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1、AdamL.Cohen,MSIIIGillianLieberman,MDOctober-November,2002PETScanningforMalignantMelanoma:AnEvidenceBasedApproachAdamL.Cohen,HarvardMedicalSchoolYearIIIGillianLieberman,MDAdamL.Cohen,MSIIIGillianLieberman,MDPatientSW•40yowomans/pmelanomaresectiononrightarm,
2、whopresentedin1999,oneyearafterchemotherapyandradiation,withasubcutaneousnoduleandmassinherrightaxilla.•Biopsyofthenoduleindicatedmelanomarecurrence.•ChestCTscanreportedas“irregularsofttissuedensityinrightaxilla,...Presumedduetopost-surgicalchange.Metastat
3、icmelanoma,however,cannotbeexcluded.”•Head,abdomen,andpelvicCTscanswereunremarkable.2AdamL.Cohen,MSIIIGillianLieberman,MDCTScanofSWLeftUnansweredQuestions:BIDMCPACS•Residualtumororscar?3•Anymetastases?AdamL.Cohen,MSIIIGillianLieberman,MDFDG-PETShowsMetabol
4、ism?•FDG(2-18F-2-deoxy-D-glucose)accumulatesincellsthattakeupglucosebutdonothaveglucose-6-phosphatase.BloodTissueGLUT1HexokinaseGylcolysisGlucoseGlucoseGlucose-6-PATPGLUT1HexokinaseGylcolysisFDGFDGFDG-6-PATPGlucose-6-phosphatase•Manymalignantcellsrelymostl
5、yonglycolysisandusuallylackglucose-6-phosphatase.4AdamL.Cohen,MSIIIGillianLieberman,MDPhysiologicPositiveswithPET•Brainandmyocardiumalwayspositive,particularlyinafedstate•Musclethathasbeenrecentlyexercised•ExcretedFDGinurinarysystem•GIsystem:lymphoidtissue
6、oractivity•Lactation•Thymus•Epiphysis•Post-chemotherapybonemarrowhyperplasia5AdamL.Cohen,MSIIIGillianLieberman,MDOtherFalsePositives•Inflammation–Post-surgery,post-radiation,orpost-chemotherapy–Infection–Auto-immune–Stoma–Injury•Benignneoplasms6AdamL.Cohen
7、,MSIIIGillianLieberman,MDDetectionofFDGCoincidencedetectorCoincidencedetectorPhotonγdetectorse-e+γ18FAccuracyandresolutiondependon:•Electrondensity•Photonscatter•Photonattenuation7AdamL.Cohen,MSIIIGillianLieberman,MDDetectionofFDGhttp://radiology.bidmc.har
8、vard.edu/kinds_of_exams/nuclear/nucmed.html8AdamL.Cohen,MSIIIGillianLieberman,MDPETScanofSWCourtesyofDr.KevinDonohoe,BIDMC•Therearetwopositiveareasintherightaxillaandonepositiveareaintherightneck.9•Theseareal
