| PET-CT | |
|---|---|
| Diagnostics | |
A complete body PET / CT Fusion image |
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| OPS-301 code | 3-75 |
Positron emission tomography - computed tomography (better known by its acronym PET-CT or PET/CT) is a medical imaging device which combines in a single gantry system both a Positron Emission Tomography (PET) and an x-ray Computed Tomography, so that images acquired from both devices can be taken sequentially, in the same session from the patient and combined into a single superposed (co-registered) image. Thus, functional imaging obtained by PET, which depicts the spatial distribution of metabolic or biochemical activity in the body can be more precisely aligned or correlated with anatomic imaging obtained by CT scanning. Two- and three-dimensional image reconstruction may be rendered as a function of a common software and control system.
PET-CT has revolutionized many fields of medical diagnosis, by adding precision of anatomic localization to functional imaging, which was previously lacking from pure PET imaging. For example, in oncology, surgical planning, radiation therapy and cancer staging have been changing rapidly under the influence of PET-CT availability, to the extent that many diagnostic imaging procedures and centers have been gradually abandoning conventional PET devices and substituting them by PET-CTs. Although the combined/hybrid device is considerably more expensive, it has the advantage of providing both functions as stand-alone examinations, being, in fact, two devices in one.
The only other obstacle to a wider dissemination of PET-CT is the difficulty and cost of producing and transporting the radiopharmaceuticals used for PET imaging, which are usually extremely short-lived (for instance, the half life of radioactive fluorine18 used to trace glucose metabolism (using fluorodeoxyglucose, FDG) is two hours only. Its production requires a very expensive cyclotron as well as a production line for the radiopharmaceuticals.
An example of how PET-CT works in the work-up of FDG metabolic mapping follows:
A whole body scan, which usually is made from mid-thighs to the top of the head, takes from 5 minutes to 40 minutes depending on the acquisition protocol and technology of the equipment used. FDG imaging protocols acquires slices with a thickness of 2 to 3 mm. Hypermetabolic lesions are shown as false color-coded pixels or voxels onto the gray-value coded CT images. Standardized Uptake Values are calculated by the software for each hypermetabolic region detected in the image. It provides a quantification of size of the lesion, since functional imaging does not provide a precise anatomical estimate of its extent. The CT can be used for that, when the lesion is also visualized in its images (this is not always the case when hypermetabolic lesions are not accompanied by anatomical changes).
FDG doses in quantities sufficient to carry out 4-5 examinations are delivered daily, twice or more times per day, by the provider to the diagnostic imaging center.
For uses in stereotactic radiation therapy of cancer, special fiducial marks are placed in the patient's body before acquiring the PET-CT images. The slices thus acquired may be transferred digitally to a linear accelerator which is used to perform precise bombardment of the target areas using high energy photons (radiosurgery).