Zytoon AA(1), Murakami K, El-Kholy MR, El-Shorbagy E, Ebied O. While this might be a reasonable approach to communicate the site of a lesion, it diminishes the power of PET to characterise disease based on the degree of its metabolic activity. However, in clinical practice, it is not uncommon to observe high-grade gliomas with low FDG uptake. Furthermore, the brain can appreciate these images as being volumetric, especially when rotating. There are also changes in the brain during childhood maturation [2]. FOIA Follicular lymphoma, in which most lesions can have a SUVmax in excess of 10 but regions of high-grade transformation with corresponding values of >15, is a particular case in point. The exception is when the lymph node is centrally necrotic as a small rim of viable tumour is subject to partial volume effects with expectant lower intensity of uptake; integrating the CT morphology is therefore critical to reaching an accurate interpretation (see Fig. Correlation with prior contrast-enhanced CT (c) demonstrates the node has rim enhancement and central necrosis consistent with malignant aetiology. 2020 Feb 20;12(2):497. doi: 10.3390/cancers12020497. The “rainbow” colour scale may also be difficult for individuals with colour blindness to interpret. The clinical significance and management of lesion motion due to respiration during PET/CT scanning. Interpretation of structural abnormalities that are not associated with metabolic abnormality requires particular care and can give significant insights into the nature of pathological processes. Patient with prior lung malignancy presents for surveillance. We selectively review the non-attenuation corrected (NAC) series when there is uncertainty about possible reconstruction artefacts due to metallic objects or patient movement between PET and CT components. This particularly aids recognition of the shape of regions increased activity, and particularly whether they are spherical, tubular or geographic. However, other clinicopathological parameters and immunohistopathological status, which included tumor size, age, histology, estrogen receptor, progesterone receptor and Her2/neu overexpression, did not correlate significantly with FDG uptake. Post treatment restaging PET/CT demonstrated a complete metabolic response (a–d, c upper SUV threshold adjusted to liver background as detailed above, d upper SUV threshold of 5). The report only mentions the one uptake of 8.3 and does not mention other uptakes. It can also be used with other PET agents especially when no arterial input function is available for more detailed pharmacokinetic modeling. We include the American Joint Committee on Cancer (AJCC) TNM stage for staging scans where our referral-base utilises this staging schema. These are the stand-alone PET data, the CT and the fused PET/CT images. Conclusion: Privacy, Help The uptake of 18F-FDG by tissues is a marker for the tissue uptake of glucos Gland Surg. Material and methods: Without intravenous contrast, additional identification of typical oncologic complications such as pulmonary embolism or venous thrombosis cannot be identified. To keep the report succinct, we avoid repetition of interpretative findings in Findings and descriptive findings in the Conclusion. SDHB) found in patients with hereditary paraganglioma and pheochromocytoma highlight this phenomenon. On the other hand, nodal status weakly correlated with the delayed phase (p=0.0907). Mutations in subunits of succinate dehydrogenase (e.g. 2017 Oct-Dec;16(4):275-280. doi: 10.4103/1450-1147.215485. doi:10.2967/jnumed.109.074484. Recognition of other pitfalls requires knowledge of the typical pattern of the various malignancies but is beyond the scope of this review. 1). Cohesive integration of functional and anatomic information provided by PET and CT, respectively, is essential for correct interpretation. Associations Between PET Parameters and Expression of Ki-67 in Breast Cancer. PET/CT: will it change the way that we use CT in cancer imaging? Hicks RJ. glucose substance they inject into you. Whilst there is a wealth of literature addressing the utility of PET in a large array of malignancies, the art of how to review and interpret PET/CT is generally acquired like an apprentice and not well addressed in the literature. ▪ Technique: We suggest including the following minimum details to document the method so that others can be reassured that the scan was technically adequate, and to enable similar acquisition parameters for subsequent scans: acquisition field-of-view, model of PET/CT scanner, reconstruction technique (e.g. Cancer Imaging. It is important to be familiar with the varying degree of FDG accumulation in the liver that represents normal distribution and physiological changes, before attempting to interpret whole-body positron emission tomography (PET) imaging for malignancy detection. Interpretation of 18 F-FDG PET/ CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. The PET findings are presented first but are directly correlated with the associated correlative CT findings rather than performing sequential or separate PET and CT reports. Not all metabolically active abnormalities are malignant and a variety of physiologic and inflammatory patterns must be recognised. An important aspect of interpretation is assessment of the technical adequacy of the study and ideally should be done before the patient leaves the department to enable repeat acquisition of any critical regions inadequately assessed on the initial examination. Focal uptake by the thyroid is associated with a 25–50% risk of malignancy. There are, however, situations where the acquisition of contrast-enhanced CT is preferred or can be tailored based on findings on the whole body low dose PET/CT without contrast in order to clarify the nature or anatomical relations of FDG-avid foci. It is also important to determine the methodology to be used for CT acquisition. 2013 Nov;34(11):1055-67. doi: 10.1097/MNM.0b013e3283658369. PubMed  Evolving literature suggests that intensity of uptake is an independent prognostic factor and in some tumour subtypes superior to histopathologic characterisation. Regulation of cancer cell metabolism. Conclusion: Age has a significant and positive impact on both maximum and mean standard uptake values of the liver on FDG PET imaging. Correspondence to By definition, any structure with uptake more intense than that in the liver must also have facilitated … 2016;16:8. doi:10.1186/s40644-016-0067-3. The ability to non-invasively measure glycolytic activity, defining what we refer to as the “metabolic signature”, however, is a key feature of FDG PET/CT that is overlooked by many reporters. Purpose: The intensity of physiological 18F-2-deoxy-D-glucose (FDG) uptake in the liver varies. Callahan J, Kron T, Schneider-Kolsky M, Hicks RJ. Barrington SF, Mikhaeel NG, Kostakoglu L, Meignan M, Hutchings M, Mueller SP, Schwartz LH, Zucca E, Fisher RI, Trotman J, Hoekstra OS, Hicks RJ, O’Doherty MJ, Hustinx R, Biggi A, Cheson BD. Some benign conditions like infection can have high uptake. Finally, it is important to widen the PET window in order to review the brain, otherwise easily discernible abnormalities can be missed (see Fig. Enhanced white adipose tissue metabolism in iatrogenic Cushing’s syndrome with FDG PET/CT. Binns DS, Pirzkall A, Yu W, Callahan J, Mileshkin L, Conti P, Scott AM, Macfarlane D, Fine BM, Hicks RJ, Team OSS. It is important to review these images on a workstation that has capacity to triangulate findings in axial, coronal and sagittal planes. These allow glucose to be diverted into the pentose phosphate shunt pathway. 2012;53(10):1499–505.