British Journal of Radiology (2006) 79, 32-36
© 2006 British Institute of Radiology
doi: 10.1259/bjr/18454286
President's conference papers |
The contribution of PET/CT to improved patient management
P J Ell, FMedSci, FRCP, FRCR
Institute of Nuclear Medicine, UCL, London, UK
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Abstract
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With the introduction of both SPET/CT and PET/CT, multimodality imaging has truly entered routine clinical practice. Multiple slice spiral CT scanners have been incorporated with multiple detector gamma cameras or PET systems, such that the benefit of these modalities can be achieved in one patient sitting. The subject of this manuscript is PET/CT and its impact on patient management. Applications of PET/CT span the whole field of medical and surgical oncology since very few cancers do not take up the labelled glucose tracer, 18F-FDG. Given the contrast achieved, high-quality data can be obtained with FDG PET/CT. This technology has now spread worldwide and has been the subject of intense interest, as witnessed by the vast body of published evidence. In this short overview, only a brief discussion of the main clinical applications is possible. Novel applications of PET/CT outside the field of oncology are expected in the near future.
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Introduction
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The technologies of positron emission tomography (PET) and spiral computed tomography (CT) have been combined in a single multimodality detection instrument. The PET/CT scanner provides, in a single patient sitting, both the data to be expected from a high-end advanced spiral CT scanner and information recorded by a top of the range PET scanner, capable of depicting the distribution of positron-labelled tracers such as fluorodeoxyglucose (FDG). Routine image fusion is obtained, CT data being merged with PET data to aid in the exact localization of the site of FDG uptake. CT information is also used for the purpose of attenuation correction, which is now almost instantaneous; as a consequence, whole-body PET/CT studies can be obtained in less than 30 min. This has led to an increase in patient acceptance and throughput (30% over that achieved with PET alone). Scanning times are expected to improve further in the near future. With PET/CT studies obtained from a flat bed, this information can be used to improve radiotherapy planning, a novel and rapidly evolving application of this technology. PET/CT leads to improved lesion detection and localization and a faster learning curve for all involved; it has achieved significant acceptance at multidisciplinary case conferences [1, 2].
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Applications
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Tables 1 and 2
summarize the present and predicted areas of application of PET/CT, and anticipated changes in tracer use. There are realistic expectations that a number of novel tracers, labelled with, for example, 18F or even 68Ga (to mention just two radionuclides), will lead to useful clinical studies on atherosclerosis [3], angiogenesis, hypoxia and detection of amyloid plaque in Alzheimer's disease. Other tracers such as 18F-labelled thymidine (FLT: a marker of TK1 activity and indirectly of cellular proliferation) and 18F-labelled dopamine have already been applied in the fields of oncology (FLT and dopamine) [34, 35] and movement disorders (dopamine). The discussion below will, however, be restricted to the use of FDG in oncology.
Labelled FDG provides some of the highest signal-to-noise ratios to have been observed in nuclear medicine. This is the result of a number of factors which play a role in the cellular uptake of FDG: over-expression of membrane GLUT transporters, increased glucose transport in malignancy, increased glycolysis, and increased hexokinase activity coupled with a decrease in glucose-6-phosphatase activity. It is also now well known that maximal FDG uptake in the lesion is not reached within the first hour of intravenous administration. Invariably, a further increase in the signal-to-noise ratio can be observed at 2 h, and a plateau is reached much later. It must also be stressed that FDG is not a cancer-specific ligand: macrophages actively take up FDG [4, 5], and granulomas and inflammatory lesions can be falsely interpreted as malignant.
From a practical point of view, the unit most often used to quantitate FDG uptake is the standardized uptake value (SUV). This normalizes the FDG taken up in a region of interest to the total amount of tracer injected and the patient's body weight. The SUV is time dependent, since FDG continues to accumulate during the period of imaging. For each study, SUVs have to be measured at the same time after administration of FDG. From a region of interest, average or maximum SUVs can be obtained, the maximum SUV being the most reproducible value for comparative purposes. SUVs greater than three are most often associated with malignancy. Whilst this cut-off is somewhat arbitrary, it is of value since it helps to distinguish malignant from benign nodal disease: enlarged nodes on CT with low SUVs are almost always benign.
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PET/CT and FDG in oncology
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As one might expect, the main areas of interest are in diagnosis, staging, treatment monitoring and radiotherapy planning [6].
