Atlas of PET/CT with SPECT / CT with DVD

1. PREFACE

2. TECHNICAL CONSIDERATIONS FOR PET/CT AND SPECT/CT

3. PET/CT OF THE BRAIN

3.1 Normal pattern
3.2 Benign abnormalities
3.2.1 Congenital encephalomalacia
3.2.2 Post-surgical changes
3.2.3 Radiation necrosis
3.3 Tumors
3.3.1 Primary brain tumor
3.3.2 Metastases
3.3.3 Residual tumor & post-surgical changes
3.3.4 Recurrent tumor & radiation necrosis
3.3.5 Pituitary adenoma & stroke
3.4 Neurological disorders
3.4.1 Epilepsy ?classic interictal pattern
3.4.2 Epilepsy ?interictal pattern & cerebellar diaschisis
3.4.3 Epilepsy ?interictal & decreased cerebellar uptake
3.4.4 Alzheimer뭩 disease ?diffuse pattern
3.4.5 Alzheimer뭩 disease ?frontal predominance

4. PET/CT OF THE HEAD & NECK

4.1 Normal pattern
4.2 Physiologic, Artifacts & Pitfalls
4.2.1 Artifact - miss-registration due to patient movement
4.2.2 Physiologic ?muscles uptake in tongue
4.2.3 Physiologic ?unilateral muscle uptake, mastication
4.2.4 Physiologic - bilateral muscle uptake, mastication
4.2.5 Physiologic ?unilateral muscle uptake, neck
4.2.6 Physiologic ?unilateral muscle uptake, torticollis & metal artifact
4.2.7 Pitfall - vocal cord paralysis, left
4.2.8 Pitfall - vocal cord paralysis, right & supraclavicular node
4.2.9 Benign - brown fat, neck
4.2.10 Benign - brown fat, neck & shoulders
4.2.11 Benign - post-treatment changes, skin & subcutaneous tissue
4.2.12 Benign - post-treatment changes, reconstituted lymphoid tissue & muscles
4.2.13 Benign - post-surgical changes & missing salivary gland
4.2.14 Benign - post-treatment changes & FDG-negative salivary gland
4.2.15 Pitfall - post-surgical changes, missing orbit & ethmoid air cells
4.3 Inflammation & Infection
4.3.1 Inflammation, tracheostomy
4.3.2 Infection, acne
4.3.3 Infection, maxillary sinusitis, partial involvement
4.3.4 Infection, maxillary sinusitis, involvement of whole sinus
4.3.5 Mucus cyst in maxillary sinus, FDG-negative
4.3.6 Inflammation, rheumatoid arthritis, atlanto-dental joint
4.4 Tumors
4.4.1 Scalp, melanoma
4.4.2 Scalp, melanoma
4.4.3 Scalp, FDG-negative
4.4.4 Auditory canal
4.4.5 Parotis & peri-parotid nodes
4.4.6 Parotis
4.4.7 Nasopharynx, response to treatment
4.4.8 Lip
4.4.9 Base of tongue
4.4.10 Tongue & level II nodes
4.4.11 Tonsil & level II nodes
4.4.12 Pharynx
4.4.13 Pharynx & cervical nodes
4.4.14 Larynx & tracheostomy
4.4.15 Larynx & tracheal cartilage destruction
4.4.16 Vocal cord
4.4.17 Cervical esophageal cancer
4.4.18 Neural sheath
4.4.19 Bone, vertebral metastasis
4.5 Lymph Nodes
4.5.1 Level I
4.5.2 Level I & II
4.5.3 Level II
4.5.4 Level II
4.5.5 Level II & III
4.5.6 Level IV
4.5.7 Level V
4.5.8 Level VI
4.6 Thyroid
4.6.1 Benign - Thyroiditis
4.6.2 Benign ?Multinodular retrosternal goiter
4.6.3 Benign ?Adenoma & distorted anatomy
4.6.4 Tumor - Primary thyroid cancer

