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About PET/CT Scanning

A PET/CT scan combines a PET scan and a CT scan (also known as a CAT scan) into one comprehensive examination unlike any other available today. PET is very good at determining whether or not a tumor is malignant by evaluating its metabolic activity. Most tumors demonstrate an elevated level of activity that functionally distinguishes it from normal tissues. CT scans provide cross-sectional anatomic images (called slices) of your body. Together, these images are called PET/CT, and the power of these two techniques together provides far greater value than either provided alone.

The PET/CT scan is a powerful tool used by doctors when evaluating patients who may or may not have cancer. It allows them to effectively diagnose and evaluate cancer and whether or not it has spread to other areas of the body. It is often used to measure the response of a tumor to therapy, which ultimately guides therapeutic decisions. If a therapy is found to be effective, it can be continued with greater confidence. If found ineffective, more appropriate alternate therapies can be instituted earlier, and futile therapeutic options can be avoided sooner. PET-CT is also used to direct or guide biopsies and surgeries as well as focusing radiation treatments. Once in remission, patients can be reliably monitored for possible recurrence at regular intervals as well.

We also offer pre-authorization services for our referring offices.

PET/CT Lung Scan

Lung Cancer Screening

A PET scan can show how the lungs and surrounding tissue function, vs. a CT scan which is more about seeing the structure of the lungs. This test is done by using a radioactive substance known as a tracer, which the machine can monitor as it flows through the lung. The purpose of this exam is to diagnose lung cancer or to see how lung cancer has spread.

How is the lung scan performed?

The tracer is given through an IV and as it flows through your cardiovascular system, it reaches your lungs. It then collects in the organ and tissue surrounding the lung. It takes about one hour for the tracer to be absorbed in your body before a radiologist can scan your lungs. The tracer allows your radiologist to see the state of your lungs and lung tissue.

You will lay on a narrow table which will shift you into a tunnel-shaped scanner. The scanner detects the tracer and creates 3D images from the scans. during this taste, which can take about 90 minutes, you need to be very still, as sudden movements can disrupt the results. The only physical discomfort you will feel is from the IV (injecting the tracer), but the scan itself causes no pain. Usually, a blanket and pillow are placed down so you aren’t lying on a cold, hard table for a long period of time.

Many times, a CT scan is also done, resulting in what’s called a PET/CT scan of the lungs. While the PET scan shows the function of the lungs, the CT shows the structure of the lungs. The combination of these two scans provides a story that neither scan can do alone. It paints a complete picture for your radiologist to diagnosis your condition.

Preparation for a PET/CT lung scan

For the most part, the only prep you have to do outside of forms and pre-registration is fasting. You shouldn’t eat 4-6 hours before the exam, and you should only consume water. If any of these apply to you, tell your radiologist before getting the exam:

  • You have any form of claustrophobia (medicine may be given to reduce anxiety)
  • You are pregnant or may be pregnant
  • Have any allergies to medication, especially injected dye
  • You have diabetes/are on insulin. There will be a separate preparation for patients with diabetes

The best part about the PET/CT lung scan is that there is no recovery. After the exam, you are at 100%, unless any medication was given to reduce anxiety.

PET Imaging Institute will send your results to your referring physician.

PET/CT Bone Scan

How do I prepare for the scan?

The only preparation needed for a bone scan is purely administrative. You will be given the forms to fill out, and your radiologist will ask questions such as what medication you’re currently taking and if you have any medication allergies. You can eat and drink as normal before the test. You will be asked to take off jewelry and change into a hospital gown.

Why Get a Bone Scan?

Some of the most prevalent cancers in the United States are commonly associated with metastatic bone disease. This is of particular clinical importance in breast and prostate cancers because of the prevalence of these diseases. 70% of breast and prostate cancer patients had evidence of metastatic bone disease. Bone metastatic disease itself may complicate a wide range of other malignancies, resulting in considerable morbidity and complex demands on health care resources. Carcinomas of the lung, head and neck, thyroid, and kidney also commonly give rise to bone metastases. It’s extremely important to diagnose this disease early on. Bone PET/CT offers very high-resolution images of the skeleton, far greater than conventional bone scans. This is of value not only in assessing for the presence of bone metastatic disease but offers higher diagnostic confidence in excluding the presence of disease as well.

How is the Bone Scan Performed?

