Atlas and Anatomy of Pet/MRI, Pet/CT and Spect/CT 9783319286501, 9783319286525, 3319286501

Table of contents :
Preface......Page 6
Acknowledgments......Page 8
Contents......Page 10
Contributors......Page 12
1.1.2 Case 2......Page 13
1.2.1 Case 1......Page 34
1.2.2 Case 2......Page 40
1.3.1 Case 1......Page 44
1.3.2 Case 2......Page 61
1.4.1 Case 1......Page 66
1.4.2 Case 2......Page 70
1.4.4 Case 4......Page 85
1.4.5 Case 5......Page 105
1.4.7 Case 7......Page 113
1.4.8 Case 8......Page 120
1.5.1 Case 1......Page 127
1.5.3 Case 3......Page 147
1.6.2 Case 2......Page 176
1.6.3 Case 3......Page 194
References......Page 208
2.1.1.2 Case 2......Page 210
2.1.2.1 Case 1......Page 241
2.1.2.2 Case 2......Page 250
2.1.2.3 Case 3......Page 263
2.1.3.1 Case 1......Page 277
2.1.3.2 Case 2......Page 293
2.1.3.3 Case 3......Page 306
2.1.3.4 Case 4......Page 315
2.1.3.5 Case 5......Page 324
2.1.3.6 Case 6......Page 331
2.1.4.1 Case 1......Page 341
2.1.4.2 Case 2......Page 351
2.1.4.3 Case 3......Page 362
2.2.1.1 Case 1......Page 370
2.2.1.2 Case 2......Page 375
2.2.2.1 Case 1......Page 382
2.2.2.2 Case 2......Page 389
2.2.3.1 Case 1......Page 396
2.2.3.2 Case 2......Page 402
2.2.4.2 Case 2......Page 411
2.2.5.1 Case 1......Page 427
2.2.6.1 Case 1......Page 433
2.2.7.1 Case 1......Page 443
References......Page 451
3.1.1.1 Case 1......Page 454
3.1.2.2 Case 2......Page 455
3.1.3.2 Case 2......Page 456
3.1.3.4 Case 4......Page 457
3.1.3.6 Case 6......Page 458
3.1.3.8 Case 8......Page 459
3.1.3.9 Case 9......Page 466
3.1.3.10 Case 10......Page 467
3.1.3.11 Case 11......Page 468
3.1.3.12 Case 12......Page 469
3.1.3.13 Case 13......Page 470
3.1.3.18 Case 18......Page 471
3.1.3.21 Case 21......Page 477
3.1.5.1 Case 1......Page 479
3.1.6.1 Case 1......Page 481
3.1.6.3 Case 3......Page 493
3.1.6.5 Case 5......Page 499
3.1.7.2 Case 2......Page 503
3.1.7.5 Case 5......Page 514
3.1.8.1 Case 1......Page 517
3.1.9.1 Case 1......Page 518
3.1.10.1 Case 1......Page 521
3.1.10.4 Case 4......Page 523
3.1.10.7 Case 7......Page 526
3.1.10.9 Case 9......Page 529
3.2.1.2 Case 2......Page 531
3.2.1.3 Case 3......Page 539
3.2.2.1 Case 1......Page 542
3.2.3.1 Case 1......Page 549
3.3.1.1 Case 1......Page 561
3.3.1.2 Case 2......Page 570
3.3.2.1 Case 1......Page 571
3.3.4.1 Case 1......Page 572
3.3.4.2 Case 2......Page 573
3.3.5.1 Case 1......Page 574
3.3.6.2 Case 2......Page 575
3.3.6.5 Case 5......Page 576
3.3.7.1 Case 1......Page 581
3.3.8.1 Case 1......Page 582
3.3.9.1 Case 1......Page 594
References......Page 596
Index......Page 600

Citation preview

E. Edmund Kim · Hyung-Jun Im Dong Soo Lee · Keon Wook Kang

Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT

123

Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT

Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT

E. Edmund Kim, MD, MS Department of Radiological Sciences, School of Medicine, University of California at Irvine, Irvine, CA, USA

Hyung-Jun Im, MD, PhD Department of Nuclear Medicine, Seoul National University, Seoul, Republic of Korea

Dong Soo Lee, MD, PhD Department of Nuclear Medicine and Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea

Keon Wook Kang, MD, PhD Department of Nuclear Medicine and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea

E. Edmund Kim, MD, MS Department of Radiological Sciences School of Medicine University of California at Irvine Irvine, CA, USA Dong Soo Lee, MD, PhD Department of Nuclear Medicine and Department of Molecular Medicine and Biopharmaceutical Sciences Seoul National University Seoul, Republic of Korea

Hyung-Jun Im, MD, PhD Department of Nuclear Medicine Seoul National University Seoul, Republic of Korea Keon Wook Kang, MD, PhD Department of Nuclear Medicine and Cancer Research Institute Seoul National University Seoul, Republic of Korea

ISBN 978-3-319-28650-1 ISBN 978-3-319-28652-5 DOI 10.1007/978-3-319-28652-5

(eBook)

Library of Congress Control Number: 2016935407 © Springer International Publishing Switzerland 2016 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG Switzerland

Preface

Since we published Sectional Anatomy: PET/CT and SPECT/CT in 2007, there has been a significant increase in the use of hybrid imaging in clinical practice and also reports of higher sensitivity and specificity than those of the single imaging modality, thus making the integrated approach a more accurate imaging test. The precise lesion localization within the anatomic context, which frequently is critical, may not be possible in PET or SPECT. It is not easy to consider three dimensions in our mind’s eye and view the relationship of the pathology with surrounding normal organs in axial, coronal, and sagittal imaging. With gradual improvement of instruments as well as software for attenuation corrections, we have used new PET/CT and SPECT/CT images and also added PET/MRI images. In all hybrid imaging, a good workflow is paramount for cost-effectiveness in clinical practice. Since data acquisition on emission systems can only be dynamic or static, the major variations of imaging protocols are on the anatomic imaging side. This atlas intends to provide educational information on sectional anatomy and illustrate common pathologies for trainees and practitioners in the fields of nuclear medicine, radiology, oncology, neurology, cardiology, and general medicine. E. Edmund Kim, MD, MS Hyung-Jun Im, MD, PhD Dong Soo Lee, MD, PhD Keon Wook Kang, MD, PhD

v

Acknowledgments

We express our gratitude to all our colleagues at the Seoul National University Hospital as well as the University of Texas M.D. Anderson Cancer Center, and also sincere thanks to our wives and children who support our works. We appreciate Mr. Lee Klein and his assistants at Springer who helped in the creation of this book.

vii

Contents

1

Atlas and Anatomy of PET/MR ................................................................................... 1.1 Brain.................................................................................................................... 1.1.1 Case 1 ...................................................................................................... 1.1.2 Case 2 ...................................................................................................... 1.2 Head and Neck .................................................................................................... 1.2.1 Case 1 ...................................................................................................... 1.2.2 Case 2 ...................................................................................................... 1.3 Chest ................................................................................................................... 1.3.1 Case 1 ...................................................................................................... 1.3.2 Case 2 ...................................................................................................... 1.4 Abdomen ............................................................................................................. 1.4.1 Case 1 ...................................................................................................... 1.4.2 Case 2 ...................................................................................................... 1.4.3 Case 3 ...................................................................................................... 1.4.4 Case 4 ...................................................................................................... 1.4.5 Case 5 ...................................................................................................... 1.4.6 Case 6 ...................................................................................................... 1.4.7 Case 7 ...................................................................................................... 1.4.8 Case 8 ...................................................................................................... 1.5 Pelvis ................................................................................................................... 1.5.1 Case 1 ...................................................................................................... 1.5.2 Case 2 ...................................................................................................... 1.5.3 Case 3 ...................................................................................................... 1.6 Musculoskeletal System...................................................................................... 1.6.1 Case 1 ...................................................................................................... 1.6.2 Case 2 ...................................................................................................... 1.6.3 Case 3 ...................................................................................................... References ....................................................................................................................

1 1 1 1 22 22 28 32 32 49 54 54 58 73 73 93 101 101 108 115 115 135 135 164 164 164 182 196

2

Atlas and Anatomy of PET/CT .................................................................................... 2.1 FDG..................................................................................................................... 2.1.1 Brain/Head and Neck .............................................................................. 2.1.2 Chest ....................................................................................................... 2.1.3 Abdomen ................................................................................................. 2.1.4 Others ...................................................................................................... 2.2 Non-FDG ............................................................................................................ 2.2.1 11C-Acetate ............................................................................................

199 199 199 230 266 330 359 359

ix

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Contents

3

2.2.2 11C-methionine....................................................................................... 2.2.3 11C-PIB .................................................................................................. 2.2.4 18F-FP-CIT ............................................................................................. 2.2.5 18F-Flumazenil ....................................................................................... 2.2.6 66Ga-Arginine-Glycine-Aspartic Acid (RGD) ....................................... 2.2.7 68Ga-DOTA-TOC .................................................................................. References ....................................................................................................................

371 385 400 416 422 432 440

Atlas and Anatomy of SPECT/CT ............................................................................... 3.1 Tumors ................................................................................................................ 3.1.1 Hepatocellular Carcinoma ...................................................................... 3.1.2 Liver Metastases ..................................................................................... 3.1.3 Neuroendocrine Tumor ........................................................................... 3.1.4 Neuroblastoma ........................................................................................ 3.1.5 Paraganglioma......................................................................................... 3.1.6 Thyroid Cancer ....................................................................................... 3.1.7 Parathyroid Adenoma.............................................................................. 3.1.8 Mesothelioma.......................................................................................... 3.1.9 Bone Tumor ............................................................................................ 3.1.10 Bone Metastases...................................................................................... 3.2 Bone .................................................................................................................... 3.2.1 Trauma .................................................................................................... 3.2.2 Degenerative Disease .............................................................................. 3.2.3 Avascular Necrosis (AVN) ...................................................................... 3.3 Others .................................................................................................................. 3.3.1 Gastrointestinal Bleeding ........................................................................ 3.3.2 Abscess ................................................................................................... 3.3.3 Ectopic Thyroid ...................................................................................... 3.3.4 Cerebrospinal Fluid (CSF) ...................................................................... 3.3.5 Central Venous Line Obstruction ............................................................ 3.3.6 Lymph Node............................................................................................ 3.3.7 Lung (V/Q).............................................................................................. 3.3.8 Accessory Spleen .................................................................................... 3.3.9 Adrenal Hyperplasia ............................................................................... References ....................................................................................................................

443 443 443 444 445 468 468 470 492 506 507 510 520 520 531 538 550 550 560 561 561 563 564 570 571 583 585

Index .................................................................................................................................. 589

Contributors

Jamilla Gomez, MD National Kidney and Transplant Institute, Quezon City, Philippines Hyung-Jun Im, MD, PhD Department of Nuclear Medicine, Seoul National University, Seoul, Republic of Korea Keon Wook Kang, MD, PhD Department of Nuclear Medicine and Cancer Research Institute, Seoul National University, Seoul, Republic of Korea E. Edmund Kim, MD, MS Department of Radiological Sciences, School of Medicine, University of California at Irvine, Irvine, CA, USA Yong-il Kim, MD, PhD Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea

Dong Soo Lee, MD, PhD Department of Nuclear Medicine and Department of Molecular Medicine and Biopharmaceutical Sciences, Seoul National University, Seoul, Republic of Korea

Sohyun Park, MD Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea Min Young Yoo, MD Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea

xi

1

Atlas and Anatomy of PET/MR

After the huge success of hybrid positron emission tomography/computed tomography (PET/ CT), there has been a continuous effort to develop a hybrid positron emission tomography/ magnetic resonance image (PET/MR) machine. Recently, a magnetic field–compatible PET component has been developed by a substituting photomultiplier tube (PMT) for an avalanche photodiode (APD) or silicon multiplier (SiPM). This enables development and commercialization of PET/MR. Commercial simultaneous PET/MR is now seeking clinical validation. A simultaneous PET/MR system has several intrinsic advantages over a PET/CT system, including a lower radiation dose, higher soft tissue resolution of anatomic images, and the possibility of using a novel multifunctional PET/MR probe. In addition, there is the potential for the simultaneous acquisition of an anatomic image and PET. PET/MR has a higher soft tissue resolution than PET/CT; therefore the image reader should be well trained in reading normal anatomy and abnormal findings in MR for the proper reading of PET/MR. There are many MR books and atlases available to help understand and read MR images; however, there are few PET/MR atlases. This chapter includes typical PET/MR cases of patients with malignant tumors in the area of the brain, head and neck, chest, abdomen, pelvis, and musculoskeletal system. In each case, pathologic findings and essential surrounding normal structures for interpretation are indicated and named [1–4].

1.1

Brain

1.1.1

Case 1

A male patient, age 75, presented with worsening dizziness and weakness in both legs for 1 month. A tumorous condition in the brain was suspected on brain CT and therefore 18 F-Fludeoxyglucose (FDG) PET/MR was used. Brain FDG PET/MR revealed a well-enhanced mass with intense metabolic activity involving the body of the corpus callosum. There was no abnormal lesion with increased metabolic activity in the rest of the imaged body. Primary central nervous system (CNS) lymphoma was suspected, and stereotaxic biopsy revealed a diffuse large B-cell lymphoma [5, 6] (Figs. 1.1, 1.2, 1.3, 1.4, 1.5, 1.6, 1.7, and 1.8).

