Hybrid 18FDG-positron emission tomography and computed tomography (18FDG -PET/CT) is an indispensable imaging modality in the fields of neurology, cardiology, infection/ inflammation and most especially, oncology. Cancer cells have increased metabolic activity and generally have increased glucose uptake. 18FDG-PET/CT detects abnormal glucose metabolism within the body. Primary malignant lesion and local and distant metastases would usually show increased 18FDG tracer uptake on PET/CT images.
Note to referring physician: The CT component of PET/CT camera helps in correcting artifacts on PET images and provide more accurate anatomic localization. Outside diagnostic CT scans (from other institutions) can also be combined with the PET images. The use of IV CT contrast is not recommended in order to prevent image artifacts, potential allergic reactions and risk of nephrotoxicity.
1. Oncologic indications for 18FDG -PET/CT scan:
- Initial staging of disease
- Treatment response monitoring
- Re-staging of disease
- Radiotherapy planning
- Evaluation of unknown primary malignancies
(Studies have shown effectiveness of 18FDG -PET/CT scan in the up-staging or down-staging of cancer, leading to change of treatment. Residual and recurrent cancer lesions can also be differentiated from post-radiation and post-surgical changes. A second or even third concurrent primary malignancy may also be detected.)
2. 18F-choline PET-CT: Single step, whole body and non-invasive. Allows localization of cancer and loco-regional metastases. Accurately evaluates Prostate Cancer.
Prostate Carcinoma: Life Threatening Cancer Affecting Men
The major goals of pre-therapeutic imaging are to determine the local extent of prostate carcinoma in terms of:
- Intra-prostate localization
- extracapsular extension
- seminal vesicle invasion
- tumor infiltration into neurovascular bundles, surrounding tissues and organs in the small pelvis
- detection of loco-regional metastases via the lymph nodes
- detection of distant metastases
Both anatomic and functional molecular imaging of prostate carcinoma are important when there are problems in diagnosis, such as when prostate punch biopsies are negative, while suspicion of prostate carcinoma persists.
Not all tumors show significant increase of metabolic activity with 18F-FDG PET/CT as seen in neuroendocrine tumors, hepatic tumors and prostate cancer.
Choline presents high affinity for malignant prostate tissue, even if low grade. 18F-choline PET/CT is highly sensitive and accurate in staging and restaging prostate cancer pre-operatively and after treatment.
18F-choline PET/C is a useful imaging modality in such patients. It is highly efficient in preoperative management and staging of cancer once metastatic disease is strongly suspected.
Indications for 18F-choline PET/CT
In the evaluation of patients with prostate cancer, it covers a wide spectrum of clinical settings:
- Localization of intra-prostatic neoplastic lesions
- Initial staging
- Detection of occult metastases
- Characterization of images on conventional imaging modalities
Sensitive. Specific. Accurate.
18F-choline PET/CT may be superior to bone scintigraphy for the early detection of metastatic bone disease due to the detection of bone marrow metastases.
Localization of recurrent prostate cancer is critical for selecting a local or systemic therapeutic strategy.
18F-choline PET/CT augments the diagnostic imaging spectrum for the assessment of relapsing prostate cancer.
It is useful in demonstrating the spread of disease preoperatively and to detect local recurrent disease after radical prostatectomy or radiation therapy.
18F-choline PET/CT is also useful for the evaluation of other cancers such as hepatocellular carcinoma.
Optimizing 18F-Choline PET/CT for Patients
- Gives relevant impact on patient management.
- Allows the distinction between patients treatable with local radiation therapy, from those with distant spread in whom systemic therapy was planned.
- Provides good quality imaging to visualize recurrent disease.
- Avoids false-positive results related to urinary excretion.
- 18F-choline PET/CT allows early localization of recurrent prostate carcinoma.
Patient Preparation Instructions Before 18F-Choline PET/CT Procedure
- Abstain from food 6hrs prior to the procedure.
Only water intake during the fasting period.
- If sedated, NO FOOD or WATER, 8-hrs fasting time.
