[¹⁸F]fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography imaging in oncology: initial staging and evaluation of cancer therapy

Abstract

Positron emission tomography (PET) with [¹⁸F]fluoro-2-deoxy-D-glucose (FDG) has proven to be a valuable diagnostic modality in various diseases. Its accuracy has been improved with the hybrid PET/computed tomography (CT) technique because of precise anatomic location of areas of abnormal FDG accumulation. This integrated PET/CT modality has been widely adopted, particularly in oncology. This paper reviews the role of FDG-PET/CT imaging in breast cancer, non-small-cell lung cancer, colorectal cancer, head and neck cancer as well as lymphoma on the basis of recent key articles. Special attention is paid to preoperative diagnostic workup, evaluation of treatment response and survival prognosis. Experience from specialized centers indicates that there is strong evidence for the clinical effectiveness of FDG-PET/CT in staging, restaging and the prediction of response to therapy in the above-mentioned malignancies. It is concluded that this imaging modality contributes considerably to improved patient management and paves the way to personalize cancer treatment in a cost-effective way.

Fig. 1

FDG-PET/CT study in a 60-year-old male suffering from large B-cell lymphoma before and after 6 cycles of R-CHOP, and 2 cycles of HD-MTX. Complete metabolic response was observed 3 months after chemotherapy. The largest abdominal tumor burden (SUV_max: 38) shown transaxially (a) disappeared completely (SUV_max: 2) as shown in b. The whole-body images demonstrate an extensive intense disease (c), which disappears totally in all regions (d).

Fig. 2

FDG-PET/CT study in a 54-year-old male patient with squamous cell cancer in the base of the tongue. FDG imaging (a) demonstrates metastatic disease to the upper jugular lymph nodes (level II). In a transaxial fusion image (c), these lesions can be confirmed on a CT overlay. In the images 1 month later, after external beam radiation therapy, both these lesions have disappeared (b, d).