitations of hybrid scintillation gamma cameras compared to dedicated PET tomo- graphs.The book is designed to be used by residents training in nuclear medicine and radiology,by nuclear medicine physicians and radiologists in private or academic practice who need to become familiar with this technology,and those whose specialties carry over to FDG imaging.The first three chapters cover the technical aspects of FDG imaging,includ- ing the history of PET development, physics of positron imaging, and FDG production and distribution. Chapters 4, 5, and 6 are devoted to clinical applications in the fields of neurology,cardiology,and oncology. Each chapter begins with an introduction summarizing the literature, principles for interpretation of FDG images and clinical indications. Chapter 6 begins with a section describing the normal and physiologic variations of FDG distribution, as well as the related pitfalls in image interpretation. The following sections of Chapter 6 are devoted to the role of FDG imaging in different types of body tumors.After the intro- duction,each of the clinical chapters includes a series of cases presenta- tions ranging from the simple to the more complex. In an attempt to simulate normal clinical practice,cases have been organized without any order of priority. We sincerely hope this text will provide nuclear physicians, radiolo- gists,trainees,and those with an interest in FDG imaging with a refer- ence text of teaching files that will enhance their practice of clinical PET and help those preparing for board examinations. Dominique Delbeke,MD,PhD William H. Martin,MD James A. Patton,PhD Martin P. Sandler,MD ix Acknowledgments We wish to acknowledge the work of our Vanderbilt PET technologists, Janine E.Belote,M.Dawn Shone,and Sarah A.Washburn,for their out- standing technical assistance in acquiring and processing the images shown in this book.We are particularly indebted to Ronald C.Arildsen and Thomas A. Powers from body CT and Dr. Robert M. Kessler from neuroradiology in the Department of Radiology and Radiological Sciences at Vanderbilt University Medical Center for their invaluable help in interpreting the correlative studies. We would like to thank all contributors,including the authors and publishers,who have granted us permission to reproduce their illustrations. Dominique Delbeke,MD,PhD William H. Martin,MD James A. Patton,PhD Martin P. Sandler,MD xi Contents Foreword,by R. Edward Coleman . . . . . . . . . . . . . . . . . . . . . . . . . vii Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Chapter 1 History of PET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Michael E.Phelps Chapter 2 Physics of PET . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 James A. Patton Chapter 3 FDG Production and Distribution . . . . . . . . . . . . . . . . . . . . . . . 37 Jeff Clanton Chapter 4 Clinical Applications for the Central Nervous System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Dominique Delbeke Chapter 5 Cardiac Applications of FDG Imaging with PET and SPECT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Jeroen J. Bax,Chris Y. Kim,Don Poldermans,Abdou Elhendy, Eric Boersma,A.F.L. Schinkel,Gerrit W. Sloof,and Martin P. Sandler Clinical Applications in Oncology Chapter 6.1 Normal Distribution of FDG . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Marcus V. Grigolon,William H.Martin,and Dominique Delbeke xiii
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