5. PET/CT OF THE CHEST

5.1 Normal Pattern
5.2 Chest wall
5.2.1 Pitfall ?Gynecomastia
5.2.2 Pitfall - Muscular uptake, asymmetric
5.2.3 Pitfall - Axillary post-injection uptake
5.2.4 Benign ?Brown fat, shoulder & upper chest wall
5.2.5 Benign ?Post-surgical changes
5.2.6 Tumor ?Chest wall recurrence, breast cancer
5.3 Breast
5.7.1 Artifact ?Saline implants, cold lesion
5.7.2 Pitfall - Seroma
5.7.3 Benign ?Granuloma
5.7.4 Benign ?Post-radiation changes
5.7.5 Tumor ?Large primary breast cancer
5.7.6 Tumor - Primary breast cancer & axillary nodes
5.7.7 Tumor ?Recurrent breast cancer & axillary nodes
5.4 Skeleton
5.4.1 Benign ?Rib fractures, varying ages
5.4.2 Benign ?Fracture, sternum
5.4.3 Benign ?Osteophyte, thoracic vertebra
5.4.4 Benign ?Post-radiation 밹old?vertebrae
5.4.5 Tumor ?Metastasis, rib
5.4.6 Tumor ?Metastasis, sternum
5.4.7. Tumor ?Metastases, thoracic vertebrae
5.5 Pleura
5.5.1 Benign ?Inflammation, pleurodesis, localized pattern
5.5.2 Benign ?Inflammation, pleurodesis, diffuse pattern
5.5.3 Tumor - Malignant pleural effusion
5.5.4 Tumor ?Pleural thickening, mesothelioma
5.5.5 Tumor ?Pleural nodule, malignant implant
5.5.6 Tumor ?Pleural masses, mesothelioma
5.6 Lung
5.6.1 Pitfall ?Miss-registration, related to respiration
5.6.2 Benign - Post-radiation changes
5.6.3 Benign - Pneumonia
5.6.4 Benign ?Pulmonary sarcoidosis
5.6.5 Benign ?FDG-negative small lung nodule
5.6.6 Benign ?FDG-negative lung nodule & interval shrinkage
5.6.7 Benign ?Single lung nodule, granuloma
5.6.8 Tumor ?Single lesion, primary lung cancer
5.6.9 Tumor ?Single cystic lesion, primary lung cancer
5.6.10 Tumor - Moderate FDG avidity, bronchiolo-alveolar lung cancer
5.6.11 Tumor ?Pancoast, with chest involvement & lung metastasis
5.6.12 Tumor ?Response to treatment, primary & hilar nodes
5.6.13 Tumor ?Metachronous lung cancer
5.6.14 Tumor ?Recurrent mesothelioma & post-surgical changes
5.6.15 Tumor ?Multiple lesions, multifocal lung cancer
5.6.16 Tumor ?Multiple lesions, lymphoma
5.6.17 Tumor ?Multiple lesions, inhomogeneous pattern, lymphoma
5.6.18 Tumor ?Multiple lesions, metastases
5.6.19 Tumor ?Multiple lesions, FDG-negative metastases
5.6.20 Tumor ?Multiple lesions, treated & new metastases
5.7 Thoracic Lymph Nodes
5.7.1 Supraclavicular
5.7.2 Retroclavicular & pectoralis
5.7.3 Axillary & pectoralis
5.7.4 Axillary
5.7.5 Internal mammary
5.7.6 Supradiaphragmatic
5.8 Mediastinal Lymph Nodes
5.8.1 Anterior mediastinal & paratracheal
5.8.2 Prevascular, normal size
5.8.3 Aorto-pulmonary window
5.8.4 Precarinal & subcarinal
5.8.5 Paraesophageal
5.8.6 Multiple: pretracheal,paratracheal, tracheo-bronchial & hilar
5.8.7 Response to treatment, Retrocaval-paratracheal & paraspinal
5.9 Mediastinum
5.9.1 Pitfall ?Brown fat
5.9.2 Pitfall - Blood clot
5.9.3 Benign ?Thymus
5.9.4 Tumor - Bulky disease, lymphoma
5.9.5 Tumor ?Endotracheal lesion, recurrent lung cancer
5.10 Esophagus
5.10.1 Pitfall - Hiatal hernia
5.10.2 Pitfall - Gastric pull-up
5.10.3 Benign - Esophagitis, post-radiation
5.10.4 Tumor - Esophageal cancer, proximal
5.10.5 Tumor - Esopageal cancer, distal
5.10.6 Tumor - Response to treatment, distal
5.11 Cardio-vascular
5.11.1 Benign - Takayasu뭩 aortitis
5.11.2 Benign - Coronary calcifications & pericardial effusion
5.11.3 Assessment of myocardium - Scar
5.11.4 Assessment of myocardium - Viability & apical scar
5.11.5 Assessment of myocardium - Cardiomyopathy
5.11.6 Cardiac PET/CT ?Normal myocardial perfusion & coronary anatomy
5.11.7 Cardiac PET/CT ?Ischemia & coronary calcifications, narrowing

