FDG PET/CT Gynecologic and Genitourinary Oncologic Imaging

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification for enrollments starting after January 30, 2024:

Nuclear Medicine Technology: 2.50
Image Production: 0.50
Instrumentation: 0.50
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00

Outline

1. Introduction
2. FDG PET/CT Imaging Protocol
3. Technical Pitfalls
   1. Attenuation Correction
   2. Misregistration
4. Limitations and Pitfalls of Gynecologic and Genitourinary Oncologic FDG PET/CT
5. Physiologic Pitfalls
   1. Endometrial and Ovarian Uptake
   2. Bowel Activity
   3. Tracer Excretion
   4. Brown Adipose Tissue Uptake
6. Low-Level FDG Uptake
   1. Prostate Caner
   2. Cystic and Mucinous Tumors
   3. Necrotic Lymph Nodes
   4. Peritoneal Carcinomatosis
7. Ovarian, Tubal, and Uterine Disease
   1. Ovarian and Tubal Disease
   2. Uterine Disease
8. Kidney and Urinary Tract Disease
   1. Kidney
   2. Urinary Tract
9. Conclusion

Objectives

Upon completion of this course, students will:

1. know the various abbreviations utilized in the article relating to GYN and GU oncologic imaging
2. be familiar with the aspects of FDG PET/CT to review for patients with ovarian cancer
3. know the basic components of PET/CT imaging techniques for GYN and GU oncologic imaging
4. recognize the basic mechanism of FDG uptake and metabolism within the body
5. be familiar with the indications for FDG PET/CT use for GYN malignancies
6. be familiar with the indications for FDG PET/CT use for GU malignancies
7. know the patient preparation steps and scanning protocols recommended by the SNM and EANM for FDG PET/CT imaging of GYN and GU malignancies
8. understand why the timing of post-therapeutic FDG PET/CT for response assessment in GYN and GU malignancies is often crucial
9. be familiar with structures and material that can lead to potential attenuation artifacts, making it essential to evaluate both attenuation-corrected and non-attenuated-corrected PET images
10. understand PET/CT misregistration and know the ways to reduce and prevent it
11. identify the areas or conditions whose assessment may be limited due to respiratory motion during the CT and PET components of a PET/CT study
12. know the conditions that can possibly mimic or mask disease in GYN and GU oncologic FDG PET/CT due to the low specificity of FDG uptake
13. be familiar with the variation of physiologic FDG uptake within the endometrium during a premenopausal woman’s menstrual cycle
14. identify the possible causes of ovarian FDG uptake in premenopausal women and how the physiologic uptake manifests
15. know the additional correlative information needed when visualizing endometrial or ovarian FDG activity in postmenopausal women
16. be familiar with the regions of the GI tract where possible physiologic FDG activity can be particularly intense
17. be familiar with the possible components for the mechanism of physiologic FDG activity in the bowel
18. distinguish between the typical appearance of physiologic and that of pathologic FDG uptake in the bowel
19. be familiar with some non-pathologic bowel conditions that can mimic the typical pathologic FDG bowel activity pattern
20. be familiar with the typical glucose and FDG excretion pattern and the importance of using correlative information for corrected image interpretation
21. know the regions of the body where brown adipose tissue can typically be found
22. recognize what patient groups may demonstrate FDG uptake more than other groups
23. understand why FDG PET/CT plays a limited role in the assessment of prostate cancer
24. be familiar with the reasons why FDG PET/CT is thought to have low sensitivity for cystic and mucinous tumors
25. be familiar with the important role of FDG PET/CT in the assessment of lymph node involvement in GYN and GU malignancy staging, and especially in the assessment of cervical cancers
26. recognize the importance for the detection of peritoneal carcinomatosis in patients with ovarian cancer
27. be familiar with the situations in which false negative results may occur with integrated FDG PET and contrast-enhanced CT for peritoneal disease
28. know the imaging modality of choice for adnexal masses
29. be familiar with benign conditions and masses that may yield false-positive results with adnexal and/or tubal FDG uptake
30. be familiar with the characteristics of benign uterine leiomyomas that are thought to regulate their wide range of variable FDG uptake
31. understand the role of FDG PET/CT imaging for renal cell carcinomas and their secondary metastases
32. recognize the problems with evaluating GYN malignancies with FDG PET/CT in the presence of vesicovaginal fistulations
33. know the methods suggested in the article for improving the detection of bladder tumors
34. be familiar with how urinary bladder diverticula and hernias can affect FDG PET/CT interpretations
35. understand how urinary diversions can make FDG PET/CT interpretation difficult