PET/CT of the Pancreas

A review of PET/CT for depicting pancreatic tumors and distant metastases, performing preoperative staging, and monitoring response to treatment.

Course ID: Q00345 Category:
Modalities: , , ,

3.5

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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: 1.00
Procedures: 1.00
Abdomen and Pelvis: 1.00

Magnetic Resonance Imaging: 1.00
Procedures: 1.00
Body: 1.00

Nuclear Medicine Technology: 2.75
Image Production: 0.25
Instrumentation: 0.25
Procedures: 2.50
Endocrine and Oncology Procedures: 2.50

Registered Radiologist Assistant: 2.50
Procedures: 2.50
Abdominal Section: 2.50

Sonography: 1.00
Procedures: 1.00
Abdomen: 1.00

Radiation Therapy: 2.50
Patient Care: 1.25
Patient and Medical Record Management: 1.25
Procedures: 1.25
Treatment Sites and Tumors: 1.25

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