1.1.2

Case 2

A 74-year-old female patient suffering from a tingling sensation in her right hand and aphasia for 10 days was examined. A tumorous condition in the brain was suspected on brain CT, and FDG PET/MR was performed.

© Springer International Publishing Switzerland 2016 E.E. Kim et al., Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT, DOI 10.1007/978-3-319-28652-5_1

1

2

1 Atlas and Anatomy of PET/MR

Fig. 1.1 (1) Primary central nervous system lymphoma

Brain FDG PET/MR revealed multiple round-shaped enhancing hypermetabolic nodules with peritumoral edema in the left frontal parietal lobes and cerebellum that were appeared to be metastases. In whole-body FDG PET/MR, hypermetabolic bone spinal lesions were found in C7 and L5, suggesting bone metastases. Also, an infiltrative lesion with increased metabolic activity was found in the sigmoid colon. Subsequent colonoscopy and colonoscopic biopsy revealed sigmoid colon cancer. The metastatic lesions were considered to have originated from the colon cancer [7] (Figs. 1.9, 1.10, 1.11, 1.12, 1.13, 1.14, 1.15, 1.16, 1.17, 1.18, 1.19, 1.20, and 1.21).

1.1

Brain

3

Fig. 1.2 (1) Right postcentral gyrus (2) Left precentral gyrus

(3) Left postcentral gyrus (4) Falx cerebri

4

1 Atlas and Anatomy of PET/MR

Fig. 1.3 (1) Left superior frontal gyrus (2) Left precentral gyrus

(3) Left postcentral gyrus (4) Peritumoral edema

1.1

5

Brain

Fig. 1.4 (1) Left superior frontal gyrus (2) Left precentral gyrus (3) Left postcentral gyrus

(4) Peritumoral edema (5) Primary central nervous system lymphoma in right parietal white matter

(6) Primary central nervous system lymphoma in right frontal white matter

6

1 Atlas and Anatomy of PET/MR

Fig. 1.5 (1) Left superior frontal gyrus (2) Left precentral gyrus (3) Left postcentral gyrus

(4) Peritumoral edema (5) Primary central nervous system lymphoma involving right parietal white matter

(6) Primary central nervous system lymphoma involving corpus callosum

1.1

Brain

7

Fig. 1.6 (1) Left lateral ventricle (2) Left precentral gyrus (3) Left postcentral gyrus

(4) Peritumoral edema (5) Primary central nervous system lymphoma involving posterior corpus callosum

(6) Primary central nervous system lymphoma involving posterior corpus callosum

8

1 Atlas and Anatomy of PET/MR

Fig. 1.7 (1) Left caudate nucleus (2) Left putamen

(3) Left insular cortex (4) Left thalamus

(5) Left lateral ventricle trigone (6) Corpus callosum (splenium)

1.1

9

Brain

Fig. 1.8 (1) Left lateral rectus muscle (2) Left temporal cortex (3) Midbrain (4) Occipital cortex

(5) Cerebellar vermis (6) Right lateral rectus muscle (7) Optic nerve (8) Right medial rectus muscle

10

1 Atlas and Anatomy of PET/MR

Fig. 1.9 (1) Bone metastasis in cervical spine (2) Bone metastasis in lumbar spine (3) Sigmoid colon cancer

1.1

Brain

11

Fig. 1.10 (1) Falx cerebri (2) Superior sagittal sinus (3) Right parietal bone

(4) Right postcentral gyrus (5) Right coronal suture (6) Frontal bone

12

1 Atlas and Anatomy of PET/MR

Fig. 1.11 (1) Superior sagittal sinus (2) Sagittal suture (3) Right parietal bone

(4) Right postcentral gyrus (5) Right coronal suture (6) Frontal bone

(7) Falx cerebri (8) Metastasis in left frontal lobe

1.1

13

Brain

Fig. 1.12 (1) Superior sagittal sinus (2) Sagittal suture (3) Right parietal bone (4) Right postcentral gyrus

(5) Right precentral gyrus (6) Right coronal suture (7) Right frontal bone (8) Falx cerebri

(9) Metastasis in left frontal lobe (10) Peritumoral edema in left parietal lobe

14

1 Atlas and Anatomy of PET/MR

Fig. 1.13 (1) Superior sagittal sinus (2) Sagittal suture (3) Right parietal bone

(4) Right postcentral gyrus (5) Right precentral gyrus (6) Right coronal suture

(7) Right frontal bone (8) Lateral ventricle (9) Peritumoral edema in left parietal lobe

1.1

15

Brain

Fig. 1.14 (1) Superior sagittal sinus (2) Occipital bone (3) Right occipital cortex (4) Right parietal bone

(5) Right temporal cortex (6) Right insular cortex (7) Right frontal lobe (8) Lateral ventricle (anterior horn)

(9) Lateral ventricle (trigone with ventricle) (10) Metastasis in left temporal lobe

16

1 Atlas and Anatomy of PET/MR

Fig. 1.15 (1) Superior sagittal sinus (2) Occipital bone (3) Right occipital cortex (4) Right parietal bone (5) Right temporal cortex

(6) Right insular cortex (7) Right frontal cortex (8) Lateral ventricle (anterior horn) (9) Right caudate nucleus (head) (10) Right putamen

(11) Right thalamus (12) Lateral ventricle (trigone with ventricle) (13) Metastasis in left temporal lobe

1.1

Brain

17

Fig. 1.16 (1) Superior sagittal sinus (2) Occipital bone (3) Right occipital cortex

(4) Right temporal cortex (5) Right frontal cortex (6) Frontal sinus

(7) Right putamen (8) Right thalamus (9) Lateral ventricle (trigone with ventricle)

18

1 Atlas and Anatomy of PET/MR

Fig. 1.17 (1) Occipital bone (2) Right occipital cortex (3) Vermis of cerebellum

(4) Right temporal cortex (5) Right frontal lobe (6) Right eyeball

(7) Ethmoid sinus (8) Left middle cerebral artery (9) Pons

1.1

Brain

19

Fig. 1.18 (1) Occipital bone (2) Transverse sinus (3) Cerebellum

(4) Right temporal cortex (5) Lateral rectus muscle of right eye (6) Right eyeball

(7) Ethmoid sinus (8) Left middle cerebral artery (9) Pons

20

1 Atlas and Anatomy of PET/MR

Fig. 1.19 (1) Occipital bone (2) Transverse sinus (3) Cerebellum

(4) Right temporal cortex (5) Lateral rectus muscle of right eye (6) Right eyeball

(7) Ethmoid sinus (8) Pituitary gland (9) Pons

1.1

Brain

21

Fig. 1.20 (1) Cerebellum (2) Right jugular vein

(3) Right maxillary sinus (4) Medulla oblongata

(5) Metastasis in left cerebellum

22

1 Atlas and Anatomy of PET/MR

Fig. 1.21 (1) Bone metastasis in right transverse process of C7

(2) Dilated ureter (3) Bone metastasis in L5 vertebral body

1.2

Head and Neck

1.2.1

Case 1

(4) Sigmoid colon cancer

A 55-year-old male patient visited an Ear Nose and Throat (ENT) clinic because of a sore throat. On ENT examination, a soft tissue mass was found in right nasopharyngeal wall. Subsequent biopsy revealed nasopharyngeal cancer. FDG PET/MR was done for the initial staging of nasopharyngeal cancer. On FDG PET/MR, a soft tissue lesion with increased metabolic activity was found in the right nasopharyngeal area, which is consistent with nasopharyngeal cancer. An enlarged lymph node (LN) with increased metabolic activity in the right side of the neck (level II) was found, suggestive of metastatic LN [2, 8, 9] (Figs. 1.22, 1.23, 1.24, 1.25, 1.26, and 1.27).

1.2

Head and Neck

23

Fig. 1.22 (1) Nasopharyngeal cancer

(2) Right side of neck LN metastasis

24

1 Atlas and Anatomy of PET/MR

Fig. 1.23 (1) Nasal septum (2) Right maxillary sinus (3) Right masseter muscle (4) Right temporalis muscle

(5) Right lateral pterygoid muscle (6) Right medial pterygoid muscle (7) Right mandible (8) Right external auditory canal

(9) Right internal carotid artery (10) Right sigmoid sinus (11) Right nasopharyngeal cancer arising from Rosenmuller fossa

1.2

Head and Neck

25

Fig. 1.24 (1) Nasal septum (2) Right maxillary sinus (3) Right masseter muscle (4) Right temporalis muscle

(5) Right lateral pterygoid muscle (6) Right medial pterygoid muscle (7) Right mandible (8) Right external auditory canal

(9) Right internal c. arotid artery (10) Right sigmoid sinus (11) Right nasopharyngeal cancer arising from Rosenmuller fossa

26

1 Atlas and Anatomy of PET/MR

Fig. 1.25 (1) Hard palate (2) Right masseter muscle (3) Right mandible (4) Right lateral pterygoid muscle

(5) Right medial pterygoid muscle (6) Right parotid gland (7) Right internal carotid artery

(8) Right nasopharyngeal cancer arising from Rosenmuller fossa (9) Right longus capitis (10) C1, atlas

1.2

Head and Neck

27

Fig. 1.26 (1) Tongue (2) Right molar teeth (3) Right masseter muscle (4) Right mandible

(5) Right medial pterygoid muscle (6) Right palatine tonsil (7) Right external jugular vein (8) Right parotid gland

(9) Right LN metastasis, level II (10) Pharynx (11) Spinal cord

28

1 Atlas and Anatomy of PET/MR

Fig. 1.27 (1) Tongue (2) Right masseter muscle (3) Right mandible

(4) Right medial pterygoid muscle (5) Right lingual tonsil (6) Right vertebral artery

1.2.2

(7) LN, right level II without definite FDG uptake, benign (8) Spinal cord

Case 2

A 61-year-old female patient presented with a mass in the left oral cavity. Biopsy of the lesion revealed retromolar trigone squamous cell carcinoma. FDG PET/MR was performed for initial staging. On FDG PET/MR, a soft tissue mass with increased metabolic activity in the left retromolar trigone was found, which was consistent with a malignant tumor. Enlarged LNs with increased metabolic activity in both the neck level II and the left side of the neck levels III and V were also found, pointing to metastatic LNs (Figs. 1.28, 1.29, 1.30, 1.31, 1.32, and 1.33).

1.2

Head and Neck

29

Fig. 1.28 (1) Left retromolar trigone cancer (2) Left neck level II LN metastasis

(3) Left neck level III LN metastasis (4) Right neck level II LN metastasis

30

1 Atlas and Anatomy of PET/MR

Fig. 1.29 (1) Right masseter muscle (2) Right mandible (3) Right medial pterygoid muscle

(4) Right molar teeth (5) Left molar teeth (6) Left retromolar trigone cancer

(7) Left neck level II LN metastasis (8) Left sternocleidomastoid muscle

1.2

31

Head and Neck

Fig. 1.30 (1) Right neck level II LN metastasis (2) Right masseter muscle (3) Right mandible (4) Right medial pterygoid muscle

(5) Right molar teeth (6) Left molar teeth (7) Left retromolar trigone cancer (8) Left palatine tonsil

(9) Left side of neck level II LN metastasis (10) Left sternocleidomastoid muscle

32

1 Atlas and Anatomy of PET/MR

Fig. 1.31 (1) Tongue (2) Left submandibular gland

(3) Left side of neck level IB LN metastasis (4) Left internal jugular vein

1.3

Chest

1.3.1

Case 1

(5) Left sternocleidomastoid muscle (6) Left side of neck level V LN metastasis

A solitary pulmonary nodule was found in a 62-year-old male with a history of 50 pack/year of cigarette smoking. FDG PET/MR was used for a differential diagnosis. On FDG PET/MR, a small lung nodule with moderately increased metabolic activity in the left lower lobe of the lung was found. Primary lung cancer was suspected. Accordingly a left lower lobectomy was done, and the nodule was confirmed as an adenocarcinoma. Also, increased metabolic activity was found in the junction area of the descending and transverse colon. Bowel-within-bowel configuration was found, and the increased metabolic activity was shown along the lesion. It was thought most likely to be an intussusception with physiologic or inflammatory intestinal activity. Otherwise no abnormal lesions with increased metabolic activity suggesting metastasis were found [10, 11] (Figs. 1.34, 1.35, 1.36, 1.37, 1.38, 1.39, 1.40, 1.41, 1.42, 1.43, 1.44, 1.45, 1.46, 1.47, 1.48, and 1.49).