A tracer is injected into your veins, that the PET scan can scan your body. Typically, the whole body is scanned during this test. If the results indicate damage caused by bone cancer, further tests can be given with CT scans to help diagnose the disease.

The tracer takes up to a couple hours to absorb into your body after injection. You will drink plenty of water and urinate to get the radioactivity out of your body, which ends up being less than a normal X-Ray. Once your radiologist believes the tracer has absorbed, you will lay on an examination table. The scanning device will be placed over your body and you will need to remain still. You may have to change positions at your radiologist’s request. The whole scanning process takes about an hour.

PET/CT Lymphoma Scan

Lymphoma

Lymphoma is a cancer of the lymphatic system, which plays an important role in the body’s immune system. In the United States, the risk of developing Non-Hodgkin lymphoma is 2.1 percent and getting Hodgkin Lymphoma is approximately 0.2 percent, and survival depends on a timely diagnosis so that treatment can be given. PET/CT scans are performed when a doctor believes that lymphoma may be present.

How PET Scans Work to Find Lymphoma

PET scans tend to be most useful in those who have Hodgkin lymphoma or high-grade non-Hodgkin lymphoma because the lymphoma cells are typically more active. The PET scan will help the doctor determine which cells are cancerous and which ones aren’t. A PET scan will be combined with a CT scan, which provides accurate images of the body’s organs, lymph nodes, tumors.

When PET Scans are Used

PET scans are typically performed at the beginning or end of a treatment cycle. Before treatment begins, a PET scan is commonly used to determine what stage the lymphoma is and which parts of the body are affected. After treatment, diagnostic imaging will be performed to:

  • Determine the effectiveness of the treatment.
  • Create a future treatment plan based on the results.
  • Determine if the lymphoma has returned a few months or years after treatment.

During and After the Scan

The patient should not eat or drink anything other than water at least four to six hours before the scan. The PET scan will not be painful and should take less than an hour. Once the scan is completed, the patient will be able to go home afterward. The results of the scan will not be immediate. The doctor will typically receive the scan within a few days, determine their results, and talk to you about what the results mean.

PET/CT Brain Scan

Using PET/CT to Detect Alzheimer’s and Dementia

PET/CT scans work by using a “tracer” to detect during the scan. Each kind of scan uses a different tracer depending on what the radiologist is trying to find. For brain scans, the tracer is called Amyvid. This tracer was developed recently and approved by the FDA in 2012. It binds to those beta-amyloid proteins, the cause of brain plaque leading to brain cell death. The PET/CT scan picks up the tracker and it allows for early detection of plaque build up.

What Causes Degenerative Brain Disease?

Diseases like Alzheimer’s are caused by continual brain cell death. A connection scientists have made is a connection between brain cell death and plaque buildup. These plaques are clusters of built up proteins called “beta-amyloid”. This kills the brain cell, and from within the dead brain cell, “tangles” are formed. These are fibers of a protein called “tau”. Normally, tau helps transport nutrients between brain cells, but in the presence of tangles, they do just the opposite.

Who would be a candidate for PET/CT brain scans?

According to an article published in 2014, appropriate candidates for amyloid PET imaging evaluation would include:

  1. Patients complaining of persistent or progressive unexplained mild cognitive impairment (MCI)
  2. Patients meeting tests for possible AD but who have unclear clinical presentation, either atypical clinical course or etiologically mixed presentations
  3. Patients with progressive dementia and atypically early age of onset (defined as before the age of 65 years)

Additionally, inappropriate candidates for amyloid PET imaging include

  1. Patients who are 65 years or older and meet standard clinical criteria for probable AD
  2. Those whose severity of disease has to be determined
  3. Those undergoing imaging solely based on a family history of dementia or presence of other risk factors for AD, such as the ApoE-ε4 gene
  4. Patients with a cognitive complaint but no clinical confirmation of impairment
  5. Those undergoing imaging in lieu of genotyping for suspected autosomal mutation carriers
  6. Asymptomatic individuals
  7. Those undergoing imaging for nonmedical use, such as insurance coverage and legal or employment screening.

Axumin

What’s New About This PET/CT Scan?

Conventional imaging tools such as traditional FDG PET/CT scans and bone scans frequently fail to identify the site of recurrent disease when it comes to Prostate Cancer, presenting a serious challenge to urologists and radiation oncologists charged with the selection of secondary treatment, and causing significant anxiety for patients.

