Image-Guided Biopsy and PET/CT

Benefits of using FDG PET/CT for image-guided biopsy are presented along with pitfalls to avoid.

Course ID: Q00346 Category:
Modalities: , , ,


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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.]

Nuclear Medicine Technology: 2.25
Image Production: 0.25
Instrumentation: 0.25
Procedures: 2.00
Endocrine and Oncology Procedures: 2.00


  1. Introduction
  2. Mechanism of Cancer Imaging with FDG PETCCT
  3. Biologic Significance of FDG Uptake Relevant to Biopsy
  4. False-Positive FDG Uptake Relevant to Patient Selection for Biopsy
    1. Physiologic Distribution of FDG Uptake
    2. Normal Variations in FDG Uptake
      1. Brown Adipose Tissue
      2. Thymus
      3. Myocardium
      4. Spleen
      5. Skeletal Muscle
      6. Bone Marrow
    3. Benign Pathologic FDG Uptake Due to Infection and Inflammation
    4. FDG Uptake in Benign Tumors
    5. PET/CT-related Artifacts
  5. Applications of PET/CT Findings to Biopsy
    1. Lesions with Nonuniform FDG Uptake
    2. Multiple Lesions with Varying FDG Uptake
    3. Lesions Difficult to Target because of Underlying Anatomic Alterations
    4. Lesions with Few or No Morphologic Changes at Anatomic Imaging
  6. Pitfalls in Interpreting Biopsy Results on the Basis of PET/CT Findings
  7. Recent Advances in PET/CT-guided Biopsy
  8. Summary


Upon completion of this course, students will:

  1. be familiar with PET/CT terminology
  2. understand how FDG is metabolized in the human body
  3. know the advantages of using FDG PET/CT for image-guided biopsy
  4. understand the decay mechanism for nuclei with excess protons
  5. understand how the positrons undergo annihilation
  6. be familiar with the physical half-life of 18F
  7. understand how FDG is transported in human cells
  8. identify noncancerous disorders that will increase FDG uptake
  9. understand the ideal properties of the crystals used in PET scanners
  10. know the characteristics that define a true event in a PET scanner
  11. understand what effects the overall number of random events in a PET scanner
  12. know how irradiation affects human tissue on FDG PET/CT scans
  13. be familiar with organs that have normal physiological FDG uptake
  14. identify which organs have normal physiological uptake in children and young adults
  15. be familiar with normal myocardial FDG uptake on PET/CT scans
  16. know the causes of FDG musculoskeletal uptake on PET/CT scans
  17. be familiar with the effects of GCSF and chemotherapy on the uptake of FDG
  18. understand the inability to distinguish certain types of cancers from infection on FDG PET/CT
  19. be familiar with FDG PET/CT uptake associated with a healing wound
  20. be familiar with FDG avid benign tumors associated with the neck
  21. be familiar with FDG avid benign tumors associated with the abdomen
  22. be familiar with FDG avid benign tumors associated with the bones
  23. identify the PET/CT-related artifacts created from using CT data
  24. identify the causes for PET/CT misregistration artifacts
  25. understand the causes for PET/CT attenuation artifacts
  26. be familiar with PET quality control tests
  27. be familiar with CT quality control tests
  28. identify the area of the body encompassed in a whole-body FDG PET/CT
  29. be familiar with the normal physiological uptake in organs in the human body
  30. understand the terminology related to SUVs
  31. identify causes of false negatives on FDG PET/CT scans
  32. be familiar with cancers that have inherently low FDG uptake on PET/CT scans
  33. understand how SUV is defined
  34. understand the effects that partial volume averaging may have on SUV results
  35. be familiar with the possibility of reoccurring disease from microscopic residual disease
  36. be familiar with the role of ultrasound when conducting a FDG PET/CT image-guided biopsy
  37. be familiar with counter indications for performing CT image-guided biopsy
  38. identify the risks associated with CT image-guided biopsy
  39. be familiar with the lack of specificity of FDG distribution when performing FDG PET/CT image-guided biopsy
  40. identify the causes for false positive results when performing FDG PET/CT image-guided biopsy