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Diagnosis
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PET/CT is infrequently used to offer or aid in the diagnosis of a patient's primary condition, the principal indications for this purpose being suspected paraneoplastic syndrome, pyrexia of unknown origin and unresolved suspicion of a CNS tumour (the more frequent application is for differential diagnosis of post-treatment radiation necrosis versus recurrence, rather than diagnosis at presentation). Impressive data have been obtained in the diagnosis of paraneoplastic syndromes and a variety of vasculitides and arteritides [7]. Occasionally PET has helped in the evaluation of patients with malignant paragangliomas and carcinoid tumours [8], and PET/CT holds promise for this indication.
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Staging and re-staging
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It is in the setting of cancer staging that PET/CT comes into its own. Combined PET/CT has been shown to be superior to other imaging modalities in most tumour types. A gain of 20% was documented when the TNM tumour classification was used as the comparator and PET/CT was compared with whole-body MRI [9].
In lymphoma, PET/CT is better than CT in the diagnosis of both nodal and extranodal disease, and can detect disease in normal-sized lymph nodes that will be overlooked by CT. As a consequence, PET/CT upstages approximately 40% of all cases of lymphoma. PET/CT is also better than CT for the purpose of post-therapy evaluation owing to its greater predictive value: a positive post-treatment PET study is associated with poorer prognosis, whilst a scan performed after the first cycle of treatment is often predictive of response, especially in cases of aggressive Hodgkin's disease and non-Hodgkin's lymphoma [10–12]. FDG PET is useful to guide adoptive immunotherapy with donor lymphocyte infusions post transplant [13].
With regard to non-small cell lung cancer (NSCLC), three major studies have shown that PET/CT prevents unnecessary surgery in one out of five patients deemed operable by other criteria [14–16]. This is because PET/CT upstages a large proportion of patients by demonstrating both soft tissue and skeletal involvement. A further study found that PET/CT resulted in a change in management in 30% of patients with NSCLC [17]. Recently, Goren et al [18] discussed the relative roles of CT, PET and endoscopic-guided ultrasound with needle aspiration in the management of patients with lung cancer.
There is a clear clinical role for PET/CT in colorectal cancer. It is of value for staging of recurrent disease, detection of liver involvement, detection of local recurrence, differential diagnosis of recurrent disease from scar and assessment of patients who present with rising tumour markers [19–21]. A meta-analysis carried out over a 5-year period showed that FDG PET changed the management in approximately 35% of patients in the setting of colorectal cancer. Often PET/CT demonstrates multiple liver deposits not seen on other imaging modalities [22]. A case could now be made that PET/CT should be the first imaging modality to be employed in the staging and re-staging of colorectal cancer.
PET/CT is also applied to the staging and re-staging of patients with cancers in the head and neck, breast, oesophagus, pancreas, cervix and testicle, as well as patients with sarcomas and melanomas.
In the head and neck, PET/CT misses micrometastatic disease (as do all imaging modalities) but it is useful in the context of upstaging N0 disease [23, 24]. In patients who present with cervical adenopathy and negative cross-sectional imaging (CT/MRI), PET/CT is a useful investigation [25]. Patients with advanced disease tend to be upstaged with PET/CT. PET/CT is useful in disease monitoring after therapy (surgery, chemotherapy or radiation), but the optimal timing of this application remains controversial. The possibility of a false positive inflammatory response must be borne in mind. In thyroid cancer, PET/CT should be restricted to the re-staging of patients with raised serum markers (thyroxine-binding globulin, calcitonin, carcinoembryonic antigen) who present with negative cross-sectional imaging and negative 131I scans [26, 27].
In breast cancer, PET/CT is not used to stage the axilla owing to its failure to detect micrometastatic disease. PET/CT is, however, useful in re-staging, in the detection of nodal disease and in the visualization of distant disease in unsuspected sites. PET/CT scanning uncovers deposits in the skeleton and can be helpful in the evaluation of internal mammary and mediastinal node involvement. It also appears useful in the evaluation of response to treatment, absence of response on PET/CT carrying a worse prognosis. Scarring and fibrotic masses can be distinguished from active disease on the basis of FDG uptake.
