FAQ's
Our Team
Team of Professionals
Dr. G Shailaja Reddy
Shri T Raghav Reddy
Shri T Shekhar reddy
Dr. K V Venugopal Reddy
Clinical Indications for use of PET/CT
1. ONCOLOGY
Lymphoma
Breast Cancer
Lung Cancer
FDG PET/CT is an efficient modality for staging of lung cancers. PET/CT is the best modality to differentiate tumor from adjacent atelectasis, in identifying chest wall invasion, and in detection of pleural metastases. PET/CT has higher sensitivity and specificity in the mediastinal staging of lymph nodes in comparison to CT
Small Cell Lung Cancer
Head & Neck Cancers
FDG PET/CT has a well-established role in the detection of distant metastasis and second primary in locally advanced head and neck cancers.
Detection of distant metastasis early in the work-up algorithm leads to change in the treatment plan and in prognosis.
A negative PET/CT study has nearly 100% accuracy in predicting the absence of distant metastatic disease and second primary.
Esophageal Cancer
PET/CT is recommended for staging if no evidence of M1 disease (staging). PET/CT is recommended to assess treatment response following both neoadjuvant and definitive chemoradiation generally 5-6 weeks after completion of therapy (restaging).
Radiation therapy planning: PET/CT scan images allow an informed determination of treatment volumes and fields borders prior to simulation.
Gastric Cancer
PET/CT is recommended for staging if no evidence of M1 disease (staging).
PET/CT is recommended to assess treatment response following both neoadjuvant and definitive chemoradiation generally 5-6 weeks after completion of therapy (restaging).
Radiation therapy planning: PET/CT scan images allow an informed determination of treatment volumes and fields borders prior to simulation.
Cervical Cancer
Lymph nodal involvement is an important prognostic factor in cervical cancer management. FDG PET/CT has a potential role in detection of lymph nodal metastasis in locally advanced cervical carcinoma (≥IB2) in which extra-pelvic spread is common. PET can detect nodal metastasis when CT findings are normal. PET/CT is valuable in treatment planning with external beam RT and brachytherapy.
Melanoma
PET/CT is the best modality for N and M staging of advanced cutaneous melanoma and for detection of metastasis in mucosal melanomas of head and neck and anorectum.
Thyroid Cancer
It is considered appropriate to perform FDG PET in thyroid malignancies with high-risk pathology subtypes like tall cell, solid, insular variants, etc. In metastatic thyroid disease, current evidence suggests that FDG PET scan identifies the metastatic lesions not identified by radioiodine scan. This has important treatment implications. For undifferentiated and anaplastic thyroid tumors, FDG PET/CT is the imaging of choice.
Testicular Cancer
PET CT is a valuable tool in post chemotherapy assessment and recurrence of seminomas. In addition to the above mentioned clinical indications PET/CT plays a significant role in the staging, treatment response, recurrence of bone cancer, colorectal cancer, endometrial cancer, hepatocellular carcinoma etc. For Neuroendocrine tumors and Prostate Cancer Gallium labelled with DOTANOC and PSMA are the agents of choice for PET/CT imaging.
Colon Cancer
Work-up, Recurrence, Treatment response assessment / Surveillance
Rectal Cancer
Work-up, Recurrence, Treatment response assessment / Surveillance
Anal Cancer
Work-up, Recurrence, Treatment response assessment / Surveillance
Thyroid Cancer
Papillary / Follicular Carcinoma (Including Hurthle Cell Carcinoma) {when I-131 imaging is negative and stimulated Tg >2-5 ng/ml} Work-up, Recurrence, Treatment response assessment / Surveillance
Anaplastic Carcinoma
Diagnostic Procedure, Staging, Recurrence, Treatment response assessment.
Testicular Cancer Pure Seminoma
(Post chemotheraphy assessment – Recurrence – Post- Chemotherapy Surveillance) Recurrence, Treatment response assessment / Surveillance
Chordoma
Work-up, Recurrence, Treatment response assessment / Surveillance
Ewing’s Sarcoma Family of Tumours
Work-up, Recurrence, Treatment response assessment / Surveillance
Osteosarcoma
Work-up, Relapse, Treatment response assessment / Surveillance
Mutiplle Myeloma
Work-up, Relapse, Treatment response assessment / Surveillance
Neuroendocrine Tumours Neuroendocrine Tumours of the GIT, Lung and Thymus (Carcinoid Tumor)
Evaluation, Recurrence, Treatment response assessment / Surveillance
Neuroendocrine Tumours
Recurrence, Treatment response assessment / Surveillance
Neuroendocrine Tumours of Unknown Primary
Work-up
Poorly differentiated (High Grade) NET / Large or Small Cell carcinoma other than Lung
Evaluation, Recurrence, Treatment response assessment / Surveillance
Adrenal Gland Tumours
- Evaluation in suspected carcinoma
- Carcinoma – Staging, Recurrence, Treatment response assessment / Surveillance
Pheochromocytoma / Paraganglioma
Evaluation, Recurrence, Treatment response assessment / Surveillance
Thymomas and Thyme Carcinomas
Evaluation
Occult Primary (Cancer of Unknown Primary - CUP)
Initial evaluation additional work-up
Ovarian Cancer (Including Fallopian tube cancer and primary peritoneal cancer) Epithelial Ovarian Cancer / Fallopian tube cancer / Primary peritoneal cancer
