Positron emission tomography/computed tomography: protocol issues and options.

Combined positron emission tomography/computed tomography (PET/CT) became FDA-approved for clinical use in late 2001. There are several design advantages of combined PET/CT over PET and CT acquired on separate devices, including more accurate CT and PET data co-registration, improved lesion localization, consolidation of imaging studies, and reduced scan times compared to dedicated PET. There are several protocols that can used to scan patients on combined PET/CT devices. Although there is no single "correct" protocol for performing a PET/CT scan, the use of oral and intravenous contrast media may improve the diagnostic value of the CT component. Whether to utilize contrast media depends on important clinical variables, including the specific type of tumor and the likelihood of encountering viable abdominal and pelvic malignancy. This article discusses various protocols pertinent to PET/CT imaging, including how the CT portion of a PET/CT scan can be performed and optimized, as well as PET/CT interpretation and reporting issues.

[1]  L L Berland,et al.  Contrast enhancement technique for dynamic hepatic computed tomographic scanning. , 1983, Radiology.

[2]  Townsend,et al.  7. Survey of Results of Whole Body Imaging Using the PET/CT at the University of Pittsburgh Medical Center PET Facility. , 2000, Clinical positron imaging : official journal of the Institute for Clinical P.E.T.

[3]  P M Silverman,et al.  Assessment of a technology that permits individualized scan delays on helical hepatic CT: a technique to improve efficiency in use of contrast material. , 1996, AJR. American journal of roentgenology.

[4]  G. Israel,et al.  How I do it: evaluating renal masses. , 2005, Radiology.

[5]  Yuji Nakamoto,et al.  Respiratory motion artifacts on PET emission images obtained using CT attenuation correction on PET-CT , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[6]  E Grabbe,et al.  Parenchymal liver enhancement with bolus-triggered helical CT: preliminary clinical results. , 1995, Radiology.

[7]  M. Atkins,et al.  Liver metastases from melanoma: detection with multiphasic contrast-enhanced CT. , 1999, Radiology.

[8]  N. Obuchowski,et al.  Enhancement characteristics of papillary renal neoplasms revealed on triphasic helical CT of the kidneys. , 2002, AJR. American journal of roentgenology.

[9]  G. Glazer,et al.  Hypervascular hepatic metastases: CT evaluation. , 1987, Radiology.

[10]  P. Vernon,et al.  Application of intravenous contrast in PET/CT: does it really introduce significant attenuation correction error? , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[11]  Gustav K. von Schulthess,et al.  Clinical evaluation of a breathing protocol for PET/CT , 2004, European Radiology.

[12]  Yuji Nakamoto,et al.  Clinically significant inaccurate localization of lesions with PET/CT: frequency in 300 patients. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[13]  W. Foley,et al.  Multiphase hepatic CT with a multirow detector CT scanner. , 2000, AJR. American journal of roentgenology.

[14]  David W Townsend,et al.  Concurrent PET/CT with an integrated imaging system: intersociety dialogue from the Joint Working Group of the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance. , 2005, Journal of the American College of Radiology : JACR.

[15]  20. The Case for PET/CT. Experience at the University of Pittsburgh. , 2000, Clinical positron imaging : official journal of the Institute for Clinical P.E.T.

[16]  H. Libshitz,et al.  Detection of hepatic metastases in breast cancer: the role of nonenhanced and enhanced CT scanning. , 1990, Journal of computer assisted tomography.

[17]  Thomas Beyer,et al.  Positron emission tomography/computed tomography--imaging protocols, artifacts, and pitfalls. , 2004, Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging.

[18]  R. Baron,et al.  Helical biphasic contrast-enhanced CT of the liver: technique, indications, interpretation, and pitfalls. , 1996, Radiology.

[19]  Thomas Beyer,et al.  To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[20]  T. Ichikawa,et al.  Hepatic adenomas: imaging and pathologic findings. , 2001, Radiographics : a review publication of the Radiological Society of North America, Inc.

[21]  I. Francis,et al.  Renal masses: assessment of corticomedullary-phase and nephrographic-phase CT scans. , 1995, Radiology.

[22]  D. Lu,et al.  Two-phase helical CT for pancreatic tumors: pancreatic versus hepatic phase enhancement of tumor, pancreas, and vascular structures. , 1996, Radiology.

[23]  Barton F Branstetter,et al.  Combined PET-CT in the head and neck: part 1. Physiologic, altered physiologic, and artifactual FDG uptake. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[24]  G. V. von Schulthess,et al.  PET/CT of the abdomen: optimizing the patient breathing pattern , 2003, European Radiology.

