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PET / CT is an imaging technique that is a combination of PET (Positron Emission Tomography), which shows the functions of organs and tissues in the human body at the metabolic level, and computed tomography (CT) that can provide detailed anatomical information.
Especially in the department of oncology, PET / CT is used to detect the tumors, determine the extent of tumor spread, radiotherapy planning, evaluate the response to treatment, and in some cases, determine whether the existing mass is benign or malignant.
PET / CT also plays a role in determining the focus of epilepsy, in neurological cases such as Alzheimer’s disease, and in the investigation of the presence of living tissue in the heart after a heart attack in our country as well as in the whole world.
At which stages of cancer is PET / CT used?
PET / CT is not a test that provides a diagnosis in a single stage of cancer. In addition to providing early diagnosis, it is also used in the metastasis stage and after treatment.
PET / CT in early diagnosis
PET / CT provides very important advantages in early diagnosis by providing the opportunity to detect many diseases at the beginning. Before PET / CT was invented, the presence of cancer in the nodules in the body can only be determined by biopsy, but now, with PET / CT, whether these lesions are cancer or not can be found with high sensitivity.
In imaging with this method, it is possible to image tumors with a diameter of only 5 mm, as the information about the patient’s body images is obtained by advanced computer systems. The device helps to diagnose quickly and safely without removing any parts by taking advantage of the increased glucose metabolism, which is a feature of cancer cells.
PET / CT in the metastasis stage
In many cancers, it is possible to evaluate whether the disease has spread to another organ as the whole body is seen at the same time with the images obtained with PET / CT to determine whether it is spread to the surrounding tissues or lymph nodes. PET / CT is beneficial in determining the extent of the disease called staging.
PET / CT after treatment
Most cancers are highly treatable when diagnosed early. For example, in patients with early detection of breast cancer, the 5-year survival rate exceeds 80%. PET / CT has a very important place in imaging, especially thanks to its detailed information about the tumor.
With PET, the metabolism of tissues can be seen, and therefore, after the presence of a lesion is anatomically determined, it can be understood that it is benign and malignant.
With PET-CT, it is recognized whether there is still an active disease while the cancer location is detected precisely and after the treatment. Thus, it is understood whether the patient has given a complete response to the treatment.
Thanks to all these features, PET / CT enables early and accurate diagnosis of cancer and observation of the effects of treatment.
Diseases for which PET / CT test is applied
Defining the changes at the cellular level with high sensitivity, PET / CT test plays a role in the diagnosis and treatment of different tumors.
PET / CT has an important place in the investigation of lung cancer. Increased F-18 Fluorodeoxyglucose (FDG) uptake in lung nodules in PET / CT examination is considered as an indicator of 96% cancerous tissue.
In the staging of lung cancers, evaluation of the presence of a tumor, regional lymph nodes, and metastasis is of great importance before starting treatment because these data are guiding in treatment planning. When several stages of treatment are planned, PET / CT comes into play and provides very useful information especially in the evaluation of lymph nodes and metastases.
Metastasis of surgically removed lung cancers can be detected with high sensitivity with PET / CT. Another advantage of clinical whole-body PET / CT imaging is that apart from detecting recurrence, distant metastases can also be found.
Detection of distant metastases that will change the treatment approach can be monitored with this device at every stage of the treatment.
The importance of PET / CT applications is increasing in Hodgkin or non-Hodgkin lymphomas. The sensitivity and specificity rate of this device in the diagnosis of lymphomas is 90-100%.
Besides, in cases with unusual locations of lymphoma such as primary small bowel lymphoma, lesions can be visualized with PET / CT.
Staging in lymphomas is of great importance in the planning of the treatment. The involvement of lymph nodes or organs in the thorax, abdomen, and pelvis is of vital importance in determining the treatment.
Although PET / CT is not among the classical diagnostic methods in thyroid cancers, it helps the diagnosis of suspected lesions. In fine needle aspiration biopsy, PET / CT can be applied when sufficient tissue for histological examination and distinguishing between benign and malignant follicular nodules is a problem.
PET / CT has an important role in determining recurrence or metastatic spread in patients with thyroid cancer, especially in patients with negative I-131 whole-body scans.
Physical examination and mammography are the most commonly used methods for diagnosing breast cancer, but for some reasons (dense breast, mammoplasty, previous needle biopsies, etc.), these tests can be difficult to perform. Due to the presence of these conditions, PET / CT is beneficial in terms of diagnosis in lesions that are too small to be diagnosed by mammography and in fibrocystic disease.
