Positron Emission Tomography with Computed Tomography (PET/CT)

135 Pages·2015·8.12 MB·English

Positron Emission
Tomography with
Computed Tomography
(PET/CT)
Jonas Francisco Y. Santiago
123
Positron Emission Tomography with Computed
Tomography (PET/CT)

Jonas Francisco Y. Santiago
Positron Emission
Tomography with Computed
Tomography (PET/CT)
Jonas Francisco Y. Santiago
Department of Nuclear Medicine
and PET Center
St. Luke’s Medical Center
Taguig City, MM
Philippines
ISBN 978-3-319-05517-6 ISBN 978-3-319-05518-3 (eBook)
DOI 10.1007/978-3-319-05518-3
Springer Cham Heidelberg New York Dordrecht London
Library of Congress Control Number: 2014942986
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This book is dedicated to Agnetha and
Frida, the two women who have inspired
me endlessly for the last 33 years to work
hard and to dream big.

Foreword
This textbook explains clearly how molecular hybrid imaging technology can con-
tribute to the management of a very diverse group of patients with emphasis on the
singular experience at St. Luke’s Hospital. It is particularly relevant to have this
experience made available generously through the efforts of Dr. Santiago to ensure
the success and broad application of this modality to help the nation in terms of the
proper management of all of these patients. This is a laudable effort to ensure accu-
rate diagnosis, proper monitoring of therapy and early detection of recurrence and
management of these patients in the most effi cient fashion. It is certain that such
advanced technology entails high costs, but multiple studies have demonstrated that
the outcome benefi ts such as ensuring proper diagnosis is reached early and proper
therapy performed for the right patient outweighs the overhead. The great majority
of the chapters in this book are for rare and unusual cases. This would be useful in
a situation when one encounters in practice various types of tumors as well as infec-
tious and benign processes which could interfere or manifest the pattern of expected
FDG activity to be different from what we expect. It is with great care that the
author has ensured that there be citations to allow the readers to go further and dig
deeper through the widely available literature and corroborate and enhance the
guidance provided by the book. I have known Dr. Santiago and Mr. Ledesma per-
sonally and recognized early on that they were visionaries in introducing this
modality into the country at a time when people thought it was foolhardy. It was a
bold step which allowed practicing physicians to keep abreast of the modalities
available to the rest of the advanced centers and not only in providing the best care,
but in ensuring that the trainees and future physicians are made aware of the
advances of molecular imaging and its advantages for the patient. For imaging phy-
sicians, experience in molecular imaging cannot be overemphasized. The manage-
ment of cancer patients for which FDG PET/CT imaging is used around the world
involves a multidisciplinary team. Patients are no longer cared for by a single physi-
cian, but by a team of physicians, and a critical member of such a team is the imag-
ing specialist. We no longer are confi ned to the subspecialties of anatomy based
modalities such as radiology or more functional based modalities such as nuclear
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viii Foreword
medicine. The future is bright for physicians to be experienced in both functional
and anatomical modalities to ensure that they hold an essential place in multidisci-
plinary care of not only cancer patients, but patients in general. Care of patients is a
collaborative enterprise and this excellent textbook is making a major contribution
to enhancing the ability of Filipino physicians in their various disease management
teams to provide the very best care for their patients. I highly recommend this text-
book to physicians and trainees who might deal with the challenge of providing the
right treatment to the right patient at the right time.
Homer A. Macapinlac
Division of Diagnostic Imaging
Department of Nuclear Medicine
The University of Texas MD Anderson Cancer Center
Houston , TX , USA
Division of Diagnostic Imaging
Department of Cancer Systems Imaging
The University of Texas MD Anderson Cancer Center
Houston , TX , USA
Pref ace
A t this juncture in the history of Nuclear Medicine in the Philippines when a sharp
rise in the number of positron emission tomography facilities or centers is poised to
happen in a year or so, I believe the onus is on the pioneers of the modality to make
sure that the fi eld fl ourishes for the future generations to benefi t from. This can only
be done through the selfl ess and magnanimous spirit present in each scientist who
desires that his discoveries be known to all through published work so that others
may build on it or benefi t from it. Thus the concept for this book was born. It is
essentially a compilation of interesting and uniquely educational PET scans (at least
in my view based on my exposure and experience) that I have encountered and
described and interpreted in my more than 10 years of practice having read or
reviewed each and every scan that was ever done in St. Luke’s Medical Center. The
book does not aim to teach the readers how to read PET scans, hence, the limited
number of images provided for each case showing only the pertinent fi ndings.
Rather, the book serves to alert the reader whether novice or expert to the possible
alternative interpretation in a seemingly easy to read scan.
T he book is made up of chapters which in turn is made up of general topics rel-
evant to a reader who may be under pressure to put out a scan report at the end of
the day. This will facilitate the search for cases should the reader encounter a similar
patient or situation in his practice.
Special thanks are in order for my colleagues Raymund Conlu, Gerard Goco, and
Patricia Bautista for reviewing the manuscript. I would also like to thank the follow-
ing nuclear medicine doctors (in no particular order): Juanito Olpindo, Eric Cruz,
Jefferson Pagsisihan, Emelyn De Jesus, Enrique Ote, Dennis De Leon, Eduardo
Ongkeko, Cynthia Liao, Elyzel Puguon, Jamilla Gomez, Susan Camomot, Allan
Domingo, Marlon Fetalvo, Janet Mea, Joel Mendoza, Masoud Elgadafi , Morteza
Barai, Angelin Apostol, Christine Gruenberg, and Karina Dela Cruz-Del Mundo.
They searched for many of the medical literature cited in this book. I would like to
thank Ms. Peachy Domingo and Bryan Cyril Jacalne who were instrumental in
retrieving many of the study reports that I had to review, some of which were more
than 10 years old. I would like to thank Bernard Laya and Irma Kintanar who
reviewed the CT images and Glenda Y. Pua who reviewed some of the Pathology
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