Specialty Imaging PET

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SPECIALTY IMAGING: PET ISBN: 978-0-323-52484-1

Copyright © 2018 by Elsevier. All rights reserved.

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This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be
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Notices

Knowledge and best practice in this field are constantly changing. As new research and
experience broaden our understanding, changes in research methods, professional practices,
or medical treatment may become necessary.

Practitioners and researchers must always rely on their own experience and knowledge in
evaluating and using any information, methods, compounds, or experiments described
herein. In using such information or methods they should be mindful of their own safety
and the safety of others, including parties for whom they have a professional responsibility.

With respect to any drug or pharmaceutical products identified, readers are advised to check
the most current information provided (i) on procedures featured or (ii) by the manufacturer
of each product to be administered, to verify the recommended dose or formula, the
method and duration of administration, and contraindications. It is the responsibility of
practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to
take all appropriate safety precautions.

To the fullest extent of the law, neither the Publisher nor the authors, contributors, or
editors, assume any liability for any injury and/or damage to persons or property as a matter
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products, instructions, or ideas contained in the material herein.

Publisher Cataloging-in-Publication Data

Names: Bennett, Paige.

Title: Specialty Imaging. PET / [edited by] Paige Bennett.
Other titles: PET.
Description: First edition. | Salt Lake City, UT : Elsevier, Inc., [2017] | Includes
bibliographical references and index.
Identifiers: ISBN 978-0-323-52484-1
Subjects: LCSH: Tomography--Handbooks, manuals, etc. | Radiography--Handbooks, manuals, etc. |
MESH: Radiography--methods--Atlases. | Radiography, Dual-Energy Scanned Projection--methods--Atlases. |
Tomography, Emission-Computed, Single-Photon--methods--Atlases. | Tomography, X-Ray
Computed--methods--Atlases.
Classification: LCC RC78.S63 2017 | NLM WN 200 | DDC 616.0757’2--dc23

International Standard Book Number: 978-0-323-52484-1

Cover Designer: Tom M. Olson, BA

Printed in Canada by Friesens, Altona, Manitoba, Canada

Last digit is the print number: 9 8 7 6 5 4 3 2 1

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 DEDICATION

For Dad, Mom, Betsy, Sidney, and Lee Andrew.

Thankful for this time with you all.

PB

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 CONTRIBUTING AUTHORS
Ashley F. Blurton, MD, MS Jacob Blackwell, MD
Assistant Professor Wake Forest School of Medicine
Nuclear Medicine Winston-Salem, North Carolina
Department of Radiology and Medical Imaging
University of Virginia School of Medicine Adam G. Johnson, MD
Charlottesville, Virginia Wake Forest School of Medicine
Winston-Salem, North Carolina
Angela P. Bruner, PhD, DABR
Director, Radiation Safety Officer, Medical Physicist Robert M. Morgan, Jr., MD
Radiation Safety & Medical Physics Wake Forest School of Medicine
Baylor Scott & White Health Winston-Salem, North Carolina
Dallas, Texas
Eric L. Yuan, MD
Erica Cohen, MD Wake Forest School of Medicine
Assistant Chief of Nuclear Medicine Winston-Salem, North Carolina
Edward Hines VA Medical Center
Hines, Illinois
Assistant Professor of Radiology
Loyola University Medical Center
Maywood, Illinois

Erin Grady, MD, CCD, FACNM

Additional Contributors
Nuclear Medicine Physician
Christiana Care Health System John Bailey, MD
Newark, Delaware Aidan Burke, MD
Abdul-Rahman Abualuz, MD Hollins Clark, MD
Department of Radiology
James Patrick Davidson, MD
Wake Forest Health Sciences
Winston-Salem, North Carolina Pushpender Gupta, MBBS
Brian L. Bones, MD Kelli Y. Ha, MD
Department of Radiology John M. Holbert, MD, FACR
Wake Forest Health Sciences
Winston-Salem, North Carolina Katarina Kesty, MD, MBA

