The 19th Annual Congress of Vietnamese Society of Radiology and Nuclear Medicine, 2017

1. Evaluation the ResultsEvaluation the Results of 18F-FDG PET/CTof 18F-FDG PET/CT
Implementation for Cancer Diseases at Da NangImplementation for Cancer Diseases at Da Nang
Hospital from 2014 to 2017Hospital from 2014 to 2017
NGUYỄN VĂN MINHNGUYỄN VĂN MINH
Nuclear Medicine DepartmentNuclear Medicine Department
Da Nang HospitalDa Nang Hospital

2. ► PET-CT: Nuclear Imaging technique combinePET-CT: Nuclear Imaging technique combine
 Positron Emission Tomography (PET)Positron Emission Tomography (PET)
 Computed Tomography (CT)Computed Tomography (CT)
► Fused image:Fused image:
 Functional imaging obtained by PET + Anatomic imagingFunctional imaging obtained by PET + Anatomic imaging
obtained by CT.obtained by CT.
PET-CT : detect and locate lesions in one examinationPET-CT : detect and locate lesions in one examination
What’s PET-CT?

3. PET-CT system
PET AnatomicFunctional CT
PET/CT

4. PET-CT imagePET-CT imagePET-CT imagePET-CT image
PET + CT : Fused image

5. ► To diagnose diseases : in cardiology, in neurology andTo diagnose diseases : in cardiology, in neurology and
especially in oncology.especially in oncology.
► In oncology:In oncology:
 To diagnose cancer and stage of cancerTo diagnose cancer and stage of cancer
 To choose treatment strategy.To choose treatment strategy.
 To evaluate the effective of treatment.To evaluate the effective of treatment.
 To follow cancer recurrenceTo follow cancer recurrence
PET-CT APPLICATION

6. 108 Hospital
Bach Mai Hospital
Viet Duc Hospital
Cho Ray Hospital
175 Hospital
115 Hospital
Da Nang Hospital
PET-CT
in Viet Nam

7. PET-CT at Da Nang HospitalPET-CT at Da Nang Hospital
► Since Sept 8Since Sept 8thth
20142014
► Number of cases: 2570 cases (Sept 2014 to SeptNumber of cases: 2570 cases (Sept 2014 to Sept
2017)2017)

8. PET-CT at Da Nang HospitalPET-CT at Da Nang Hospital
PET-CT DISCOVERY 710, CT16 slices, GEPET-CT DISCOVERY 710, CT16 slices, GE

9. RadiopharmaceuticalRadiopharmaceutical
1818
F-FDGF-FDG (2-fluoro-2-deoxy-D-glucose) solution which is(2-fluoro-2-deoxy-D-glucose) solution which is
produced by Cyclotron of Da Nang Hospitalproduced by Cyclotron of Da Nang Hospital

10. Procedure for PET-CTProcedure for PET-CT
 The patient fasts for at least 4 hoursThe patient fasts for at least 4 hours
 Clinical examinationClinical examination
 Setup an intravenous lineSetup an intravenous line
 Injection ofInjection of 1818
F-FDG (dose 0.14mCi/kg)F-FDG (dose 0.14mCi/kg)

11. Procedure for PET-CTProcedure for PET-CT
 The patient rests lying in isolation room, quiets downThe patient rests lying in isolation room, quiets down
muscular activitymuscular activity
 PET-CT Acquisition after 45-60 min of injectionPET-CT Acquisition after 45-60 min of injection
 Image acquisition lasts for about 20minImage acquisition lasts for about 20min
 Images were analyzed with PETVCAR software.Images were analyzed with PETVCAR software.
 Interpreter.Interpreter.

12. Pre-acquisitionPre-acquisition

13. Images AcquisitionImages Acquisition

14. AnalysisAnalysis

15. Research SubjectResearch Subject
All patients who had PET-CT acquisitionAll patients who had PET-CT acquisition
at Da Nang Hospital from Sept 2014 to Sept 2017at Da Nang Hospital from Sept 2014 to Sept 2017

16. Research MethodResearch Method
► Research MethodsResearch Methods
Retrospective, Statistical, Descriptive Study.Retrospective, Statistical, Descriptive Study.
► Data Collection MethodsData Collection Methods
Data were collected by clinical examination, sub-clinicalData were collected by clinical examination, sub-clinical
examinations, PET/CT results.examinations, PET/CT results.
► Data Analysis MethodsData Analysis Methods
By Medical Statistical SofwareBy Medical Statistical Sofware

17. Results & Discussion
Table 1. Distribution of patients by ages
Age in years Cases Percentagee%
≤ 10 15 0,58
11-20 41 1,60
21-40 271 10,54
41-60 1217 47,36
61-80 904 35,18
≥ 81 122 4,75
Sum 2570 100
Mai Trong Khoa (2009): 61.2 percent of patients were
aged between 30 and 60 years (reasonable with age
at risk of cancer )

18. Table 2. Distribution of patients by period.
Period Number of cases Percentage(%)
9/2014 - 2/2015 401 15,60
30,35
3/2015 - 8/2015 379 14,75
9/2015 - 2/2016 445 17,31
37,43
3/2016 - 8/2016 517 20,12
9/2016 - 2/2017 420 16,34
32,22
3/2017 - 9/2017 408 15,88
Total 2570 100 100
Number of PET-CT patients increased in 2nd
year (37.43%)
and reduced in 3rd
year (32.22%)
Results & Discussion

