nmt432 PET oncology

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  1. Significance high tumor markers: CEA, M protein, AFP, S100, PSA?
    • CEA = colorectal
    • M protein = multiple myeloma
    • AFP = hepatocellular cancer or testicular
    • S100 = Melanoma
    • PSA = Prostate.
  2. Identify normal sites of 18FDG uptake?
    brain, heart, muscle, kidneys, bladder, liver.
  3. How is 18FDG metabolized in tumors cells?
    brought in by GLUT-1 Hexokinase converts FDG to FDG-6P
  4. Pattern of 18FDG thymus uptake
    inverted v
  5. Is FDG secreted in breast milk? Explain uptake seen in the lactating breast
    • no.
    • Uptake by GLUT-1 which is activated by suckling.
  6. What are the patient preps in IDDM & NIDDM for FDG PET imaging?
    • IDDM(Insulin-Dependent Diabetes Mellitus) patients, no insulin for 2hrs prior to FDG.
    • NIDDM should not take med within 4hrs of FDG.
  7. What is the typical blood sugar levels ideal for FDG PET imaging?
  8. What are the types of PET studies for which anxyolytics are given & why?
    used for breast, head and neck, and thyroid. it is sedation to keep Pt still and calm to reduce muscle uptake.
  9. How does the fasting state & fed state affect myocardial uptake of FDG? Why?(
    in the fasting state the heart uses fatty acids for energy. in the fed state the heart uses glucose.
  10. Why is temperature control of PET suite important?
    cold can cause uptake in brown fat.
  11. What is brown fat and how s it different from white fat?
    brown fat has lots of mitochondria, and capillaries. in new borns brown fat is more promenant and helps keep them warm..
  12. What type of lymphomas are covered for PET imaging?
    • hodgkins - HL
    • non hodgkins - NHL
    • cutaneous T-cell lymphoma - CTL
  13. Difference between HL, NHL & CTL
    • HL: Systemic spread, mostly above diaphram, extranodal in marrow, liver and lung. mostly in young adults.
    • NHL: B-cell related, less systemic than HL, mostly in adults, most common form.
    • CTL: NHL with mutation of T-cells with subcutaneous nodules.
  14. Identify the default imaging areas for NHL, HL & CTL & Why?
    • arms up
    • base of skull to pelvis
    • for CTL head to toe, because it spreads throughout body
  15. What is myeloma and how is it imaged using PET?
    • Myeloma is marrow cancer.
    • arms to sides
  16. What is ABN and name a PET study that would need it.
    • advance beneficiary notice.
    • leukemia
  17. What type of thyroid cancer is indicated in PET imaging?
    poorly differentiated thyroid cancers.
  18. How does NaF imaging differ from FDG/MDP imaging?
    no advanced prep needed.
  19. How does FDG brain uptake mechanism differ from brain SPECT Rps’?
    FDG uptake is proportional to brain glucose utilization. Spect uptake is based on cerebral blood flow.
  20. How will you prepare the patient for FDG brain imaging?
    • fast 6hrs
    • run IV 10min before inj
    • Pt sits quietly in armchair with legs and arms crosssd
    • no reading or talking
    • low light, quiet
    • after 5-10min inj tracer.
  21. Identify the image pattern of ictal vs. inter-ictal FDG imaging & CVAs
    • Ictal imaging has hot Focus.
    • Inter-icatal has reduced activity in affected area.
    • cerebrovascular accident (CVA) lack of glucose metabolic uptake.
  22. FDG PET is approved by medicare for what purpose in epilepsy?
    Pre sugical eval of patients with refractory seizures.
  23. What pattern of FDG localizaton is expected in Dementia patients? Why?
    decreased due to neuron death.
  24. What is FDG PET approved for in Alzheimer’s imaging?
    evaluation, but not diagnosis.
  25. PET radiopharmaceutical conditionally approved for amyloid plaque imaging?
    18F-AV-45 Fluorbetapir (Amyvid)
  26. What does Fluorbetapir bind to and what is it used for?
    binds to beta amyloid in brain. is used for Alzheimers.
  27. What is the effect of anesthesia and high blood glucose on FDG brain imaging?
    reduces uptake in cerebral cortex.
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nmt432 PET oncology
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