How We Read Oncologic FDG PET/CT

Abstract

18F-fluorodeoxyglucose (FDG) PET/CT is a pivotal imaging modality for cancer imaging, assisting diagnosis, staging of patients with newly diagnosed malignancy, restaging following therapy and surveillance. Interpretation requires integration of the metabolic and anatomic findings provided by the PET and CT components which transcend the knowledge base isolated in the worlds of nuclear medicine and radiology, respectively. In the manuscript we detail our approach to reviewing and reporting a PET/CT study using the most commonly used radiotracer, FDG. This encompasses how we display, threshold intensity of images and sequence our review, which are essential for accurate interpretation. For interpretation, it is important to be aware of benign variants that demonstrate high glycolytic activity, and pathologic lesions which may not be FDG-avid, and understand the physiologic and biochemical basis of these findings. Whilst FDG PET/CT performs well in the conventional imaging paradigm of identifying, counting and measuring tumour extent, a key paradigm change is its ability to non-invasively measure glycolytic metabolism. Integrating this “metabolic signature” into interpretation enables improved accuracy and characterisation of disease providing important prognostic information that may confer a high management impact and enable better personalised patient care.

An International Survey on Clinical Reporting of PET/CT Examinations: A Starting Point for Cross-Specialty Engagement

“…Two aspects of high-quality PET/CT reporting should be considered by every reader. First, the report should cover the essential elements, such as the clinical history, the imaging procedure, the description of comparison studies (if available), the delineation of findings (relevant and incidental), and the final impression (26). Examples of essential report elements for 18 F-FDG PET/CT imaging are provided by the Society of Nuclear Medicine and Molecular Imaging PET PROS initiative (18) and in the recommendations by Niederkohr et al (Table 1 in (5)).…”

Clinical significance of metabolism-related biomarkers in non-Hodgkin lymphoma – MCT1 as potential target in diffuse large B cell lymphoma

“…While providing diagnostic and prognostic information, these tools are usually complemented by other ancillary methods to allow the early identification of patients with immuno-chemotherapy refractory disease. Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose (FDG-PET) is a reliable cancer outcome predictor [7,8] based on the prevalence of enhanced glucose uptake by human cancers. FDG-PET is increasingly used for the global assessment of lymphomas, allowing not only evaluation of tumour extensiveness and aggressiveness, but also quantification of their metabolic activity [9][10][11][12].…”

Integrating deep and radiomics features in cancer bioimaging

“…MCC test MCC train , mostly affect the PET-only modality, thus confirming the intrinsic difficulties of quantitative interpretation of PET images. This is also an open problem also in the clinical practice, in particular for head and neck pathologies [52], [53]. In fact, despite the applied conversion to SUV, technical differences between PET scanners, and nonlinear effects associated to GTV segmentation as well as other patient-dependent parameters are not taken into account [41], [42], [54].…”