6. PET/CT OF THE ABDOMEN

6.1 Normal pattern
6.2 Abdominal wall
6.2.1 Pitfall ?Colostomy
6.2.2 Pitfall ?Pararenal brown fat
6.2.3 Pitfall ?Anterior abdominal brown fat,
6.2.4 Pitfall ?Paracolic brown fat
6.2.5 Benign - Surgical scar
6.2.6 Benign ?Rib fracture
6.2.7 Tumor - Metastasis
6.3 Liver & spleen
6.3.1 Pitfall ?Intracholdedocal stent
6.3.2 Pitfall ?Lesions at liver/lung interface
6.3.3 Benign ?Chronic cholecystitis
6.3.4 Tumor ?Primary hepatocellular carcinoma
6.3.5 Tumor ?Single liver metastasis at lower pole
6.3.6 Tumor ?Multiple liver metastases
6.3.7 Tumor ?Recurrent metastasis at site of surgery
6.3.8 Tumor ?Single spleen metastasis
6.3.9 Tumor ?Multiple lesions in spleen
6.3.10 Tumor ?Spelnomegaly & diffuse involvement by lymphoma
6.4 Pancreas
6.4.1 Tumor ?Cancer in head of pancreas
6.4.2 Tumor ?Cancer in tail of pancreas
6.4.3 Tumor & inflammatory process ?Multiple pancreatic lesions
6.5 Stomach
6.5.1 Physiologic gastric uptake
6.5.2 Tumor - Lymphoma in distal antrum
6.5.3 Tumor - Gastric cancer, diffuse involvement
6.5.4 Tumor ?Large mass, GIST
6.5.5 Tumor ?Recurrence in gastric stump
6.6 Bowel
6.6.1 Benign ?Colon adenoma
6.6.2 Tumor ?Primary colon cancer
6.6.3 Tumor ?Metastasis in small intestine
6.7 Peritoneum
6.7.1 Benign - Granulomatotic nodule
6.7.2 Tumor - Single metastatic nodule
6.7.3 Tumor - Multiple metastatic nodules
6.7.4 Tumor ?Diffuse pattern, peritoneal seeding
6.7.5 Tumor ?Peritoneal masses, GIST
6.8 Kidney & Adrenals
6.8.1 Pitfall ?Regional lymphadenopathy near renal pelvis
6.8.2 Pitfall ?Single kidney
6.8.3 Pitfall ?Ectopic kidney
6.8.4 Pitfall ?Horseshoe kidney
6.8.5 Pitfall ?Distorted renal pelvis
6.8.6 Tumor - Single renal metastasis
6.8.7 Tumor ?Multiple renal lesions, lymphoma
6.8.9 Tumor ?Single adrenal metastasis
6.8.10 Tumor - Bilateral adrenal involvement, lymphoma
6.9 Lymph Nodes
6.9.1 Gastro-hepatic ligament
6.9.2 Hepatic hilum
6.9.3 Splenic hilum
6.9.4 Mesenteric & retroperitoneal
6.9.5 Root of mesentery
6.9.6 Para-aortic
6.9.7 Aorto-caval
6.9.8 Iliac
6.10 Vascular
6.10.1 Pitfall - Aortic wall calcifications
6.10.2 Pitfall - Aortic aneurysm
6.10.3 Benign - Aortic graft infection & psoas muscle abscess
6.11 Bone (Lumbar spine)
6.11.1 Benign - Degenerative changes, vertebral body
6.11.2 Benign - Degenerative changes, articular facets
6.11.3 Benign - Degenerative changes, intervertebral disc
6.11.4 Tumor - Lytic FDG-avid metastasis
6.11.5 Tumor ?Sclerotic FDG-negative metastases
6.11.6 Tumor ?Bone & soft tissue metastasis