Work-up, Relapse, Treatment response assessment / Surveillance
Malignant Germ Cell Tumours
Evaluation, Recurrence, Treatment response assessment / Surveillance
Ulterine Neoplasms Endometrial Carcinoma
Work-up, Recurrence, Surveillance
Uterine Sarcoma
Additional evaluation, Recurrence, Treatment response assessment / Surveillance
Soft tissue sarcomas Extremity / Superfical trunk / Head & Neck
Work-up, Recurrence, Treatment response assessment / Surveillance
Retroperitoneal / Intra-abdominal
Recurrence, Treatment response assessment / Surveillance
GIST
Work-up, Treatment response assessment / Surveillance
Desmoid tumours (Aggressive fibromatosis)
Recurrence, Treatment response assessment / Surveillance
Rhabdomyosarcoma (Excluding those identified within another histology)
• Initial Staging
• Work-up, Recurrence, Treatment response assessment / Surveillance-for non-pleomorphic rhabdomyosarcoma
Pancreatic Adenocarcinoma
Work-up, Recurrence, Treatment response assessment / Surveillance
Kidney Cancer
Work-up, Recurrence, Treatment response assessment / Surveillance
Urinary Bladder Cancer
Work-up, Recurrence, Treatment response assessment / Surveillance
Prostate Cancer
Staging work-up, Treatment response assessment / Radical prostatectomy biochemical failure, RT recurrence
Hepatobiliary Cancers Hepatocellular Carcinoma
Work-up, Recurrence, Treatment response assessment / Surveillance
Gall Bladder Cancer, Intrahepatic and Extrahepatic Cholangiocarcinomas
Recurrence, Treatment response assessment / Surveillance
CNS Cancers Adult Low-Grade Infiltrative Supratentorial Astrocytoma / Oligodenroglioma (excluding Pilolcytic Astrocytoma)
Work-up, Recurrence, Treatment response assessment / Surveillance
Anaplastic Gliomas (includes classification of mixed anapaestic Oligodenroglioma, anaplastic astrocytoma, anaplastic Oligodenroglioma And other rare anaplastic gliomas) / Glioblastoma
Work-up, Recurrence, Treatment response assessment / Surveillance
Adult Medulloblastoma and Supratentorial PNET (excluding Esthesioneuroblastoma)
Work-up, Recurrence, Treatment response assessment / Surveillance
Primary CNS Lymphoma
Evaluation
Primary Spinal Cord Tumours
Recurrence, Surveillance
Limited (1-3) Metastatic Lesions
Work-up, Recurrence, Treatment response assessment / Surveillance
Metastatic Spine Tumours
• Work-up
• For RT planning, as and when indicated, for the aforementioned tumours
2. PET/CT beyond Oncology
FDG PET/CT is widely used in a variety of non-oncologic conditions interconnecting to such disciplines as general internal medicine, infectious diseases, cardiology, neurology, surgery, traumatology, orthopedics, pediatrics, endocrinology, rheumatology, psychiatry, neuropsychology, and cognitive neuroscience. The aim of this review was to summarize the current evidence of FDG PET/CT applications in evaluating non-oncologic pathologies and the relevant information it can add to achieve a final diagnosis.
FDG PET/CT in patients with fever of unknown origin.
Accurate diagnosis of the cause of fever of unknown origin (FUO) can guide therapeutic intervention, reduce hospitalization time, and decrease morbidity and mortality. Localization of the source of infection can also guide biopsy procedures and therapy planning.
Cardiology
Moderate to severe left ventricular systolic dysfunction
Presumed or known CAD
Eligibility for revascularization
Neurology
In neurology, FDG PET/CT is playing an important role in the evaluation of various epileptic syndromes as well as in the clinical assessment of patients with a multitude of other disorders, including cognitive impairment and dementias.
CNS
• Dementing disorders
• Preoperative evaluation of partial epilepsy
• Movement disorders
Inflammation and Infection {with 2-deoxy-2-(F-18)-fluoro-D-glucose (F-18 FDG)}
• Sarcoidosis
• Peripheral bone osteomyelitis (non-postoperative, non-diabetic foot)
• Suspected spinal infection (spondylodiscitis or vertebral osteomyelitis, nonpostoperative)
• Evaluation of fever of unknown origin (including true FUO, postoperative fever and recurrent sepsis, immunodeficiency (both induced and acquired)-related FUO, neutropenic fever, and isolated acute-phase inflammation markers (persistently raised C-reactive protein and/or erythrocyte sedimentation rate
• Evaluation of metastatic infection and of high-risk patients with bacteremia
• Primary evaluation of vasculitides (ex. giant cell arteritis, etc…)
F18-Sodium Fluoride PET /CT Bone Scan
1. To identify skeletal metastases, including localization and and determination of extent of disease.
2. Back pain and otherwise unexplained bone pain
3. Child abuse
4. Abnormal radiographic or laboratory findings
5. Osteomyelitis
6. Trauma
7. Inflammatory and Degenerative Arthritis
8. Avascular Necrosis
9. Osteonecrosis of the mandible
10. Condylar hyperplasia
11. Metabolic bone disease
12. Paget’s disease
13. Bone graft viability
14. Complications of prosthetic joints
15. Reflex sympathetic dystrophy.
16. Distribution of osteoblastic activity prior to administration of therapeutic radiopharmaceuticals for treating bone pain