19. Table 3. Distribution of patients by hospitals.
Hospital Number of cases Percentage(%)
Hospitals in Da Nang 2264 88,11
Hue Central Hospital 222 8,64
Hue University Hospital 74 2,87
Hospital of Northern Quang Nam 5 0,19
Quang Ngai Hospital 5 0,19
Total 2570 100
• Number of cases from hospitals in Da Nang was 88.11%
• Number of cases from others hospitals increased in time
but still in the low rate.
Results & Discussion

20. Chart 1. Distribution of patients by diagnosis
Common cancer types: lung cancer, breast cancer, colon
cancer, stomach cancer
Results & Discussion

21. Table 4. Distribution of patients by indication purposes
Purpose Number of cases Percentage(%)
Cancer Diagnosis 376 14,64
Detection of unknown original cancer 131 5,11
Staging before treatment 980 38,13
Evaluation of treatment response 35 1,36
Evaluation of post-treatment response 906 35,25
Restaging after treatment 142 5,52
Total 2570 100
Main purposes : Cancer Diagnosis ( 14,64%), Staging before treament
( 38,13%), Evaluation of treatment responde (35,25% )
Results & Discussion

22. Table 6. Location of primary tumors
Location Number of cases Percentage(%)
Lung 41 31,30
Head and neck 32 24,43
Esophagus 8 6,11
Colon 5 3,82
Breast 3 2,28
Not detected 42 32,06
Total 131 100
Lung cancer: 31.3%
Head and neck tumors: 24.43%
Not detected by PET-Ct: 32.06% (according to research of Trong
Khoa MAI
Results & Discussion

23. PET/CT CASESPET/CT CASES
at Da Nang Hospitalat Da Nang Hospital

24. PET-CT in cancer diagnose : malignant
Patient: Male, 57 years old. Diagnosis: Pancreatic tumors
PET-CT : Lesions at pancreas with high Max SUV + nodal metastases
Max SUV 8,71
Max SUV 9,74

25. PET-CT in cancer diagnose : benign
Patient: Female, 30 years old .Diagnosis: Pancreatic tumors
PET-CT : MaxSUV low  maybe benign lesions

26. PETPET-CT diagnoses unknown cause prolonged fever-CT diagnoses unknown cause prolonged fever
Patient: male, 72 years old, unknown cause prolonged feverPatient: male, 72 years old, unknown cause prolonged fever
PET-CT: lymphomaPET-CT: lymphoma

27. PET- CT: unknown original metastasis cancer
Patient: Male, 46 years old, Nodal metastases in thePatient: Male, 46 years old, Nodal metastases in the
neck, Squamous cell carcinomaneck, Squamous cell carcinoma
Nodal
metastases
Clear tumor in
PET CT
Unclear tumor in CT

28. PET-CT for staging before treatment : reduce stage
Patient : male, 66 years old, esophagus cancer,
suspected lung metastasis

29. điều trịđiều trịPET-CT for staging before treatment : Increase stage
Patient: male, 57 years old, Diagnose before PET CT :
Colon cancer T3N1Mx

30. PET-CT for follow-upPET-CT for follow-up
Patient: male, 55 years old, stomach cancer, had surgery,Patient: male, 55 years old, stomach cancer, had surgery,
chemotherapy 1 year agochemotherapy 1 year ago
PET-CTPET-CT  nodal metastases at hilum of the livernodal metastases at hilum of the liver
Max SUV = 10,79

31. PET-CT evaluates response of treatment
Patient: male, 53 years old, Lymphoma non hodgkin,
stage IIB, after 3 cycles of chemotherapy.

32. PET-CT evaluates response of treatmentPET-CT evaluates response of treatment
Patient: male, 39years old, lung cancer, brain metastasisPatient: male, 39years old, lung cancer, brain metastasis
PET-CT 2 months after radiotherapyPET-CT 2 months after radiotherapy
Max SUV = 27,25 Max SUV = 12,58
Oct 28th Mar 12th

33. - PET-CT: has run at Da Nang Hospital since Sept 2014, to Sept 2017PET-CT: has run at Da Nang Hospital since Sept 2014, to Sept 2017
number of cases was 2570 .number of cases was 2570 .
- Common cancer types: Lung cancer (26,69%), breast cancer(11,31%),Common cancer types: Lung cancer (26,69%), breast cancer(11,31%),
lymphoma (9,07%), head and neck cancer (6,43%).lymphoma (9,07%), head and neck cancer (6,43%).
- Indication purposes: staging before treatment (38,13%), evaluation ofIndication purposes: staging before treatment (38,13%), evaluation of
response after treatment (35,25%).response after treatment (35,25%).
- PET/CT made changes in staging(43,30%) and made changes inPET/CT made changes in staging(43,30%) and made changes in
treatment strategy (14,68%).treatment strategy (14,68%).
- PET-CT at Da Nang Hospital helps improve diagnosis, treatment, follow-PET-CT at Da Nang Hospital helps improve diagnosis, treatment, follow-
up in cancer patients, also helps patients save time and money.up in cancer patients, also helps patients save time and money.
Conclusion