While breast cancer is still the most common cancer among women worldwide, the condition of the underarm lymph nodes is the most important determining factor. Diagnosing the metastatic armpit lymph nodes with PET / CT has great importance for planning the treatment.
Pancreatic cancers, in which abdominal pain and weight loss are the main symptoms, can usually be detected in later phases of the disease. Besides, it is not always possible to make a differential diagnosis with imaging methods.
The sensitivity of PET / CT to distinguish between pancreatic adenocarcinomas and benign pancreatitis, which also has a mass effect, is over 94%. Also, PET / CT provides important information in the staging of pancreatic cancers and the investigation of the metastasis.
The sensitivity of PET / CT is very high in detecting colon and rectal cancers, which constitute approximately 13% of all malignant cancers. However, in routine practice, the use of PET is not common in the diagnosis of primary colon cancers or the initial staging, if metastases in or outside the liver are not investigated.
The diagnosis of colorectal cancers can be detected with a sensitivity of more than 90% with economical and widely applied methods such as colonoscopy and barium colon radiography. It is known that PET / CT will be useful in terms of the diagnosis of colon adenomas.
One of the malignant types of tumors in which recurrence is most common after treatment is colorectal cancer. Frequently, 30-40% recurrence can be detected within two years after treatment. In some patients, it is seen only as liver metastasis.
However, the number of recurrence foci and whether there is extrahepatic spread are among the important factors in treatment planning. PET / CT application becomes important, especially since MRI does not provide sufficient usefulness in the differentiation of tumor recurrence and postoperative scar tissue.
To sum up, PET / CT is a useful option for preoperative staging when recurrence of colon cancer is suspected, when an elevated tumor marker is detected despite the absence of any known focus when a decision cannot be made with conventional imaging methods, and before recurrence is surgically removed.
Melanoma is the most aggressive type of skin cancer. It can metastasize to any organ, even earlier to regional lymph nodes. Although its treatment includes surgical removal, lymph node removal is preferred only in patients with metastatic spread due to the complication rate varying between 5-40%. With PET / CT, the status of the regional lymph nodes and the presence of metastases in other organs can be investigated with high accuracy.
One of the diseases diagnosed by PET / CT is brain tumors. Especially after the surgery of brain tumors, some changes occur in the brain tissue of the patients who undergo radiotherapy due to radiation necrosis after a certain period. PET / CT diagnoses all of the changes detected during imaging whether it is caused by radiation-induced tissue necrosis or recurrence of the tumor.
Other application areas
In addition to these frequently applied clinical conditions, PET / CT can be used for head and neck tumors, mesothelioma, mediastinal masses, esophageal cancer, stomach cancer, small intestine tumors, gastrointestinal stromal tumors, liver and biliary tract tumors, gynecological malignancies, and genito-urinary system tumors.
Also, it can diagnose bone tumors, soft tissue sarcomas, neuroblastoma, and metastatic tumors of unknown primary origin. PET/ CT not only diagnoses the disease but also stages and evaluates the response to the treatment.
How does the PET / CT procedure work?
This procedure uses a radioactive material called a radiopharmaceutical. This material is injected into the bloodstream, swallowed, or inhaled. The material accumulates in the area of your body under examination where it gives off a small amount of energy in the form of gamma rays.
Special cameras detect this energy and, with the help of a computer, create pictures that provide details about the structure and function of organs and tissues.
Hot spots, called denser areas, noticed during imaging indicate where the radio tracker has accumulated in large quantities and where there is a high level of chemical or metabolic activity. Less dense areas or cold spots indicate less radiotracer concentration and less activity.
How is the procedure performed?
PET / CT can be performed on outpatients and hospitalized patients. After the patient lies on the examination table, the nurse inserts an intravenous (IV) catheter into a vein in the hand or arm.
It takes about 30-60 minutes for the radiopharmaceutical to circulate in the body and be absorbed by the area being examined. The patient is asked to rest quietly, to stop moving and speaking.
To begin imaging, the patient is moved to the PET / CT scanner and asked to remain still during imaging. Total scan time is usually about 30 minutes.
Depending on which area is being studied, additional tests involving other tracers or drugs may be used. This can add up to three hours of processing time.
The procedure is painless, except for intravenous injections. Significant discomfort or side effects are rare. The small amount of radiotracer in the patient’s body loses its radioactivity over time through the natural radioactive decay process.
It can also be excreted through urine or feces in the first few hours or days following the test. Drink plenty of water to help remove radioactive material from the body.
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