PET/CT imaging

Clinical case - Managing motion helps in finding cancer recurrence

   
 
     
  Who we are  
 
 
  Doctor RenĂ©e Ahond-Vionnet
Senior Clinical lecturer in Nuclear Medicine Department

Centre Hospitalier De Nevers, Nuclear Medicine Department
Nevers, France

The nuclear medicine department of CH NEVERS, France, led by Dr Ahond-Vionnet, has 2 Gamma-Camera systems (one double-head Millenium MG and one hybrid Infinia Hawkeye4).

  
 

Since April 2008, the department is equipped with a GE PET/CT Discovery RX with Motion Free and PET VCAR applications.

  
 

This PET/CT system helps clinicians to improve diagnostics and therapy follow-up of patients with cancerous lesions.

Thanks to Motion Free, we help radiotherapy physicists and physicians to define more accurately the irradiation dose and volume for RT planning.

  
  T E P Loire Bourgogne  
     
  Patient History  
 
 
 

Male - 78 years old - 168cm - 67kg

  
 

Suffered from pancreatic cancer operated in march 2007

  
 

Increase of the CA 19-9 marker to 213.

  
 

A 18F-FDG PET/CT acquisition was requested in June2008 for research of distant metastasis and/or recurrence.

  
     
     
  Acquisition  
 
 
  Scanner: GE Discovery RX  
     
  PET acquisition: Whole-body acquisition  
 
– 3D acquisition using VUE Point HD reconstruction
– Post-injection time: 1h
– Acquisition time:
 
  • Whole body-acquisition: 1 min30/bed
  • MotionFree acquisition: 10 min acquisition – 5 bins
    		•
    – Dose: 234 MBq of 18F-FDG
    		 
         
      CT acquisition:  
     
    – Static CT Attenuation Correction whole-body acquisition
    – MotionFree acquisition both for CTAC and diagnosis
    – Detector configuration: 16 x 1.25 mm
    – Slice thickness: 1.25 mm
    – kVp: 120, mA: 80-160 Smart mA-Auto mA
    		 
         
         
      Findings  
     
    		 
     

    The static scan shows a small uptake in the pancreatic head with suspicion of metastasis (SUVmax=3,7)

    The respiratory gating acquisition clearly highlights the hypermetabolic lesion in the head of the pancreas (SUVmax=6,2).

    		  
     
    Negative static coronal and axial views showing slight uptake in the pancreas head
     
    		Positive MotionFree coronal and axial view showing hypermetabolic lesion in the pancreas head  
    Negative static coronal and axial views showing slight uptake in the pancreas head   Positive MotionFree coronal and axial view showing hypermetabolic lesion in the pancreas head  
           
    Static Acquisition   MotionFree Acquisition  
    Static Acquisition   MotionFree Acquisition  
    		 
         
         
      Conclusion  
     
    		 
     

    The whole-body PET scan reveals a non significant uptake in the head of the pancreas. The MotionFree acquisition helps confirming the uptake as a malignant lesion.

    		  
     

    Using the MotionFree acquisition helps confirming the uptake as a malignant lesion is pathologic, therefore confirming recurrence.

    		  
       
     
    		 
       
       
       
       
       
       
         
    Who we are  
    Patient History  
    Acquisition  
    Findings  
    Conclusion