Clinical case - Improvement in staging confidence

Staging Confidence

Who we are

Professor Juhani Knuuti
Director

Adj. Prof. Marko Seppänen
Diagnostic Service Manager

 

Turku PET Centre
Turku, Finland

As a Finnish National Research Institute, Turku PET Centre led by Professor J. Knuuti, promotes the use of PET in the medical research field. The Centre was founded in 1974 by the University of Turku, Åbo Akademi University and the Turku University Hospital. The Centre integrates top scientific expertise with excellent facilities and equipments. Fruitful interaction and collaboration between basic scientists and clinical investigators is a long-standing tradition.

The latest imaging technology is available, some unique in Europe. The Centre provides several tracers for routine and research clinical imaging in Oncology, Neurology and Cardiology, using the Europe's first 64 slices PET/CT system. With its excellent cyclotron and radiochemistry laboratories, Turku PET Centre develops and produces the latest PET tracers for clinical imaging.

Patient History

Female - 61 years old - 163cm - 69kg

The patient has been smoking since teenage. Suffered hemoptysis and, thereafter, diagnosed a squamocellular cancer in left lung (CT exam).

Referred to 18F-FDG PET/CT for staging purposes.

Acquisition

Scanner: GE Discovery VCT

PET acquisition: Whole-body acquisition

  • 3D acquisition using both VUE Point & VUE Point HD reconstructions
  • Acquisition time: 12 min
  • Post-injection time: 50 min
  • Dose: 315 MBq of 18F-FDG

CT acquisition: Low Dose with shallow breathing without contrast media

  • Rotation speed: 0.8 second
  • FOV: 70 cm
  • Pitch: 1.375 mm/rot
  • Slice thickness: 3.75 mm
  • Smart mA, NI: 25, kVp: 140, mA: 80
  • Dose: 2 mSv

 

Findings

 

                    

                    

VUE Point:                                      VUE Point HD:
Matrix of 128 x 128 pixels             Matrix of 256 x 256 pixels

There is a metabolically active tumour in the left upper
lobe representing the primary tumour and one enlarged
and active lymph node metastasis in left hiliar causing
some atelectasis to the upper lobe. Another metabolically
active small lesion was discovered in subcarinal space
with suspicion of lymph node metastasis.

 

Conclusion

Using a matrix of 256x256 pixels improved the diagnostic confidence that the subcarinal lymph node is pathological. The primary tumour is also better delineated from the hiliar lymph node which may be beneficial for the radiotherapy planning and improve the staging when lymph node metastases are located close to the primary tumour, i.e. in oesophageal cancer. Finally, the use of integrated PET/CT technique enables the detection of viable tumour from atelectasis that can be seen on low dose CT images.