Positron emission tomography (PET) and computed tomography (CT) complement each other’s strengths in integrated PET/CT. Most PET/CT studies in oncology are performed with 18F-fluorodeoxyglucose (FDG). FDG is a glucose analogue that is taken up and trapped within viable cells. An increased glycolytic activity is a characteristic in many types of cancers resulting in avid accumulation of FDG. These tumours excel as “hot spots” in FDG-PET/CT imaging. FDG-PET/CT proved to be of high diagnostic value in staging and restaging of different malignant diseases, such as colorectal cancer, lung cancer, breast cancer, head and neck cancer, malignant lymphomas, and many more.
- Primary presentation: diagnosis: unknown primary malignancy, differentiation of benign and malignant lesions of e.g. a solitary lung nodule, especially in case of discrepant clinical and radiological estimates of the likelihood of cancer;
- Staging on presentation: non-small-cell lung cancer, T3 oesophageal cancer, Hodgkin’s disease, non-Hodgkin’s lymphoma, locally advanced cervical cancer, ENT tumours with risk factors and locally advanced breast cancer.
- Response evaluation: malignant lymphoma, gastrointestinal stromal tumors (GIST), at present other applications only in a research setting. Application for oesophageal, colorectal, lung and breast cancer appear promising.
- Restaging in the event of potentially curable relapse (for FDG avid tumours)
- Establishing and localizing disease sites as a cause for elevated serum markers (e.g. colorectal, thyroid, ovarian, cervix, melanoma, breast and germ–cell tumours)
- Image guided biopsy (e.g. brain tumours) and radiotherapy planning.
- Fletcher JW, Djulbegovic B, Soares HP, Siegel BA, Lowe VJ, Lyman GH, et al. Recommendations on the use of F-18-FDG PET in oncology. J Nucl Med. 2008;49:480–508. [Medline]
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- Diagnostic performance of PET/CT with tracers other than F-18-FDG in oncology: an evidence-based review. Treglia G1, Sadeghi R, Del Sole A, Giovanella L. Clin Transl Oncol. 2014 Sep;16(9):770-5. [Medline]