In the curative setting, PET/CT is used for the investigation of the nodal spread of oesophageal cancer. Here, PET/CT is better than CT alone. A growing body of evidence shows the utility of PET/CT in the evaluation of response to therapy. A study by Weber et al [28] investigated 40 patients. A PET study was performed at baseline and 2 weeks after initiation of chemotherapy. The first scan had a sensitivity of 93% and a specificity of 95%. Patients who responded to therapy had a reduction in FDG uptake by 54%, whilst in non-responders the reduction in FDG was of the order of 15% or less. In a similar study by Brucher et al [29], 27 patients with oesophageal carcinoma were given chemotherapy and radiotherapy. Patients responding to the treatment had a reduction in FDG uptake of 72%, whereas those who did not respond had a reduction of only 22%. Most studies of this type now point to the utility of FDG PET in the assessment of early response to treatment.
In melanoma patients, PET/CT is not useful for initial staging or in early disease, but it is of value for re-staging of more advanced disease. Melanoma metastases are intensely FDG avid. PET/CT is also used in the re-staging of patients with carcinoma of the cervix. Recurrent disease can be distinguished from non-viable necrotic or fibrotic post-therapy tissue. PET/CT has been used in a variety of other cancer types, such as GIST tumours, mesotheliomas, multiple myelomas and sarcomas. Pancreatic cancer, neuroendocrine tumours and germ cell tumours and their deposits can all exhibit intense FDG uptake. In contrast, prostate cancer and deposits from this tumour often exhibit poor FDG avidity; hence PET/CT with FDG is not useful in this context.
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Treatment monitoring
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In part, this application has already been alluded to. It is evident that a metabolic response can precede a change in tumour size, and a reduction in FDG uptake can be seen within a matter of hours in patients with lymphoma or germ cell cancer in whom treatment is effective [30, 31]. Eventually PET/CT will be used to assess the biology of the individual tumour and its response to treatment [32], with novel markers aimed at imaging proliferation [33–36], hypoxia, angiogenesis, apoptosis, etc.
PET/CT is useful to assess the efficacy of novel therapies. This has been demonstrated with Gleevec in the treatment of germ cell cancers, but PET/CT will have wide applicability in a number of new settings. It will be used as a surrogate marker for drug response, and this might imply yet another revision of the established but still insufficiently used RECIST criteria for tumour response to therapy.
Eary et al [37], studied the effect of tumour heterogeneity, reflected in heterogeneity in FDG uptake, in patients with sarcomas. A 30% increase in risk of death was observed for every increase of 1 standard deviation (SD) in tumour heterogeneity, and there was a 12% increase in risk of death for every increase of 1 SD in the maximum SUV. However, the concept of a metabolic response as assessed by FDG will need to be validated in larger studies. In breast carcinoma patients treated with Tamoxifen, a flare response, albeit transient, has been described [38]. When such a response occurs it tends to do so 8–10 days after the commencement of Tamoxifen, and is usually an indicator of subsequent patient response to the treatment [38]. It is also recognized that patients studied soon after radiotherapy may exhibit an increase in FDG activity owing to an inflammatory response [39]. MacManus et al [40] have nevertheless shown the utility of evaluation of the metabolic response by PET in patients with NSCLC.
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Radiotherapy planning
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A PET/CT scanner can be used to inform radiotherapy planning. The CT component of the instrument is identical to a conventional spiral CT and modern PET/CT scanners are available with 4-, 8- or 16-slice spiral CT scans. The CT component can be used for attenuation purposes only, in order to aid in the localization of the abnormality seen on the PET scanner, or it can be used at high power to record data identical to those that would be obtained using a conventional CT. In patients with cancer, radiation exposure should often be considered of secondary importance, given their age, survival rates and therapeutic aspects. It can therefore be argued that PET/CT should become the first imaging study in a significant proportion of patients with cancer. From the above it can be seen that the CT information obtained from the PET/CT instrument can also be used for the purpose of volume planning and that the available PET information can be similarly used to better delineate tumour margins, whilst also distinguishing viable from non-viable tumour and aggressive from less aggressive disease. Ultimately, a more rational approach to radiotherapy planning is an achievable goal. Data are beginning to accrue that confirm this approach and its utility [41].
