Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2007; 17(03): 169-180
DOI: 10.4103/0971-3026.33629
PET/CT

FDG-PET AND PET/CT - Part I

Amol M Takalkar
PET Imaging Center, Biomedical Research Foundation of Northwest Louisiana, Shreveport, LA; Dept. of Radiology, Nuclear Medicine Section, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA
,
Ghassan El-Haddad
PET Imaging Center, Biomedical Research Foundation of Northwest Louisiana, Shreveport, LA, USA
,
David L Lilien
PET Imaging Center, Biomedical Research Foundation of Northwest Louisiana, Shreveport, LA; Dept. of Radiology, Nuclear Medicine Section, Louisiana State University Health Sciences Center - Shreveport, Shreveport, LA, USA
› Author Affiliations
› Further Information
  PDF Download Permissions and Reprints

Abstract

Positron emission tomography (PET) with 18 F fluoro-deoxyglucose (FDG) is now an established functional imaging modality predominantly used in the work-up of several neoplastic diseases. It also has several neurological and cardiac applications in routine clinical practice. However, the radiopharmaceutical, 18 F-FDG, most commonly used for clinical PET studies today is also taken up by inflammatory and infectious cells and it also has a potential role in inflammation imaging in the future. Since this technique provides a map of glucose metabolism in the body, it is extremely important to understand the bio-distribution of FDG in the human body and factors that alter it. Accordingly, the technique used and several patient factors have a significant impact on the quality of images obtained. Hence, it becomes critical to perform this highly sophisticated exam with adequate patient preparation, following an accepted technique and interpret the images with the knowledge of normal and physiologic bio-distribution of FDG in several body organs and tissues. With this objective, this two-series review article will review the current principles and practice of clinical FDG-PET. The first section of this article deals mostly with basic aspects of FDG-PET and PET/CT including properties of FDG, PET instrumentation and technique and normal variants.

Keywords

FDG - PET - PET/CT


Publication History

Article published online:
31 July 2021

© 2007. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India

 

