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Role of dual PET/CT scanning in abdominal malignancies

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Cancer Imaging

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      Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma.

      The purpose of this study was to compare (18)F-FDG PET and PET/CT in a population of patients with colorectal cancer. PET and PET/CT images from 45 patients (17 women, 28 men; mean age +/- SD, 60.8 +/- 11.1 y) with known colorectal cancer referred for PET from June to November 2001 were retrospectively reviewed. Images were acquired with a PET/CT scanner, and (68)Ge attenuation correction was applied. PET images and fused (68)Ge attenuation-corrected PET and CT images were independently and separately interpreted by a moderately experienced reader unaware of the clinical information. Certainty of lesion characterization was scored on a 5-point scale (0 = definitely benign, 1 = probably benign, 2 = equivocal, 3 = probably malignant, 4 = definitely malignant). Lesion location was scored on a 3-point scale (0 = uncertain, 1 = probable, 2 = definite). The presence or absence of tumor was subsequently assessed using all available clinical, pathologic, and follow-up information. Analysis was provided for lesions detected by both PET and PET/CT. The frequency of equivocal and probable lesion characterization was reduced by 50% (50 to 25) with PET/CT, in comparison with PET. The frequency of definite lesion characterization was increased by 30% (84 to 109) with PET/CT. The number of definite locations was increased by 25% (92 to 115) with PET/CT. Overall correct staging increased from 78% to 89% with PET/CT on a patient-by-patient analysis. PET/CT imaging increases the accuracy and certainty of locating lesions in colorectal cancer. More definitely normal and definitely abnormal lesions (and fewer probable and equivocal lesions) were identified with PET/CT than with PET alone. Staging and restaging accuracy improved from 78% to 89%.
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        Combining anatomy and function: the path to true image fusion.

        Modern imaging technologies visualize different aspects of disease in a non-invasive way. Considerable progress has been made in the fusion of images from different imaging modalities using software approaches. One goal of fusion software is to align anatomical and functional images and allow improved spatial localization of abnormalities. The resulting correlation of the anatomical and functional images may clarify the nature of the abnormality and help diagnose or stage the underlying disease. Whereas successful image fusion software has been developed for the brain, only limited success has been achieved for image alignment in other parts of the body. The development and current status of alternative approaches are presented. Dual-modality imaging is described with devices where two modalities are combined and mounted in a single gantry. The use of existing scanner technology ensures that no compromises are made in the clinical efficacy of either the anatomical or functional imaging modality. A combined positron emission tomography (PET) and computed tomography (CT) scanner has been developed and is undergoing clinical evaluation. Combining PET with MR is technologically more challenging because of the strong magnetic fields restricting the use of certain electronic components. An overview of the current status and future prospects of dual-modality imaging devices is presented.
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          Combined PET/CT Imaging in Oncology. Impact on Patient Management.

          Purpose: In this work, we describe five oncology patients whose clinical management were uniquely benefited by a novel scanner that acquires positron emission tomography (PET) and x-ray computed tomography (CT) in the same imaging session.Procedures: Co-registered 2-[F(18)]-fluoro-2-deoxy-D-glucose (FDG)-PET and CT images were acquired using a combined PET/CT scanner. Pathology and clinical follow-up data were used to confirm PET/CT scan results.Results: The combined PET/CT scanner demonstrated the ability to distinguish malignant lesions from normal physiologic FDG uptake in the striated muscles of the head and neck as well as excretory and bowel activity in the abdomen and pelvis. Additionally, the technology positively affected patient management through localization for surgical and radiation therapy planning as well as assessment of tumor response.Conclusion: Our experience indicates that simultaneous acquisition of co-registered PET and CT images enabled physicians to more precisely discriminate between physiologic and malignant FDG uptake and more accurately localize lesions, improving the value of diagnostic PET in oncologic applications.
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            Author and article information

            Affiliations
            Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 270, 55 Fruit St, Boston, MA 02114, USA
            Author notes
            Corresponding address: Dr Michael A Blake, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, White 270, 55 Fruit St, Boston, MA 02114, USA. Email: mblake2@ 123456partners.org
            Journal
            Cancer Imaging
            CI
            Cancer Imaging
            e-MED
            1740-5025
            1470-7330
            2004
            21 July 2004
            : 4
            : 2
            : 121-123
            18250019
            1434594
            CI40019
            10.1102/1470-7330.2004.0019
            jCI.v4.i2.pg121 ci040019
            Copyright © 2004 International Cancer Imaging Society
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            Editorial

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