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PET CT PRESENTATION

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Information about PET CT PRESENTATION
Education

Published on January 8, 2009

Author: swagatdash

Source: authorstream.com

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PET CT IN UROLOGICAL MALIGNANCIES : PET CT IN UROLOGICAL MALIGNANCIES Dr. Harsh Mahajan, MD Director & Chief Radiologist Department of Nuclear Medicine & PET CT Mahajan Imaging Centre Sir Ganga Ram Hospital New Delhi Why Use PET ? : Why Use PET ? PET assesses physiology and biochemical aspect rather than anatomy Disease picked up before structural changes Disease picked up despite structural distortions Whole body screening Grading of cancers Surveillance of high risk groups Prediction of response to therapy Issues in GU Malignancies : Issues in GU Malignancies Anatomical correlates offered by PET CT offer significant advantages in interpretation Application of iterative reconstruction methodology,ie. Optimized Segmentation Estimation Maximization (OSEM) in order to reduce the impact of radioactivity in the urinary tract and bladder on tumor detection and quantification Renal Malignancies : Renal Malignancies PET CT in Renal Malignancies : PET CT in Renal Malignancies Excretion of FDG through the urinary tract limits the utility of FDG PET imaging in the detection of renal cancers. PET and CT individually have comparable accuracy (94 %) Ramdave S,Gwynne T W,Berlangieri,S U et al 2001,J Uro 166:825-830 PET CT in Renal Malignancies : PET CT in Renal Malignancies Incremental role in restaging rather than primary staging of the disease Staging nodal involvement,detection of recurrence and evaluation of metastatic disease Superior to anatomical imaging for demonstrating changes in metabolic parameters following biological therapy Akhurst T,Ng V V,Larson S M et al 2000,Clin Positron Imag 3:57-65 Case : Case 68 Y /M Recently diagnosed case of left renal mass on routine USG History of one or two episodes of hematuria in the recent past Slide 12: Multiple mediastinal and abdominal lymph nodes Case : Case 52 Y / M Known case of left renal cell carcinoma diagnosed in 2007 Left radical nephrectomy performed on March 12, 2007 Underwent radiotherapy till May 18, 2007 Came for routine follow up Case : Case 42 Y /M Recently diagnosed case of right renal mass Slide 18: Mild FDG avid RCC, with no locoregional or distant metastasis Case : Case 49 Y /M Recently diagnosed case of right renal mass on USG PET CT scan for lesion characterisation and to guide for nephrectomy ( ? Partial ?? Radical) Slide 20: Upper pole RCC Slide 21: Partial nephrectomy for upper pole tumor PET CT in Renal malignancies : PET CT in Renal malignancies PET CT can specially help in noninvasive evaluation of Bosniak category III and IV renal masses Helpful in the non invasive characterization of malignant potential of small renal masses For loco regional and distant metastasis Sensitivity – 65 – 77% Specificity – 75 – 100 % PPV > 90% Clinical Nephrology 2002 Malignancies of Urinary Bladder : Malignancies of Urinary Bladder PET CT in urinary Bladder Carcinoma : PET CT in urinary Bladder Carcinoma FDG is excreted primarily through kidneys with consequent accumulation of significant radiotracer in the urinary bladder Difficult to diagnose and stage primary urothelial cancers Alternative radiotracers not having renal excretion have promising role 11C-choline,18F-flouroethylcholine,18F-methylcholine PET CT in Urinary bladder carcinoma : PET CT in Urinary bladder carcinoma Accurate nodal staging Sensitivity of 67 % and specificity of 86 % for the detection of pelvic lymph node metastasis ( Urologe Annals 1999) Improved detection of osseous and hepatic metastases Differentiating post radiation therapy scar from recurrent tumor Assessment of neoadjuvant therapy response Case : Case 65 Y /M Known case of high grade urothelial carcinoma arising from the prostatic urethra Underwent TURP and radiotherapy till December 2007 Complaining of mild decrease in the urinary outflow with nodules in the shaft of the penis PET CT scan for the evaluation of disease status Slide 27: Carcinoma urinary bladder with hepatic and penile metastasis Slide 28: Carcinoma bladder with multiple hepatic, penile and lymph nodal metastasis Case : Case 80 Y/ M Known case of high grade transitional carcinoma of bladder Underwent CPE, TURP, TURBT PET CT for the evaluation of locoregional and distant metastatic disease Slide 30: Recurrence at bladder base with mediastinal lymphadenopathy Prostate Cancers : Prostate Cancers PET CT in Prostatic Malignancies : PET CT in Prostatic Malignancies Diagnosis & initial staging Advanced metastatic disease Recurrent disease Monitoring treatment response Rakesh Kumar MD, Hongming Zhuang MD, PhD and Abass Alavi MD , Radiologic clinics of North America,November 2004 PET CT in Prostatic Malignancies : PET CT in Prostatic Malignancies Case : Case 76 Y/ M Known case of transitional carcinoma of penile urethra Status post operative Presented with complaints of recent onset of severe left hip pain Slide 36: Sternal and left sacroiliac joint skeletal metastases PET Radiotracers in Prostate Cancer : PET Radiotracers in Prostate Cancer 18F-FDG 18F-fluoride 11C-acetate 11C-methionine 11C-choline 18F-fluoroethylcholine 18F-methylcholine 18F-cis-4-L-proline 15O-H2O 18F-fluoromisonidazole

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