  • References

  • 1 Warburg O, Wind F, Negelein E. The metabolism of tumors in body. J Gen Physiol 1927;8:519-30.
  • 2 Warburg O. On the origin of cancer cells. Science 1956;123:309-14.
  • 3 Cherry SR, Sorenson JA, Phelps ME. Physics in nuclear medicine. 3 rd ed. Saunders: Philadelphia, PA; 2003. p. 325-59.
  • 4 Wahl RL. Targeting glucose transporters for tumor imaging: "Sweet" idea, "sour" result. J Nucl Med 1996;37:1038-41.
  • 5 Wahl R. Positron emission tomography in oncology. In : Henkin RV, Boles MA, Dillehay GL, et al , editors. Nuclear medicine. Mosby: St. Louis, MO; 1996. p. 1524-45.
  • 6 McGowan KM, Long SD, Pekala PH. Glucose transporter gene expression: Regulation of transcription and mRNA stability. Pharmacol Ther 1995;66:465-505.
  • 7 von Shulthess GK. Radiopharmaceuticals for clinical PET, PET-CT and SPECT-CT imaging. In : von Shulthess GK. Molecular anatomic imaging. 2 nd ed. Lippincott, Williams and Wilkins: Philadelphia, PA; 2007. p. 107.
  • 8 Schmitz R, Alessio A, Kinahan P. The physics of PET/Ct scanners. In : Lin EG, Alavi A. PET and PET/CT: A clinical guide. Thieme: New York, NY; 2005. p. 3-14.
  • 9 Hamblen SM, Lowe VJ. Clinical 18F-FDG oncology patient preparation techniques. J Nucl Med Technol 2003;31:3-7.
  • 10 Buscombe J, Signore A. FDG-PET in infectious and inflammatory disease. Eur J Nucl Med Mol Imaging 2003;30:1571-3.
  • 11 Yuh-Feng T, Chin-Chu W, Cheng-Tau S, Min-Tsung T. FDG-PET CT features of an intraabdominal gossypiboma. Clin Nucl Med 2005;30:561-3.
  • 12 Ak I, Gulbas Z. Intense F-18 FDG accumulation in stomach in a patient with Hodgkin lymphoma: Helicobacter pylori infection as a pitfall in oncologic diagnosis with F-18 FDG-PET imaging. Clin Nucl Med 2005;30:41.
  • 13 Davison JM, Montilla-Soler JL, Broussard E, Wilson R, Cap A, Allen T. F-18 FDG-PET-CT imaging of a mycotic aneurysm. Clin Nucl Med 2005;30:483-7.
  • 14 Shrikanthan S, Aydin A, Dhurairaj T, Alavi A, Zhuang H. Intense esophageal FDG activity caused by Candida infection obscured the concurrent primary esophageal cancer on PET imaging. Clin Nucl Med 2005;30:695-7.
  • 15 Nguyen BD, Civelek AC. Bone scintigraphy of caudal regression syndrome. Clin Nucl Med 1996;21:802-4.
  • 16 Jacene HA, Stearns V, Wahl RL. Lymphadenopathy resulting from acute hepatitis C infection mimicking metastatic breast carcinoma on FDG-PET/CT. Clin Nucl Med 2006;31:379-81.
  • 17 Jeffry L, Kerrou K, Camatte S, Lelievre L, Metzger U, Robin F, et al . Peritoneal tuberculosis revealed by carcinomatosis on CT scan and uptake at FDG-PET. BJOG 2003;110:1129-31.
  • 18 Bakheet SM, Powe J, Ezzat A, Rostom A. F-18-FDG uptake in tuberculosis. Clin Nucl Med 1998;23:739-42.
  • 19 Takalkar A, Bruno L, Reddy M, Lilien DL. Intense FDG activity in peritoneal tuberculosis mimics peritoneal carcinomatosis. Clin Nuc Med 2007;32:244-6.
  • 20 Zhuang H, Pourdehnad M, Lambright ES, Yamamoto AJ, Lanuti M, Li P, et al . Dual time point 18 F-FDG-PET imaging for differentiating malignant from inflammatory processes. J Nucl Med 2001;42:1412-7.
  • 21 Boerner AR, Weckesser M, Herzog H, Schmitz T, Audretsch W, Nitz U, et al . Optimal scan time for fluorine-18 fluorodeoxyglucose positron emission tomography in breast cancer. Eur J Nucl Med 1999;26:226-30.
  • 22 Hustinx R, Smith RJ, Benard F, Rosenthal DI, Machtay M, Farber LA, et al . Dual time point fluorine-18 fluorodeoxyglucose positron emission tomography: A potential method to differentiate malignancy from inflammation and normal tissue in head and neck. Eur J Nucl Med 1999;26:1345-8.
  • 23 Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual-time-point 18 F-FDG-PET for the evaluation of pulmonary nodules. J Nucl Med 2002;43:871-5.
  • 24 Kumar R, Loving VA, Chauhan A, Zhuang H, Mitchell S, Alavi A. Potential of dual-time-point imaging to improve breast cancer diagnosis with 18 F-FDG-PET. J Nucl Med 2005;46:1819-24.
  • 25 Mavi A, Urhan M, Yu JQ, Zhuang H, Houseni M, Cermik TF, et al . Dual time point 18 F-FDG-PET imaging detects breast cancer with high sensitivity and correlates well with histologic subtypes. J Nucl Med 2006;47:1440-6.
  • 26 Xiu Y, Bhutani C, Dhurairaj T , Yu JQ, Dadparvar S, Reddy S, et al . Dual-time point FDG-PET imaging in the evaluation of pulmonary nodules with minimally increased metabolic activity. Clin Nucl Med 2007;32:101-5.
  • 27 Basu S, Alavi A. Partial volume correction of standardized uptake values and the dual time point in FDG-PET imaging: Should these be routinely employed in assessing patients with cancer? Eur J Nucl Med 2007.
  • 28 Andrade RS, Heron DE, Degirmenci B, Filho PA, Branstetter BF, Seethala RR, et al . Post treatment assessment of response using FDG-PET/CT for patients treated with definitive radiation therapy for head and neck cancers. Int J Radiat Oncol Biol Phys 2006;65:1315-22.
  • 29 Klabbers BM, Lammertsma AA, Slotman BJ. The value of positron emission tomography for monitoring response to radiotherapy in head and neck cancer. Mol Imaging Biol 2003;5:257-70.
  • 30 Goerres GW, Schmid DT, Bandhauer F, Huguenin PU, von Schulthess GK, Schmid S, et al . Positron emission tomography in the early follow-up of advanced head and neck cancer. Arch Otolaryngol Head Neck Surg 2004;130:105-9.
  • 31 Ryan WR, Fee WE Jr, Le QT, Pinto HA. Positron-emission tomography for surveillance of head and neck cancer. Laryngoscope 2005;115:645-50.
