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Fig. 1
Principles of positron emission tomographic (PET) imaging. A. The PET scanner is a clinical imaging instrument that exploits the physical properties of positron-emitting isotopes such as F-18, which are generally produced by cyclotrons through acceleration of charged particles. B. Positron-emitting isotopes spontaneously undergo radioactive decay by emitting a positron from its nucleus. The positron loses energy soon after its emission and collides with a nearby electron, which results in annihilation of both antiparticles with production of two gamma-rays that travel toward 180 degree opposite directions. C. When a patient is intravenously injected with a positron emitting molecular radioprobe, such as F-18 2-fluoro-2-deoxy-D-glucose (FDG), a PET scanner can detect the coincident gamma-rays and images can be reconstructed showing accurate in vivo locations and concentration of the tracer.
Fig. 2
Comparison of In-111 octreotide and F-18 FDG PET/CT images in a patient with medullary thyroid carcinoma. The 58 year-old male showed increased plasma calcitonin levels during follow-up after total thyroidectomy and right neck dissection for medullary thyroid carcinoma. In-111 octreotide scintigraphy at 4 hr post-injection (A) demonstrates no abnormality on anterior and posterior views. However, PET/CT reveals abnormal increased FDG uptakes in the right level II cervical (B, arrow) and right paratracheal lymph node regions (C, arrow head), which were surgically confirmed to be medullary thyroid carcinoma.
Fig. 3
Comparison of I-131 MIBG and F-18 FDG PET/CT images in a 53 year-old male patient who hade undergone pelvic mass excision for paraganglioma. I-131 MIBG scintigraphy at 48 hr post-injection shows no abnormal radioaccumulation (A). In contrast, PET/CT demonstrates a large number of lesions that have substantial FDG activity, consistent with multiple bone and lymph node metastases (B: whole body projection PET image, C: transaxial CT (upper), PET (middle), and fusion images (lower) of the sacral region).
Fig. 4
In-111 octreotide scintigraphy of a 43 year-old female with metastatic gastrinoma. Intensely increased primary tumor radioactivity is seen in pancreas (arrow head), along with mutifocal radiouptakes in liver indicating multiple hepatic metastases
Fig. 5
Comparison of In-111 octreotide and F-18 FDG PET/CT images in a 71 year-old female with malignant thymic carcinoid. In-111 octreotide scintigraphy shows a single abnormal radioactive lesion pertaining to the primary thymic mass (A). F-18 FDG PET/CT reveals multiple metastases in the right supraclavicular lymph node (B), pancreas (D), and pelvic lymph nodes (E), in addition to the primary thymic mass (C)
Fig. 6
Comparison of dual-phase Tc-99m sestamibi and C-11 methionine PET images in a 22 year-old male with primary hyperparathyroidism. On dual-phase Tc-99m sestamibi scintigraphy, the large field-of-view provided by parallel-hole collimators (A) allowed detection of an abnormal lesion in the right anterior mediastinum (arrow), which was missed on smaller field-of-view images obtained using a pinhole collimator (B). C-11 methionine PET (C) also demonstrates the right anterior mediastinal lesion with abnormal radioactivity (arrow), which was surgically confirmed to be an ectopic parathyroid adenoma.
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