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Review
. 2009 Oct;50(10):1655-65.
doi: 10.2967/jnumed.108.055780. Epub 2009 Sep 16.

18F-FDG PET/CT for image-guided and intensity-modulated radiotherapy

Eric C Ford  1 , Joseph Herman, Ellen Yorke, Richard L Wahl
Affiliations
Review

18F-FDG PET/CT for image-guided and intensity-modulated radiotherapy

Eric C Ford et al. J Nucl Med. 2009 Oct.

Abstract

Advances in technology have allowed extremely precise control of radiation dose delivery and localization within a patient. The ability to confidently delineate target tumor boundaries, however, has lagged behind. (18)F-FDG PET/CT, with its ability to distinguish metabolically active disease from normal tissue, may provide a partial solution to this problem. Here we review the current applications of (18)F-FDG PET/CT in a variety of disease sites, including non-small cell lung cancer, head and neck cancer, and pancreatic adenocarcinoma. This review focuses on the use of (18)F-FDG PET/CT to aid in planning radiotherapy and the associated benefits and challenges. We also briefly consider novel radiopharmaceuticals that are beginning to be used in the context of radiotherapy planning.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

FIGURE 1
FIGURE 1
Pancreatic adenocarcinoma delineated on CT alone by radiation oncologist (yellow) and on 18F-FDG PET/ CT by nuclear medicine physician (blue). Images are from coronal cut of patient with CT (A) and 18F-FDG PET/CT image fusion (B). Tick marks are 1 cm.
FIGURE 2
FIGURE 2
CT (A) and 18F-FDG PET (B) transverse slices for patient with base-of-tongue cancer, and profile plot of 18F-FDG signal along horizontal line (C). Example 18F-FDG signal threshold levels (red lines, C) demonstrate that cutoff levels of 40% and 70% of maximum would result in very different tumor volumes.
FIGURE 3
FIGURE 3
Size of GTV vs. threshold level of 18F-FDG PET signal chosen for automatic contouring. Volumes are plotted as percentage relative to CT-based volume. Data are shown for 8 patients with head and neck cancer.
FIGURE 4
FIGURE 4
Pancreatic adenocarcinoma delineated on CT alone by radiation oncologist (yellow) and on 18F-FDG PET/ CT by nuclear medicine physician (blue). Images are from coronal cut of patient with CT (A) and 18F-FDG PET/CT image fusion (B). Tick marks are 1 cm.
See this image and copyright information in PMC

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