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Imaging the skeleton
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With PET, it is possible to obtain data from skeletal metastases via two tracers: 18F-labelled fluoride ion, which is directly taken up by the skeleton, and 18F-FDG. More data need to be obtained before final recommendations can be made regarding the use of these two tracers for skeletal imaging. It is already apparent, however, that in many cancers, FDG can demonstrate both soft tissue and skeletal involvement; indeed, it has been advocated that conventional bone scanning is no longer required when staging NSCLC patients with FDG. In multiple myeloma, FDG is superior to conventional bone scanning in the detection of bony deposits. If scanner availability and tracer costs were not limiting factors, 18F-fluoride scanning of the skeleton would come to replace the conventional bone scan owing to the merits of PET/CT co-registration in the context of both malignant and benign bone disease [42–44].
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Future developments
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Multimodality imaging is here to stay and image fusion will become routine. The first truly routine implementation of image fusion involving a large number of patients has been achieved with PET/CT. The design properties of PET/MRI are under consideration, and progress has already been made in this field with small animal scanners. The next generation of PET/CT technology is likely to make use of new radiation detectors and electronics. Discussions are now focusing, for example, on the reduction of whole-body imaging times to less than 15 min and the introduction of routine respiratory and cardiac gating for improvement of lesion localization and margin definition. Multiple slice spiral CT scans will open the way for cardiac imaging, and interesting developments are expected in this field, which, as with nuclear medicine in general, is heavily dependent on the emergence of new, clinically useful ligands. There is realistic hope that these new ligands will lead to novel practical applications in neurology, cardiology and oncology. As individually tailored medicines begin to impact on healthcare, these technologies will find special relevance in determining patient response to these therapies. An early indicator of lack of response may be not only beneficial but also immensely important in economic terms. The future for PET/CT imaging as a surrogate endpoint for novel therapeutic interventions is bright. This will imply a rethink of traditional criteria for lesion response – conventional RECIST criteria will need to be re-assessed in the light of the metabolic parameter made available by PET [45].
Received for publication May 31, 2005.
Accepted for publication September 6, 2005.
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References
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|---|
- Ell PJ and von Schulthess GK. PET/CT: A new road map. Eur J Nucl Med 2002;29:719–20.
- Schoder H, Erdi YE, Larson SM, Yeund, HWD. PET/CT: a new imaging technology in nuclear medicine. Eur J Nucl Med Mol Imaging 2003;30:1419–37.[CrossRef][Medline]
- Davies RJ, Rudd JH, Weissberg PL. Molecular and metabolic imaging of atherosclerosis. J Nucl Med 2004;45:1898–907.[Abstract/Free Full Text]
- Bomanji JB, Syed R, Brock C, Jankowska P, Dogan A, Costa DC, et al. Challenging cases and diagnostic dilemmas: case 2. Pitfalls of positron emission tomography for assessing residual mediastinal mass after chemotherapy for Hodgkin's disease. J Clin Oncol 2002;20:3347–9.[Free Full Text]
- Kjaer A, Lebech AM, Eigtved A, et al. Fever of unknown origin: prospective comparison of diagnostic value of 18F-FDG PET and 111ln-granulocyte scintigraphy. Eur J Nucl Med Mol Imaging 2004;31:622–6.[CrossRef][Medline]
- Bomanji JB, Costa DC, Ell PJ. The clinical role of positron emission tomography. The Lancet Oncology 2001;3:157–64.
- Rees J, Hain, Johnson N, Hughes, Costa DC, Ell PJ. The role of fluorodeoxyglucose positron emission tomography scanning in the diagnosis of paraneoplastic neurological disorders. Brain 2001;124:2223–31.[Abstract/Free Full Text]
- Le Rest C, Bomanji JB, Costa DC, Townsend CE, Visvikis D, Ell PJ. Functional imaging of malignant paragangliomas and carcinoid tumours. Eur J Nucl Med 2001;38:478–82.