1.3

33

Chest

Fig. 1.32 (1) Thyroid cartilage (2) Cricoid cartilage (3) Left common carotid artery

(4) Left internal jugular vein (5) Left sternocleidomastoid muscle (6) Spinal cord

(7) Left trapezius muscle

34

1 Atlas and Anatomy of PET/MR

Fig. 1.33 (1) Trachea (2) Cricoid cartilage (3) Left common carotid artery

(4) Left internal jugular vein (5) Left sternocleidomastoid muscle (6) Left side of neck level III LN metastasis

(7) Spinal cord (8) Left trapezius muscle

Fig. 1.34 (1) Lung cancer in left lower lobe (LLL)

Fig. 1.35 (1) Right erecter spinae muscle (2) Anterior scalene muscle (3) Right external jugular vein (4) Right internal jugular vein

(5) Right internal jugular artery (6) Thyroid gland (7) Trachea (8) Left sternocleidomastoid muscle

(9) Esophagus (10) Left external jugular vein (11) Left trapezius muscle (12) Vertebral body

36

1 Atlas and Anatomy of PET/MR

Fig. 1.36 (1) Right erecter spinae muscle (2) Right glenoid (3) Lung right upper lobe (RUL) (4) Right subclavian vein (5) Right subclavian artery

(6) Right common carotid artery (7) Trachea (8) Left common carotid artery (9) Left subclavian artery (10) Left subclavian vein

(11) Left pectoralis minor muscle (12) Left pectoralis major muscle (13) Left glenohumeral joint (14) Left humerus head (15) Vertebral body

1.3

37

Chest

Fig. 1.37 (1) Erecter spinae muscle (2) Glenoid, scapula (3) Lung RUL (4) Right brachiocephalic vein

(5) Right brachiocephalic artery (6) Manubrium (7) Trachea (8) Left common carotid artery

(9) Left brachiocephalic vein (10) Left subclavian artery (11) Vertebral body

38

1 Atlas and Anatomy of PET/MR

Fig. 1.38 (1) Right erecter spinae muscle (2) Lung RUL (3) Right brachiocephalic vein (4) Right brachiocephalic artery

(5) Left brachiocephalic vein (6) Trachea (7) Left common carotid artery (8) Left subclavian artery

(9) Aortic arch (10) Lung left upper lobe (LUL) (11) Vertebral body

1.3

Chest

39

Fig. 1.39 (1) Right erecter spinae muscle (2) Lung RUL (3) Right brachiocephalic vein (4) Right brachiocephalic artery

(5) Left brachiocephalic vein (6) Trachea (7) Left common carotid artery (8) Aortic arch

(9) Lung LUL (10) Vertebral body

40

1 Atlas and Anatomy of PET/MR

Fig. 1.40 (1) Right erector spinae muscle (2) Right major fissure (3) Azygos vein

(4) Superior vena cava (SVC) (5) Ascending aorta (6) Carina

(7) Descending aorta (8) Left fissure (9) Vertebral body

1.3

41

Chest

Fig. 1.41 (1) Right erector spinae muscle (2) Right major fissure (3) Right main bronchus (4) SVC

(5) Ascending aorta (6) Left main bronchus (7) Left pulmonary artery (8) Descending aorta

(9) Left fissure (10) Vertebral body

42

1 Atlas and Anatomy of PET/MR

Fig. 1.42 (1) Right erector spinae muscle (2) Right major fissure (3) Right main bronchus (4) Right pulmonary artery

(5) Ascending aorta (6) Left main bronchus (7) Pulmonary trunk (8) Left pulmonary artery

(9) Descending aorta (10) Vertebral body

1.3

43

Chest

Fig. 1.43 (1) Right erector spinae muscle (2) Right main bronchus (3) Right pulmonary artery

(4) Ascending aorta (5) Pulmonary trunk (6) Left upper lobar bronchus

(7) Left lower lobar bronchus (8) Descending aorta (9) Vertebral body

44

1 Atlas and Anatomy of PET/MR

Fig. 1.44 (1) Right erecter spinae muscle (2) Right middle lobar bronchus (3) Ascending aorta

(4) Pulmonary trunk (5) Descending aorta (6) Lung cancer in LLL

(7) Vertebral body

1.3

45

Chest

Fig. 1.45 (1) Right erector spinae muscle (2) Liver dome (3) Right atrium

(4) Right ventricle (5) Left ventricle (6) Left atrium

(7) Descending aorta (8) Vertebral body

46

1 Atlas and Anatomy of PET/MR

Fig. 1.46 (1) Inferior vena cava (inferior vena cava) (2) Right ventricle

(3) Left ventricle (4) Esophagus

(5) Aorta (6) Vertebral body

1.3

47

Chest

Fig. 1.47 (1) Right hepatic vein (2) Middle hepatic vein

(3) Left hepatic vein (4) Aorta

48

1 Atlas and Anatomy of PET/MR

Fig. 1.48 (1) Left crura (2) Right crura (3) Inferior vena cava (4) Gall bladder

(5) Portal vein (6) Descending aorta (7) Pancreas (8) Transverse colon

(9) Descending colon (10) Left adrenal gland (11) Spleen

1.3

49

Chest

Fig. 1.49 (6) Descending aorta (7) Left adrenal gland (8) Intussusception with increased 18 F-Fludeoxyglucose (FDG) uptake (9) Left kidney

(1) Left crura (2) Right crura (3) Right adrenal gland (4) Inferior vena cava (5) Portal vein

1.3.2

(10) Spleen

Case 2

A 42-year-old patient presented with a palpable left breast mass. Breast cancer was suspected after breast ultrasonography, and the lesion was confirmed as breast cancer by core needle biopsy. FDG PET/MR was used for initial staging. On FDG PET/MR, an infiltrative breast mass with increased metabolic activity in the left breast and enlarged LNs with increased metabolic activity in the ipsilateral axilla were found, which are consistent with left-sided breast cancer and ipsilateral axillary LN metastasis [12] (Figs. 1.50, 1.51, 1.52, 1.53, and 1.54).

50

1 Atlas and Anatomy of PET/MR

Fig. 1.50 (1) Left axilla LN metastasis

(2) Cancer of left breast

1.3

51

Chest

Fig. 1.51 (1) Right clavicle (2) Right pectoralis major muscle (3) Right brachiocephalic trunk

(4) Left common carotid artery (5) Left subclavian artery (6) Left pectoralis major muscle

(7) Left pectoralis minor muscle (8) Left axillary level I LN metastasis

52

1 Atlas and Anatomy of PET/MR

Fig. 1.52 (1) Right pectoralis minor muscle (2) Right pectoralis major muscle (3) Aortic arch (4) Left pectoralis major muscle

(5) Left pectoralis minor muscle (6) Left axillary level I LN with fatty hilum and without FDG uptake (probably benign)

1.3

53

Chest

Fig. 1.53 (1) Right pectoralis minor muscle (2) Right pectoralis major muscle (3) Right internal mammary vessels

(4) Sternum (5) Left internal mammary vessels (6) Left pectoralis major muscle

(7) Left pectoralis minor muscle

54

1 Atlas and Anatomy of PET/MR

Fig. 1.54 (1) Right internal mammary vessels (2) Sternum

(3) Left internal mammary vessels (4) Normal tissue of left breast

1.4

Abdomen

1.4.1

Case 1

(5) Cancer of left breast

A 60-year-old male patient presented with a weight loss of 10 kg over 7 months. Endoscopy revealed gastric cancer and a biopsy revealed adenocarcinoma. FDG PET/MR was done for initial staging. On FDG PET/MR, a hypermetabolic lesion along the lesser curvature of the stomach was seen, pointing to gastric cancer. A focal lesion with increased metabolism was found in the liver S5, suggestive of liver metastasis [13, 14] (Figs. 1.55, 1.56, 1.57, and 1.58).

1.4 Abdomen

55

Fig. 1.55 (1) Stomach cancer

(2) Liver metastasis

56

1 Atlas and Anatomy of PET/MR

Fig. 1.56 (1) Abdominal aorta (2) Stomach cancer in lesser curvature

(3) Colon (4) Spleen

(5) Vertebral body (6) Magnetic resonance artefact

57

1.4 Abdomen

Fig. 1.57 (1) Abdominal aorta (2) Stomach cancer (3) Spleen

(4) Left crura (5) Vertebral body (6) Right crura

(7) Liver metastasis, S5 (8) Gall bladder

58

1 Atlas and Anatomy of PET/MR

Fig. 1.58 (1) Dermoid cyst (2) Right gluteus maximus muscle

1.4.2

(3) Right femur (4) Penis

Case 2

A 69-year-old female patient presented with abdominal discomfort. She had had a right nephrectomy 10 years ago because of a liposarcoma in the right kidney. Endoscopy was done and revealed gastric cancer, and the lesion was confirmed as signet-ring cell carcinoma. FDG PET/MR was done for initial staging of gastric cancer. On FDG PET/MR, a hypermetabolic lesion was seen in the antrum of the stomach. Several enlarged LNs with increased metabolism found in the lesser curvature area were suggestive of metastases. Multiple soft tissue lesions with low signal intensity in a fat-suppressed T1-weighted image and moderately increased metabolic activity were found at the retrocrural and peritoneal areas. These lesions were considered as recurred liposarcoma [15] (Figs. 1.59, 1.60, 1.61, 1.62, 1.63, 1.64, 1.65, 1.66, 1.67, 1.68, 1.69, 1.70, 1.71, 1.72, and 1.73).

1.4 Abdomen

59

Fig. 1.59 (1) Gastric cancer

(2) LN metastasis

(3) Recurred liposarcoma

60

1 Atlas and Anatomy of PET/MR

Fig. 1.60 (1) Vertebral body (2) Latissimus dorsi muscle (3) Lung right left lobe (RLL) (4) Esophagus

(5) Right atrium (6) Right ventricle (7) Recurred liposarcoma (8) Interventricular septum

(9) Left ventricle (10) Descending aorta

61

1.4 Abdomen

Fig. 1.61 (1) Vertebral body (2) Latissimus dorsi muscle (3) Hepatic cyst (4) Lung right middle lobe (RML)

(5) Inferior vena cava (6) Recurred liposarcoma around descending aorta (7) Descending aorta

62

1 Atlas and Anatomy of PET/MR

Fig. 1.62 (1) Vertebral body (2) Latissimus dorsi muscle (3) Inferior vena cava

(4) Middle hepatic vein (5) Left hepatic vein (6) Recurred liposarcoma

(7) Descending aorta

63

1.4 Abdomen

Fig. 1.63 (1) Vertebral body (2) Latissimus dorsi muscle (3) Right hepatic vein (4) Middle hepatic vein

(5) Left hepatic vein (6) Recurred liposarcoma in retrocrural area (7) Spleen

(8) Descending aorta

64

1 Atlas and Anatomy of PET/MR

Fig. 1.64 (1) Vertebral body (2) Latissimus dorsi muscle (3) Inferior vena cava, collapsed

(4) Body of stomach (5) Spleen (6) Aorta

(7) Recurred liposarcoma in retrocrural area

65

1.4 Abdomen

Fig. 1.65 (1) Vertebral body (2) Latissimus dorsi muscle (3) Portal vein

(4) LN metastases, lesser curvature (5) Body of stomach (6) Spleen

(7) Aorta (8) Recurred liposarcoma in retrocrural area

66

1 Atlas and Anatomy of PET/MR

Fig. 1.66 (1) Vertebral body (2) Latissimus dorsi muscle (3) Inferior vena cava

(4) Portal vein (5) LN metastases, lesser curvature (6) Stomach, body

(7) Spleen (8) Aorta (9) Recurred liposarcoma in retrocrural area

67

1.4 Abdomen

Fig. 1.67 (1) Vertebral body (2) Latissimus dorsi muscle (3) Inferior vena cava

(4) Portal vein (5) LN metastases, lesser curvature (6) Stomach, body

(7) Spleen (8) Aorta (9) Recurred liposarcoma in retrocrural area

68

1 Atlas and Anatomy of PET/MR

Fig. 1.68 (1) Spinalis muscle (2) Right portal vein (3) Recurred liposarcoma (4) Gall bladder (5) Common hepatic artery

(6) Stomach cancer, antrum (7) Gastroduodenal artery (8) Celiac trunk (9) Recurred liposarcoma (10) Pancreatic tail

(11) Spleen (12) Kidney (13) Adrenal gland (14) Aorta

69

1.4 Abdomen

Fig. 1.69 (1) Spinalis muscle (2) Liver (3) Recurred liposarcoma (4) Gall bladder

(5) Stomach cancer, antrum (6) Pancreas, body (7) Recurred liposarcoma (8) Pancreatic tail

(9) Spleen (10) Kidney (11) Adrenal gland (12) Aorta

70

1 Atlas and Anatomy of PET/MR

Fig. 1.70 (1) Spinalis muscle (2) Liver (3) Recurred liposarcoma

(4) Gall bladder (5) Stomach cancer, antrum (6) Superior mesenteric artery

(7) Kidney (8) Aorta

71

1.4 Abdomen

Fig. 1.71 (1) Spinalis muscle (2) Liver

(3) Recurred liposarcoma (4) Gall bladder

(5) Kidney (6) Aorta

72

1 Atlas and Anatomy of PET/MR

Fig. 1.72 (1) Spinalis muscle (2) Liver

(3) Recurred liposarcoma (4) Renal pelvis

(5) Abdominal aorta

73

1.4 Abdomen

Fig. 1.73 (1) Sacrum (2) Right gluteus maximus muscle (3) Right gluteus medius muscle

1.4.3

(4) Right gluteus minimus muscle (5) Right iliac bone (6) Right iliacus muscle

(7) Right psoas major muscle (8) Recurred liposarcoma in psoas major muscle

Case 3

A 59-year-old male patient presented who had had jaundice for 1 month. A pancreatic mass was found in the abdomen and CT-FDG PET/MR was done for initial staging. On FDG PET/MR, a mild hypermetabolic lesion was found in the pancreatic head, suggesting pancreatic cancer. The common and both intrahepatic bile ducts were dilated because of obstruction. Otherwise, no abnormal hypermetabolic lesion suggesting metastasis was found [16–18] (Figs. 1.74, 1.75, 1.76, 1.77, 1.78, 1.79, 1.80, 1.81, 1.82, and 1.83).

