Positron Emission Tomography-Computed Tomography: A Disease-Oriented Approach PDF

Preface

The introduction of dedicated instruments to perform functional positron emission imaging in combination with CT opens an extraordinary vista for the diagnostic imager. Suddenly, we have been confronted with closely registered images that permit the reliable, and almost instantaneous, fusion of anatomy with metabolic information. Findings on PET may be explained now by their relationship to normal anatomy or may take on greater significance because of abnormal CT findings. CT findings may now be recognized, more thoroughly considered, or summarily dismissed based on their metabolic attributes. Relatively inconspicuous findings on PET take on greater meaning when they relate to identifiable structures. While this dual modality imaging provides a great many answers, inevitably combined PET/CT raises new questions and creates new challenges for us. For the physician coming from a nuclear medicine/PET background, the detailed body of knowledge developed over the past 20 years in chest and body CT must be mastered to better clarify the meaning of metabolic activity and thereby extend the clinical utility of PET. For the CT radiologist who needs to wield the metabolic tool of PET with facility and expertise, an in-depth understanding of the subtleties of functional imaging both in terms of patient preparation and image interpretation is necessary.

This book aims to provide a thorough understanding of the technical demands involved in combining CT and FDG PET: patient preparation, acquisition techniques including potential pitfalls and limitations, and the basics of instrumentation and physics needed for developing cogent technical approaches. Technical advances and controversies including the use of CT contrast and, when clinically relevant, newer radiopharmaceuticals (beyond the most clinically available 18F-2-deoxy-fluoro-D-glucose or FDG) are addressed briefly.

The raison d'etre of this work is to offer the practicing nuclear medicine physician/ radiologist a thorough understanding of the clinical application of these dedicated PET/CT scanners to oncology and neurologic disease. Whenever possible, the place of PET/CT in the diagnostic algorithm is explored and with it the particular information provided by both FDG PET and CT for the analysis of a particular diagnostic problem. When clinical questions remain even after PET/CT, further answers may come from other anatomic or functional imaging. We explore these strategies when there is evidence to support their use.

In this context, we have attempted to provide a comprehensive, disease-oriented approach to PET/CT. We review the diagnostic setting in which PET/CT will prove most valuable, the PET findings, literature-based evidence for utility, applications, and limitations to each disease and specific clinical settings related to that disease. In each section we have attempted to include CT findings that will bear on the PET interpretation and vice versa. It is our hope that this book will provide a practical, comprehensive guide for the imagers on the front line of clinical diagnosis and management of cancer and central nervous system diseases.

As we think about the genesis of this book, first and foremost we should acknowledge the support and enthusiasm for PET/CT of our chairman, Dr. Robert Grossman. We thank our radiology and clinical colleagues for their patience, questions, and feedback. We have learned from them continuously. We are also grateful for the efforts and untiring interest of our fellows and residents and for their contributions to this text. The book would have been impossible without the input of our team in the Diagnostic Imaging Department at the NYU Clinical Cancer Center. They have been enthusiastic, creative, and expert technologists in this adventure: Barbara Moczulska, Veronica Briglall, Gregory Vaynshteyn, and Lewen Cao. They taught each other their respective modalities and helped us with the ins and outs of putting PET and CT together; the nurses Christine Compton Perez and Maureen Stasi who have skillfully guided our patients and us through dietary dilemmas, diabetes medications, and contrast issues; and Emilio Vega, whose technical expertise has repeatedly weighed in when we were uncertain about the best way to adapt our CT protocols. Our thanks also to Martha Helmers and Tony Jalandoni, who helped us with the images for this book with their ever-present patience and attention to detail.