This overview of the oncologic applications of positron emission tomography (PET) focuses on the technical aspects and clinical applications of a newer technique: the combination of a PET scanner and a computed tomography (CT) scanner in a single (PET/CT) device. Examples illustrate how PET/CT contributes to patient care and improves upon the previous state-of-the-art method of comparing a PET scan with a separate CT scan. Finally, the author presents some of the results from studies of PET/CT imaging that are beginning to appear in the literature.

† Breast cancer, colon cancer, lung cancer, lymphoma, melanoma, sarcoma, and head and neck cancer.‡ Patient management includes diagnostic management and treatment management. § Patient clinical outcomes include overall survival, event-free survival, progression-free survival, disease-specific survival, disease-free survival, skeletal-related events, or change in outcome.

Positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) was performed in 19 patients with brain metastases from non-central nervous system (CNS) neoplasms and one patient with a primary CNS lymphoma. Various histopathologic types were represented by the primary neoplasms in the patients with metastases. Only 21 of the 31 lesions (68%) were detected with FDG PET as discrete, metabolically active foci (relative to surrounding structures). Six of the nondetected lesions may have been nondiscernible owing to their small size and/or isointensity relative to closely apposed normal gray matter. However, four lesions of at least 1.2 cm in diameter showed frankly decreased FDG accumulation relative to normal brain. These findings suggest that studies of FDG accumulation by a variety of non-CNS neoplasms and their CNS metastases are in order and that extrapolation of the successes of FDG PET in imaging of primary glial tumors to imaging of brain metastases should proceed with caution.

FDG PET can aid in differentiating benign from malignant strictly intraosseous lesions.

Positron emission tomography (PET) with fluorine-18 fluoro-2-deoxy-D-glucose (FDG) was performed in 19 patients referred for clinical evaluation of soft-tissue masses. These patients had 20 different lesions and had been evaluated previously with computed tomography (CT) and/or magnetic resonance (MR) imaging. The diagnoses were subsequently confirmed with open biopsy or excision (19 lesions) or by clinical and radiographic follow-up (one lesion). Semiquantitative assessment of FDG accumulation (differential uptake ratio) within the suspected tumor helped correctly separate the 10 malignant tumors from the 10 benign lesions. In contrast, a simple ratio of FDG uptake within the suspected tumor to that within comparable normal soft tissue was less successful in helping make this distinction, with overlap in 12 of the 20 cases. Careful comparison with findings from other available imaging studies is essential for accurate interpretation of PET studies of soft-tissue masses, but in many cases, PET may be a useful adjunct in the preoperative evaluation of suspected soft-tissue tumors, yielding valuable information that is not provided with CT or MR imaging.