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Pediatr Surg Int 2005;21(5): 341–345. 524Chapter 28 Current Research Efforts Section 5 Imaging Atlas 29 PET–Computed Tomography Atlas M. Beth McCarville Fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a functional imaging modality that capitalizes on the fact that pathologic processes are generally highly metab olically active and accumulate more glucose (and FDG) than normal tissue. However, sites of normal metabolic activity can also demonstrate intense FDG uptake and can sometimes be difficult to distinguish from disease activity. Fusion imaging modalities that acquire both functional and correlative anatomic imaging provide an important advantage over PET alone because they allow the accurate anatomic localization of sites of increased FDG activity (1–5). In this chapter, normal sites of FDG activ- ity are correlated with computed tomography (CT) anatomy in images obtained during PET-CT scanning. Examples of pathologic FDG activ- ity are included to illustrate the unique value of this fusion imaging modality in distinguishing normal from pathologic activity. Head and Neck Identifying normal FDG activity in the head and neck, as elsewhere in the body, is aided by its bilaterally symmetric distribution. Because the brain is exclusively dependent on glucose metabolism, it accumulates intense FDG activity. Accumulation is greatest in the cerebral cortex, basal ganglia, thalamus, and cerebellum (Figs. 29.1 and 29.2). Intense activity is sometimes present, not only in the brain, but also in the ocular muscles and optic nerves (Fig. 29.2). Because FDG is known to accu- mulate in saliva (6,7), minimal to moderate activity may be present in the salivary and parotid glands (Fig. 29.3). Fluorodeoxyglucose uptake also occurs in the lymphatic tissues of the pharynx, specifically within the Waldeyer ring, which consists of the nasopharyngeal, palatine, and lingual tonsils (Fig. 29.3). In patients who are tense, FDG activity may be very prominent in the neck muscles secondary to contraction- induced metabolic activity. Fluorodeoxyglucose activity in the normal thyroid gland is usually absent or minimal but can be prominent. Intrin- sic laryngeal muscles of phonation can exhibit intense FDG activity 527 [...]... and Kostakoglu et al (2) describe the clinical applications of PET in oncology in adult patients As more experience is gained in the pediatric population, indications for pediatric FDG -PET imaging are emerging (3–5) As with any other nuclear imaging modality, it is very important to recognize artifacts while reading the whole-body FDG -PET images for the subsequent correct management of patients Recognition... discusses the normal biodistribution of FDG in pediatric patients, common artifacts seen on whole-body FDG -PET images, common causes of false-positive and false-negative findings, and recognition of artifacts Scanning Protocol Performing FDG -PET studies on pediatric patients presents a special challenge The issues that require consideration specifically in the pediatric population include intravenous access,... specific to pediatric PET imaging have been dealt with in recent articles (6–8) Procedure guidelines and patient preparation techniques for the adult FDG -PET imaging have been published in the literature (9–11) Institutions performing PET studies on pediatric patients are recommended to consult these reports and to develop their own protocols Essentially, patient preparation is the same for pediatric. .. Axial PET- CT images show FDG activity in both supraclavicular brown fat (arrows) and pathologic supraclavicular nodes (arrowheads) This example illustrates the value of PET- CT in identifying adenopathy that may be difficult to distinguish from physiologic brown fat activity on PET alone B A C Figure 29.7 A: MIP anterior PET image shows normal thymic contour and FDG activity (arrow) in a 3-year-old girl... 1998;171: 1103 –1 110 3 Charron M, Beyer T, Bohnen NN, et al Image analysis in patients with cancer studied with a combined PET and CT scanner Clin Nucl Med 2000; 25:905– 910 4 Bar-Shalom R, Yefremov N, Guralnik L, et al Clinical performance of PET/ CT in evaluation of cancer: additional value for diagnostic imaging and patient management J Nucl Med 2003;44:1200–1209 5 Townsend DW, Beyer T A combined PET/ CT... skeleton: MR imaging study Radiology 1990;177:83–88 Sugawara Y, Fisher SJ, Zasadny KR, et al Preclinical and clinical studies of bone marrow uptake of fluorine- 1- uorodeoxyglucose with or without granulocyte colony-stimulating factor during chemotherapy J Clin Oncol 1998;16:173–180 30 Common Artifacts on PET Imaging Peeyush Bhargava and Martin Charron Whole-body positron emission tomography (PET) with... quadrilateral-shaped configuration with homogeneous density In B A C Figure 29.5 A: Maximum intensity projection (MIP) image showing intense, symmetric activity in the supraclavicular regions (arrow) B,C: Axial PET- CT images allow localization of this activity to supraclavicular brown fat (arrows) This finding is common in pediatric patients M.B McCarville A 531 B Figure 29.6 A 26-year-old woman with non-Hodgkin’s... chest region Eur J Nucl Med Mol Imaging 2002;29:1393–1398 Cohade C, Osman M, Pannu HK, et al Uptake in supraclavicular area fat (“USA-Fat”): description on 18F-FDG PET/ CT J Nucl Med 2003;44: 170–176 Hedlund GL, Kirks DR Respiratory system In: Kirks DR, ed Practical Pediatric Imaging, 2nd ed Cincinnati: Little, Brown, 1991:517–707 Gordon BA, Flanagan FL, Dehdashti F Whole-body positron emission tomography:... An 18-year-old woman under treatment for rhabdomyosarcoma who had recently received granulocyte colony-stimulating factor (GCSF) MIP anterior image shows marrow activity that is diffusely increased relative to the liver This pattern of marrow activity is commonly seen in patients receiving G-CSF M.B McCarville R A 541 L B Figure 29.23 This example illustrates the value of correlative PET- CT imaging. .. is seen A B Figure 29 .10 A,B: Axial PET- CT images show normal FDG activity in the crus of the left diaphragm (straight arrows) and normal, homogeneous FDG uptake within the liver (curved arrows) and spleen (arrowheads) The spleen usually shows activity that is equal to or less than that of the liver 534 A Chapter 29 PET Computed Tomography Atlas B Figure 29.11 A,B: Axial PET- CT images show a focal . lym- phoma: detection with FDG -PET versus CT. Radiology 1998;206:475– 481. 129.Moog F, Bangerter M, Diederichs CG, et al. Lymphoma: role of whole- body 2-deoxy- 2-( F-18)fluoro-D-glucose (FDG) PET. malignancy grade with PET in non-Hodgkin’s lymphoma. J Nucl Med 1995;36:1790–1796. 133. Newman JS, Francis IR, Kaminski MS, et al. Imaging of lymphoma with PET with 2-( F-18 )- uoro-2-deoxy-D-glucose: correlation. Neoplasms in a pediatric pop- ulation: 2-( F-18 )- uoro-2-deoxy-D-glucose PET studies. Radiology 1995; 194:495–500. 176.Hawkins DS, Rajendran JG, Conrad III EU, et al. Evaluation of chemother- apy response