1.4.4

Case 4

A 58-year-old male patient presented after having jaundice and dark urine for 1 week. A pancreatic mass was found on endoscopic ultrasonography and confirmed as adenocarcinoma by fine needle aspiration biopsy. FDG PET/MR was done for initial staging of pancreatic cancer. On FDG PET/MR, a moderate hypermetabolic lesion was found in the pancreatic head. The superior mesenteric vein was encased by the tumor. The common and both intrahepatic bile ducts and the pancreatic duct were dilated because of obstruction. Otherwise, no abnormal hypermetabolic lesion suggesting metastasis was found (Figs. 1.84, 1.85, 1.86, 1.87, 1.88, 1.89, 1.90, 1.91, 1.92, and 1.93).

74

1 Atlas and Anatomy of PET/MR

Fig. 1.74 (1) Pancreatic cancer

75

1.4 Abdomen

Fig. 1.75 (1) Dilated intrahepatic bile duct (2) Right hepatic vein (3) Middle hepatic vein

(4) Left hepatic vein (5) Esophagus (6) Aorta

(7) Spleen

76

1 Atlas and Anatomy of PET/MR

Fig. 1.76 (1) Gall bladder (2) Dilated right hepatic duct (3) Dilated left hepatic duct

(4) Left portal vein (5) Abdominal aorta (6) Stomach

(7) Spleen

77

1.4 Abdomen

Fig. 1.77 (1) Gall bladder (2) Right portal vein (3) Dilated common hepatic duct

(4) Left portal vein (5) Inferior vena cava (6) Abdominal aorta

(7) Stomach (8) Spleen

78

1 Atlas and Anatomy of PET/MR

Fig. 1.78 (1) Cystic duct (2) Duodenum, first portion (3) Pylorus, stomach (4) Dilated common hepatic duct

(5) Portal vein (6) Abdominal aorta (7) Stomach body (8) Splenic vessel

(9) Spleen (10) Inferior vena cava

79

1.4 Abdomen

Fig. 1.79 (1) Cystic duct opening (2) Duodenum, first portion (3) Pylorus, stomach (4) Dilated common hepatic duct

(5) Portal vein (6) Abdominal aorta (7) Stomach body (8) Splenic vessel

(9) Spleen (10) Inferior vena cava

80

1 Atlas and Anatomy of PET/MR

Fig. 1.80 (1) Inferior vena cava (2) Duodenum, first portion (3) Dilated common bile duct

(4) Portal vein (5) Celiac trunk (6) Abdominal aorta

(7) Pancreatic duct (8) Pancreas tail (9) Spleen

81

1.4 Abdomen

Fig. 1.81 (1) Duodenum, second portion (2) Pancreas head (3) Common bile duct (4) Pancreatic cancer

(5) Superior mesenteric vein (6) Superior mesenteric artery (7) Left renal vein (8) Abdominal aorta

(9) Left kidney (10) Descending colon

82

1 Atlas and Anatomy of PET/MR

Fig. 1.82 (1) Duodenum, second portion (2) Pancreas head (3) Sphincter of Oddi

(4) Inferior vena cava (5) Superior mesenteric vein (6) Superior mesenteric artery

(7) Abdominal aorta (8) Left renal vein (9) Left kidney

83

1.4 Abdomen

Fig. 1.83 (1) Duodenum, second portion (2) Pancreas head (3) Sphincter of Oddi

(4) Inferior vena cava (5) Superior mesenteric vein (6) Superior mesenteric artery

(7) Abdominal aorta (8) Left renal vein (9) Left kidney

84

1 Atlas and Anatomy of PET/MR

Fig. 1.84 (1) Pancreatic cancer

85

1.4 Abdomen

Fig. 1.85 (1) Common bile duct (2) Stomach

(3) Splenic artery (4) Inferior vena cava

(5) Portal vein

86

1 Atlas and Anatomy of PET/MR

Fig. 1.86 (1) Gall bladder (2) Common bile duct, dilated (3) Splenic artery

(4) Pancreatic duct, dilated (5) Left adrenal gland (6) Inferior vena cava

(7) Right adrenal gland

87

1.4 Abdomen

Fig. 1.87 (1) Gall bladder (2) Common blue duct, dilated (3) Portal vein

(4) Pancreatic duct, dilated (5) Splenic vein (6) Abdominal aorta

(7) Inferior vena cava

88

1 Atlas and Anatomy of PET/MR

Fig. 1.88 (1) Gall bladder (2) Duodenum

(3) Pancreatic duct, dilated (4) Common hepatic artery

(5) Inferior vena cava

89

1.4 Abdomen

Fig. 1.89 (1) Gall bladder (2) Duodenum

(3) Pancreatic duct, dilated (4) Common bile duct, dilated

(5) Inferior vena cava

90

1 Atlas and Anatomy of PET/MR

Fig. 1.90 (1) Duodenum (2) Common bile duct, dilated

(3) Pancreatic duct, dilated (4) Superior mesenteric artery

(5) Abdominal aorta (6) Inferior vena cava

91

1.4 Abdomen

Fig. 1.91 (1) Duodenum (2) Common bile duct (3) Pancreatic cancer in pancreatic head

(4) First branch of superior mesenteric artery, abutting pancreatic cancer (5) Superior mesenteric artery

(6) Abdominal aorta

92

1 Atlas and Anatomy of PET/MR

Fig. 1.92 (1) Common bile duct (2) Pancreatic duct (3) Pancreatic cancer

(4) Superior mesenteric vein, encased by the tumor (5) Superior mesenteric artery

(6) Abdominal aorta (7) Inferior vena cava

93

1.4 Abdomen

Fig. 1.93 (1) Duodenum (2) Ampula of Vater

(3) Pancreatic head (4) Left renal vein

1.4.5

(5) Abdominal aorta (6) Right renal artery

Case 5

A 53-year-old male patient had had sigmoid colon cancer and underwent operation 3 years earlier. Recently, his serum level of carcinoembryonic antigen (CEA) had increased; thus FDG PET/MR was done to find a recurrent focus. On FDG PET/MR, a hypermetabolic mass was found in S7 of the liver, which is suggestive of metastasis. The patient underwent right-sided liver posterior sectionectomy, and the lesion was revealed as metastatic adenocarcinoma from the prior sigmoid colon cancer [19–21] (Figs. 1.94, 1.95, 1.96, 1.97, 1.98, 1.99, 1.100, and 1.101).

94

1 Atlas and Anatomy of PET/MR

Fig. 1.94 (1) Liver metastasis, right lobe

(2) Liver metastasis, left lobe

95

1.4 Abdomen

Fig. 1.95 (1) Liver dome (2) Inferior vena cava

(3) Esophagus (4) Aorta

96

1 Atlas and Anatomy of PET/MR

Fig. 1.96 (1) Liver S7 metastasis (2) Inferior vena cava

(3) Esophagus (4) Aorta

97

1.4 Abdomen

Fig. 1.97 (1) Liver S7 metastasis (2) Right hepatic vein (3) Left hepatic vein

(4) Esophagus (5) Aorta (6) Stomach

(7) Spleen

98

1 Atlas and Anatomy of PET/MR

Fig. 1.98 (1) Right hepatic vein (2) Middle hepatic vein (3) Left hepatic vein

(4) Esophagus (5) Aorta (6) Stomach

(7) Spleen

99

1.4 Abdomen

Fig. 1.99 (1) Right portal vein (2) Left portal vein

(3) Inferior vena cava (4) Aorta

(5) Stomach (6) Spleen

100

1 Atlas and Anatomy of PET/MR

Fig. 1.100 (1) Inferior vena cava (2) Liver metastasis, S2

(3) Aorta (4) Left kidney

(5) Spleen

101

1.4 Abdomen

Fig. 1.101 (1) Inferior vena cava (2) Pancreas

(3) Aorta (4) Left kidney

1.4.6

(5) Spleen

Case 6

A 42-two-year-old patient who was a hepatitis B virus carrier underwent abdominal ultrasonography for a routine health check. A liver mass was found on ultrasonograpy. FDG PET/MR was used for a differential diagnosis of the liver mass. On FDG PET/MR, a 4.7-cm sized, lobulated arterial enhancing hypermetabolic mass with a necrotic portion and washout on delayed phase was found in S7 of the liver suggestive of malignant mass. The patient underwent right liver posterior sectionectomy, and the lesion was revealed as combined hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) [22, 23] (Figs. 1.102, 1.103, 1.104, and 1.105).

1.4.7

Case 7

A 58-eight-year old patient presented with increased size of a known schwannoma in the liver. FDG PET/MR was done to search for malignant transformation. On FDG PET/MR, an internal septum with delayed enhancement and hypermetabolism and fluid-fluid level was observed, which indicates necrotic or hemorrhage change. Excisional biopsy was done, and a schwannoma with necrosis was revealed [24, 25] (Figs. 1.106, 1.107, and 1.108).

102

1 Atlas and Anatomy of PET/MR

Fig. 1.102 (1) Malignant mass in liver

103

1.4 Abdomen

Fig. 1.103 (1) Malignant liver mass (hepatocellular carcinoma and cholangiocarcinoma) with arterial enhancement and washout on delayed phase in S7

(2) Right hepatic vein (3) Middle hepatic vein (4) Left hepatic vein (5) Inferior vena cava

(6) Aorta (7) Spleen

104

1 Atlas and Anatomy of PET/MR

Fig. 1.104 (1) Malignant liver mass (hepatocellular carcinoma and cholangiocarcinoma) with arterial enhancement and washout on delayed phase in S7

(2) Right hepatic vein (3) Middle hepatic vein (4) Left hepatic vein (5) Inferior vena cava

(6) Aorta (7) Spleen

105

1.4 Abdomen

Fig. 1.105 (1) Daughter nodules with arterial enhancement, washout on delayed phase and subtle hypermetabolism in S7

(2) Portal vein (3) Inferior vena cava (4) Aorta

(5) Stomach (6) Spleen

106

1 Atlas and Anatomy of PET/MR

Fig. 1.106 (1) Schwannoma in liver

107

1.4 Abdomen

Fig. 1.107 (1) Internal necrotic portion in cystic schwannoma with delayed enhancement

(2) Myocardium (3) Descending aorta

108

1 Atlas and Anatomy of PET/MR

Fig. 1.108 (1) Portal vein (2) Internal necrotic portion in cystic schwannoma with delayed enhancement (mild FDG uptake)

1.4.8

(3) Aorta (4) Stomach

Case 8

A 62-year-old female patient presented with dyspnea. On echocardiography, a mass was found in the right atrium (RA). FDG PET/MR was carried out for differential diagnosis. On FDG PET/MR, a soft tissue mass with contrast enhancement, hypermetabolism, high signal intensity in a diffusion weighted image, and low signal intensity on apparent diffusion coefficient (ADC) maps was found along the RA and inferior vena cava, which is suggestive of a malignant vascular origin tumor. Biopsy of the tumor revealed leiomyosarcoma (Figs. 1.109, 1.110, 1.111, 1.112, 1.113, 1.114, and 1.115).

1.4 Abdomen

109

Fig. 1.109 (1, 2) Focal hypermetabolic foci in leiomyosarcoma in inferior vena cava

110

1 Atlas and Anatomy of PET/MR

Fig. 1.110 (1) Ascending aorta (2) Main pulmonary artery

(3) Left atrium (4) Descending aorta

111

1.4 Abdomen

Fig. 1.111 (1) Liver dome (2) Leiomyosarcoma in inferior vena cava

(3) Right ventricle (4) Left ventricle

(5) Descending aorta (6) Esophagus

112

1 Atlas and Anatomy of PET/MR

Fig. 1.112 (1) Liver, right lobe (2) Leiomyosarcoma in inferior vena cava

(3) Liver, left lobe (4) Esophagus

(5) Aorta

113

1.4 Abdomen

Fig. 1.113 (1) Stomach (2) Gall bladder

(3) Pancreas (4) Leiomyosarcoma in inferior vena cava

(5) Spleen

114

1 Atlas and Anatomy of PET/MR

Fig. 1.114 (1) Duodenum (2) Jejunum

(3) Leiomyosarcoma in IVC (focal hypermetabolism in tumor)

(4) Kidney

1.5

115

Pelvis

Fig. 1.115 (1) Ascites (2) Extruded leiomyosarcoma from inferior vena cava

(3) Left renal vein (4) Kidney

1.5

Pelvis

1.5.1

Case 1

A 73-year-old female patient presented after having hematochezia for 1 month. A colonoscopy was done, and a rectal mass was found at 1 cm from the anal verge. Biopsy revealed adenocarcinoma. FDG PET/MR was employed for initial staging. On FDG PET/MR, a hypermetabolic rectal mass with vaginal posterior wall invasion was found, indicating rectal cancer. Multiple enlarged LNs with increased metabolic activity were found in perirectal, sacral, bilateral internal iliac, and para-aortic areas, suggesting LN metastases. Hypermetabolic nodules were found in both lungs, suggesting lung metastases. A hypermetabolic lesion was found at the right ureter resulting in right hydronephroureterosis, pointing to periureteral metastasis [26, 27] (Figs. 1.116, 1.117, 1.118, 1.119, 1.120, 1.121, 1.122, 1.123, 1.124, 1.125, 1.126, 1.127, 1.128, 1.129, 1.130, 1.131, 1.132, 1.133, 1.134, and 1.135).

