PET/CT imaging

Clinical case - Managing motion helps in finding liver recurrence

   
 
     
  Who we are  
 
 
  Doctor Diana Salvo, MD
Clinical Director and Head of Institute of Nuclear Medicine


Doctor Annibale Versari, MD
Senior Clinical lecturer in Multimodality Imaging


Federica Fioroni,
MS, Medical Physicist


Archipedale Santa Maria Nuova,
Reggio Emilia, Italy


The Reggio Emilia ASMN PET Center was created in 2000. In 2002, a 10 MeV Cyclotron (Minitrace GE) was installed in order to produce clinical 18F-FDG and 18F-Choline. A protocol to produce 18FLT and 18F-MISO will also be available soon for research purpose.
In 2005, the first PET system was replaced by a GE Discovery STE PET/CT system.
The center is accredited as Center of Excellence of the Italian association of Nuclear Medicine for the problems related to "PET and radiotherapy" and, on these themes, it delivers brief theoretical/practical stages that are opened to physicists, radiotherapists and nuclear physicians.

 
  Santa Maria Nuevo  
     
  Patient History  
 
 
 

Male - 75 years old - 160cm - 46kg

 
 

In 2002: endoscopic removal of "early gastric cancer".

 
 

In 2005: total gastrectomia for local recurrence (diversified adenocarcinoma moderately, presence of metastases in 1 lymph node on 5).

 
 

In March 2007: echography with contrast shows a secondary lesion in the 8th liver segment. PET whole-body shows an uptake of 2.2 cm in the same segment. Two radiofrequency thermoablations of the lesion were done. In August a new whole-body PET is negative.

 
 

In 2008: echography with contrast shows a new lesion of 20 mm in the 4th segment of the liver.

 
     
     
  Acquisition  
 
 
 

Scanner: GE Discovery STE

 
     
  PET acquisition: Whole-body static and MotionFree acquisition  
 
3D acquisition using VUE Point HD reconstruction
Acquisition time:                   
  Whole-body acquisition: 3 min/bed
  MotionFree acquisition: 6 bins - 2 min/bin
Post-injection time: 1h30 min
Dose: 174 MBq of 18F-FDG
 
     
  CT acquisition:  
 
Static CT Attenuation Correction whole-body acquisition
MotionFree acquisition both for CTAC and diagnosis
 
     
     
  Findings  
 
 
 

Whole-body PET/CT scan is totally negative.

 
 

MotionFree PET/CT scan shows a 7 mm uptake area in the same place of the previous lesion.

 
     
 
Negative static whole-body PET/CT scan MIP  

Negative static whole-body PET/CT scan MIP

 
Positive MotionFree PET/CT scan MIP
 
MotionFree PET/CT image showing a 7mm lesion supporting local recurrence  

Positive MotionFree PET/CT scan MIP

 

MotionFree PET/CT image showing a 7mm lesion supporting local recurrence

 
Fused coronal and sagittal views of MotionFree PET and CT   Fused coronal and sagittal views of MotionFree PET and CT  

Fused coronal and sagittal views of MotionFree PET and CT

 
 
     
     
  Conclusion  
 
 
 

The lesion showed by the echography in 2008 was not confirmed as disease. The PET whole-body was negative but a suspected recurrence was found only in the MotionFree acquisition.

 
   
 
 
   
   
   
   
   
   
     
Who we are  
Patient History  
Acquisition  
Findings  
Conclusion  
     
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