From PET to PET/CT

  • Osama Mawlawi
  • Richard WendtIII
  • Wai-Hoi Gary Wong


In the decade since the previous edition of this chapter was written, positron emission tomography (PET), and more recently PET/computed tomography (CT), has continued to grow in prominence within the field of nuclear medicine imaging. Surveys conducted by the market research firm IVM (Greenbelt, MD) show an average annual increase of 10.4 % in the number of PET and PET/CT studies performed between 2005 and 2008 (IMV Medical Information Division. PET Market summary report. 2008). The trend, however, has seen a decline in recent years. This overall growth in utilization is reflected in the growing number of peer-reviewed publications and scientific presentations at international nuclear medicine meetings on PET and PET/CT imaging. The advantages of PET/CT over dedicated PET imaging (described below) have also drastically changed the characteristics of the scanner models that are available from manufacturers. As of the middle of the first decade of 2000, none of the three principal manufacturers of PET scanners (GE Healthcare, Siemens Medical Solutions, and Philips Medical Systems) still offered a dedicated PET system; only hybrid PET/CT systems were being manufactured.


Positron Emission Tomography Positron Emission Tomography Image Attenuation Correction Positron Emission Tomography Scanner Filter Back Projection 
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  1. 1.
    IMV Medical Information Division. PET market summary report. 2008.
  2. 2.
    Phelps ME, Huang SC, Hoffman EL, et al. Tomographic measurement of local cerebral glucose rate in humans with (F-18)2-fluoro-2-deoxy-D-glucose: validation of method. Ann Neurol. 1979;6(5):371–88.PubMedCrossRefGoogle Scholar
  3. 3.
    Huang SC, Phelps ME, Hoffman EJ, et al. Noninvasive determination of local cerebral metabolic rate of glucose in man. Am J Physiol. 1980;238(1):E69–82.PubMedGoogle Scholar
  4. 4.
    Smith TA. FDG uptake, tumor characteristics and response to therapy: a review. Nucl Med Commun. 1988;19(2):97–105.CrossRefGoogle Scholar
  5. 5.
    Delbeke D. Oncological applications of FDG-PET imaging: brain tumors, colorectal cancer, lymphoma and melanoma. J Nucl Med. 1999;40(4):591–603.PubMedGoogle Scholar
  6. 6.
    Gambhir SS, Czernin J, Schwimmer J, et al. A tabulated summary of the FDG-PET literature. J Nucl Med. 2001;42(5):1S–93.PubMedGoogle Scholar
  7. 7.
    Bailey DL. Transmission scanning in emission tomography. Eur J Nucl Med. 1998;25:774–87.PubMedCrossRefGoogle Scholar
  8. 8.
    Zaidi H, Hasegawa B. Determination of the attenuation map in emission tomography. J Nucl Med. 2003;44(2):291–315.PubMedGoogle Scholar
  9. 9.
    Meikle SR, Dahlbom M, Cherry SR. Attenuation correction using count-limited transmission data in positron emission tomography. J Nucl Med. 1993;34:143–50.PubMedGoogle Scholar
  10. 10.
    Xu M, Cutler P, Luk W. An adaptive local threshold segmented attenuation correction method for whole-body PET imaging. IEEE Trans Nucl Sci. 1996;43:331–6.CrossRefGoogle Scholar
  11. 11.
    Bettinardi V, Pagani E, Gilardi M. An automatic classification technique for attenuation correction in positron emission tomography. Eur J Nucl Med. 1999;26:447–58.PubMedCrossRefGoogle Scholar
  12. 12.
    Bengel FM, Ziegler SI, Avril N, et al. Whole-body positron emission tomography in clinical oncology: comparison between attenuation corrected and uncorrected images. Eur J Nucl Med. 1997;24:1091–8.PubMedGoogle Scholar
  13. 13.
    Wahl RL. To AC or not to AC: that is the question. J Nucl Med. 1999;40:2025–8.PubMedGoogle Scholar
  14. 14.
    Diederichs CG. Prospective comparison of FDG-PET of pancreatic tumors with high end spiral CT and MRI. J Nucl Med. 1998;39(5):81.Google Scholar
  15. 15.
    Eubank WB, Mankoff DA, Schmeidl UP. Imaging of oncologic patients: benefit of combined CT and FDG-PET in the diagnosis of malignancy. Am J Roentgenol. 1998;171:1103–10.Google Scholar
  16. 16.
    Wahl RL, Quint LE, Greenough RL, et al. Staging of mediastinal non-small cell lung cancer with FDG-PET, CT and fusion images: preliminary prospective evaluation. Radiology. 1994;191(2):371–7.PubMedGoogle Scholar
  17. 17.
    Wahl RL, Quint LE, Cieslak RD, et al. “Anatometabolic” tumor imaging: fusion of FDG-PET with CT or MRI to localize foci of increased activity. J Nucl Med. 1993;34(7):1190–7.PubMedGoogle Scholar
  18. 18.