- Antoch G, Vogt FM, Freudenberg LS, Nazaradeh F, Goehde SC, Barkhausen J, et al. Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology. JAMA 2003;290:3199–206.[Abstract/Free Full Text]
- Burton C, Ell PJ, Linch D. The role of PET imaging in lymphoma. Br J Haematol 2004;126:772–84.[CrossRef][Medline]
- Hillner BE, Tunuguntla R, Fratkin M. Clinical decisions associated with positron emission tomography in a prospective cohort of patients with suspected or known cancer at one United States center. J Clin Oncol 2004;22:4147–56.[Abstract/Free Full Text]
- Hutchings M, Eigtved AI, Specht L. FDG-PET in the clinical management of Hodgkin's lymphoma. Crit Rev Oncol/Hematol 2004;52:19–32.[Medline]
- Hart DP, Avivi I, Thomson KJ, Peggs KS, Morris EC, Goldstone AH, et al. Use of 18F-FDG positron emission tomography following allogeneic transplantation to guide adoptive immunotherapy with donor lymphocyte infusions. Br J Haematol 2005;128:824–9.[Medline]
- Lardinois D, Weder W, Hany TF, Kamel EM, Korom S, Seifert B, et al. Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomography. N Engl J Med 2003;348:2500–7.[Abstract/Free Full Text]
- van Tinteren H, Hoekstra OS, Smit EF, van den Bergh JH, Schreurs AJ, Stallaert RA, et al. Effectiveness of positron emission tomography in the preoperative assessment of patients with suspected non-small-cell lung cancer: the PLUS multicentre randomised trial. Lancet 2002;359:1388–93.[CrossRef][Medline]
- Verboom P, van Tinteren H, Hoekstra OS, Smit EF, van den Bergh HAM, Schreurs AJM, et al, and the PLUS study group. Cost-effectiveness of FDG-PET in staging non-small cell lung cancer: the PLUS study. Eur J Nucl Med Mol Imaging 2003;30:1444–9.[CrossRef][Medline]
- Keidar Z, Haim N, Guralnik L, et al. PET/CT using 18-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management. J Nucl Med 2004;45:1640–6.[Abstract/Free Full Text]
- Goren HJM, Slijfer DTh, deVries EGE. Positron emission tomography, computerized tomography, and endoscopic ultrasound with needle aspiration of lung cancer. ASCO Educational Book 2005:579–86.
- Arulampalam THA, Costa DC, Loizidou M, Visvikis D, Ell PJ, Taylor I. Positron emission tomography in colorectal cancer. Br J Surg 2001;88:176–89.[CrossRef][Medline]
- Arulampalam THA, Francis DL, Visvikis D, Taylor I, Ell PJ. FDG-PET for the pre-operative staging of colorectal liver metastases. Eur J Surg Oncol 2004;30:286–91.[CrossRef][Medline]
- Huebner RH, Park KC, Shepherd JE, Schwimmer J, Czernin J, Phelps ME, et al. A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancer. J Nucl Med 2000;41:1177–89.[Abstract/Free Full Text]
- Dietlein M, Weber W, Schwaiger M, Schicha H. [18F-Fluorodeoxyglucose positron emission tomography in restaging of colorectal cancer. Nuklearmedizin 2003;42:145–56.[Medline]
- Hyde NC, Prvulovich E, Newman L, Waddington WA, Visvikis D, Ell PJ. A new approach to pre-treatment assessment of the NO neck in oral squamous cell carcinoma: the role of sentinel node biopsy and positron emission tomography. Oral Oncol 2003;29:350–60.
- Myers LL, Wax MK, Nabi H, Simpson GT, Lamonica D. Positron emission tomography in the evaluation of the N0 neck. Laryngoscope 1998;108:232–6.[CrossRef][Medline]
- Hughes SJ, Prvulovich EM, Witherow H, Kalavrezos N, Ell PJ. A comparison of FDG PET/CT and MRI versus histology for staging of primary head and neck cancers and detection of recurrent disease. J Nucl Med 2004;45:80.[Abstract/Free Full Text]
- Chung JK, So Y, Lee JS, Choi CW, Lim SM, Lee DS, et al. Value of FDG PET in papillary thyroid carcinoma with negative 131I whole-body scan. J Nucl Med 1999;40:986–92.[Abstract/Free Full Text]
- Schluter B, Bohuslavizki KH, Beyer W, Plotkin M, Buchert R, Clausen M. Impact of FDG PET on patients with differentiated thyroid cancer who present with elevated thyroglobulin and negative 131I scan. J Nucl Med 2001;42:71–6.[Abstract/Free Full Text]
