petctinoncology-snm.ppt

* H6636. CT VA Fresno 5/2008 PET/CT 6/20/2008 * * 47 year old man who had biopsy proven recurrent thyroid cancer 3 months after thyroidectomy. The PET scan shows multiple hypermetabolic lymph nodes in the right neck and supraclavicular region, which were not visible with radioiodine. * E1638. PET/CT 10/17/07. * 49 year-old man with newly diagnosed lung cancer. CT of the thorax showed a mass in the upper lobe of the upper lobe of the left lung. There was no sign of metastatic disease. PET showed the primary tumor, as well as a hypermetabolic mass in the pelvis. Fused transaxial PET-CT images showed probable metastatic disease behind the left psoas muscle. CT with IV contrast was subsequently performed, and showed an enhancing mass in the same area. The patient developed additional distant metastases and died a few months later. * M6736. PET/CT 9/25/07. * H5493. PET/CT before chemotherapy 7/24/07; after chemotherapy 11/1/07 * * * D1693. PET/CT 5/24/07. * * 3 * A8665. PET/CT 6/6/07. * L0918. PET/CT 9/11/07. * L0918. PET/CT 9/11/07. * * * * 56 year man with HCV, end stage liver disease, and presumed hepatoma Standard CT PET/CT Physiologic Uptake: Brown Fat Infection 68 year old man with solitary lung nodule. Biopsy: aspergillosis Granulomatous Disease 62 year old man with hilar and mediastinal adenopathy. Biopsy: sarcoidosis Adenoma 82 year old man with wt loss and liver masses Adenoma 82 year old man with wt loss and liver masses Clinical Impact of PET/CT ? More accurate diagnosis ? Avoidance of unnecessary tests, and potentially harmful procedures ? Better treatment or management National Oncologic PET Registry 36.5% change in decision to treat or not treat Conclusions 1. CT is the first imaging test of choice in most cases 2. PET - CT is more accurate than CT alone ? Characterizing lesions difficult to biopsy ? Detecting occult cancer ? Determining extent of cancer and response to therapy 3. PET - CT changes management 36% Why PET-CT? * * 3 * 3 * * * * * 3 * *