Arab Health 2011: PET/CT Imaging in Urology
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Transcript of Arab Health 2011: PET/CT Imaging in Urology
Clinical Indications forPET.CT Imaging
in Urology
Thomas F. Heston, MD, FACNM, FASNC, FAAFP
Why PET/CT Works:The Warburg Effect
● Normal Cells● Low rate of glycolysis
● Aerobic metabolism
● Most Cancer Cells● High rate of glycolysis
● Anaerobic metabolism
Imaging Glycolysis: 18-F FDG
e+ e-
511 γ
511 γ
Imaging the glycolisis: Positron Emission Tomography
Imaging the Warburg Effect: Why it Works
The Warburg Effect: Cancer Types
● Nearly all solid tissue tumors● Lung
● Colon
● Breast
● Notable Exceptions● Slow growth: prostate cancer (use 18F-fluoride)
● Mucinous: BAC
● Early Disease: tumors < 0.5 cm
18-F FDG PET/CT Works Because:
● Tumor cells have increased glycolysis
● O-18 enriched water bombarded by protons
---> F-18 ---> 18F-FDG
● FDG hits a metabolic dead end
● PET images 18F positron emissions
● CT allows anatomic localization
Imaging the Warburg Effect: Normal vs Abnormal
Normal PET/CT
Abnormal PET/CT
Prostate Cancer
F-18 NaF vs Tc-99m MDP
● PET/CT more accurate● Sensitivity: 90% vs 80%
● Specificity: 95%+ vs 90%
● PET/CT more comfortable● Shorter uptake time
● Shorter scan time
PET/CT vs SPECT
http://www.cms.gov/mcd/publiccomment_popup.asp?comment_id=19917
Dual Tracer Acquisition
PET/CT in Prostate Cancer: Conclusions
● Workup: in selected patients only
● Restaging in pts with PSA relapse● Nodal disease
● Osseous disease
● Dual FDG / NaF imaging
Renal Cell Carcinoma
PET/CT in Renal Cell Carcinoma
● FDG excreted by the urinary tract
● Indications● Staging high risk patients for metastatic
disease
● When other imaging is non-diagnostic
Research Studies
PET/CT vs Bone Scan - 1● 44 pts with high risk prostate cancer
● Gleson score >= 8 or PSA >= 20 ng/mL
● Prevalence: 52% with bony mets
● Gold Standard● All imaging results including MRI & CT
● Biopsy in selected cases
● Clinical follow-upEven-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006 Feb;47(2):287-97.
PET/CT vs Bone Scan - 2
Even-Sapir E, Metser U, Mishani E, Lievshitz G, Lerman H, Leibovitch I. The detection of bone metastases in patients with high-risk prostate cancer: 99mTc-MDP Planar bone scintigraphy, single- and multi-field-of-view SPECT, 18F-fluoride PET, and 18F-fluoride PET/CT. J Nucl Med. 2006 Feb;47(2):287-97.
● Agreement: 22/42 (52%)
● MDP understaged 13/42 (31%)
● MDP overstaged 7/42 (17%)
FDG PET/CT vs MDP Bone Scan - 1
● 70 pts with a variety of cancers with bone mets
● Per Patient Basis: PET/CT 97% vs BS 86% sensitivity
● Per Lesion Basis: PET/CT 92% vs BS 70% sensitivity
● Incidental Findings: in 24 patients, organ metastases
were found and in 7/7 pts with unknown primary, the
primary was found
Ozülker T, Küçüköz Uzun A, Ozülker F, Ozpaçac T. Comparison of (18)F-FDG-PET/CT with (99m)Tc-MDP bone scintigraphy for the detection of bone metastases in cancer patients. Nucl Med Commun. 2010 Jun;31(6):597-603.
Thank You!