reading a report to patient of pet/ct

Body oncology positron emission tomography–computed tomographic (PET-CT) exams areparticularly complex and time-consuming studies to interpret and report. An integratedapproach is required to provide the referring physician with the full clinical value of thiscombined modality. Special attention to the Positron Emission Tomography–ComputedTomographic Report Findings section and Impression section is necessary to insure all theinformation relevant to the patient’s care are clearly communicated to the referringphysicians.

Full Answer

What is PET/CT interpretation?

Interpretation of PET/CT The reader is directed to the initial article in this series, which details many of the principles that we use in formulating an impression of a scan, in reporting its findings and reaching a conclusion. Tumours grow as spheres: differentiating malignant from inflammatory aetiology

What is the best way to present pet and CT findings?

We strongly prefer this to an anatomic report (e.g. head, neck, chest, abdomen/pelvis) as the important findings are documented first, and incidental findings last. The PET findings are presented first but are directly correlated with the associated correlative CT findings rather than performing sequential or separate PET and CT reports.

What does a negative PET/CT report mean?

Applying conventional diagnostic imaging paradigms, a negative PET/CT study in a patient with biopsy proven malignancy would be considered false-negative. A more useful report, however, would highlight the powerful prognostic information this provides.

How should we interpret PET/CT for lymphoma?

Detailed knowledge of the anatomic appearance of pathologic, inflammatory and benign processes is therefore critical to correctly interpret PET/CT. For example, focal intense abnormality on PET alone indicative of residual or recurrent lymphoma, may be revised to fat necrosis when CT appearances are integrated [ 10 ].

How do I read a PET scan report?

PET scans use a special dye containing radioactive “tracers” that are injected into a vein and absorbed by certain organs and tissues. This enables doctors to examine a patient's blood flow, oxygen intake, and how well their organs and tissues are functioning.

How do you analyze a CT scan report?

Step 1: Blood. Look for any evidence of bleeding throughout all slices of the head CT. ... Step 2: Cisterns. Two key questions to answer regarding the four key cisterns (Circummesencephalic, Suprasellar, Quadrigeminal and Sylvian) ... Step 3: Brain. Examine the brain for: ... Step 4: Ventricles. ... Step 5: Bone.

What do PET scan results mean?

Positron emission tomography (PET) scans detect early signs of cancer, heart disease and brain disorders. An injectable radioactive tracer detects diseased cells. A combination PET-CT scan produces 3D images for a more accurate diagnosis.

How do you read a SUV on a PET scan?

Typically, a standardized uptake value (SUV), a quantity that incorporates the patient's size and the injected dose, that is more than 2.0 is considered to be suggestive of malignancy, whereas lesions with SUVs less than this value are considered to be benign. The SUV of this nodule in the right upper lobe is 4.0.

How do you describe CT findings?

When describing findings on CT, we use words that refer to how dense the abnormality is in relation to a reference structure. Reference structures include bone, gray matter, white matter, CSF, fat, air etc.

How do you read a CT?

0:569:34How to read a CT Abdomen for Med students and Residents - Part 1YouTubeStart of suggested clipEnd of suggested clipAnd rotation in your head. So the first thing is just kind of looking at the major organs this isMoreAnd rotation in your head. So the first thing is just kind of looking at the major organs this is going to be our liver. This right here is going to be our pancreas. This is going to be our spleen.

What does red mean in a PET scan?

A PET scan can compare a normal brain (left) with one affected by Alzheimer's disease (right). The loss of red color with an increase in yellow, blue and green colors shows areas of decreased metabolic activity in the brain due to Alzheimer's disease.

What is SUV value in PET scan?

SUV value is defined as the tissue concentration of tracer as measured by a PET scanner divided by the activity injected divided usually by body weight [1]. The uptake value is represented by pixel or voxel intensity value in the ROI of the image, which is then converted into the activity concentration.

What does a hot spot on a PET scan mean?

Areas of the body that use a lot of glucose, such as the brain and heart, will pick up this radioactive material and appear hot. Abnormal cells in the body that use a lot of glucose will also appear as "hot spots." Cancer cells are highly metabolic and use a lot of sugar.

What does an SUV of 2.5 mean on a PET scan?

An SUV of 2.5 or higher is generally considered to be indicative of malignant tissue; however, there has been a wide range of SUVs reported for similar diseases. Table 4-2 summarizes some of these reported values. 74. It is important to recognize that an SUV around 2.5 can be measured in non-malignant regions.

What is SUVmax range?

Median SUVmax values of grade 1, 2 and 3 were 5.7 (range 2.1-18.2), 9.5 (range 2.2-21.3), and 11.6 (range 3.5-23), respectively.

What is normal SUV in lymph nodes?

