PET/CT of the Pancreas

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 1.25
Procedures: 1.25
Abdomen and Pelvis: 1.25

Magnetic Resonance Imaging: 1.25
Procedures: 1.25
Body: 1.25

Nuclear Medicine Technology: 3.25
Image Production: 0.25
Instrumentation: 0.25
Procedures: 3.00
Endocrine and Oncology Procedures: 3.00

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Abdominal Section: 3.00

Sonography: 1.25
Procedures: 1.25
Abdomen: 1.25

Radiation Therapy: 3.00
Patient Care: 1.50
Patient and Medical Record Management: 1.50
Procedures: 1.50
Treatment Sites and Tumors: 1.50

Outline

1. Introduction
2. Multidetector CT
3. Positron Emission Tomography
4. PET/CT: Technical Considerations
5. Role of PET/CT in Pancreatic Imaging
6. Diagnosing Pancreatic Cancer When Other Imaging Findings Are Equivocal
7. Preoperative Staging
   1. Characterization of Lymph Nodes
   2. Depiction of Liver Metastases
   3. Depiction of Peritoneal Metastases
   4. Depiction of Distant Metastases
8. Depiction of Tumor Recurrence and Monitoring Response to Therapy
9. Other Pancreatic Neoplasms
   1. Pancreatic Endocrine Neoplasms
   2. Pancreatic Lymphoma
   3. Metastases
   4. Cystic Neoplasms
   5. Pancreatitis
10. Recent Developments in PET
    1. Novel Radiotracers
    2. PET/MR Imaging
11. Summary

Objectives

Upon completion of this course, students will:

1. be familiar with PET/CT imaging of the pancreas
2. be familiar with the various acronyms for pancreatic diseases
3. know the various uses for PET/CT in the assessment of pancreatic adenocarcinomas
4. know the goal of pancreatic cancer imaging
5. understand why multi-detector CT is the mainstay for imaging of suspected pancreatic cancer
6. be familiar with the limitations of multi-detector CT imaging of suspected pancreatic cancer
7. understand the categorization of patient examination results
8. understand the sensitivity component of examination results
9. understand the terms “positive predictive value” and “negative predictive value”
10. know the end goal of any diagnostic examination
11. be familiar with some of the characteristics of malignant lesions
12. know the comparison points between FDG PET and contrast-enhanced CT for distinguishing between MFP and pancreatic cancer
13. understand how elevated glucose levels affect FDG PET imaging of pancreatic malignancy
14. know some of the drawbacks of PET imaging
15. know the standard blood glucose level restrictions for FDG injection
16. understand the effects of circulating insulin levels on FDG uptake
17. know the necessity for utilizing a neutral oral contrast agent over a positive one in PET/CT
18. be familiar with the weight-based PET imaging time per bed position scanning settings
19. know the basis for the amount of CT IV contrast material administration
20. be familiar with the typical patient preparation steps for FDG PET imaging
21. know the disease which is the fourth leading cause of cancer-related death in the US
22. know the 5-year survival rate after a diagnosis of pancreatic cancer
23. identify the only curative treatment for locally resectable and non-metastatic pancreatic cancer
24. know the items to identify in order to determine the resectability of a pancreatic adenocarcinoma
25. identify a possible cause of pancreatic cancer biopsy sampling error that is inherent to most pancreatic cancers and recurrent tumors
26. know why about 10% of pancreatic adenocarcinomas and metastases are not depicted at contrast-enhanced CT, even when larger than 2cm
27. understand how the SUVmax of a malignant lesion compares to normal liver tissue
28. understand the reasoning for setting a cancer diagnosis SUV threshold of 4.0 to distinguish between MFP and pancreatic adenocarcinoma
29. know the components of the most commonly used SUV calculation
30. identify what is usually indicative of a poor prognosis for pancreatic cancer
31. be familiar with the term “in situ” in TNM tumor staging
32. understand the pancreatic cancer TNM staging system for translating categories into stages
33. be familiar with the causes of reactive lymph node enlargement around the pancreas
34. be familiar with the reasons for the poor performance of FDG PET for lymph node staging
35. identify the imaging modality that is superior for depiction of distant metastases
36. identify the main objective of pancreatic cancer staging after initial diagnosis and confirmation of local resectability
37. know what is indicative of pancreatic adenocarcinoma recurrence three months after surgery
38. identify the recommended minimum wait time before performing follow-up FDG PET after surgery
39. know how pancreatic endocrine neoplasms are named
40. be familiar with what characterizes most pancreatic neuroendocrine tumors
41. know what critical piece of information is necessary to diagnose pancreatic lymphoma
42. be familiar with primary malignancies that most commonly metastasize to the pancreas
43. identify the SUV cutoff that can be utilized to distinguish between benign and malignant IPMNs
44. be familiar with the characterizations of Type I AIP
45. know some of the characteristics and advantages of ¹⁸F FLT