Clinical case - Managing motion helps in finding cancer recurrence

Finding Cancer Recurrence

Who we are

Doctor Diana Salvo, MD
Clinical Director and Head of Institute of Nuclear Medicine

Doctor Annibale Versari, MD
Senior Clinical lecturer in Multimodality Imaging

 

Federica Fioroni,
MS, Medical Physicist

Archipedale Santa Maria Nuova,
Reggio Emilia, Italy

The Reggio Emilia ASMN PET Center was created in 2000. In 2002, a 10 MeV Cyclotron (Minitrace GE) was installed in order to produce clinical 18F-FDG and 18F-Choline. A protocol to produce 18FLT and 18F-MISO will also be available soon for research purpose.

In 2005, the first PET system was replaced by a GE Discovery STE PET/CT system.

The center is accredited as Center of Excellence of the Italian association of Nuclear Medicine for the problems related to "PET and radiotherapy" and, on these themes, it delivers brief theoretical/practical stages that are opened to physicists, radiotherapists and nuclear physicians.

Patient History

Male - 75 years old - 160cm - 46kg

In 2002: endoscopic removal of "early gastric cancer".

In 2005: total gastrectomia for local recurrence (diversified adenocarcinoma moderately, presence of metastases in 1 lymph node on 5).

In March 2007: echography with contrast shows a secondary lesion in the 8th liver segment. PET whole-body shows an uptake of 2.2 cm in the same segment. Two radiofrequency thermoablations of the lesion were done. In August a new whole-body PET is negative.

In 2008: echography with contrast shows a new lesion of 20 mm in the 4th segment of the liver.

Acquisition

Scanner: GE Discovery STE

PET acquisition: Whole-body static and MotionFree acquisition

  • 3D acquisition using VUE Point HD reconstruction
  • Acquisition time:
    • Whole-body acquisition: 3 min/bed
    • MotionFree acquisition: 6 bins - 2 min/bin
  • Post-injection time: 1h30 min
  • Dose: 174 MBq of 18F-FDG

CT acquisition:

  • Static CT Attenuation Correction whole-body acquisition
  • MotionFree acquisition both for CTAC and diagnosis

Findings

 

Whole-body PET/CT scan is totally negative.

MotionFree PET/CT scan shows a 7 mm uptake area
in the same place of the previous lesion.

                    

        Negative static whole-body PET/CT scan MIP

                    

Positive MotionFree                     MotionFree PET/CT
PET/CT scan MIP                          image showing a 7mm lesion 
                                                       supporting local recurrence

                    

Fused coronal and sagittal views of MotionFree PET and CT

Conclusion

The lesion showed by the echography in 2008 was not confirmed as disease. The PET whole-body was negative but a suspected recurrence was found only in the MotionFree acquisition.