The median SUVmax values of pathologically negative and positive lymph nodes were 1.6 (range, 0.4–11.3) and 5.4 (range, 1.1–17.8), respectively (Figure 1).

What is the difference between a PET scan and a CT scan?

Positron emission tomography (PET) scanning using 2-18F-fluoro-deoxy-D-glucose (18FDG) uptake has been in clinical use for over a decade [1,2]. The advantage of PET scanning is that it provides functional information of lesions detected, and can help distinguish between malignant and non-malignant tissues. However, PET scanning has poor spatial resolution in terms of localising lesions. In contrast, computerised tomography (CT) scanning give good anatomical, but not functional information. Since 2000, purpose-built combined positron emission tomography/computerised tomography (PET/CT) scanners have been in use which overcome the respective shortcomings of PET and CT scans [3,4]. The use of PET/CT scans therefore holds much promise in the advancement of tumour localisation and management. Nevertheless, several pitfalls remain [5]. Of these, the biggest problem is that of accurate image alignment. This case report illustrates an example of mislocation of a tumour in a patient with germ cell tumour (GCT) by PET/CT, and the subsequent potential clinical impact which results.

Why use a PET scanner?

The use of combined positron emission tomography/computerised tomography (PET/CT) scanners in oncology has been shown to improve the staging of tumours and the detection of relapses. However, mis-registration errors are increasingly recognised to be a common pitfall of PET/CT studies.

Why did the PET/CT mislocate the lesion?

In particular, there may be movement artefact due to respiration effects , which is increasingly recognised [5]. CT acquires imaging data rapidly within one breath-hold, whilst PET takes many minutes to accumulate a composite image during which time the patient is breathing. Consequently, peripheral lung lesions maybe mislocated by 15 mm on PET when compared to CT [11]. In our patient, misregistration due to breathing could have occurred, but given the central location of the lesion (that is, not in the lung periphery) this seems less likely. Furthermore, recent PET/CT scans use respiration-averaged CT to match PET images or respiratory gating of the PET acquisition to improve on misregistration issues [12]. This is further improved by more detector rows in the scanner [13].

What is written consent?

Written consent was obtained from the patient or their relative for publication of the patient's details.

Can PET scans mislocalize lesions?

While these issues are becoming well-recognised in radiology, the potential for PET/CT to mislocalise lesions is not well appreciated by clinicians requesting these scans. We therefore suggest that in cases such as this, where there is a discrepancy between in the PET and PET/CT, a disclaimer ought to be inserted in the PET/CT report to highlight the potential misregistration which may occur. Furthermore, what has not been addressed is the clinical impact that these misregistrations may have. This report underlines the importance of reviewing PET/CT images and obtaining confirmatory/complementary anatomical imaging of 18FDG-PET-defined lesions prior to embarking on major surgery.

What is a PET scan?

Positron emission tomography, also called PET imaging or a PET scan, is a diagnostic examination that involves getting images of the body based on the detection of radiation from the emission of positrons. Positrons are tiny particles emitted from a radioactive substance administered to the patient.

Can a technologist do a contrast screening?

The technologist will verify your identification and exam requested. You will be given a contrast screening form to complete. In certain situations, the doctor may order lab tests prior to contrast being given. Commonly, contrast is injected into a vein to better define the images throughout the body.

Abstract

Our objective was to identify core elements for inclusion in oncologic PET reports and to evaluate a sample of reports in the National Oncologic PET Registry database. Methods: A list of desirable elements in PET reports was compiled from American College of Radiology and Society of Nuclear Medicine guidelines.

MATERIALS AND METHODS

The report elements included in our review of PET reports were compiled from the ACR communication guidelines ( 1 ), the SNM general imaging guideline ( 2 ), and the ACR and SNM PET/CT guidelines ( 3, 4) ( Table 1 ).

RESULTS

Three cases were excluded from the analysis, 1 from the common cases and 2 from the set of 180, because the reports either were incomplete or did not appear to correspond to the data on indication and location of cancer. There was generally excellent interrater agreement for the cases read in common by the 4 reviewers.

DISCUSSION

The content of the report of an imaging test has important ramifications for how a patient is managed and the study reimbursed. If elements related to the performance of the examination and the relevant findings are not included in the report, information that may be important for appropriate patient management may be lost.

CONCLUSION

Several elements that should be in a PET report are not present in most reports. Only 9 of the 34 elements reviewed were found in more than 90% of the reports. These deficiencies may result in reports that are less helpful to referring physicians, cause misdiagnoses, and lead to coding and billing errors.

Acknowledgments

Funding for development of the National Oncologic PET Registry was provided by the Academy for Molecular Imaging, but the registry is otherwise self-supported by the fees paid by participating PET facilities.