7 PET/CT OF THE PELVIS

7.1.1 Normal pattern - Male pelvis
7.1.2 Normal pattern - Female pelvis
7.2 Pelvic wall, Soft tissues & Peritoneum
7.2.1 Pitfall ?Focal uptake, Colostomy
7.2.2 Pitfall ?Focal uptake, Inguinal hernia
7.2.3 Pitfall ?Focal uptake, Urinary catheter
7.2.4 Benign ?Skin granuloma
7.2.5 Benign ?Infection, pilonidal sinus
7.2.6 Benign ?Infection, pelvic abscess
7.2.7 Tumor - Presacral recurrence, rectal cancer
7.2.8 Tumor ?Metastasis, psoas muscle
7.2.9 Tumor ?Metastases, focal peritoneal nodule
7.2.10 Tumor - Diffuse peritoneal involvement
7.3 Gastro-intestinal tract
7.3.1 Pitfall ?Physiologic bocal uptake in bowel
7.3.2 Benign ?Rectal polyp
7.3.3 Benign ?Inflammatory bowel disease
7.3.4 Tumor ?Primary rectal cancer
7.3.5 Tumor ?Primary recto-sigmoid cancer & para-rectal nodes
7.3.6 Tumor ?Response to treatment, Metastatic rectal cancer
7.3.7 Tumor - Recurrence, rectal cancer
7.3.8 Tumor ?Recurrence, rectal cancer & iliac nodes
7.4 Urinary tract
7.4.1 Pitfall - Ectopic pelvic kidney
7.4.2 Pitfall - Renal transplant
7.4.3 Pitfall ?Focal uptake in ureter
7.4.4 Pitfall ?Focal uptake in obstructed ureter
7.4.5 Pitfall - Dilated prostatic urethra
7.4.6 Pitfall - Bladder diverticulum
7.4.7 Pitfall - Bladder herniation
7.4.8 Tumor ?Carcinoma of ureter
7.4.9 Tumor- Carcinoma of urinary bladder
7.5 Ovary, Cervix, Uterus
7.5.1 Pitfall - Ovulating ovary
7.5.2 Pitfall ?Menstruation
7.5.3 Tumor- Lymphoma in ovary
7.5.4 Tumor ?Primary ovarian cancer
7.5.5 Tumor ?Ovarian cancer, recurrence at site of previous surgery
7.5.6 Tumor ?Primary cervical cancer
7.5.7 Tumor ?Primary cervical cancer, inhomogeneous uptake pattern
7.5.8 Tumor ?Primary cervical cancer & iliac nodes
7.5.9 Tumor ?Recurrence, cervical cancer
7.6 Prostate, Testis
7.6.1 Benign - Prostatic hypertrophy
7.6.2 Benign ?Infection, Orchi-epidydimitis
7.6.3 Tumor - Lymphoma in testis
7.7 Lymph Nodes
7.7.1 Common & external iliac lymph nodes
7.7.2 Internal iliac lymph nodes
7.7.3 Internal iliac lymph nodes, lower pelvis
7.7.4 Inguinal lymph nodes & cervical cancer
7.7.5 Inguinal lymph nodes & metastatic gluteal mass
7.8 Vascular
7.8.1 Pitfall ?Non-infected aorto-bifemoral bypass
7.8.2 Benign - Infected vascular graft
7.9 Bone
7.9.1 Pitfall ?Post-radiation 밅od?sacrum
7.9.2 Benign - Sacral fracture
7.9.3 Benign ?Paget뭩 disease
7.9.4 Tumor ?Metastasis in sacrum & epidural space
7.9.5 Tumor ?Metastasis in ilium & soft tissue

8. PET/CT OF EXTREMITIES

8.1 Skin
8.1.1 Benign - Surgical scar
8.1.2 Benign - Infected surgical scar
8.1.3 Benign - Infected ulcers
8.1.4 Tumor ?Nodules, malignant melanoma
8.2 Soft tissue
8.2.1 Benign - Abscess
8.2.2 Tumor - Subcutaneous nodule, lymphoma
8.2.3 Tumor - Subcutaneous nodule, melanoma
8.2.4 Tumor ?Sarcoma & bone involvement
8.3 Joints
8.3.1 Artifact - Periprosthetic uptake, metal-induced & reactive process
8.3.2 Benign - Periarticular uptake, bursitis
8.3.3 Benign - Periarticular uptake, synovitis
8.3.4 Benign ?Teno-synovitis & tendon tear
8.3.5 Benign - Periprosthetic uptake, low grade infection
8.4 Muscles
8.4.1 Physiologic ?Tense muscles
8.4.2 Tumor ?Metastasis, breast cancer
8.4.3 Tumor ?Metastases, rhabdo-myosarcoma
8.5 Lymph Nodes
8.5.1 Epitrochlear
8.5.2 Popliteal
8.5.3 Popliteal, large node
8.6 Vascular
8.6.1 Pitfall ?Vascular uptake peri-calcifications
8.6.2 Benign - Infected vascular graft
8.7 Bone & bone marrow
8.7.1 Benign - Osteomyelitis
8.7.2 Tumor ?Metastasis in scapula
8.7.3 Tumor ?Metastasis in humerus
8.7.4 Tumor ?Metastasis in femur
8.7.5 Tumor - Bone & soft tissue involvement, lymphoma
8.7.6 Tumor - Bone marrow involvement, multiple myeloma
8.7.7 Tumor - Bone marrow & soft tissue involvement, lymphoma
8.7.8 Tumor - Bone marrow & soft tissue involvement, lymphoma