116

1 Atlas and Anatomy of PET/MR

Fig. 1.116 (1) Thyroiditis (2) Lung metastasis (3) Right hydronephrosis

(4) Aortocaval LN metastasis (5) Right periureteral metastasis (6) Pelvic LN metastasis

(7) Rectal cancer (8) Urinary bladder

1.5

117

Pelvis

Fig. 1.117 (1) Right obturator externus muscle (2) Right obturator internus muscle (3) Right pectineus muscle (4) Pubic bone

(5) Urethra (6) Vagina (7) Left ischium (8) Left gluteus major muscle

(9) Rectum (10) Rectal cancer involving posterior wall of vagina

118

1 Atlas and Anatomy of PET/MR

Fig. 1.118 (1) Right femur head (2) Right ischium (3) Pubic bone (4) Urinary bladder

(5) Vagina (6) Left ischium (7) Perirectal LN metastasis (8) Rectal cancer

(9) Rectal cancer involving posterior wall of vagina

1.5

119

Pelvis

Fig. 1.119 (1) Right femur head (2) Right inguinal LN metastasis (3) Pubic bone

(4) Urinary bladder (5) Vagina. (6) Left ischium (7) Perirectal LN metastasis

(8) Rectal cancer (9) Rectal cancer involving posterior wall of vagina

120

1 Atlas and Anatomy of PET/MR

Fig. 1.120 (1) Right head of femur (2) Ligament of head of femur (3) Right obturator internus muscle

(4) Urinary bladder (5) Vagina (6) Left ischium

(7) Perirectal LN metastasis (8) Rectal cancer

1.5

121

Pelvis

Fig. 1.121 (1) Right head of femur (2) Urinary bladder (3) Uterus

(4) Rectum (5) Left femoral vein (6) Left femoral artery

(7) Left obturator LN metastasis (8) Perirectal LN metastasis (9) Right obturator LN metastasis

122

1 Atlas and Anatomy of PET/MR

Fig. 1.122 (1) Right iliac bone (2) Right periureteral metastasis

(3) Sigmoid colon (4) Pericolic LN metastasis

(5) Sacrum

1.5

123

Pelvis

Fig. 1.123 (1) Right iliac bone (2) Right iliacus muscle (3) Right external iliac vessels

(4) Right hydroureterosis (5) Sigmoid colon (6) Left psoas muscle

(7) Sacrum

124

1 Atlas and Anatomy of PET/MR

Fig. 1.124 (1) Ascending colon (2) Right psoas major muscle (3) Right hydroureterosis

(4) Inferior vena cava (5) Aortocaval LN metastasis (6) Abdominal aorta

(7) Quadratus lumborum muscle (8) Vertebral body

1.5

125

Pelvis

Fig. 1.125 (1) Ascending colon (2) Right psoas major muscle (3) Inferior vena cava

(4) Aortocaval LN metastasis (5) Abdominal aorta (6) Quadratus lumborum muscle

(7) Vertebral body

126

1 Atlas and Anatomy of PET/MR

Fig. 1.126 (1) Ascending colon (2) Right kidney

(3) IVC (4) Abdominal aorta

(5) Left ureter (6) Vertebral body

1.5

127

Pelvis

Fig. 1.127 (1) Ascending colon (2) Hydronephrosis, right (3) Inferior vena cava

(4) Abdominal aorta (5) Transverse colon (6) Left ureter

(7) Descending colon (8) Vertebral body

128

1 Atlas and Anatomy of PET/MR

Fig. 1.128 (1) Ascending colon (2) Right hydronephrosis

(3) Abdominal aorta (4) Left renal pelvis

(5) Descending colon (6) Vertebral body

1.5

129

Pelvis

Fig. 1.129 (1) Right lobe of liver (2) Gall bladder (3) Inferior vena cava (4) Left lobe of liver

(5) Stomach (6) Pancreas (7) Abdominal aorta (8) Descending colon

(9) Spleen (10) Left adrenal gland (11) Right adrenal gland

130

1 Atlas and Anatomy of PET/MR

Fig. 1.130 (1) Portal vein (2) Inferior vena cava

(3) Stomach (4) Abdominal aorta

(5) Spleen

1.5

131

Pelvis

Fig. 1.131 (1) Right hepatic vein (2) Middle hepatic vein

(3) Inferior vena cava (4) Left hepatic vein

(5) Thoracic aorta

132

1 Atlas and Anatomy of PET/MR

Fig. 1.132 (1) Liver (2) Sternum (3) Right ventricle of heart

(4) Left ventricle of heart (5) Serratus anterior muscle (6) Latissimus muscle

(7) Lung metastasis, LLL (8) Descending aorta

1.5

133

Pelvis

Fig. 1.133 (1) Right pectoralis major muscle (2) Right pectoralis minor muscle (3) Sternum

(4) Ascending aorta (5) Pulmonary trunk (6) Lung metastasis, LUL

(7) Descending aorta (8) Left main bronchus (9) Right main bronchus

134

1 Atlas and Anatomy of PET/MR

Fig. 1.134 (1) Right pectoralis major muscle (2) Right pectoralis minor muscle (3) Trachea

(4) Right brachiocephalic artery (5) Left common carotid artery (6) Left brachiocephalic vein

(7) Left subclavian artery (8) Esophagus (9) Right brachiocephalic vein

1.5

135

Pelvis

Fig. 1.135 (1) Thyroid gland

(2) Spinal cord

1.5.2

Case 2

A 59-year-old female patient had an abnormality in her Pap smear test. Subsequent cervical punch biopsy revealed squamous cell carcinoma. FDG PET/MR was done for initial tumor staging. On FDG PET/MR, a hypermetabolic mass was found in the uterine cervix indicative of cervical cancer. The mass involved the posterior upper vaginal wall but not the parametrium. No abnormal hypermetabolic lesion suggesting metastasis was found [28–30] (Figs. 1.136, 1.137, 1.138, 1.139, 1.140, and 1.141).

1.5.3

Case 3

A 41-year-old female patient presented with vaginal bleeding. Squamous cell carcinoma was revealed by cervical biopsy. FDG PET/MR was done for the initial staging. On FDG PET/MR, a hypermetabolic uterine cervical mass involving the parametrium and the lower third of the vagina was found, pointing to cervical cancer. Hypermetabolic and enlarged LNs were found in both the external iliac and left internal and perirectal areas, suggesting metastatic LNs (Figs. 1.142, 1.143, 1.144, 1.145, 1.146, 1.147, 1.148, 1.149, 1.150, 1.151, 1.152, 1.153, 1.154, 1.155, 1.156, 1.157, 1.158, 1.159, 1.160, 1.161, 1.162, 1.163, and 1.164).

136

1 Atlas and Anatomy of PET/MR

Fig. 1.136 (1) Cervical cancer

1.5

137

Pelvis

Fig. 1.137 (1) Right internal iliac vessels (2) Right external iliac vessels

(3) Cervical cancer (4) Left external iliac vessels

(5) Left internal iliac vessels (6) Rectum

138

1 Atlas and Anatomy of PET/MR

Fig. 1.138 (1) Right external iliac vessels (2) Cervical cancer

(3) Urinary bladder (4) Left external iliac vessels

(5) Left internal iliac vessels (6) Rectum

1.5

139

Pelvis

Fig. 1.139 (1) Right femoral vessels (2) Cervix

(3) Rectum (4) Urinary bladder

(5) Left femoral vessels (6) Left femur head

140

1 Atlas and Anatomy of PET/MR

Fig. 1.140 (1) Right external iliac vessels (2) Left iliac bone

(3) Uterine cervical cancer (4) Rectus abdominis muscle

(5) Left external iliac vessels (6) Rectum

1.5

141

Pelvis

Fig. 1.141 (1) Promontory, sacrum (2) Sacrum (3) Uterine fundus (4) Uterine body

(5) Cervical cancer involving posterior vaginal fornix (6) Rectum (7) Vagina

(8) Urinary bladder (9) Pubic bone

142

1 Atlas and Anatomy of PET/MR

Fig. 1.142 (1) Cervical cancer (2) Right pelvic LN metastasis

(3) Left pelvic LN metastasis (4) Left pelvic LN metastasis

1.5

143

Pelvis

Fig. 1.143 (1) Psoas muscle (2) Rectus abdominis

(3) Common iliac artery (4) Common iliac vein

144

1 Atlas and Anatomy of PET/MR

Fig. 1.144 (1) Psoas muscle (2) Sacrum

(3) External iliac artery (4) Internal iliac artery

1.5

145

Pelvis

Fig. 1.145 (1) Psoas muscle (2) Sacrum

(3) External iliac artery (4) Internal iliac artery

146

1 Atlas and Anatomy of PET/MR

Fig. 1.146 (1) Internal iliac artery (2) External iliac LN metastasis

(3) External iliac artery (4) External iliac vein

1.5

147

Pelvis

Fig. 1.147 (1) Right external iliac LN metastasis (2) Right external iliac vein (3) Right external iliac artery

(4) Left internal iliac artery (5) Left external iliac LN metastasis (6) Left external iliac artery

(7) Left external iliac vein

148

1 Atlas and Anatomy of PET/MR

Fig. 1.148 (1) Rectum (2) Cervical cancer (3) Right external iliac artery (4) Right external iliac vein

(5) Uterus, fundus (6) Sigmoid colon (7) Metastatic LN in left internal iliac area (8) Left external iliac artery

(9) Left external iliac vein (10) Left internal iliac artery

1.5

149

Pelvis

Fig. 1.149 (1) Rectum (2) Cervical cancer (3) Right external iliac artery (4) Right external iliac vein

(5) Uterus, fundus (6) Sigmoid colon (7) Metastatic LN in left internal iliac area (8) Left external iliac artery

(9) Left external iliac vein (10) Left internal iliac artery

150

1 Atlas and Anatomy of PET/MR

Fig. 1.150 (1) Rectum (2) Cervical cancer (3) Right external iliac artery (4) Right external iliac vein

(5) Uterus, body (6) Left adnexa (7) Left internal iliac artery (8) Left external iliac artery

(9) Left external iliac vein (10) Metastatic LN, perirectal area

1.5

151

Pelvis

Fig. 1.151 (1) Cervical cancer (2) Right femur head (3) Right acetabulum (4) Right femoral artery

(5) Right femoral vein (6) Uterus, fundus (7) Urinary bladder (8) Left femoral vein

(9) Left femoral artery (10) Coccyx

152

1 Atlas and Anatomy of PET/MR

Fig. 1.152 (1) Cervical cancer (2) Right femur head (3) Right acetabulum (4) Right femoral artery

(5) Right femoral vein (6) Urinary bladder (7) Left acetabulum (8) Left femoral artery

(9) Left femoral vein (10) Coccyx

1.5

153

Pelvis

Fig. 1.153 (1) Right ischium (2) Rectum

(3) Urethra (4) Right pubis

(5) Left pectineus muscle (6) Left obturator externus muscle

154

1 Atlas and Anatomy of PET/MR

Fig. 1.154 (1) Gluteus maximus muscle (2) Rectum

(3) Rectum (4) Sacrum

(5) Ilium (6) Perirectal LN metastasis

1.5

155

Pelvis

Fig. 1.155 (1) Ischium (2) Rectum

(3) Sacrum (4) Ilium

(5) Cervical cancer

156

1 Atlas and Anatomy of PET/MR

Fig. 1.156 (1) Ischium (2) Rectum

(3) Sacrum (4) Ilium

(5) Pelvic LN metastasis (6) Cervical cancer

1.5

157

Pelvis

Fig. 1.157 (1) Femur (2) Uterus (3) Right Ilium

(4) Left ilium (5) Pelvic LN metastasis

(6) Bilateral parametrial invasion of cervical cancer

158

1 Atlas and Anatomy of PET/MR

Fig. 1.158 (1) Femur head (2) Right ovary

(3) Right pelvic LN metastasis (4) Left pelvic LN metastasis

(5) Left ovary (6) Urinary bladder

1.5

159

Pelvis

Fig. 1.159 (1) Right femur head (2) Right acetabulum

(3) Uterus (4) Left psoas muscle

(5) Left acetabulum (6) Urinary bladder

160

1 Atlas and Anatomy of PET/MR

Fig. 1.160 (1) Obturator externus muscle (2) Femur head (3) Acetabulum

(4) Iliacus muscle (5) Ilium (6) Gluteus maximus muscle

(7) Gluteus medius muscle (8) Ischium

1.5

161

Pelvis

Fig. 1.161 (1) Obturator externus muscle (2) Pubic bone (3) Urinary bladder

(4) Ovary (5) Rectus abdominis muscle (6) Ilium

(7) Gluteus maximus muscle (8) Ischium

162

1 Atlas and Anatomy of PET/MR

Fig. 1.162 (1) Pubic bone (2) Bladder (3) Uterus, fundus

(4) Uterus, body (5) Rectus abdominis muscle (6) Sacrum

(7) Gluteus maximus muscle (8) Uterine cervical cancer

1.5

163

Pelvis

Fig. 1.163 (1) Pubic bone (2) Urinary bladder (3) Uterus, fundus

(4) Uterus, body (5) Rectus abdominis muscle (6) Sacrum S1

(7) Uterine cervical cancer, lower vaginal extension (8) Rectum

164

1 Atlas and Anatomy of PET/MR

Fig. 1.164 (1) Pubic bone (2) Urinary bladder (3) Uterus fundus

(4) Sacrum S1 (5) Cervical cancer, lower vaginal extension

1.6

Musculoskeletal System

1.6.1

Case 1

(6) Rectum

A 42-year-old female patient presented with a palpable mass in her right lower leg. Synovial sarcoma was revealed by fine needle biopsy. FDG PET/MR was used for the initial staging. On FDG PET/MR, a multilobulated soft tissue mass with moderately increased metabolism was found in the posterior compartment of her right lower leg, i.e., a malignant mass. Enlarged LNs with mildly increased metabolism were found in the right external iliac, inguinal, and popliteal regions but proved to be benign reactive LNs after excisional biopsy [31, 32] (Figs. 1.165, 1.166, 1.167, 1.168, 1.169, 1.170, 1.171, 1.172, 1.173, 1.174, 1.175, and 1.176).

