PET-CT in the UK: current status and future directions

Abstract

Positron emission tomography-computed tomography (PET-CT) has taken the oncological world by storm since being introduced into the clinical domain in the early 21 st century and is firmly established in the management pathway of many different tumour types. Non-oncological applications of PET-CT represent a smaller but steadily growing area of interest. PET-CT continues to be the focus of a large number of research studies and keeping up-to-date with the literature is important but represents a challenge. Consequently guidelines recommending PET-CT usage need to be revised regularly to encompass new developments. The purpose of this article is two-fold: firstly it provides a detailed review of the evidence-base underpinning the major uses of PET-CT in clinical practice which may be of value to a wide-range of individuals including those directly involved with PET-CT and to a much larger group with limited exposure but for whom a précis of the current state-of-play may help inform other radiology and multidisciplinary team (MDT) work; the second purpose is as a companion to revised guidelines on Evidence-Based Indications for PET-CT in the UK (being published concurrently) providing a detailed commentary on new indications with a summary of emerging data supporting these additional clinical uses of the technique.

Feasibility of a streamlined imaging protocol in technetium-99m-Tektrotyd somatostatin receptor SPECT/CT

“…However, despite the obvious strengths of SSR PET-CT, adoption into routine clinical practice in the UK has been slow due to a combination of financial and regulatory issues [6]. Consequently, SRS using Indium-111 (In-111) labelled radiopharmaceuticals has continued to be widely utilised for staging of neuroendocrine malignancies, with single photon emission computed tomography / computed tomography (SPECT/CT) fusion improving diagnostic assessment beyond that of traditional planar imaging.…”

Clinical PET Imaging in Prostate Cancer

“…Choline PET/CT images that demonstrate positive nodal involvement are of clinical value; however, negative scans cannot exclude micrometastatic disease in small nodes. It is because of the moderate sensitivity of choline PET/CT that current guidelines do not routinely recommend choline PET/CT for nodal staging, although there may be a role in high-risk staging or in patients with equivocal findings at conventional imaging, as suggested in the PET guidelines of the Royal College of Radiologists and the Royal College of Physicians (48) (Fig 7).…”

Update: PET/CT und PET/MRT bei Tumoren des Kopf-Hals-Bereiches

“…So wurden im Jahr 2013 in Deutschland 988 PET/CT-Untersuchungen bei stationären Patienten mit einem Malignom der Mundhöhle oder des Rachens durchgeführt [38]. Die FDG-PET/ CT ist etabliert bei der Evaluation klinisch und computer-/magnetresonanztomografisch unklarer Fälle, bei der Detektion okkulter Primärtumore beim CUP-Syndrom (CUP: cancer of unknown primary), bei der Therapiekontrolle nach Radiochemotherapie und bei der Rezidivdiagnostik [60]. Da bei onkologischen Fragestellungen regulär Ganzkörperaufnahmen akquiriert werden, hilft die PET/CT, eine Fernmetastasierung zu erkennen.…”