    Vanteenkiste JF, Stroobants SG, Dupont PJ, et al. FDG-PET scan in potentially operable non-small cell lung cancer: Do anatometabolic PET-CT fusion images improve the localization of regional lymph node metastases? The Leuven Lung Cancer Group. Eur J Nucl Med. 1998;25(11):1495–501.CrossRefGoogle Scholar
  19. 19.
    Woods RP, Cherry SR, Mazziotta JC. Rapid automated algorithm for aligning and reslicing PET images. J Comput Assist Tomogr. 1992;16(4):620–33.PubMedCrossRefGoogle Scholar
  20. 20.
    Kinahan PE, Townsend DW, Beyer T, et al. Attenuation correction for a combined 3D PET/CT scanner. Med Phys. 1998;25:2046–53.PubMedCrossRefGoogle Scholar
  21. 21.
    Hany TF, Steinert HC, Goerres GW, et al. PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology. 2002;225(2):575–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Israel O, Mor M, Gaitini D, et al. Combined functional and structural evaluation of cancer patients with a hybrid camera-based PET/CT system using F-18-FDG. J Nucl Med. 2002;43(9):1129–36.PubMedGoogle Scholar
  23. 23.
    Cohade C, Osman M, Leal J, et al. Direct comparison of FDG-PET arid PET-CT imaging in colorectal cancer. J Nucl Med. 2002;43(Suppl 5):78.Google Scholar
  24. 24.
    Freudenberg LS, Antoch G, Mueller SP, et al. Preliminary results of whole-body FDG-PET/CT in lymphoma. J Nucl Med. 2002;43(Suppl 5):106.Google Scholar
  25. 25.
    Yeung HW, Schoder H, Larson SM. Utility of PET/CT for assessing equivocal PET lesions in oncology: initial experience. J Nucl Med. 2002;43(Suppl 5):115.Google Scholar
  26. 26.
    Bar-Shalom R, Keidar Z, Guralnik L, et al. Added value of fused PET/CT imaging with FDG in diagnostic imaging and management of cancer patients. J Nucl Med. 2002;43(Suppl 5):117.Google Scholar
  27. 27.
    Mah K, Caldwell CB, Ung YE, et al. The impact of 18F-FDG-PET on target and critical organs in CT-based treatment planning of patients with poorly defined non-small-cell lung carcinoma: a prospective study. Int J Radiat Oncol Biol Phys. 2002;52(2):339–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Erdi YE, Rosenzweig K, Erdi AK, et al. Radiotherapy treatment planning for patients with non-small-cell lung cancer using positron emission tomography (PET). Radiother Oncol. 2002;62:51–60.PubMedCrossRefGoogle Scholar
  29. 29.
    Mutic S, Grigsby PW, Low DA, et al. PET-guided three-dimensional treatment planning of intracavitary gynecologic implants. Int J Radiat Oncol Biol Phys. 2002;52(4):1104–10.PubMedCrossRefGoogle Scholar
  30. 30.
    Dizendorf E, Ciernik IF, Baumert B, et al. Impact of integrated PET CT scanning on external beam radiation treatment planning. J Nucl Med. 2002;43(Suppl 5):118.Google Scholar
  31. 31.
    Goerres GW, Hany TF, Kamel E, et al. Head and neck imaging with PET and PET/CT: artifacts from dental metallic implants. Eur J Nucl Med Mol Imag. 2002;29(3):367–70.CrossRefGoogle Scholar
  32. 32.
    Goerres GW, Ziegler SI, Burger C, et al. Artifacts at PET and PET/CT caused by metallic hip prosthetic material. Radiology. 2003;226(2):577–84.PubMedCrossRefGoogle Scholar
  33. 33.
    Antoch G, Freudenberg LS, Egelhof T, et al. Focal tracer uptake: a potential artifact in contrast-enhanced dual-modality PET/CT scans. J Nucl Med. 2002;10:1339–42.Google Scholar
  34. 34.
    Dizendorf EV, Treyer V, von Schulthess GK, et al. Application of oral contrast media in coregistered positron emission tomography-CT. AJR. 2002;179(2):477–81.PubMedGoogle Scholar
  35. 35.
    Cohade C, Osman M, Nakamoto Y, et al. Initial experience with oral contrast in PET/CT: phantom and clinical studies. J Nucl Med. 2003;44(3):412–6.PubMedGoogle Scholar
  36. 36.
    Arttoch G, Freudenberg LS, Stattaus J, et al. A whole-body positron emission tomography-CT: optimized CT using oral and IV contrast materials. AJR. 2002;179(6):1555–60.Google Scholar
  37. 37.
    Mawlawi O, Macapinlac H, Erasmus J, et al. Transformation of CT numbers to PET attenuation factors in the presence of iodinated IV contrast. Eur J Nucl Med Mol Imag. 2002;29:S108.Google Scholar
  38. 38.
    Goerres GW, Burger C, Kamel E, et al. Respiration-induced attenuation artifact at PET/CT: technical considerations. Radiology. 2003;226(3):906–10.PubMedCrossRefGoogle Scholar
  39. 39.
    Goerres GW, Kamel E, Heidelberg TNH, et al. PET-CT image co-registration in the thorax: influence of respiration. Eur J Nucl Med Mol Imag. 2002;29(3):351–60.CrossRefGoogle Scholar
  40. 40.