1.6.2

Case 2

A 39-year-old male patient presented with a palpable mass in the right thigh. Myxoid liposarcoma was revealed by needle biopsy. FDG PET/MR was done for initial staging. On FDG PET/MR, a well-marginated enhancing mass with mildly increased metabolism was found in the right inner thigh, which is indicative of myxoid liposarcoma [33] (Figs. 1.177, 1.178, 1.179, 1.180, 1.181, and 1.182).

165

1.6 Musculoskeletal System

Fig. 1.165 (1) Synovial sarcoma in right lower leg

(2) Right popliteal reactive LN (3) Right inguinal reactive LN

(4) Right external iliac reactive LN

166

1 Atlas and Anatomy of PET/MR

Fig. 1.166 (1) Right iliac bone (2) Right external iliac LN (reactive)

(3) Right external iliac vessel (4) Sigmoid colon

(5) Uterus (6) Rectum

167

1.6 Musculoskeletal System

Fig. 1.167 (1) Right femur (2) Right tensor fasciae latae muscle (3) Right rectus femoris muscle (4) Right sartorius muscle

(5) Right inguinal LN (reactive) (6) Right pectineus muscle (7) Right obturator externus muscle (8) Right obturator internus muscle

(9) Right ischium (10) Right gluteus maximus muscle

168

1 Atlas and Anatomy of PET/MR

Fig. 1.168 (1) Right femur (2) Right vastus lateralis muscle (3) Right tensor fasciae latae muscle (4) Right vastus intermedius muscle

(5) Right rectus femoris muscle (6) Right sartorius muscle (7) Right inguinal LN (reactive) (8) Right adductor brevis muscle

(9) Right adductor magnus muscle (10) Right gluteus maximus muscle

169

1.6 Musculoskeletal System

Fig. 1.169 (1) Right femur (2) Right vastus lateralis muscle (3) Right vastus medialis and intermedius muscle

(4) Right rectus femoris muscle (5) Right sartorius muscle (6) Right adductor longus muscle (7) Right gracilis muscle

(8) Right semitendinosus muscle (9) Right gluteus maximus muscle

170

1 Atlas and Anatomy of PET/MR

Fig. 1.170 (1) Right femur (2) Right vastus lateralis muscle (3) Right vastus medialis and intermedius muscle

(4) Right rectus femoris muscle (5) Right sartorius muscle (6) Right gracilis muscle (7) Right adductor magnus muscle

(8) Right semimembranosus (9) Right semitendinosus muscle (10) Right biceps femoris muscle

171

1.6 Musculoskeletal System

Fig. 1.171 (1) Right femur (2) Right vastus lateralis muscle (3) Right vastus intermedius muscle (4) Right rectus femoris muscle

(5) Right vastus medialis (6) Right sartorius muscle (7) Right gracilis muscle (8) Right semimembranosus

(9) Right semitendinosus muscle (10) Right biceps femoris muscle

172

1 Atlas and Anatomy of PET/MR

Fig. 1.172 (1) Right femur (2) Right vastus lateralis muscle (3) Right rectus femoris muscle (4) Right vastus medialis

(5) Right sartorius muscle (6) Right gracilis muscle (7) Right semimembranosus (8) Right semitendinosus muscle

(9) Right biceps femoris muscle (10) Popliteal LN (reactive)

173

1.6 Musculoskeletal System

Fig. 1.173 (1) Right femur (2) Right patella (3) Right sartorius muscle

(4) Right gracilis muscle (5) Right semimembranosus (6) Right semitendinosus muscle

(7) Popliteal LN (reactive) (8) Right gastrocnemius muscle (9) Right biceps femoris muscle

174

1 Atlas and Anatomy of PET/MR

Fig. 1.174 (1) Fibula (2) Fibularis longus muscle

(3) Tibialis anterior muscle (4) Tibia

(5) Synovial sarcoma (6) Gastrocnemius muscle

175

1.6 Musculoskeletal System

Fig. 1.175 (1) Fibula (2) Tibia

(3) Synovial sarcoma (4) Gastrocnemius muscle

176

1 Atlas and Anatomy of PET/MR

Fig. 1.176 (1) Tibia (2) Synovial sarcoma

(3) Calcaneus (4) Talus

1.6 Musculoskeletal System

177

Fig. 1.177 (1) Liposarcoma

178

1 Atlas and Anatomy of PET/MR

Fig. 1.178 (1) Femur (2) Vastus intermedius muscle (3) Vastus lateralis muscle (4) Rectus femoris muscle

(5) Vastus medialis muscle (6) Sartorius muscle (7) Femoral artery (8) Femoral vein

(9) Gracilis muscle (10) Biceps femoris muscle

179

1.6 Musculoskeletal System

Fig. 1.179 (1) Femur (2) Vastus intermedius muscle (3) Vastus lateralis muscle (4) Rectus femoris muscle

(5) Vastus medialis muscle (6) Liposarcoma (7) Femoral vessel (8) Sartorius muscle

(9) Gracilis muscle (10) Biceps femoris muscle

180

1 Atlas and Anatomy of PET/MR

Fig. 1.180 (1) Femur (2) Vastus intermedius muscle (3) Vastus lateralis muscle (4) Rectus femoris muscle

(5) Vastus medialis muscle (6) Liposarcoma (7) Femoral vessel (8) Sartorius muscle

(9) Gracilis muscle (10) Biceps femoris muscle

181

1.6 Musculoskeletal System

Fig. 1.181 (1) Femur (2) Vastus intermedius muscle (3) Vastus lateralis muscle (4) Rectus femoris muscle

(5) Vastus medialis muscle (6) Liposarcoma (7) Femoral vessel (8) Sartorius muscle

(9) Gracilis muscle (10) Biceps femoris muscle

182

1 Atlas and Anatomy of PET/MR

Fig. 1.182 (5) Vastus medialis muscle (6) Liposarcoma (7) Femoral vessel (8) Sartorius muscle

(1) Femur (2) Vastus intermedius muscle (3) Vastus lateralis muscle (4) Rectus femoris muscle

1.6.3

(9) Gracilis muscle (10) Biceps femoris muscle

Case 3

A 16-year-old female patient complained of pelvic pain. Computed tomographic scans revealed a destructive bone lesion in the right pelvic bone. Needle biopsy revealed osteosarcoma. FDG PET/MR was utilized for initial staging. On FDG PET/MR, a bony destructive mass was found in the left pelvic bone involving the ilium, sacrum, and acetabulum and encasing the left internal iliac vessels and sacral plexus with increased metabolic activity, which is indicative of osteosarcoma. Inside the mass, there was an area with signal void on T2WI hyperintensity and T1WI/strong contrast enhancement suggestive of aneurysmal changes in the tumor vessels. Metastatic multiple hypermetabolic lung nodules were found [34–36] (Figs. 1.183, 1.184, 1.185, 1.186, 1.187, 1.188, 1.189, 1.190, 1.191, 1.192, 1.193, 1.194, and 1.195).

1.6 Musculoskeletal System

183

Fig. 1.183 (1) Right iliac bone metastasis

(2) Left pelvic bone osteosarcoma

184

1 Atlas and Anatomy of PET/MR

Fig. 1.184 (1) Common right iliac vein (2) Common right iliac artery

(3) Common left iliac artery (4) Common left iliac vein

(5) L5 vertebral body

185

1.6 Musculoskeletal System

Fig. 1.185 (1) Common right iliac vein (2) Common right iliac artery (3) Common left iliac artery

(4) Common left iliac vein (5) Osteosarcoma involving left iliac bone (6) L5 spine

(7) Right iliac bone metastasis

186

1 Atlas and Anatomy of PET/MR

Fig. 1.186 (1) Common right iliac vein (2) Right external iliac artery (3) Right internal iliac artery (4) Left common iliac artery

(5) Left common iliac vein (6) Intratumoral aneurysmal change of tumor vessel

(7) Left sacral ala involvement of osteosarcoma (8) Right iliac bone metastasis

187

1.6 Musculoskeletal System

Fig. 1.187 (1) Right internal iliac vein (2) Right external iliac vein (3) Right external iliac artery (4) Right internal iliac artery

(5) Left external iliac artery (6) Left internal iliac artery (7) Intratumoral aneurysmal change of tumor vessel

(8) Left sacral ala involvement of osteosarcoma (9) Left sacral canal, 2nd (10) Right iliac bone metastasis

188

1 Atlas and Anatomy of PET/MR

Fig. 1.188 (1) Right internal iliac vein (2) Right external iliac vein (3) Right external iliac artery (4) Right internal iliac artery (5) Left external iliac artery (6) Left external iliac vein

(7) Left internal iliac artery (8) Left internal iliac vein (9) Obturator artery (10) Intratumoral aneurysmal change of tumor vessel

(11) Left sacral ala involvement of osteosarcoma (12) Sacral plexus (13) Right iliac bone metastasis

189

1.6 Musculoskeletal System

Fig. 1.189 (1) Left external iliac artery (2) Left external iliac vein (3) Left internal iliac artery (4) Left internal iliac vein

(5) Obturator artery (6) Intratumoral aneurysmal change of tumor vessel

(7) Left sacral ala involvement of osteosarcoma

190

1 Atlas and Anatomy of PET/MR

Fig. 1.190 (1) Left external iliac artery (2) Left external iliac vein

(3) Left iliac bone osteosarcoma (4) Obturator artery

(5) Intratumoral aneurysmal change of tumor vessel

191

1.6 Musculoskeletal System

Fig. 1.191 (1) Urinary bladder (2) Acetabulum

(3) Femur head (4) Uterus

(5) Rectum

192

1 Atlas and Anatomy of PET/MR

Fig. 1.192 (1) Lung metastasis, RUL (2) Ascending aorta

(3) Sternum (4) Mammary gland

(5) Pulmonary trunk

193

1.6 Musculoskeletal System

Fig. 1.193 (1) Lung metastasis, RML (2) Ascending aorta

(3) Pulmonary trunk (4) Lung metastasis, LLL

(5) Right pulmonary artery

194

1 Atlas and Anatomy of PET/MR

Fig. 1.194 (1) Ascending aorta (2) Main pulmonary artery

(3) Lung metastasis (4) Descending aorta

1.6 Musculoskeletal System

195

Fig. 1.195 (1) Lung metastases, right left lobe (RLL)

