About this Research Topic
PET-CT imaging is a dual-modality diagnostic technology that merges metabolic and structural imaging. There are several currently available radiotracers, but 18F-FDG is the most commonly utilized due to its widespread availability. The normal biodistribution of these PET radiotracers as well as the technical aspects of image acquisition and inadequate patient preparation affect the quality of PET-CT imaging. In addition, normal variants, artefacts and incidental findings may impede accurate image interpretation and can potentially lead to misdiagnosis. In order to correctly interpret PET-CT imaging, it is necessary to have a comprehensive knowledge of the normal anatomy and to be cognisant of potential imaging pitfalls. The interpreter must be familiar with benign conditions which may accumulate radiotracer potentially mimicking neoplastic processes and also be aware of malignancies which can demonstrate low radiotracer uptake.
The purpose of this topic is to outline the basic principles of PET-CT imaging, with a focus on 18F-FDG PET-CT and 68Ga-DOTA PET-CT. Basic physiology, variant imaging appearances and potential pitfalls of image interpretation are presented within the context of common use cases of PET technology in patients with cancers and other pathologies, benign and malignant.
Increased glucose uptake in tumour cells is a result of increased anaerobic glycolysis, known as the Warburg effect. Cancer cells express an increased number of specific glucose transporter proteins compared to normal tissue cells. Diagnosis of malignant tumours is therefore a major indication for 18F-FDG PET–CT imaging.
Incidental findings and technical artefacts are common on 18F-FDG PET-CT imaging. Comprehensive knowledge of variant physiological biodistribution and potential pitfalls of image interpretation are vital to maximise diagnostic accuracy. Patient outcomes can also be improved with appropriate complementary use of structural imaging with either CT, MR or ultrasound in a number of malignant pathologies.
• Normal biodistribution of FDG
• Patients preparation, image acquisition
• Normal. Anatomy
• Normal (physiological) variants
• Attenuation correction Artifacts
• Pitfalls, false positives and false negatives
Keywords: imaging, pet, spect, CT, pitfalls, artifacts
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