PET or PETCT is far superior to Plain Films, CT, or even a conventional Bone Scan for detection of s

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PET or PET/CT is far superior to Plain
Films, CT, or even a conventional Bone Scan for
detection of skeletal metastases!!
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Lesions as large as this patients are
frequently associated with a soft tissue
component that may compromise the spinal cord
and/or nerve roots. Therefore, thoraco-lumbar
MRI would be prudent.
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How many FDG-avid tumor cells, bunched
together in a lump does it take to be visible
inside a human body on a typical PET/CT??

• A. 10,000
• B. 100,000
• C. 10
• D. Almost 1,000,000

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FDG is very good for detecting some
tumors, but NOT good for detecting others, and
there is probably nothing we can ever do about
this fact, right?
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Why have fast (64-slice) CT in a cancer
hospital? Corollary Why have CT angiography
in a cancer hospital??
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Coronary CTA in RPCI
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Because 2 patients each week in our cancer
center need cardiac clearance before they undergo
MAJOR surgery, and for such clearance a fast
coronary artery screen with a negative
predictive value of over 98 is ideal!
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AND because developing the technology of
imaging and reconstructing with a fast scanner is
invaluable in many other areas of vascular/tumor
imaging.
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44 y/o woman with meningioma
CTA 1998
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45 y/o woman with meningioma
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47 y/o man with neck mass
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Embolization planning with CTV
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CTA gives simultaneous vascular soft tissue and
bony detail
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Putting it all Together
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Virtual colonoscopy is CUTE but has no
real future in colon screening, because you cant
biopsy during the exam, like the colonoscopist
can biopsy during the real colonoscopy.
Right?
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Cool as it may be, FDG-PET images suffer
from intrinsically poor spatial resolution,
regardless of scanner technology, and will never
compete with CT or MR for the detection of two or
three millimeter lesions. Yes??
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New PEM Flex? Solo II Clinical System
PEM Flex is a trademark of Naviscan PET Systems,
Inc. Photos courtesy of Naviscan PET Systems,
Inc.
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Tomographic Display
2mm Resolution
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Surgical Planning
Multifocality/Multicentricity
Unsuspected 2nd Lesion
X-Ray
PEM
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Surgical Planning Bilateral Disease
Unsuspected Contralateral Lesion
X-Ray
PEM
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PEM Depiction of DCIS
Case Study 50 year old women with bilateral
breast masses. X-ray guided bx showed cancer in
right breast, papilloma in the left breast. PEM
findings Left breast very suspicious for cancer.
Surgery revealed DCIS.
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Occult Cancer
8 months later high resolution PET scan with
compression shows intense focus (4-mm invasive
ductal carcinoma)
X-ray guided core biopsy showed no cancer
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Problem Solving
MRI positive in R L breasts
R
L
Contrast Enhanced MRI
PEM negative left breast
L
R
PEM
Pathology Results (L) Mild ADH negative for
cancer (R) IDCILC
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Dense Breast
Superior
RCC
RMLO
X-Ray
Inferior
PEM
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We have examined a number of assumptions and
found that
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PET and PET CT are FAR more sensitive
than plain films, CT, or a conventional bone scan
for the detection of metastases, because
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FDG-PET VISUALIZES THE BONE PET IMAGES
THE BONE MARROW, AND THE VAST MAJORITY OF
SKELETAL METASTASES BEGIN IN THE BONE MARROW
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FDG-PET CANNOT detect clusters of
malignant cells unless there are almost 1 million
of them in a lump! THEREFORE
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Cinching down a therapy field to
Cinching-down the therapy field
toavoid treating non-malignant tissue and
avoiding collateral damage is a problematical
approach.
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The interpretation of a bone scan must
be more than defining the number of lesions and
comparing them to old studies!
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The value of FDG is limited in many tumors, but
it can be The value of FDG-PET can be
enhanced in the search for many thyroid cancers,
by THYROGEN, raising the possibility of a new
paradigm for other trophic-factor dependent
cancers.
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• CT Angiography has a major role in cancer
  imaging for

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• Pre-surgical coronary clearance and

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• Reconstructions of all sorts to aid pre-surgical
  planning and provide a road map for the surgeon

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• CTColonoscopy is the future the numbers are
  inexorable. The future is soon.

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FDG-PET may achieve unexpectedly-high
spatial resolution in certain applications.
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• The very best of the superb CT reconstructed
  images are the work of Alan M. Litwin, M.D., a
  premier Body Imager at Roswell Park, and, as I
  always say, a Crazed Genius (emphasis on
  Crazed.)