(2) Lung metastasis, LLL

(3) Aorta

196

1 Atlas and Anatomy of PET/MR

References 1. Platzek I, Beuthien-Baumann B, Langner J, Popp M, Schramm G, Ordemann R, et al. PET/MR for therapy response evaluation in malignant lymphoma: initial experience. MAGMA. 2013;26:49–55. 2. Platzek I, Beuthien-Baumann B, Schneider M, Gudziol V, Langner J, Schramm G, et al. PET/MRI in head and neck cancer: initial experience. Eur J Nucl Med Mol Imaging. 2013;40:6–11. 3. Rischpler C, Nekolla SG, Dregely I, Schwaiger M. Hybrid PET/MR imaging of the heart: potential, initial experiences, and future prospects. J Nucl Med. 2013;54:402–15. 4. Pace L, Nicolai E, Luongo A, Aiello M, Catalano OA, Soricelli A, et al. Comparison of whole-body PET/CT and PET/MRI in breast cancer patients: lesion detection and quantitation of 18F-deoxyglucose uptake in lesions and in normal organ tissues. Eur J Radiol. 2014;83:289–96. 5. Catana C, Drzezga A, Heiss WD, Rosen BR. PET/MRI for neurologic applications. J Nucl Med. 2012;53:1916–25. 6. Mohile NA, Deangelis LM, Abrey LE. The utility of body FDG PET in staging primary central nervous system lymphoma. Neurol Oncol. 2008;10:223–8. 7. Hammoud MA, McCutcheon IE, Elsouki R, Schoppa D, Patt YZ. Colorectal carcinoma and brain metastasis: distribution, treatment, and survival. Ann Surg Oncol. 1996;3:453–63. 8. Loeffelbein DJ, Souvatzoglou M, Wankerl V, Dinges J, Ritschl LM, Mucke T, et al. Diagnostic value of retrospective PET-MRI fusion in head-and-neck cancer. BMC Cancer. 2014;14:846. 9. Kuhn FP, Hullner M, Mader CE, Kastrinidis N, Huber GF, von Schulthess GK, et al. Contrastenhanced PET/MR imaging versus contrast-enhanced PET/CT in head and neck cancer: how much MR information is needed? J Nucl Med. 2014;55:551–8. 10. Heusch P, Buchbender C, Kohler J, Nensa F, Gauler T, Gomez B, et al. Thoracic staging in lung cancer: prospective comparison of 18F-FDG PET/MR imaging and 18F-FDG PET/CT. J Nucl Med. 2014;55:373–8. 11. Kohan AA, Kolthammer JA, Vercher-Conejero JL, Rubbert C, Partovi S, Jones R, et al. N staging of lung cancer patients with PET/MRI using a three-segment model attenuation correction algorithm: initial experience. Eur Radiol. 2013;23:3161–9. 12. Gaeta CM, Vercher-Conejero JL, Sher AC, Kohan A, Rubbert C, Avril N. Recurrent and metastatic breast cancer PET, PET/CT, PET/MRI: FDG and new biomarkers. Q J Nucl Med Mol Imaging. 2013;57:352–66. 13. Lim JS, Yun MJ, Kim MJ, Hyung WJ, Park MS, Choi JY, et al. CT and PET in stomach cancer: preoperative staging and monitoring of response to therapy. Radiographics. 2006;26:143–56. 14. Wu CX, Zhu ZH. Diagnosis and evaluation of gastric cancer by positron emission tomography. World J Gastroenterol. 2014;20:4574–85. 15. Francis IR, Cohan RH, Varma DGK, Sondak VK. Retroperitoneal sarcomas. Cancer Imaging. 2005;5:89–94. 16. Tatsumi M, Isohashi K, Onishi H, Hori M, Kim T, Higuchi I, et al. 18F-FDG PET/MRI fusion in characterizing pancreatic tumors: comparison to PET/CT. Int J Clin Oncol. 2011;16:408–15. 17. Lee ES, Lee JM. Imaging diagnosis of pancreatic cancer: a state-of-the-art review. World J Gastroenterol. 2014;20:7864–77. 18. Dibble EH, Karantanis D, Mercier G, Peller PJ, Kachnic LA, Subramaniam RM. PET/CT of cancer patients: part 1, pancreatic neoplasms. Am J Roentgenol. 2012;199:952–67. 19. Ozkan E, Soydal C, Araz M, Kir KM, Ibis E. The role of 18F-FDG PET/CT in detecting colorectal cancer recurrence in patients with elevated CEA levels. Nucl Med Commun. 2012;33:395–402. 20. Bamba Y, Itabashi M, Kameoka S. Management of local recurrence of colorectal cancer: the role of PET/CT. Abdom Imaging. 2011;36:322–6. 21. Yong TW, Yuan ZZ, Jun Z, Lin Z, He WZ, Juanqi Z. Sensitivity of PET/MR images in liver metastases from colorectal carcinoma. Hell J Nucl Med. 2011;14:264–8. 22. Oliva MR, Saini S. Liver cancer imaging: role of CT, MRI, US and PET. Cancer Imaging. 2004;4 Spec No A:S42–6. 23. Donati OF, Hany TF, Reiner CS, von Schulthess GK, Marincek B, Seifert B, et al. Value of retrospective fusion of PET and MR images in detection of hepatic metastases: comparison with 18F-FDG PET/CT and Gd-EOB-DTPA-enhanced MRI. J Nucl Med. 2010;51:692–9. 24. Akin M, Bozkirli B, Leventoglu S, Unal K, Kapucu LO, Akyurek N, et al. Liver schwannoma incidentally discovered in a patient with breast cancer. Bratisl Lek Listy. 2009;110:298–300. 25. Ota Y, Aso K, Watanabe K, Einama T, Imai K, Karasaki H, et al. Hepatic schwannoma: imaging findings on CT, MRI and contrast-enhanced ultrasonography. World J Gastroenterol. 2012;18:4967–72. 26. Squillaci E, Manenti G, Mancino S, Ciccio C, Calabria F, Danieli R, et al. Staging of colon cancer: whole-body MRI vs. whole-body PET-CT--initial clinical experience. Abdom Imaging. 2008;33: 676–88.

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197 27. Partovi S, Kohan A, Paspulati R, Ros P, Herrmann K. PET/MR in colorectal cancer. In: Carrio I, Ros P, editors. PET/MRI. Heidelberg, Berlin: Springer; 2014. p. 95–108. 28. Sala E, Wakely S, Senior E, Lomas D. MRI of malignant neoplasms of the uterine corpus and cervix. AJR Am J Roentgenol. 2007;188:1577–87. 29. Zhang S, Xin J, Guo Q, Ma J, Ma Q, Sun H, et al. Defining PET tumor volume in cervical cancer with hybrid PET/MRI: a comparative study. Nucl Med Commun. 2014;35:712–9. 30. Son H, Kositwattanarerk A, Hayes MP, Chuang L, Rahaman J, Heiba S, et al. PET/CT evaluation of cervical cancer: spectrum of disease. Radiographics. 2010;30:1251–68. 31. Schuler MK, Richter S, Beuthien-Baumann B, Platzek I, Kotzerke J, van den Hoff J, et al. PET/MRI imaging in high-risk sarcoma: first findings and solving clinical problems. Case Rep Oncol Med. 2013;2013:793927. 32. Partovi S, Kohan AA, Zipp L, Faulhaber P, Kosmas C, Ros PR, et al. Hybrid PET/MR imaging in two sarcoma patients—clinical benefits and implications for future trials. Int J Clin Exp Med. 2014;7:640–8. 33. Suzuki R, Watanabe H, Yanagawa T, Sato J, Shinozaki T, Suzuki H, et al. PET evaluation of fatty tumors in the extremity: possibility of using the standardized uptake value (SUV) to differentiate benign tumors from liposarcoma. Ann Nucl Med. 2005;19:661–70. 34. Byun BH, Kong CB, Lim I, Kim BI, Choi CW, Song WS, et al. Early response monitoring to neoadjuvant chemotherapy in osteosarcoma using sequential (1)(8)F-FDG PET/CT and MRI. Eur J Nucl Med Mol Imaging. 2014;41:1553–62. 35. Brenner W, Bohuslavizki KH, Eary JF. PET imaging of osteosarcoma. J Nucl Med. 2003;44:930–42. 36. Im HJ, Kim TS, Park SY, Min HS, Kim JH, Kang HG, et al. Prediction of tumour necrosis fractions using metabolic and volumetric 18F-FDG PET/CT indices, after one course and at the completion of neoadjuvant chemotherapy, in children and young adults with osteosarcoma. Eur J Nucl Med Mol Imaging. 2012;39:39–49.

2  Atlas and Anatomy of PET/CT

PET-CT is a combined system of the positron emission tomography (PET) and computed tomography (CT) scanner, which enables co-registered images from both devices. By PET-CT, functional imaging obtained by PET, which shows metabolic or biochemical activity in the body, can be correlated with the anatomic imaging obtained by a CT scanner. PET-CT has revolutionized medical diagnosis by adding the precision of anatomic localization to functional imaging. Many diagnostic imaging procedures in oncology (e.g., cancer staging, surgical planning, radiation therapy) and neurology (Alzheimer disease, Parkinson disease) have been changed rapidly under the influence of PET-CT availability. In this chapter, oncologic PET/CT cases are mainly covered. The cases are presented in multiple slices with annotation of important structures. The first part of this chapter consists of fludeoxyglucose (FDG) PET/ CT cases, and the second part consists of non-FDG PET/CT cases. In the non-FDG PET/CT portion, several neurologic application of PET/CT are included.

2.1

FDG

2.1.1

Brain/Head and Neck

2.1.1.1  Case 1 A 56-year-old female patient suffered from headaches in the frontal area for 2–3 months. Brain FDG PET/CT was performed for a malignancy work-up. On FDG PET/CT, a hypermetabolic mass was found in the cingulate cortex and corpus callosum. The FDG uptake was irregular and with showed calcification. The brain mass was proved to be meningioma (WHO grade I) (Figs. 2.1, 2.2, 2.3, 2.4, 2.5, 2.6, 2.7, 2.8, 2.9, 2.10, 2.11, 2.12, 2.13, 2.14, 2.15, 2.16, 2.17, 2.18, 2.19, 2.20, 2.21, and 2.22) [1].

2.1.1.2  Case 2 A 73-year-old male patient presented with a left-sided neck mass. Needle biopsy was performed, and the mass proved to be metastatic squamous cell carcinoma. FDG PET/CT was performed to look for the primary malignancy site and staging work-up. On FDG PET/CT, a hypermetabolic lesion was found in the left maxillary sinus, which was suggestive of primary malignancy. The lesion was found to be moderately differentiated squamous cell carcinoma. Another hypermetabolic mass was found in the left neck area, which was consistent with metastatic lymph nodes (LNs). Other hypermetabolic LNs were detected in the right side of the neck level VI and left supraclavicular LNs, which pointed to metastatic LNs (Figs. 2.23, 2.24, 2.25, 2.26, 2.27, 2.28, 2.29, 2.30, and 2.31) [2–5]. © Springer International Publishing Switzerland 2016 E.E. Kim et al., Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT, DOI 10.1007/978-3-319-28652-5_2

199

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200

Fig. 2.1 (1) Falx cerebri (2) Cortical gray matter (3) Peritumoral edema

(4) Superior sagittal sinus (5) Precentral gyrus (6) Central sulcus

(7) Postcentral gyrus

2.1 FDG

201

Fig. 2.2 (1) Falx cerebri (2) Edema (3) Frontal lobe

(4) Parietal lobe (5) Superior sagittal sinus (6) Precentral gyrus

(7) Central sulcus (8) Postcentral gyrus

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Fig. 2.3 (1) Falx cerebri (2) Superior frontal gyrus (3) Edema

(4) Longitudinal cerebral fissure (5) Superior sagittal sinus (6) Subarachnoid space

203

2.1 FDG

Fig. 2.4 (1) Falx cerebri (2) Edema

(3) Part of the lateral ventricle (4) Superior sagittal sinus

204

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Fig. 2.5 (1) Falx cerebri (2) Edema

(3) Part of the lateral ventricle (4) Superior sagittal sinus

(5) Meningioma

2.1 FDG

205

Fig. 2.6 (1) Falx cerebri (2) Edema

(3) Part of the lateral ventricle (4) Occipital gyrus

(5) Superior sagittal sinus (6) Meningioma

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Fig. 2.7 (1) Falx cerebri (2) Edema

(3) Occipital gyrus (4) Superior sagittal sinus

(5) Meningioma (6) Lateral ventricle

2.1 FDG

207

Fig. 2.8 (1) Superior frontal gyrus (2) Middle frontal gyrus (3) Meningioma in the corpus callosum

(4) Edema surrounding tumor (5) Falx cerebri (6) Corona radiata (7) Lateral ventricle

(8) Superior sagittal sinus

208

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Fig. 2.9 (1) Superior frontal gyrus (2) Middle frontal gyrus (3) Meningioma in the corpus callosum

(4) Edema surrounding tumor (5) Falx cerebri (6) Corona radiata (7) Lateral ventricle

(8) Occipital cortex (9) Superior sagittal sinus

2.1 FDG

209

Fig. 2.10 (1) Falx cerebri (2) Cingulate gyrus (3) Lateral ventricle (anterior horn)

(4) Meningioma in the corpus callosum (5) Edema surrounding tumor (6) Caudate nucleus (head) (7) Putamen

  (8) Thalamus   (9) Lateral ventricle (collateral trigone) (10) Straight sinus (11) Superior sagittal sinus

210

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Fig. 2.11 (1) Falx cerebri (2) Medial frontal gyrus (3) Lateral ventricle (anterior horn)

(4) Meningioma in the corpus callosum (5) Edema surrounding tumor (6) Caudate nucleus (head) (7) Putamen

  (8) Thalamus   (9) Lateral ventricle (collateral trigone) (10) Straight sinus (11) Superior sagittal sinus

2.1 FDG

211

Fig. 2.12 (1) Falx cerebri (2) Medial frontal gyrus (3) Caudate nucleus (head) (4) Edema surrounding tumor

(5) Lateral ventricle (anterior horn) (6) Putamen (7) Cistern of lateral cerebral fossa (insular cistern)

  (8) Thalamus   (9) Lateral ventricle (trigone) (10) Straight sinus (11) Superior sagittal sinus

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212

Fig. 2.13  (1) Cingulate gyrus (2) Lateral ventricle (anterior horn)

(3) Putamen (4) Globus pallidus (pallidum) (5) Lateral ventricle (trigone)

213

2.1 FDG

Fig. 2.14  (1) Third ventricle

(2) Lateral ventricle

214

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Fig. 2.15  (1) Superior frontal gyrus (2) Middle temporal gyrus (3) Quadrigeminal and ambient cisterns

(4) Third ventricle (5) Lateral ventricle (trigone) (6) Occipital lobe (7) Straight sinus

2.1 FDG

215

Fig. 2.16  (1) Hypothalamus (2) Left eye (3) Superior temporal gyrus

(4) Vermis of the cerebellum (superior portion) (5) Aqueduct (6) Lateral ventricle

(7) Quadrigeminal cistern (8) Occipital gyri

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216

Fig. 2.17  (1) Frontal air sinus (2) Lateral sulcus (insular cistern)

(3) Superior temporal gyrus (4) Third ventricle (5) Quadrigeminal cistern

(6) Vermis of cerebellum (superior portion)

2.1 FDG

217

Fig. 2.18  (1) Temporal lobe (2) Quadrigeminal cistern (3) Occipital sinus

(4) Superior temporal gyrus (5) Mesencephalon (quadrigeminal plate)

(6) Vermis of cerebellum (superior portion)

218

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Fig. 2.19  (1) Eyeball (2) Optic nerve (3) Zygomatic bone (4) Temporal muscle (5) Sphenoidal sinus

  (6) Middle temporal gyrus   (7) Occipital gyrus   (8) Ethmoidal cells   (9) Superior temporal gyrus (10) Dorsum sellae

(11) Midbrain (12) Vermis of the cerebellum (superior portion)

2.1 FDG

219

Fig. 2.20  (1) Eyeball (2) Zygomatic bone (3) Temporal muscle (4) Squamous part of temporal bone (5) Sphenoidal sinus

(6) Petrous part of temporal bone (7) Mastoid process with mastoid air cells (8) Transverse sinus (9) Ethmoidal cells

(10) Inferior temporal gyrus (11) Pons (12) Fourth ventricle (13) Vermis of the cerebellum (superior portion)