  • 32 Porceddu SV, Jarmolowski E, Hicks RJ, Ware R, Weih L, Rischin D, et al . Utility of positron emission tomography for the detection of disease in residual neck nodes after (chemo) radiotherapy in head and neck cancer. Head Neck 2005;27:175-81.
  • 33 Greven KM, Williams DW 3 rd , McGuirt WF Sr, Harkness BA, D′Agostino RB, Keyes JW, et al . Serial positron emission tomography scans following radiation therapy of patients with head and neck cancer. Head Neck 2001;23:942-6.
  • 34 Hicks RJ, Binns D, Stabin MG. Pattern of uptake and excretion of [18] F-FDG in the lactating breast. J Nucl Med 2001;42:1238-42.
  • 35 Cook GJ, Fogelman I, Maisey MN. Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron emission tomography scanning: potential for error in interpretation. Semin Nucl Med 1996;26:308-14.
  • 36 Engel H, Steinert H, Buck A, Berthold T, Huch B φni RA, von Schulthess GK. Whole-body PET: Physiological and artifactual Fluorodeoxyglucose accumulations. J Nucl Med 1996;37:441-6.
  • 37 Cook GJ, Maisey MN, Fofelman I. Normal variants, artifacts and interpretative pitfalls in PET imaging with 18-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med 1999;26:1363-78.
  • 38 Shreve PD, Anzai Y, Wahl RL. Pitfalls in Oncologic Diagnosis with FDG-PET Imaging: Physiologic and Benign Variants. Radiographics 1999;19:61-77.
  • 39 Cook GJ. Artifacts and normal variants in whole-body PET and PET/CT imaging. In : eds. Valk PE, Debelke D. Bailey DL, et al . Positron emission tomography: Clinical practice. Springer-Verlag: London; 2006. p. 63-78.
  • 40 Lin EC, Alavi A, Cheng E. Normal variants and benign findings. In : Lin EC, Alavi A. PET and PET/CT: A clinical guide. Theime: New York, NY; 2005. p. 32-54.
  • 41 Kostakoglu L, Wong JC, Barrington SF, Cronin BF, Dynes AM, Maisey MN. Speech-related visualization of laryngeal muscles with Fluorine-18-FDG. J Nucl Med 1996;37:1771-3.
  • 42 Heller MT, Meltzer CC, Fukui MB, Rosen CA, Chander S, Martinelli MA, et al . Superphysiologic FDG uptake in the non-paralyzed vocal cord. Resolution of a false-positive pet result with combined PET-CT imaging. Clin Positron Imaging 2000;3:207-11.
  • 43 Lee M, Ramaswamy MR, Lilien DL, Nathan CO. Unilateral vocal cord paralysis causes contralateral false-positive positron emission tomography scans of the larynx. Ann Otol Rhinol Laryngol 2005;114:202-6.
  • 44 Goerres GW, von Schulthess GK, Hany TF. Positron emission tomography and PET CT of the head and neck: FDG uptake in normal anatomy, in benign lesions and in changes resulting from treatment. AJR Am J Roentgenol 2002;179:1337-43.
  • 45 Graham MM, Menda Y. Positron emission tomography/computerized tomography imaging of head and neck tumors: An atlas. Semin Nucl Med 2005;35:220-52.
  • 46 Ferdinand B, Gupta P, Kramer EL. Spectrum of thymic uptake at 18F-FDG-PET. Radiographics 2004;24:1611-6.
  • 47 Yasuda S, Fujji H, Takahashi W, Takagi S, Ide M, Shohtsu A. Lactating breast exhibiting high F-18 FDG uptake. Clin Nucl Med 1998;23:767-8.
  • 48 Fukuchi K, Ohta H, Matsumura K, Ishida Y. Benign variations and incidental abnormalities of myocardial FDG uptake in the fasting state as encountered during routine oncology positron emission tomography studies. Br J Radiol 2007;80:3-11.
  • 49 Yeung HW, Grewal RK, Gonen M, Sch φder H, Larson SM. Patterns of 18F-FDG uptake in adispose tissue and muscle: A potential source of false positives for PET. J Nucl Med 2003;44:1789-96.
  • 50 Turcotte E, Benard F, Boucher L. Use of I.V. insulin to reduce blood glucose levels before FDG-scanning in diabetic patients. J Nucl Med 2000;41:294.
  • 51 Cohade C, Osman M, Pannu HK, Wahl RL. Uptake in supraclavicular area fat ("USA-Fat"): description on 18F-FDG-PET/CT. J Nucl Med 2003;44:170-6.
  • 52 Cohade C, Mourtzikos KA, Wahl RL. "USA-Fat": prevalence is related to ambient outdoor temperature-evaluation with 18F-FDG-PET/CT. J Nucl Med 2003;44:1267-70.
  • 53 Tatsumi M, Engles JM, Ishimori T, Nicely O, Cohade C, Wahl RL . Intense 18 F-FDG Uptake in Brown Fat Can Be Reduced Pharmacologically. J Nucl Med 2004;45:1189-93.
  • 54 Garcia CA, Van Nostrand D, Atkins F, Acio E, Butler C, Esposito G, et al . Reduction of brown fat 2-deoxy-2-[F-18]fluoro-D-glucose uptake by controlling environmental temperature prior to positron emission tomography scan. Mol Imaging Biol 2006;8:24-9.
  • 55 Bhargava, P, Zhuang, H, Kumar, R, Charron M, Alavi A. Iatrogenic artifacts on whole-body F-18 FDG-PET imaging. Clin Nucl Med 2004;29:429-39.
  • 56 Thie JA. Understanding the standardized uptake value, its methods and implications for usage. J Nucl Med 2004;45:1431-4.
  • 57 Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ. The dose uptake ratio as an index of glucose metabolism: Useful parameter or over simplication. J Nucl Med 1994;35:1308-12.
  • 58 Keyes JW. SUV: Standard uptake or silly useless value? J Nucl Med 1995;36:1836-9.
  • 59 Cremerius U, Fabry U, Neuerburg J, Zimny M, Bares R, Osieka R, et al . Prognostic significance of positron emission tomography using fluorine-18-fluorodeoxyglucose in patients treated for malignant lymphoma. Nuklearmedizin 2001;40:23-30.
  • 60 Lowe VJ, Fletcher JW, Gobar L, Lawson M, Kirchner P, Valk P, et al . Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 1998;16:1075-84.