Monitoring response to treatment in patients utilizing PET
Section snippets
PET imaging and image analysis
PET is a noninvasive imaging technique that measures the concentration of positron-emitting radiopharmaceuticals in the body. Depending on the radiolabeled tracer used, PET can be used to determine various physiologic and biochemical processes in vivo. PET is highly sensitive, with the capacity to detect subnanomolar concentrations of radiotracer, and provides superior image resolution to conventional nuclear medicine imaging with gamma cameras. Currently, PET imaging can target several
Prediction of treatment response after initiation of therapy
Ten years ago, little was known about changes in tumor glucose metabolism in the course of chemotherapy or radiation therapy. Most in vitro and in vivo studies in tumor-bearing animals suggested a good correlation between tumor viability and FDG uptake. Other nonhuman studies, however, found an increase in FDG uptake of tumor cells after initiation of therapy. The concept of using FDG-PET for monitoring therapeutic response is based on the decrease of tumor glucose use and its correlation with
Fluorine-18-fluorodeoxyglucose-PET for assessment of treatment response
Restaging after completion of treatment is essential to verify response and to determine the need for subsequent additional therapy. Conventional anatomic imaging modalities often reveal residual masses where cancer was present. It is very difficult to assess if this represents viable tumor or fibrotic scar tissue. This is of particular importance in patients with Hodgkin's or high-grade non-Hodgkin's lymphoma after completion of chemotherapy. The ability accurately to monitor response to
Timing of serial PET imaging
The timing between the last treatment and FDG-PET imaging for assessment of tumor response is of crucial importance. There are no clinical data indicating that chemotherapy causes a metabolic flare phenomenon of tumor tissue, which would lead to an initial increase in FDG uptake after initiation of therapy as it was indicated by in vitro results [51], [52]. In these in vitro studies, the FDG uptake was assayed in surviving cells after chemotherapy or radiation therapy. This differs from the
PET and CT
There are exiting new developments in the field of PET instrumentation and PET tracers. PET-CT is a new imaging modality that allows the acquisition of spatially registered PET and CT data in one imaging procedure [56]. This hardware solution overcomes limitations of software fusion methods, such as alignment problems caused by internal organ movement, variations in scanner bed profile, and positioning of the patient for the scan, improving sensitivity and specificity of PET imaging. PET-CT is
Summary
Establishing new surrogate end points for monitoring response to treatment is needed for current therapy modalities and for new therapeutic strategies including molecular targeted cancer therapies. PET as a functional imaging technology provides rapid, reproducible, noninvasive in vivo assessment and quantification of several biologic processes targeted by these therapies. PET is useful in a variety of clinical relevant applications, including distinguishing between radiation necrosis and tumor
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