Image-Guided Biopsy and PET/CT

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Nuclear Medicine Technology: 2.25
Image Production: 0.25
Instrumentation: 0.25
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00

Outline

1. Introduction
2. Mechanism of Cancer Imaging with FDG PETCCT
3. Biologic Significance of FDG Uptake Relevant to Biopsy
4. False-Positive FDG Uptake Relevant to Patient Selection for Biopsy
   1. Physiologic Distribution of FDG Uptake
   2. Normal Variations in FDG Uptake
      1. Brown Adipose Tissue
      2. Thymus
      3. Myocardium
      4. Spleen
      5. Skeletal Muscle
      6. Bone Marrow
   3. Benign Pathologic FDG Uptake Due to Infection and Inflammation
   4. FDG Uptake in Benign Tumors
   5. PET/CT-related Artifacts
5. Applications of PET/CT Findings to Biopsy
   1. Lesions with Nonuniform FDG Uptake
   2. Multiple Lesions with Varying FDG Uptake
   3. Lesions Difficult to Target because of Underlying Anatomic Alterations
   4. Lesions with Few or No Morphologic Changes at Anatomic Imaging
6. Pitfalls in Interpreting Biopsy Results on the Basis of PET/CT Findings
7. Recent Advances in PET/CT-guided Biopsy
8. Summary

Objectives

Upon completion of this course, students will:

1. be familiar with PET/CT terminology
2. understand how FDG is metabolized in the human body
3. know the advantages of using FDG PET/CT for image-guided biopsy
4. understand the decay mechanism for nuclei with excess protons
5. understand how the positrons undergo annihilation
6. be familiar with the physical half-life of ¹⁸F
7. understand how FDG is transported in human cells
8. identify noncancerous disorders that will increase FDG uptake
9. understand the ideal properties of the crystals used in PET scanners
10. know the characteristics that define a true event in a PET scanner
11. understand what effects the overall number of random events in a PET scanner
12. know how irradiation affects human tissue on FDG PET/CT scans
13. be familiar with organs that have normal physiological FDG uptake
14. identify which organs have normal physiological uptake in children and young adults
15. be familiar with normal myocardial FDG uptake on PET/CT scans
16. know the causes of FDG musculoskeletal uptake on PET/CT scans
17. be familiar with the effects of GCSF and chemotherapy on the uptake of FDG
18. understand the inability to distinguish certain types of cancers from infection on FDG PET/CT
19. be familiar with FDG PET/CT uptake associated with a healing wound
20. be familiar with FDG avid benign tumors associated with the neck
21. be familiar with FDG avid benign tumors associated with the abdomen
22. be familiar with FDG avid benign tumors associated with the bones
23. identify the PET/CT-related artifacts created from using CT data
24. identify the causes for PET/CT misregistration artifacts
25. understand the causes for PET/CT attenuation artifacts
26. be familiar with PET quality control tests
27. be familiar with CT quality control tests
28. identify the area of the body encompassed in a whole-body FDG PET/CT
29. be familiar with the normal physiological uptake in organs in the human body
30. understand the terminology related to SUVs
31. identify causes of false negatives on FDG PET/CT scans
32. be familiar with cancers that have inherently low FDG uptake on PET/CT scans
33. understand how SUV is defined
34. understand the effects that partial volume averaging may have on SUV results
35. be familiar with the possibility of reoccurring disease from microscopic residual disease
36. be familiar with the role of ultrasound when conducting a FDG PET/CT image-guided biopsy
37. be familiar with counter indications for performing CT image-guided biopsy
38. identify the risks associated with CT image-guided biopsy
39. be familiar with the lack of specificity of FDG distribution when performing FDG PET/CT image-guided biopsy
40. identify the causes for false positive results when performing FDG PET/CT image-guided biopsy