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Issues, Controversies, and Clinical Utility of Combined PET/CT Imaging: What Is the Interpreting Physician Facing?

Todd M. Blodgett1, Bethany Casagranda1, David W. Townsend1 and Carolyn C. Meltzer1,2

1 Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213.
2 Departments of Psychiatry and Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA 15213.



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  		Fig. 1. —Lesions not seen on CT: PET/CT performed 4 months after resection in patient who did not undergo initial staging with PET or PET/CT. Although CT scan is essentially normal even with good contrast enhancement, patient had three small lesions (arrows) compatible with widespread metastatic disease. If lesions were present and identified using PET/CT, an unnecessary thoracotomy would have been avoided.

 


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  		Fig. 2. —PET lesions obscured by artifact: Restaging PET/CT in patient with history of squamous cell carcinoma of the right posterior oropharynx and right neck who underwent right modified neck dissection and radiation therapy and now presents with new onset of left-sided throat pain. Focal area of intense FDG uptake noted on PET would be difficult or impossible to localize without fusion images due to CT artifact obscuring anatomic detail. Fused image localizes the PET abnormality to left retromolar trigone area (arrows).

 


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  		Fig. 3. —Assessing the mediastinum: Select images from a staging PET/CT examination in patient with recently diagnosed left lower lobe squamous cell lung carcinoma. Axial CT images show normal-sized subcarinal and right paratracheal lymph nodes with intense FDG uptake that are exquisitely localized to otherwise normal-appearing lymph nodes on fused PET/CT images (arrows), making the patient stage IIIB and a nonsurgical candidate.

 


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  		Fig. 4. —Improved biopsy localization information: Select images from PET/CT study patient with a history of colorectal cancer and rising carcinoembryonic (CEA) levels. Images show a focal abnormality on PET images that appears to correlate to "stable" presacral mass on CT. Inspection of fused image shows only small portion of mass to be hypermetabolic (arrows), which led to more focused CT-guided biopsy proving recurrent adenocarcinoma.

 

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