FDG-PET is of limited use in Biochemical Recurrence because uptake in Prostate Cancer is generally suboptimal until the patient has metastatic castrate resistant disease. Physiologic excretion of FDG in the bladder may interfere with image interpretation of adjacent structures in the pelvis.  Salvage Radiation Therapy (SRT) to the prostate should be initiated well before a PSA of 10 – 20 ng/mL is reached, as studies have demonstrated that outcomes are better if treatment is initiated at low (e.g.

Enter Axumin™: On May 27, 2016 the FDA approved Axumin [fluciclovine F 18 Injection; Blue Earth Diagnostics Ltd, Oxford UK] for PET imaging in men with suspected prostate cancer recurrence based on elevated PSA levels following prior treatment.  The approval of Axumin ushers in a new era of F18 PET/CT for the detection of recurrent prostate cancer in the USA.  Data submitted to FDA included results from prospective studies at Emory University and the University of Bologna and from clinical use at two sites in Norway; the pooled data for n= 595 subjects were retrospectively analyzed.  Overall, fluciclovine F 18 PET/CT detected sites of recurrence in 68% (403/595) of patients.  For patients with baseline PSA values in the lowest quartile ( 1.78 ng/mL had a positive scan, of which 58 were confirmed as positive.

Sources:

PET Imaging Institute of South Florida is proud to offer newly available Axumin (fluciclovine F 18 Injection) scan

PET Imaging Institute is proud to announce a newly available tracer indicated specifically for Recurrent Prostate Cancer.  Prostate cancer affects one in seven men in the US, up to a third treated for prostate cancer will experience recurrent disease, most often detected only by rising Prostate Specific Antigen (PSA) levels.  Often the location and extent of the disease cannot be detected by conventional imaging in the early stages of recurrence. Although there is an ever-increasing number of treatment options, an estimated 26,100 men died of the disease in the US in 2016, generally after primary local and systemic treatments for prostate cancer failed.  Current diagnostic measures are frequently unable to reliably detect the exact location(s) of disease relapse at a time when curative treatment is still possible.

NETSPOT

A novel PET/CT tracer for the detection of Neuro Endocrine Tumors (NETs)

NETSPOT, the new tracer for Gallium 68-Dotatate scan, is the next generation of OCTREOSCAN.

It is a form of octreotide, which binds to a receptor on many NETs called the Somatostatin Receptor.  Use of NETSPOT changed patient treatment and management in 71% of patients due to greater specificity compared to Octreoscan.

Gallium PET/CT is more accurate for staging and superior to Octreoscan SPECT in the detection of overall number of lesions in the body as well as organs and bones. Gallium PET/CT also allows for calculation of standardized uptake value, has less whole body radiation, and is performed in less time versus Octreoscan.

What makes NETSPOT different?

NETSPOT™ offers superior sensitivity and accuracy compared to previously available diagnostics for NET patients. In a clinical study, NETSPOT™ demonstrated the ability to change management decisions regarding patients in 71% of cases previously imaged with Octreoscan. Saving just one patient from futile surgery can improve the treatment experience overall and significantly reduce the cost of care by reducing repetitive, often frustrating, and limitless diagnostics.

NETSPOT™ is a significant improvement over existing diagnostic tools and will enable us to more accurately stage and better manage patients.

NETSPOT™ is a novel patented kit developed by AAA for the preparation of gallium Ga 68 dotatate for injection, for localization of somatostatin receptor positive neuroendocrine tumors (NETs) in adult and pediatric patients using Positron Emission Tomography (“PET“).

This product has been designated as an orphan drug by the EMA and the FDA.

Please contact PET Imaging Institute of South Florida at 954-981-6668 for further information.

A novel PET/CT tracer for the detection of Neuro Endocrine Tumors (NETs)

NETSPOT, the new tracer for Gallium 68-Dotatate scan, is the next generation of OCTREOSCAN.

It is a form of octreotide, which binds to a receptor on many NETs called the Somatostatin Receptor.  Use of NETSPOT changed patient treatment and management in 71% of patients due to greater specificity compared to Octreoscan.

Gallium PET/CT is more accurate for staging and superior to Octreoscan SPECT in the detection of overall number of lesions in the body as well as organs and bones. Gallium PET/CT also allows for calculation of standardized uptake value, has less whole body radiation, and is performed in less time versus Octreoscan.

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