PET CT

1. Cuzino Dragoș, Cătălin Mazilu,
Mititelu Raluca
Central Emergency University
Military Hospital
FDG PET-CT in ovarian malignant
diseases. Practical issues in our
clinical experience.

2. Objectives
• Benefits and limits of the FDG PET/CT in
ovarian malignincies
• Functional imaging value
• Multiparametric and multimodal imaging
• PET/MRI.

3. Functional imaging
• Physiological increased activity –
Ovulation / Menstrual pahse. Diffuse /
focal activity.
• Pre-menopause
• Post-menopause

4. Ovarian uptake
• Ovarian physiological
activity.
Hodgkin lymphoma.

5. MRI Diffusion sequence

6. MRI aspects of the ovarian
tumors

8. Solid tumor

11. Cystic adenocarcioma

12. Mucinous adenocarcinoma

13. Endometrial ovarian
carcinoma

14. Rokitansky nodule

15. PET specific Tracer

16. Complemetary value PET/CT
- MRI

17. Peritoneal ovarian extension

18. Increased CA 125

19. Hybrid PET/MRI -PET/CT
indication

21. Pretherapeutical staging

22. Monitoring - Restaging

23. Cancer ov meta hep si splenice

24. Peritoneal
metastasis

25. • Ileostoma-
peritoneal
metastasis

26. Ileostoma- Iliac adenopathies uptake ( left flash SUV max 8,2 ) presacral
adenopathies SUV max 11 .
Peritoneal infiltrative tumor (SUV 9,8)- splenic and perisplenic tumor.

27. Intramezenteric tumor- Intense uptake SUV max 15

28. Intraperitone
al
metastasis-
near liver

29. Abdominal
adenopathies

30. Liver mets and
adenopathies

31. Peritoneal
metastasis

32. Ascita meta
peritoneala

33. Ascitis –
peritoneal mets.

36. Ovarian cancer reccurence

37. Ovarian cancer

38. False positive FDG uptake
• Infections
• Post- radiotherapy inflammation
• Fistulae
• Post-radiotherapy necrosis
• Leiomyoamas

39. Ovarian cancer/PET-CT
• Ovarian cancer reccurence detection
• RECIST
• CA 125
• Difficult cases
– Size tumor decrease needs time
– Some ovarian tumors do not increase
CA125.

40. Ovarian cancer
• Ovarian cancer
– Detection reccurence and staging
– Prognosis
– Reccurence
– Chemotherapy- evolution

41. Clinical indication
• Complementary role in imaging –
(ultrasound and MRI)
• Can increase the global value of the
imaging staging ( 92%sensibility and
85%specificity)

42. Particular aspects
• SUV threshold malignant/benign 3,25-7,9
• SUV must be compared with liver activity
• Uptake- in post-menopause- significance
of malignancies.

43. Limitation
• False negative – early stage carcinoma
• False positive – inflamatories
endometriosis, cystic lesions, luteal cyst
body, dermoid cyst, serous cyst
• Ovarian activity difficult to differentiate
from intestinal activity and adenopathies

44. Ovarian cancer –recidive-
indication
• CA 125 increased and conventional
imaging is unconclusive.
• “Second look “ laparotomy has small
sensibility for small volume < 1cm.
• Case management tumoral deposits
value – increased in tumoral deposits.

45. Conclusion
• IRM in asociere cu PET/CT – indicate in
cancerul cervical avansat inainte de
chimio-radio-terapie
• PET/CT nu este util si nici recomandat in
stadiile precoce ale cancerului cervical
• PET/CT poate fi util inainte de interventiile
chirurgicale
• Potential ca biomarker- prognostic
• Rol in plina dezvoltare al PET/IRM

46. Conclusion
PET-CT have a well defined role in
malignant pelvic disease
PET-CT have “one stop shop imaging”
benefits
PET-CT is probably the best imaging
method for evaluation of the therapeutic
answer
PET-CT can produce changes around
30% of thr management of the oncological
disease.

47. Conclusion
• MRI and clinico-ultrsound examination-
endovaginal are more efficient in loco-
regional examination
• Distance evaluation of the adenopathies
and peritoneal lesions
• 30 % of the pacient management
• Stucturate radiological report

48. PET-MRI
• One Stop Shop
• Local and whole-body staging

49. Pretherapeutical evaluation

50. PET/IRM

51. Complementary value