    Blodgett T, Beyer T, Antoch G, et al. The effect of respiratory motion on PET/CT image quality. J Nucl Med. 2002;43(Suppl 5):209.Google Scholar
  41. 41.
    Chin BB, Nakamoto Y, Kraitchman DL, et al. Quantitative differences in F-18 FDG uptake due to respiratory motion in PET CT: attenuation correction using CT in end inspiration and end expiration versus Ge-68 correction. J Nucl Med. 2002;43(Suppl 5):210.Google Scholar
  42. 42.
    Goerres GW, Kamel E, Seifert B, et al. Accuracy of image coregistration of pulmonary lesions in patients with non-small cell lung cancer using an integrated PET/CT system. J Nucl Med. 2002;43(11):1469–75.PubMedGoogle Scholar
  43. 43.
    Pan T, Mawlawi O, Nehmeh SA, et al. Attenuation correction of PET images with respiration-averaged CT images in PET/CT. J Nucl Med. 2005;46(9):1481–7.PubMedGoogle Scholar
  44. 44.
    Pan T, Mawlawi O, Luo D, et al. Attenuation correction of PET cardiac data with low-dose average CT in PET/CT. Med Phys. 2006;33:3931–8.PubMedCrossRefGoogle Scholar
  45. 45.
    Carney J, Townsend DW, Kinahan PE, et al. CT-based attenuation correction: the effects of imaging with the arms in the field of view. J Nucl Med. 2001;42(Suppl 5):211.Google Scholar
  46. 46.
    Cody D, Mawlawi O, Forster K. Preliminary study of CT transmission truncation and beam hardening artifacts on quantitative PET activity. Semin Nucl Med (accepted abstract). J Nucl Med 2003;44(Suppl 5):273.Google Scholar
  47. 47.
    Kinahan PE, Rogers JG. Analytic 3d image-reconstruction using all detected events. IEEE Trans Nucl Sci. 1989;36(1):964–8.CrossRefGoogle Scholar
  48. 48.
    Comtat C, Bataille F, Michel C, et al. OSEM-3D reconstruction strategies for the ECAT HRRT. IEEE Nuclear Science Symposium Conference Record 2004; vol 6, p. 3492–6.Google Scholar
  49. 49.
    Liu X, Comtat C, Michel C, et al. Comparison of 3-D reconstruction with 3D-OSEM and with FORE  +  OSEM for PET. IEEE Trans Med Imag. 2001;20(8):804–14.CrossRefGoogle Scholar
  50. 50.
    Panin VY, Kehren F, Michel C, et al. Fully 3-D PET reconstruction with system matrix derived from point source measurements. IEEE Trans Med Imag. 2006;25(7):907–21.CrossRefGoogle Scholar
  51. 51.
    Mullani N, Wang W, Hartz P, et al. Sensitivity improvement of TOFPET by the utilization of the inter-slice coincidences. IEEE Trans Nucl Sci. 1982;29(1):479–83.CrossRefGoogle Scholar
  52. 52.
    Budinger TF. Time-of-flight positron emission tomography: status relative to conventional PET. J Nucl Med. 1983;24:73–8.PubMedGoogle Scholar
  53. 53.
    Beyer T, Townsend DW, Brun T, et al. A combined PET/CT scanner for clinical oncology. J Nucl Med. 2000;41(8):1369–79.PubMedGoogle Scholar
  54. 54.
    GE Optima PET/CT 560 data sheet, 2011.Google Scholar
  55. 55.
    De Ponti E, Morzenti S, Guerra L, et al. Performance measurements for the PET/CT Discovery-600 using NEMA NU 2–2007 standards. Med Phys. 2011;38(2):968–74.PubMedCrossRefGoogle Scholar
  56. 56.
    Kemp B, Williams J, Ruter R, et al. Performance measurements of a whole body PET/CT system with time-of-flight capability. J Nucl Med. 2009;50(Suppl 2):1546P.Google Scholar
  57. 57.
    Jakoby BW, Bercier Y, Watson CC, et al. Performance characteristics of a new LSO PET/CT scanner with extended axial field-of-view and PSF reconstruction. IEEE Trans Nucl Sci. 2009;56(3):633–9.CrossRefGoogle Scholar
  58. 58.
    Siemens Biograph mCT 20 Excel data sheet, 2011.Google Scholar
  59. 59.
    Jakoby BW, Bercier Y, Conti M, et al. Performance investigation of a time-of-flight PET/CT scanner. IEEE Nuclear Science Symposium Conference Record 2008; Dresden, Germany p. 3738–43.Google Scholar
  60. 60.
    Surti S, Kuhn A, Werner ME, et al. Performance of Philips Gemini TF PET/CT scanner with special ­consideration for its time-of-flight imaging capabilities. J Nucl Med. 2007;48(3):471–80.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Osama Mawlawi
    • 1
  • Richard WendtIII
    • 1
  • Wai-Hoi Gary Wong
    • 2
  1. 1.Department of Imaging PhysicsThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Experimental Diagnostic ImagingThe University of Texas MD Anderson Cancer CenterHoustonUSA

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