Table Of ContentPET and PET/CT: A Clinical Guide
Second Edition
PET and PET/CT: A Clinical Guide
Second Edition
Eugene C. Lin, MD
Clinical Assistant Professor of Radiology
Department of Radiology
University of Washington
Virginia Mason Medical Center
Seattle, Washington
Abass Alavi, MD, MD(Hon), PhD(Hon)
Professor of Radiology and Neurology
Director of Research Education
Department of Radiology
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Thieme
New York • Stuttgart
Thieme Medical Publishers, Inc.
333 Seventh Ave.
New York, NY 10001
Executive Editor: Timothy Hiscock
Vice President, Production and Electronic Publishing: Anne T. Vinnicombe
Production Editor: Heidi Grauel, Maryland Composition
Vice President, International Marketing and Sales: Cornelia Schulze
Chief Financial Offi cer: Peter van Woerden
President: Brian D. Scanlan
Compositor: Manila Typesetting Company
Printer: Everbest Printing Co.
Library of Congress Cataloging-in-Publication Data
PET and PET/CT : a clinical guide / edited by Eugene C. Lin, Abass Alavi. — 2nd ed.
p. ; cm.
Rev. ed. of: PET and PET/CT / Eugene Lin, Abass Alavi. c2005.
Includes bibliographical references and index.
ISBN 978-1-60406-153-6
1. Tomography, Emission. I. Lin, Eugene. II. Alavi, Abass. III. Lin, Eugene. PET and PET/CT.
[DNLM: 1. Positron-Emission Tomography — methods. 2. Fluorodeoxyglucose F18 — diagnostic use. WN
206 P4765 2008]
RC78.7.T62L56 2008
616.07’575 — dc22
2008048664
Copyright © 2009 by Thieme Medical Publishers, Inc. This book, including all parts thereof, is legally protected
by copyright. Any use, exploitation, or commercialization outside the narrow limits set by copyright legislation
without the publisher’s consent is illegal and liable to prosecution. This applies in particular to photostat
reproduction, copying, mimeographing or duplication of any kind, translating, preparation of microfi lms, and
electronic data processing and storage.
Important note: Medical knowledge is ever-changing. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy may be required. The authors and editors of the material
herein have consulted sources believed to be reliable in their efforts to provide information that is complete
and in accord with the standards accepted at the time of publication. However, in view of the possibility of
human error by the authors, editors, or publisher of the work herein or changes in medical knowledge, neither
the authors, editors, nor publisher, nor any other party who has been involved in the preparation of this work,
warrants that the information contained herein is in every respect accurate or complete, and they are not
responsible for any errors or omissions or for the results obtained from use of such information. Readers are
encouraged to confi rm the information contained herein with other sources. For example, readers are advised
to check the product information sheet included in the package of each drug they plan to administer to be
certain that the information contained in this publication is accurate and that changes have not been made in
the recommended dose or in the contraindications for administration. This recommendation is of particular
importance in connection with new or infrequently used drugs.
Some of the product names, patents, and registered designs referred to in this book are in fact registered
trademarks or proprietary names even though specifi c reference to this fact is not always made in the
text. Therefore, the appearance of a name without designation as proprietary is not to be construed as a
representation by the publisher that it is in the public domain.
Printed in China
5 4 3 2 1
ISBN 978-1-60406-153-6
I would like to thank my colleagues at Virginia Mason Medical Center for providing
an environment which allowed me to write this book and Drs. Marie Lee and Paul
Sicuro for help in obtaining many of the images in this book. My parents instilled in
me a love of learning and working with residents and fellows throughout my career
has inspired me to continually seek out new knowledge.
Eugene C. Lin
I wish to dedicate this book to my mother Fatemeh and my wife Jane for sacrifi ces
they have made to make my life most rewarding; I cannot thank them enough for
their enormous encouragements all along.