Todd Michael Danziger, MD Amanda Jo Lott Marcellino, MD

Department of Radiology Ashley C. Mays, MD
Wake Forest Health Sciences
Winston-Salem, North Carolina Bryan J. Neth, BS
Umesh D. Oza, MD
Nathaniel Garrett Gray, MD
Department of Radiology Virginia Barnes Planz, MD
Wake Forest Health Sciences
Winston-Salem, North Carolina Anita Thomas, MD
Pavani Thotakura, MD
Jennifer Schroeder, MD
Department of Radiology Bimal Vyas, MD, MS
Wake Forest Health Sciences
Christopher T. Whitlow, MD, PhD, MHA
Winston-Salem, North Carolina

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 PREFACE
PET has revolutionized the fields of oncology, cardiology, and neurology. The overwhelming success of
F-18 FDG in clinical use has demonstrated the true power of molecular imaging and has led to additional
regulatory approvals of molecular PET agents for clinical practice, including new tracers that target amyloid
in Alzheimer disease, radiolabeled peptides that target somatostatin receptors on tumors, and radiolabeled
amino acids to image prostate cancer.

These developments have led to a renaissance in nuclear medicine that has changed the way patients
are managed and treated. The highly sensitive F-18 FDG PET is now being augmented by PET tracers
with increased specificity. PET offers physicians an early opportunity to alter therapeutics if they are not
efficacious after a trial period and before adverse effects are evident. As PET research continues, it will
continue to assist in personalized medicine by enabling highly specific therapies, giving patients the best
chance at successful treatment.

Clinicians including nuclear medicine radiologists, radiation oncologists, oncologists, oncology surgeons,
trainees in nuclear medicine and oncology plus researchers in drug development and molecular imaging
need to keep up with existing and emerging PET technologies currently in clinical practice. Specialty Imaging:
PET, first edition is a reference text covering:

• Interpretation, artifacts, and common pitfalls

• Oncologic PET diagnoses with staging tables and reporting tips
• CNS PET indications, including dementia, epilepsy, oncology
• Cardiac PET indications including stress tests, cardiac viability, sarcoidosis
• Infection and inflammation PET
• PET physics and instrumentation
• Clinical and research PET radiotracers and their indications

The authoring team that developed this text is a group of dedicated nuclear medicine physicians and
radiologists involved in both clinical practice and academic pursuits. Lead authors including myself, Dr.
Paige Bennett, and Dr. Andrew Trout have worked to deliver expertise and case examples in the fields of
neuroimaging, oncology, and pediatrics. In addition, over 30 contributing authors–led by Drs. Brad Perry
and Paula Vergara-Wentland–have generously shared their expertise and case examples inside this book to
bring the reader up-to-date on clinical PET imaging.

Akiva Mintz, MD, PhD, MHA, CFA

Professor and Vice Chair of Translational Research, Radiology
Director, PET Center
Division Chief, Nuclear Medicine and Molecular Imaging
Department of Radiology
Columbia University Medical Center
New York, New York

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ACKNOWLEDGMENTS
Lead Editor
Arthur G. Gelsinger, MA

Text Editors
Nina I. Bennett, BA
Terry W. Ferrell, MS
Lisa A. Gervais, BS
Matt W. Hoecherl, BS
Megg Morin, BA

Image Editors
Jeffrey J. Marmorstone, BS
Lisa A. M. Steadman, BS

Illustrations
Richard Coombs, MS
Lane R. Bennion, MS
Laura C. Wissler, MA

Art Direction and Design

Tom M. Olson, BA
Laura C. Wissler, MA

Production Coordinators
Rebecca L. Bluth, BA
Angela M. G. Terry, BA
Emily C. Fassett, BA

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 SECTIONS
SECTION 1:
The Basics

