Clinical Teaching Cases

The Division of Nuclear Medicine at the University of Kansas has provided excellent clinical case studies from the fields of oncology, cardiology and neurology.

Click on http://www.rad.kumc.edu/nucmed/clinical.htm and then click on any of the broad selection of cases located under "PET Clinical Teaching Case of Interest".

Clinical Applications

ONCOLOGY:

Brain Tumour

• Differentiate recurrent tumour from radiation necrosis.
• Differentiate primary CNS lymphoma from toxo-plasmosis.
• Exclude metastatic disease to brain.

Breast Cancer

• Identify involved axillary nodes or distant metastatic disease.
• Exclude local recurrence of disease.
• Evaluate response to treatment.

Colorectal Cancer

• Detect locally recurrent or distant metastatic disease in patients with elevated or rising CEA who may be candidates for surgical re-excision.
• Rule out distant metastases for preoperative evaluation.

Head & Neck Cancer

• Determine extent of local, regional and distant disease.
• Detect recurrent/residual tumour following definitive therapy.

Lung Cancer

• Distinguish malignant from benign pulmonary nodules.
• Stage for mediastinal or distant metastatic disease.
• Use as part of radiotherapy treatment planning.
• Detect recurrent/residual tumour following definitive therapy.

Lymphoma

• Determine extent of disease and measure treatment response.

Melanoma

• Identify extent of local and regional disease spread in patients with high risk melanoma (e.g., primary tumour >4mm), or in suspected recurrence.

Musculoskeletal Tumours

• Evaluate local extent of disease and exclude distant metastases.
• Measure treatment response and exclude recurrent/residual tumour following definitive therapy.

Ovarian Cancer

• Detect recurrent/residual tumour prior to surgical exploration or additional chemotherapy.

Pancreatic Cancer

• Differentiation of benign processes such as pancreatitis, mucinous cyst adenoma and pseudocyst from malignant disease.
• Rule out distant metastases for preoperative evaluation.

Thyroid Cancer

• Detect metastatic or locally recurrent disease in patient with elevated thyroglobulin after definitive initial treatment and negative I-131 examination.

References: Conti, P.S., Lilien, D.L., Howley, K., Keppler, J., Grafton, S.T., Bading, J., PET and F-18 FDG in Oncology: a Clinical Update. Nuclear Medicine and Biology, (1996) 23:717–735.  Di Chiro, G., Positron Emission Tomography Using FDG in Brain Tumors: A Powerful Diagnostic and Prognostic Tool. Investigational Radiology, (1986) 2:360–371.

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NEUROLOGY

Dementia

• Differentiate Alzheimer’s disease from multi-infarct dementia.

Epilepsy

• Localize the seizure focus in patients with intractable complex seizure disorders.

Stroke

• Evaluate extent of disease and recovery following therapy.

References: Salmon, E., Sazot, B., Maquet, P., Deguelde, C., Rigo, P., Comar, D., Franck, G., Differential Diagnosis of Alzheimer’s Disease with PET. Journal of Nuclear Medicine, (1994) 35:391–398.  Hubner, K.F., PET Imaging Neurology, Journal of Nuclear Medicine Technology, Vol. 18, number 4, December 1990.

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CARDIOLOGY

Myocardial Viability

• Distinguish viable myocardium from infarcted tissue in patients with suspected hibernating or stunned myocardium.

Coronary Artery Disease

• Identify ischemic disease.

Preoperative Prognostic Assessment

• Evaluate extent of disease in patients being considered for interventional revascularization or transplantation procedures.

References: Maddahi, J., Schelbert, H., Brunken, R., DiCarli, M., Role of Thallium-201 and PET Imaging in Evaluation of Myocardial Viability and Management of Patients with Coronary Artery Disease and Left Ventricular Dysfunction, Journal of Nuclear Medicine, (1994) 35:707–715.  Gould, L.K., PET Perfusion Imaging and Nuclear Cardiology, Journal of Nuclear Medicine, (1991) 32:579–606.

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