- If diabetic, fasting time is 4hrs. Eat a full meal before fasting. Do not inject insulin during the fasting period.
- Maintenance medications can be taken during the fasting period.
- Bring pervious medical results such as CT Scan, MRI, PET/CT Scan including films and flash drive; tumor markers, biopsy reports and lab results.
- Come in comfortable clothes without buttons, zippers and metallic objects.
- Inform us of food allergies or medications or if you feel ill and wish to defer the procedure, at least a day prior to your PET/CT scan.
- Please bring the latest creatinine result done within the month of your scheduled date. This is needed prior to your schedule.
Role of 18F-choline PET/CT in evaluation of patients with prostate carcinoma. Research Article. Hodolic, Marina. Radio Onco. 2011. Optimising 18F-Choline PET/CT Acquisition Protocol in Prostate Cancer Patients. Massaro, et.al. N Am J Med Sci. 2012
- 18F-Choline PET/CT for Prostate Cancer = P65,000
3. Neurologic indications for 18FDG -PET/CT scan:
- Aid in diagnosis and treatment response of dementia disorders (Alzheimer’s, Parkinson’s etc. )
- Aid in localization and treatment response of epilepsy disorders (post-ictal stage)
NKTI PET/CT Center’s introductory price: until end of 2015/ first 100 patients
- 18FDG -PET/CT for oncology purposes:
(regular price of Php 65,000) Php 49,900
- 18FDG -PET/CT for brain imaging:
(regular price of Php 55,000) Php 39,900
- At least 6 hours of fasting, water intake is allowed
- Refrain from strenuous physical activity (e.g. exercise) for 48 hours prior to the scan
- Inform staff if you have diabetes/ pregnant/ breastfeeding
- Inform staff of maintenance medications beforehand
- Bring all recent (within 6 months) x-ray, CT and/ or MRI films or digital format (CD/DVD/ USB)
- Please have a companion with you.
What to expect during day of the scan
- The whole procedure takes about 3-4 hours to complete. The actual scan duration is approximately 45-60 minutes, depending on the patient’s height and body built. Non-oncological indication would take a shorter time.
- You will be asked to change into a hospital gown
- 18FDG tracer would be given intravenously (IV injection). No allergy cases and side effects have been reported.
- Post-tracer injection, you will be asked to sit still or lie down for approximately 60 minutes. Talking, chewing/ eating, strenuous activity is discouraged during the waiting time before the scan.
Is PET/ CT Safe?
The 18FDG radio tracer used at NKTI has been certified to be of excellent quality based on local and international standards (FDA LOT No. CDRR-NCR-DM-348).
A patient receives about 7mSv of radiation from a PET study alone. At NKTI, the CT component is optimized to minimize additional radiation to the patient while maintaining image quality. About 5 mSv is added from the CT part, hence a total of 12 mSv received from the PET/CT scan procedure. High-dose diagnostic CT would send a total of 20 mSv to the patient. The general population receives about 1 mSv of natural background radiation a year (e.g. from sunlight).
After the scan
- No side effects.
- Drink water frequently to hasten radio tracer removal from the body.
- Regular diet can be resumed.
- Results available after two working days. Your doctor will interpret the PET/CT scan results for you.
|Co-Heads:||Dr. Angelo O. Martinez and Dr. Gerardo M. Silva|
|Dr. Raymund Augustus O. Conlu
Dr. Jamilla Cecilia L. Gomez
Dr. Joel C. Mendoza
|Dr. Rosanna E. Fragante
Dr. Rene D. Bautista
|PET Technologist:||Jeffrey John T. Salang, RMT|
|CT Technologist:||Paul Pontilan, RRT|
|Nurse:||Michelle S. Franza, RN|
Ground floor, Diagnostic Centre, NKTI
East Avenue, Diliman, Quezon City
Monday-Friday 8:00 am to 5:00 pm
Tel. no. (63) (2) 981-0300, 981-0400 local 1445, 1446 / Telefax no. 282-38-79
Mobile no. 0917-3297-812 / 0998-9507-051
Email: pet-ct[@]nkti.gov.ph / nktipetctunit[@]gmail.com