SECTION 2:
Oncology

SECTION 3:
Pediatrics

SECTION 4:
Soft Tissue Infection and Inflammation

SECTION 5:
Central Nervous System

SECTION 6:
Cardiac and Vascular

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 TABLE OF CONTENTS

SECTION 1: THE BASICS CENTRAL NERVOUS SYSTEM ONCOLOGY

INTRODUCTION 66 Brain Metastases
Abdul-Rahman Abualruz, MD, Ashley F. Blurton, MD, MS,
4 Overview and Paige Bennett, MD
Paige Bennett, MD 74 Postradiation Evaluation
Abdul-Rahman Abualruz, MD, Ashley F. Blurton, MD, MS,
INTERPRETATION
and Paige Bennett, MD
8 Approach to Interpretation 80 Primary Brain Malignancy
Erin Grady, MD, CCD, FACNM Abdul-Rahman Abualruz, MD, Ashley F. Blurton, MD, MS,
14 Artifacts and Pitfalls and Paige Bennett, MD
Erica Cohen, MD
CUTANEOUS ONCOLOGY
PROTOCOLS
84 Melanoma
20 Whole-Body PET/CT Protocols Katarina Kesty, MD, MBA and Paige Bennett, MD
Erica Cohen, MD 90 Merkel Cell Carcinoma
Robert M Morgan, Jr., MD and Paige Bennett, MD
PHYSICS AND RADIOPHARMACEUTICALS
GASTROINTESTINAL ONCOLOGY
RADIOPHARMACEUTICALS
94 Esophageal Cancer
24 Clinical Radiopharmaceuticals Paula Vergara-Wentland, MD and Paige Bennett, MD
Erin Grady, MD, CCD, FACNM 100 Gastric Cancer and Gastrointestinal Stromal Tumor
30 Radiopharmaceuticals in Development Paula Vergara-Wentland, MD and Paige Bennett, MD
Erin Grady, MD, CCD, FACNM 104 Anal Carcinoma
32 Radiopharmaceutical Production Paige Bennett, MD
Angela P. Bruner, PhD, DABR 108 Colorectal Carcinoma
Paige Bennett, MD
PHYSICS AND QUALITY CONTROL 112 Peritoneal Carcinomatosis and Mesothelioma
34 Positron Emission Tomography Paige Bennett, MD
Angela P. Bruner, PhD, DABR
42 Nonimaging Detectors GENITOURINARY ONCOLOGY
Angela P. Bruner, PhD, DABR and John Bailey, MD 116 Uterine and Endometrial Cancers
44 Radiation Biology and Dose Brad Perry, MD and Paige Bennett, MD
Angela P. Bruner, PhD, DABR and Umesh D. Oza, MD 122 Ovarian Cancer
Brad Perry, MD and Paige Bennett, MD
SECTION 2: ONCOLOGY 126 Cervical Cancer
ADRENAL ONCOLOGY Brad Perry, MD and Paige Bennett, MD
132 Vulvar and Vaginal Cancer
50 Adrenocortical Carcinoma Brad Perry, MD and Paige Bennett, MD
Adam G. Johnson, MD and Paige Bennett, MD 138 Prostate Cancer
Brad Perry, MD and Paige Bennett, MD
BREAST ONCOLOGY 148 Testicular Cancer
54 Primary Breast Cancer Brad Perry, MD and Paige Bennett, MD
Umesh D. Oza, MD and Kelli Y. Ha, MD 154 Renal Cell Carcinoma
60 Breast Cancer Staging Brad Perry, MD and Paige Bennett, MD
Paige Bennett, MD, Umesh D. Oza, MD, and Kelli Y. Ha, 158 Transitional Cell Carcinoma
MD Brad Perry, MD and Paige Bennett, MD

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 TABLE OF CONTENTS
HEAD AND NECK CANCER NEUROENDOCRINE ONCOLOGY
162 Squamous Cell Carcinoma 264 Abdominal Carcinoid Tumors
Aidan Burke, MD and Paige Bennett, MD Jennifer Schroeder, MD and Paige Bennett, MD
168 Parotid and Salivary Gland Carcinoma 270 Paraganglioma and Pheochromocytoma
Amanda Jo Lott Marcellino, MD and Paige Bennett, MD Paige Bennett, MD

