• 1/5/2007
  • Reston, VA
  • Barbara Kram
  • DotMed News (www.dotmed.com)

“PET/CT in Cancer Patient Management” is the subject of a special supplement to the January issue of the Journal of Nuclear Medicine. SNM, the largest molecular imaging and nuclear medicine association, is publishing a unique collection of articles that explore the role of 18F-FDG PET/CT imaging in patient screening, cancer diagnosis, initial treatment planning, treatment monitoring and detection of early recurrence.

“Oncologists, internists, general practitioners, radiologists and nuclear medicine physicians are frequently overwhelmed by the need to select-from among the different imaging modalities-the one that best serves the needs of their patients,” notes the supplement’s guest editor Johannes Czernin, the director of the Nuclear Medicine Clinic and professor and vice chair of molecular and medical pharmacology at the University of California, Los Angeles. “Despite the impressive growth of PET/CT, there is no consensus on the optimum clinical use of PET/CT and its implementation into patient management,” he added, thereby prompting the publication of this exceptional resource.

“Selecting the ‘best’ PET/CT protocol for a given clinical problem adds another layer of complexity for referring physicians and practicing imaging specialists who need to avoid redundancies in diagnostic tests that frequently involve radiation,” said Heinrich Schelbert, who is editor in chief of JNM, the most prominent peer-reviewed journal in nuclear medicine, molecular imaging and allied disciplines.

Doctors use positron emission tomography (PET) and computed tomography (CT) scans as standard imaging tools to pinpoint disease states in the body. When PET is used to image cancer, a radiopharmaceutical (such as fluorodeoxyglucose or FDG, which includes both a sugar and a radionuclide) is injected into a patient. Cancer cells metabolize sugar at higher rates than normal cells, and the radiopharmaceutical is drawn in higher concentrations to cancerous areas. The highly sensitive PET scan picks up the metabolic signal of actively growing cancer cells. The CT scan generates a detailed picture of internal anatomy, locating and revealing the size and shape of abnormal cancer growths. When these two results are fused together, the functional data from the PET imaging is correlated with anatomy on the CT images to give a single detailed and informative image. PET/CT allows for noninvasive evaluation of metabolic and anatomic information, providing a tremendous advantage over other currently available diagnostic tools. More than 1.3 million patients underwent whole body PET/CT and PET studies in 2005, said Schelbert, professor of molecular and medical pharmacology at UCLA. He noted that more than 500 PET/CT units were sold that year, and industry estimates indicate that more than 1,700 PET and PET/CT machines are in use today.

Besides an introduction by Lalitha K. Shankar and Daniel C. Sullivan of the Cancer Imaging Program at the National Cancer Institute, the JNM supplement includes seven articles from practitioners in the United States and abroad. The articles cover topics such as PET/CT’s accuracy over CT alone in staging and response assessment; the use of PET/CT for cancer screening; a practical set of guidelines and algorithms for the use of 18F-FDG PET/CT in the evaluation and management of head and neck cancer and thyroid cancer; and how PET/CT could make a difference in drug development and clinical management for patients.

Articles include

* “Integrating PET and PET/CT into the Risk-Adapted Therapy of Lymphoma,” Yvette L. Kasamon, oncology and medicine departments; Richard J. Jones, oncology department; and Richard L. Wahl, oncology department and Division of Nuclear Medicine at the Russell H. Morgan Department of Radiology and Radiological Science, all at Johns Hopkins Medical Institutions, Baltimore, Md.

* “Can PET/CT Replace Separate Diagnostic CT for Cancer Imaging? Optimizing CT Protocols for Imaging Cancers of the Chest and Abdomen,” Hilmar Kuehl, Patrick Veit and Gerald Antoch, Department of Diagnostic and Interventional Radiology and Neuroradiology, and Sandra J. Rosenbaum and Andreas Bockisch, Department of Nuclear Medicine, all at the University Hospital Essen, Essen, Germany.

* “Early Detection of Cancer Recurrence: 18F-FDG PET/CT Can Make a Difference in Diagnosis and Patient Care,” Ora Israel, Department of Nuclear Medicine, Rambam Health Care Campus, and B. Rappaport School of Medicine, Technion–Israel Institute of Technolog; and Abraham Kuten, B. Rappaport School of Medicine, Technion–Israel Institute of Technology, and Department of Oncology, Rambam Health Care Campus, both in Haifa, Israel.

* “Screening for Cancer With PET and PET/CT: Potential and Limitations,” Heiko Schöder, Department of Radiology/Nuclear Medicine, and Mithat Gönen, Department of Biostatistics and Epidemiology, both at Memorial Sloan-Kettering Cancer Center, New York, N.Y.

* “Monitoring Cancer Treatment With PET/CT: Does It Make a Difference?” Wolfgang A. Weber, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, and Robert Figlin, Division of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Los Angeles, Calif.

* “PET-Based Treatment Planning in Radiotherapy: A New Standard?” Vincent Grégoire, the Radiation Oncology Department and the Center for Molecular Imaging and Experimental Radiotherapy, Xavier Geets, Center for Molecular Imaging and Experimental Radiotherapy and Max Lonneux, Center for Molecular Imaging and Experimental Radiotherapy and Nuclear Medicine Department, all at Université Catholique de Louvain, St. Luc University Hospital in Brussels, Belgium; and Karin Haustermans and Sarah Roels, both at the Radiation Oncology Department, Katholiek Universiteit Leuven, Gasthuisberg University Hospital, Leuven, Belgium.

* “Clinical Role of 18F-FDG PET/CT in the Management of Squamous Cell Carcinoma of the Head and Neck and Thyroid Carcinoma,” Andrew Quon and I. Ross McDougall, both Division of Nuclear Medicine, Department of Radiology; Nancy J. Fischbein, Division of Neuroradiology, Department of Radiology; Quynh-Thu Le and Billy W. Loo, Jr., Department of Radiation Oncology; Harlan Pinto, Division of Oncology, Department of Internal Medicine; and Michael J. Kaplan, Department of Otolaryngology and Head and Neck Surgery, all at Stanford University Medical Center, Stanford, Calif.