Clinical Indications Requiring PET CT
- Detection of occult primary tumors in patients presenting with metastatic disease.
- Initial staging – including detection of cervical lymph node metastases in the clinically node negative neck, and detection of distant metastases in patients with locally advanced disease
- Detection of residual or recurrent disease.
- Detection of residual or recurrent thyroid cancer when serum thyroglobulin is elevated and radioiodine scan is negative
- Staging of patients with poorly differentiated thyroid cancers
- Evaluation of treatment response following systemic or local therapy of metastatic or locally invasive disease.
- Initial staging of patients with locally advanced or metastatic breast cancer when conventional staging studies e.g., CT or bone scan are equivocal or suspicious.
- Follow-up or surveillance patients with breast cancer when conventional studies e.g., CT or bone scan are equivocal or suspicious.
- Initial staging
- Restaging after neoadjuvant chemoradiation therapy
- Delineation of gross tumor volume in patients receiving radiation therapy
- Preoperative evaluation of patients with potentially resectable hepatic or other metastases.
- Determining location of tumors when rising CEA level suggests recurrence.
- Initial treatment planning assistance, including determination of nodal status and systemic spread.
- Detection of residual or recurrent disease following initial treatment.
- Detection and localization of potential extranodal metastatic lesions in initial evaluation of patients with advanced stage disease.
- Evaluate the extent of metastatic disease burden in patients with recurrent disease following treatment.
Bone Scan (Whole body screening)
- All common cancers
- Orthopedic conditions-Bone Tumors, Infections, etc.
- Metastatic survey
Refractory Epilepsy: Inter-ictal FDG-PET is recommended for lateralization of epileptogenic foci prior to surgical intervention in patients with medically refractory epilepsy and where inconclusive localising information is provided by a standard assessment, including seizure pattern, electroencephalography and MRI.
Dementia: In the work-up of patients with dementia, FDG-PET is helpful in identification of early Alzheimer’s disease before the onset of cerebral atrophy, especially in younger patients with dementia and normal MRI or CT.
Unknown primary with lymph nodes secondaries: Example cervical lymphadenopathy.
- To identify primary tumor
- Suspected recurrence with rising tumor markers