HEPATOBILIARY ONCOLOGY SECTION 3: PEDIATRICS

172 Biliary Malignancy 276 Pediatric Nonaccidental Trauma
Paula Vergara-Wentland, MD and Paige Bennett, MD Bimal Vyas, MD, MS and Andrew T. Trout, MD
178 Hepatocellular Carcinoma 280 Neuroblastoma
Eric L. Yuan, MD, Robert M Morgan, Jr., MD, and Paige Andrew T. Trout, MD
Bennett, MD 286 Ewing Sarcoma
Andrew T. Trout, MD
PANCREATIC ONCOLOGY 292 Osteosarcoma
182 Pancreatic Adenocarcinoma Andrew T. Trout, MD
Paula Vergara-Wentland, MD and Paige Bennett, MD 298 Pediatric Lymphoma
Andrew T. Trout, MD
THORACIC ONCOLOGY
186 Pulmonary Carcinoid Tumor
SECTION 4: SOFT TISSUE INFECTION AND
Jennifer Schroeder, MD and John M. Holbert, MD, FACR
INFLAMMATION
190 Non-Small Cell Lung Cancer 306 Abdominal Infection and Inflammatory Disease
Anita Thomas, MD Paula Vergara-Wentland, MD and Paige Bennett, MD
196 Malignant Pleural Mesothelioma 308 Granulomatous Disease
John M. Holbert, MD, FACR Todd Michael Danziger, MD and Hollins Clark, MD
200 Small Cell Lung Cancer 312 Fever of Unknown Origin
Anita Thomas, MD and Paige Bennett, MD Andrew T. Trout, MD
202 Solitary Pulmonary Nodule
Pavani Thotakura, MD and Hollins Clark, MD SECTION 5: CENTRAL NERVOUS SYSTEM
208 Thymoma and Thymic Carcinoma
Paige Bennett, MD and Anita Thomas, MD DEMENTIA
316 Alzheimer Disease
THYROID AND PARATHYROID CARCINOMA Akiva Mintz, MD, PhD, MHA, CFA and Bryan J. Neth, BS
212 Anaplastic Thyroid Carcinoma 322 Frontotemporal Dementia
Robert M Morgan, Jr., MD and Paige Bennett, MD Akiva Mintz, MD, PhD, MHA, CFA and Bryan J. Neth, BS
214 Papillary and Follicular Thyroid Cancer 326 Lewy Body Dementia
Ashley C. Mays, MD and Paige Bennett, MD Akiva Mintz, MD, PhD, MHA, CFA and Bryan J. Neth, BS
218 Medullary Thyroid Carcinoma 330 Multi-Infarct Dementia
Ashley C. Mays, MD and Paige Bennett, MD Akiva Mintz, MD, PhD, MHA, CFA, Bryan J. Neth, BS, and
Christopher T. Whitlow, MD, PhD, MHA
LYMPHOMA
EPILEPSY
222 Hodgkin Lymphoma
Virginia Barnes Planz, MD and Hollins Clark, MD 334 Intractable Seizure Disorder
228 Non-Hodgkin Lymphoma Andrew T. Trout, MD
Virginia Barnes Planz, MD and Hollins Clark, MD
INFECTION AND INFLAMMATION
MUSCULOSKELETAL ONCOLOGY 338 Cerebral Abscess and Encephalitis
232 Multiple Myeloma Akiva Mintz, MD, PhD, MHA, CFA and Paige Bennett, MD
Pushpender Gupta, MBBS
236 Sarcomas SECTION 6: CARDIAC AND VASCULAR
Nathaniel Garrett Gray, MD and Paige Bennett, MD 342 Myocardial Ischemia
242 Carcinoma of Unknown Primary Jacob Blackwell, MD and Paige Bennett, MD
Brian L. Bones, MD and Paige Bennett, MD 346 Myocardial Viability
256 Chondrosarcoma Jacob Blackwell, MD and Paige Bennett, MD
Nathaniel Garrett Gray, MD and Paige Bennett, MD 350 Cardiac Inflammation and Infection
258 Bone Metastases Paige Bennett, MD
Brian L. Bones, MD and Paige Bennett, MD 354 Vascular Infection and Inflammation
James Patrick Davidson, MD and Paige Bennett, MD
360 Large Vessel Vasculitis
James Patrick Davidson, MD and Paige Bennett, MD

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 PET
Positron Emission Tomography
With Correlative CT and MR

Bennett