[25]  R. Wahl,et al.  Initial experience with oral contrast in PET/CT: phantom and clinical studies. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[26]  Richard L Wahl,et al.  Applications of positron emission tomography/computed tomography image fusion in clinical positron emission tomography-clinical use, interpretation methods, diagnostic improvements. , 2003, Seminars in nuclear medicine.

[27]  Single-detector helical CT in PET-CT: assessment of image quality. , 2004, AJR. American journal of roentgenology.

[28]  O. Vignaux,et al.  Cirrhotic liver enhancement on dual-phase helical CT: comparison with noncirrhotic livers in 146 patients. , 1999, AJR. American journal of roentgenology.

[29]  Paul Kinahan,et al.  A combined PET/CT scanner for clinical oncology. , 2000, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[30]  G. Perlmutter,et al.  Oral contrast agents in CT of the abdomen. , 1984, Radiology.

[31]  Tinsu Pan,et al.  Correction for oral contrast artifacts in CT attenuation-corrected PET images obtained by combined PET/CT. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[32]  Gerald Antoch,et al.  Focal tracer uptake: a potential artifact in contrast-enhanced dual-modality PET/CT scans. , 2002, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[33]  S S Sagel,et al.  Dynamic contrast-enhanced CT of the liver: comparison of contrast medium injection rates and uniphasic and biphasic injection protocols. , 1993, Radiology.

[34]  R. Nelson,et al.  Pancreatic malignancy: effect of dual-phase helical CT in tumor detection and vascular opacification. , 1997, Radiology.

[35]  M. Tillich,et al.  Multiphasic helical CT of the kidney: increased conspicuity for detection and characterization of small (< 3-cm) renal masses. , 1997, Radiology.

[36]  T. Beyer,et al.  Optimized intravenous contrast administration for diagnostic whole-body 18F-FDG PET/CT. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[37]  W. Pegios,et al.  Detection of focal liver lesions at biphasic spiral CT: randomized double-blind study of the effect of iodine concentration in contrast materials. , 2000, Radiology.

[38]  A. Buck,et al.  Head and neck imaging with PET and PET/CT: artefacts from dental metallic implants , 2002, European Journal of Nuclear Medicine and Molecular Imaging.

[39]  D. Visvikis,et al.  CT-based attenuation correction in the calculation of semi-quantitative indices of [18F]FDG uptake in PET , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[40]  D W. Townsend,et al.  Combined PET/CT Imaging in Oncology. Impact on Patient Management. , 2000, Clinical positron imaging : official journal of the Institute for Clinical P.E.T.

[41]  Thomas Beyer,et al.  Acquisition protocol considerations for combined PET/CT imaging. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[42]  B L Holbert,et al.  Hepatocellular carcinoma: evaluation with biphasic, contrast-enhanced, helical CT. , 1996, Radiology.

[43]  Elliot K Fishman,et al.  Surgically staged focal liver lesions: accuracy and reproducibility of dual-phase helical CT for detection and characterization. , 2003, Radiology.

[44]  P. Ramchandani,et al.  Multiphasic renal CT: comparison of renal mass enhancement during the corticomedullary and nephrographic phases. , 1996, Radiology.

[45]  V. Vilgrain.  Focal nodular hyperplasia. , 2006, European journal of radiology.

[46]  Thomas Beyer,et al.  Dual-modality PET/CT scanning with negative oral contrast agent to avoid artifacts: introduction and evaluation. , 2004, Radiology.

[47]  Gerald Antoch,et al.  Whole-body positron emission tomography-CT: optimized CT using oral and IV contrast materials. , 2002, AJR. American journal of roentgenology.

[48]  V. Treyer,et al.  Application of oral contrast media in coregistered positron emission tomography-CT. , 2002, AJR. American journal of roentgenology.

[49]  Thomas Beyer,et al.  Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. , 2005, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[50]  Thomas Beyer,et al.  Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology , 2003, European Journal of Nuclear Medicine and Molecular Imaging.

[51]  M. Federle,et al.  Focal nodular hyperplasia: CT findings with emphasis on multiphasic helical CT in 78 patients. , 2001, Radiology.

[52]  J. Luketich,et al.  Whole-Body FDG Positron Emission Tomographic Imaging for Staging Esophageal Cancer: Comparison with Computed Tomography , 2000, Clinical nuclear medicine.

[53]  R C Nelson,et al.  Dynamic helical CT of the abdomen: prospective comparison of pre- and postprandial contrast enhancement. , 1998, Radiology.

[54]  D. Schuster,et al.  Central line injection artifact simulating paratracheal adenopathy on FDG PET imaging. , 2004, Clinical nuclear medicine.