- Weber WA, Ott K, Becker K, Dittler HJ, Helmberger H, Avril NE, et al. Prediction of response to preoperative chemotherapy in adenocarcinomas of the esophagogastric junction by metabolic imaging. J Clin Oncol 2001;19:3058–65.[Abstract/Free Full Text]
- Brucher BL, Weber W, Bauer M, Fink U, Avril N, Stein HJ, et al. Neoadjuvant therapy of esophageal squamous cell carcinoma: response evaluation by positron emission tomography. Ann Surg 2001;233:300–9.[CrossRef][Medline]
- Hoekstra OS, Ossenkoppele GJ, Golding R, van Lingen A, Visser GW, Teule GJ, et al. Early treatment response in malignant lymphoma, as determined by planar fluorine-18-fluorodeoxyglucose scintigraphy. J Nucl Med 1993;34:1706–10.[Abstract/Free Full Text]
- Oliver T, Shamash J, Powles T, Somassundram U, Ell PJ. 20 years phase
study of single agent carboplatin in metastatic seminoma: could it have been accelerated by 72 hour PET scan response? ASCO, New Orleans, June 2004. - Brugarolas J, Clark JW, Chabner B. Using "rationally designed drugs" rationally. Lancet 2003;361:1758–9.[CrossRef][Medline]
- Francis DL, Visvikis D, Costa DC, Croasdale I, Arulampalam TH, Luthra SK, et al. Assessment of recurrent colorectal cancer following 5-fluorouracil chemotherapy using both 18FDG and 18FLT PET. Eur J Nucl Med Mol Imaging 2004;31:928.[Medline]
- Francis DL, Freeman A, Visvikis D, Costa DC, Luthra SK, Novelli M, et al. In vivo imaging of cellular proferation in colorectal cancer using Positron Emission Tomography. Gut 2003;52:1602–6.[Abstract/Free Full Text]
- Francis DL, Visvikis D, Costa DC, Arulampalam THA, Townsend C, Luthra I, et al. Potential impact of [18F]3'-deoxy-3'-fluorothymidine versus [18F] fluoro-2-deoxy-D-glucose in Postron Emission Tomography for colorectal cancer. Eur J Nucl Med 2003;30:988–94.[CrossRef][Medline]
- Shields AF, Grierson JR, Dohmen BM, et al. Imaging in vivo proliferation with 18FLT and positron emission tomography. Nature Med 1998;11:1334–6.
- Eary JF, Brenner W, Vernon C, and O'Sullivan F. Tumor heterogeneity in sarcoma patients is a significant predictor of survival. Eur J Nucl Med Mol Imaging 2004;31 Suppl. 2:S232.
- Dehdashti F, Flanagan FL, Mortimer JE, Katzenellenbogen JA, Welch MJ, Siegel BA. Positron emission tomographic assessment of "metabolic flare" to predict response of metastatic breast cancer to antiestrogen therapy. Eur J Nucl Med 1999;26:51–6.[CrossRef][Medline]
- Strauss LG. Fluorine-18-deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med 1996;23:1409–15.[CrossRef][Medline]
- MacManus MP, Hicks RJ, Matthew JP, et al. Positron emission tomography is superior to computed tomography scanning for response-assessment after radical radiotherapy or chemotherapy in patients with non-small-call lung cancer. J Clin Oncol 2003;21:1285–92.[Abstract/Free Full Text]
- Scarfone C, Lavely WC, Cmelak AJ, Delbeke D, Martin WH, Billheimer D, et al. Prospective feasibility trial of radiotherapy target definition for head and neck cancer using 3-dimentional PET and CT imaging. J Nucl Med 2004;45:543–52.[Abstract/Free Full Text]
- Schirrmeister H, Guhlmann A, Kotzerke J, Santjohanser C, Kuhn T, Kreienberg R, et al. Early detection and accurate description of extent of metastatic bone disease in breast cancer with fluoride ion and positron emission tomography. J Clin Oncol 1999;17:2381–9.[Abstract/Free Full Text]
- Cook GJ, Houston S, Rubens R, Maisey MN, Fogelman I. Detection of bone metastases in breast cancer by 18FDG PET: differing metabolic activity in osteoblastic and osteolytic lesions. J Clin Oncol 1998;16:3375–9.[Abstract]
- Gayed I, Vu T, Johnson M, Macapinlac H, Podoloff D. Comparison of bone and 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography in the evaluation of bony metastases in lung cancer. Mol Imaging Biol 2003;5:26–31.[CrossRef][Medline]
- Schuetze SM, Eary JF, Griffith KA, Rubin BP, Hawkins DS, Vernon CB, et al. FDG PET but not RECIST agrees with histological response of soft tissue sarcoma to neoadjuvant chemotherapy. ASCO 2005.
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Top
Abstract
Introduction