9. SPECT/CT

9.1 Indium111-Pentetreotide SPECT/CT
9.1.1 Physiologic - Bowel & kidney uptake
9.1.2 Pitfall - Uptake in gallbladder
9.1.3 Tumor ?Residual carcinoid
9.1.4 Tumor ?Metastatic carcinoid
9.1.5 Tumor ?Disseminated carcinoid
9.1.6 Tumor ?Vertebral metastasis of neuroendocrine tumor
9.2 Iodine131 SPECT/CT
9.2.1 Physiologic ?Remnant thyroid
9.2.2 Physiologic ?Bowel uptake
9.2.3 Pitfall ?Thymic uptake
9.2.4 Pitfall ?Dental & uterine inflammatory process
9.2.5 Pitfall ?Uptake in ectopic stomach
9.2.6 Tumor ?Mediastinal nodal metastasis, thyroid cancer
9.2.7 Tumor ?Cervical & supraclavicular nodal metastases, thyroid cancer
9.2.8 Tumor ?Lung metastasis, Thyroid cancer
9.2.9 Tumor ?Bone metastasis, Thyroid cancer
9.2.10 Tumor ?Bone metastases, Thyroid cancer
9.3 Iodine123-MIBG SPECT/CT
9.3.1 Physiologic - Cardiac uptake
9.3.2 Physiologic ?Inhomogeneous cardiac uptake & pheochromocytoma
9.3.3 Physiologic ?Renal uptake
9.3.4 Physiologic ?Adrenal uptake
9.3.5 Tumor ?Bilateral pheochromocytoma
9.3.6 Tumor ?Neuroblastoma & bone marrow involvement
9.4 Gallium67 SPECT/CT
9.4.1 Pitfall ?Thymic uptake
9.4.2 Benign ?Infection, osteomyelitis
9.4.3 Benign ?Infection, bone & soft tissue; Bowel uptake
9.4.4 Benign ?Infection, paravertebral abscess
9.4.5 Benign ?Infection, liver abscess
9.4.6 Tumor ?Lymphoma involving the head and neck & mediastinum
9.4.7 Tumor ?Lymphoma in pelvic mass
9.4.8 Tumor ?Lymphoma in muscle & Pitfalls: rib fracture & lung infiltrate
9.5 In111-capromab pendetide (Prostascint? SPECT/CT
9.5.1 Normal study
9.5.2 Tumor ?Abdominal lymphadenopathy, prostate cancer
9.6. Tc99m-MIBI SPECT/CT (Parathyroid Imaging)
9.6.1 Pitfall ?Asymmetric salivary gland uptake & parathyroid adenoma
9.6.2 Tumor - Parathyroid adenoma in right lower neck
9.6.3 Tumor ?Parathyroid adenoma in left lower neck
9.6.4 Tumor ?Ectopic parathyroid adenoma
9.7. Tc99m-MDP SPECT/CT
9.7.1 Pitfall ?Uptake related to renal calculus
9.7.2 Benign - Facet joint disease
9.7.3 Benign ?Osteoarthritis in hip
9.7.4 Benign - Fibrous dysplasia
9.7.5 Benign - Myositis ossificans
9.7.6 Benign - Hematoma at injection site
9.8. In111 labeled Leucocytes SPECT/CT
9.8.1 Diabetic foot - Osteomyelitis & soft tissue
9.8.2 Diabetic foot - Soft tissue involvement
9.8.3 Diabetic foot - Soft tissue involvement
9.8.4 Bacteremia - Infected aortic plaque
9.9 Tc99m-MIBI SPECT/CT (Cardiac)
9.9.1 SPECT, myocardial perfusion/CT, attenuation correction - Normal study
9.9.2 SPECT, myocardial perfusion/CT, attenuation correction - Breast artifact
9.9.3 SPECT, myocardial perfusion/CT, attenuation correction - Diaphragm artifact
9.9.4 SPECT, myocardial perfusion/CT, attenuation correction - Scar & ischemia
9.9.5 SPECT/CT ?Normal perfusion & coronary anatomy
9.9.6 SPECT/CT ?Myocardial ischemia & coronary lesions