Abass Alavi
Contents
Preface .............................................................. xi
Contributors ........................................................ xiii
I Basic Science ..................................................... 1
Chapter 1: The Physics of PET/CT Scanners
Ruth E. Schmitz, Adam M. Alessio, and Paul E. Kinahan ............. 3
Chapter 2: Basics of Fluorodeoxyglucose Radiochemistry and Biology
Neale S. Mason and Eugene C. Lin ............................. 15
Chapter 3: The Role of Glucose and FDG Metabolism in the
Interpretation of PET Studies
Ronald L. Korn, Alison Coates, and John Millstine ................. 22
II Clinical Basics .................................................. 31
Chapter 4: Patient Preparation
Eugene C. Lin and Abass Alavi ................................ 33
Chapter 5: Standardized Uptake Value
Eugene C. Lin, Abass Alavi, and Paul E. Kinahan .................. 38
Chapter 6: Normal Variants and Benign Findings
Eugene C. Lin and Abass Alavi ................................ 42
Chapter 7: The Interpretation of FDG PET Studies
Eugene C. Lin and Abass Alavi ................................ 78
Chapter 8: The Value of PET/CT
Eugene C. Lin, Paul E. Kinahan, and Abass Alavi .................. 88
Chapter 9: Levels of Evidence for Clinical Indications of FDG PET
Eugene C. Lin ............................................. 99
III Oncologic Applications ........................................ 101
Chapter 10: Oncologic PET by Anatomical Region
Eugene C. Lin and Abass Alavi .............................. 103
Chapter 11: Therapy Response
Eugene C. Lin and Abass Alavi .............................. 117
Chapter 12: Brain Neoplasms
Eugene C. Lin and Abass Alavi .............................. 121
Chapter 13: Head and Neck Cancer
Eugene C. Lin and Abass Alavi .............................. 127
Chapter 14: Thyroid Cancer
Eugene C. Lin and Abass Alavi .............................. 136
Chapter 15: Thoracic Neoplasms
Eugene C. Lin and Abass Alavi .............................. 142
s
t
n Chapter 16: Breast Cancer
e
nt Eugene C. Lin, Marie E. Lee, and Abass Alavi ................... 155
o
C
Chapter 17: Gastric, Esophageal, and Gastrointestinal Stromal Tumors
Eugene C. Lin and Abass Alavi .............................. 164
Chapter 18: Lymphoma
Eugene C. Lin and Abass Alavi .............................. 173
Chapter 19: Melanoma
Eugene C. Lin and Abass Alavi .............................. 181
Chapter 20: Hepatobiliary Tumors
Eugene C. Lin and Abass Alavi .............................. 185
Chapter 21: Pancreatic Cancer
Eugene C. Lin and Abass Alavi .............................. 190
viii
Chapter 22: Gynecologic Tumors
Eugene C. Lin and Abass Alavi .............................. 196
Chapter 23: Urologic Tumors
Eugene C. Lin and Abass Alavi .............................. 204
Chapter 24: Colorectal Cancer
Eugene C. Lin and Abass Alavi .............................. 212
Chapter 25: Musculoskeletal Tumors
Eugene C. Lin and Abass Alavi .............................. 220
IV Nononcologic Applications .................................... 229
Chapter 26: Pediatric PET/CT
M. Beth McCarville ...................................... 231
Chapter 27: PET and PET/CT in Radiation Therapy Planning
Sandip Basu, Guobin Song, Abass Alavi, and Eugene C. Lin ........ 239
Chapter 28: FDG PET in the Evaluation of Infection and Infl ammation
Sandip Basu, Abass Alavi, and Eugene C. Lin ................... 245
Chapter 29: Neurologic Applications
Eugene C. Lin and Abass Alavi .............................. 257
s
t
Chapter 30: Cardiac PET and PET/CT n
e
Amol Takalkar, Eugene C. Lin, Elias Botvinick, nt
o
Adam M. Alessio, and Luis Araujo ........................... 263 C
Index .............................................................. 275
ix