220

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Fig. 2.21  (1) Ethmoidal air cells (2) Temporal muscle (3) Sphenoidal sinus (4) Inferior temporal gyrus

(5) Mastoid process with mastoid air cells (6) Transverse sinus (7) Sphenoidal bone (8) Pons

  (9) Ear (10) Vermis of the cerebellum (11) Cerebellar hemisphere

2.1 FDG

221

Fig. 2.22  (1) Osseous portion of the nasal septum (2) Maxillary sinus (3) Nasopharynx (4) External auditory meatus and eardrum (tympanic membrane)

(5) Mastoid process with mastoid air cells (6) Cerebellar hemisphere (7) Zygomatic arch (8) Medulla oblongata (9) Cerebellar tonsil

(10) Cisternal magna (posterior cerebellomedullary cistern)

222

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Fig. 2.23  (1) Hypermetabolic fluid-filled lesion in the left maxillary sinus

(2) Hypermetabolic metastatic lesion in the left side of the neck

2.1 FDG

223

Fig 2.24  (1) Medial pterygoid muscle (2) Pterygoid process (3) Nasal turbinate (4) Maxillary sinus

(5) Upper part of the left maxillary sinus cancer (6) Zygomatic arch (7) Mandible ramus

  (8) Lateral pterygoid muscle   (9) Longus capitis muscle (10) Condyloid process

224

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Fig. 2.25 (1) Nasopharynx (2) Pterygoid process (3) Left maxillary sinus cancer (4) Mandible ramus

(5) Masseter muscle (6) Skull base (7) Foramen magnum (8) Sternocleidomastoid muscle

2.1 FDG

225

Fig. 2.26  (1) Palatine tonsil (2) Nasopharynx (3) Lower part of the left maxillary sinus cancer

(4) Medial pterygoid (5) Mandible ramus (6) Masseter muscle (7) Parotid gland

(8) Sternocleidomastoid muscle

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226

Fig. 2.27 (1) Axis/C2 bone (2) Mandible (3) Palatine tonsil

(4) Medial pterygoid muscle (5) Masseter muscle (6) Parotid gland

(7) LN metastasis in the left side of the neck (8) Sternocleidomastoid muscle

2.1 FDG

227

Fig. 2.28 (1) C4 bone (2) Sternocleidomastoid muscle (3) Internal jugular vein (4) Common carotid artery

(5) Hyoid bone (6) Mandible (7) Hypopharynx

(8) LN metastasis in the left side of the neck with central necrosis

228

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Fig. 2.29 (1) Degenerative or metastatic lesion in the C6 spine (2) Sternocleidomastoid muscle (3) Internal jugular vein

(4) Common carotid artery (5) Thyroid cartilage (6) Cricoid cartilage

(7) LN metastasis in the left side of the neck (8) Trapezius muscle

2.1 FDG

229

Fig. 2.30 (1) Sternocleidomastoid muscle (2) Thyroid gland

(3) Left common carotid artery (4) Internal jugular vein

(5) Possible metastatic LNs in the left supraclavicular space

230

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Fig. 2.31 (1) Right subclavian artery (2) Right brachiocephalic vein (3) Right common carotid artery

(4) Possible metastatic LNs in the right side of the neck level VI (5) Esophagus

2.1.2

(6) Left common carotid artery (7) Left brachiocephalic vein (8) Left subclavian artery

Chest

2.1.2.1  Case 1 A 74-year-old female patient sought consultation after discovering a palpable breast mass. Biopsy proved the mass to be breast cancer. FDG PET/CT was performed for initial staging of the cancer. FDG PET/CT revealed a hypermetabolic mass in the upper outer quadrant of the right breast, which was consistent with breast cancer. In addition, multiple hypermetabolic LNs were found in the right axillary levels I and II and the right internal mammary areas, which were suggestive of metastatic LNs. Multiple hypermetabolic lesions also were found in the liver and bones (the sternum, left pubis, left ischium, and left femur neck), which were thought to be distant metastases (Figs. 2.32, 2.33, 2.34, 2.35, 2.36, 2.37, 2.38, 2.39, and 2.40) [6, 7].

2.1 FDG

231

Fig. 2.32 (1) Right axilla LN metastasis (2) Right breast cancer

(3) Sternal bone metastasis (4) Multiple liver metastases

(5) Left ischial bone metastasis

232

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Fig. 2.33 (1) Level I axillary lymph node (2) Level II axillary lymph node (3) Upper quadrant right breast mass (4) Right brachiocephalic vein (5) Pectoralis major muscle

(6) Pectoralis minor muscle (7) Aortic arch (8) Trachea (9) Esophagus (10) Spinal cord

(11) Erector spinae muscle (12) Subscapularis muscle (13) Scapula (14) Infraspinatus muscle (15) Teres major muscle

2.1 FDG

233

Fig. 2.34 (1) Level I axillary lymph node (2) Level II axillary lymph node (3) Upper quadrant right breast mass (4) Superior vena cava (5) Pectoralis major muscle (6) Pectoralis minor muscle

(7) Ascending aorta (8) Trachea (9) Esophagus (10) Descending aorta (11) Spinal cord (12) Erector spinae muscle

(13) Subscapularis muscle (14) Scapula (15) Infraspinatus muscle (16) Teres major muscle

234

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Fig. 2.35 (1) Upper quadrant right breast mass (2) Right mainstem bronchus (3) Superior vena cava (4) Ascending aorta (5) Pectoralis major muscle

(6) Left mainstem bronchus (7) Left pulmonary artery (8) Esophagus (9) Descending aorta (10) Spinal cord

(11) Erector spinae muscle (12) Subscapularis muscle (13) Scapula (14) Infraspinatus muscle (15) Teres major muscle

2.1 FDG

235

Fig. 2.36 (1) Upper quadrant right breast mass (2) Right mainstem bronchus (3) Superior vena cava (4) Right pulmonary artery (5) Ascending aorta (6) Pectoralis major muscle

(7) Pulmonary trunk (8) Left pulmonary artery (9) Left mainstem bronchus (10) Esophagus (11) Descending aorta (12) Erector spinae muscle

(13) Trapezius muscle (14) Subscapularis muscle (15) Scapula (16) Infraspinatus muscle (17) Teres major muscle

236

2  Atlas and Anatomy of PET/CT

Fig. 2.37 (1) Bronchus intermedius (2) Right pulmonary artery (3) Superior vena cava (4) Ascending aorta (5)  Right internal mammary lymph node metastasis (6) Pulmonary trunk

(7) Pectoralis major muscle (8) Left rib (9) Left pulmonary vein (10) Left lower lobe bronchus (11) Esophagus (12) Descending aorta (13) Erector spinae muscle

(14) Trapezius muscle (15) Subscapularis muscle (16) Scapula (17) Infraspinatus muscle (18) Teres major muscle

2.1 FDG

237

Fig. 2.38 (1) Right pulmonary vein (2) Superior vena cava (3) Right atrium (4) Sternum (bone metastasis) (5) Right ventricle

  (6) Left ventricle   (7) Left atrium   (8) Left pulmonary vein   (9) Esophagus (10) Descending aorta

(11) Erector spinae muscle (12) Trapezius muscle (13) Scapula (14) Latissimus dorsi muscle (15) Serratus anterior muscle

238

2  Atlas and Anatomy of PET/CT

Fig. 2.39 (1)  Multiple hypermetabolic metastatic lesions throughout both lobes of the liver (2) Portal vein (3)  Longitudinal plane of middle hepatic vein

(4) Liver segment IV B (5) Falciform ligament (6) Liver segment III (7) Rectus abdominis muscle (8) External oblique muscle (9) Intercostal muscle

(10) Transverse colon (11) Pancreatic tail (12) Descending colon (13) Spleen (14) Aorta

2.1 FDG

239

Fig. 2.40 (1) Left pubic bone

(2) Left ischial bone metastasis

2.1.2.2  Case 2 A 55-year-old female patient suffered from cough, excess sputum, and dyspnea for two weeks. She had a 30-pack-year smoking history. On chest x-ray, a lung mass was found in the right lower lung, and small-cell lung cancer was d­ iagnosed by bronchoscopic biopsy. FDG was used for staging work-up of small-cell lung cancer. On FDG PET/CT, a hypermetabolic mass was found in the right lower lobe of the lung encasing the right bronchi, which was consistent with small-cell lung cancer. Atelectasis of the right lower lobe of the lung was thought to be caused by bronchus obstruction of the tumor. Multiple hypermetabolic LNs were found in the subcarinal and right interlobar area, which were suggestive of metastatic LNs. Other small nodules were found in the left lower lobe of the lung with subtle FDG uptake, which were thought to be benign pulmonary nodules (Figs. 2.41, 2.42, 2.43, 2.44, 2.45, 2.46, 2.47, 2.48, 2.49, 2.50, 2.51, 2.52, 2.53, and 2.54) [8–12].

240

2  Atlas and Anatomy of PET/CT

Fig. 2.41 (1) Lung cancer

(2) Postobstructive atelectasis

241

2.1 FDG

Fig. 2.42 (1) Trachea (2) Esophagus

(3) Small cell lung cancer in the right lower lobe

2  Atlas and Anatomy of PET/CT

242

Fig. 2.43 (1) Trachea (2) Esophagus (3) Left major fissure

(4) Small cell lung cancer in the right lower lobe

2.1 FDG

243

Fig. 2.44 (1) Apical segmental bronchus, right upper lobe (2) Trachea (3) Esophagus

(4) Anterior segmental bronchus, left upper lobe (5) Apicoposterior segmental bronchus, left upper lobe

(6) Small cell lung cancer in the right lower lobe

244

2  Atlas and Anatomy of PET/CT

Fig. 2.45 (1) Posterior segmental bronchus, right upper lobe (2) Anterior segmental bronchus, right upper lobe

(3) Lobar bronchus, right upper lobe (4) Trachea (5) Esophagus

(6) Small cell lung cancer in the right lower lobe

2.1 FDG

245

Fig. 2.46 (1) Interlobar LNs metastasis, right (11 L) (2) Anterior segmental bronchus, right upper lobe (3) Lobar bronchus, right upper lobe

(4) Right mainstem bronchus (5) Carina (6) Left mainstem bronchus (7) Inferior lingula segmental bronchus

(8) Superior lingula segmental bronchus (9) Upper part of the small cell lung cancer

246

2  Atlas and Anatomy of PET/CT

Fig. 2.47 (1) Interlobar LN metastasis, right (2) Lobar bronchus, right upper lobe (3) Right main bronchus

(4) Carina (5) Left main bronchus (6) Inferior lingula segmental bronchus

(7) Superior lingula segmental bronchus (8) Upper part of the small cell lung cancer

2.1 FDG

247

Fig. 2.48 (1) Small cell lung cancer (2) Approximately 0.5 cm non-­hypermetabolic nodule in the RUL, most likely benign

(3) Right main bronchus (4) Subcarina (5) Left main bronchus

(6) Inferior lingula segmental bronchus (7) Superior lingula segmental bronchus (8) Upper part of the small cell lung cancer

248

2  Atlas and Anatomy of PET/CT

Fig. 2.49 (1) Small cell lung cancer (2) Approximately 0.5 cm non-hypermetabolic nodule in the RUL, most likely benign

(3) Right upper lobe (4) Right bronchus intermedius (5) Subcarinal LN (6) Left main bronchus

(7) Inferior lingula segmental bronchus

2.1 FDG

249

Fig. 2.50 (1) Bronchus intermedius, right lobe

(2) Subcarinal LN metastasis

(3) Lobar bronchus, left lower lobe

250

2  Atlas and Anatomy of PET/CT

Fig. 2.51 (1) Small cell lung cancer encasing right bronchus intermedius (2) Bronchus intermedius

(3) Subcarinal LN (4) Lobar bronchus, left lower lobe

(5) Superior segmental bronchus, left lower lobe

251

2.1 FDG

Fig. 2.52 (1) Bronchus intermedius (2) Lobar bronchus, left lower lobe (3) Inferior lingula segmental bronchus

(4) Superior segmental bronchus, left lower lobe

(5) Small cell lung cancer in the right lower lobe

2  Atlas and Anatomy of PET/CT

252

Fig. 2.53 (1) Lateral segmental bronchus, right middle lobe (2) Medial segmental bronchus, right middle lobe

(3)  Anteromedial segment bronchus, left lower lobe (4) Posterolateral segment bronchus, left lower lobe

(5) Small cell lung cancer in the right lower lobe

2.1.2.3  Case 3 A 74-year-old female patient was diagnosed with bladder cancer and had undergone transurethral resection of the bladder tumor (TURB). FDG PET/CT was performed for follow-­up of the cancer.

2.1 FDG

253

Fig. 2.54 (1) Mediabasal segment bronchus, left lower lobe (2) Anterobasal segment bronchus, left lower lobe

(3) Laterobasal segment bronchus, left lower lobe (4) Posterobasal segment bronchus, left lower lobe

(5) Obstructive pneumonia with atelectasis, right lower lobe (6) Small cell lung cancer in the right lower lobe

On FDG PET/CT, multiple hypermetabolic LNs were found at the left supraclavicular, mediastinal, bilateral hilar, and retroperitoneal areas. The differential diagnosis of these multiple hypermetabolic LNs were lymphoma and sarcoidosis. These lesions were proved to be sarcoidosis after biopsy of the subcarinal LN (Figs. 2.55, 2.56, 2.57, 2.58, 2.59, 2.60, 2.61, 2.62, 2.63, 2.64, 2.65, 2.66, 2.67, and 2.68) [13, 14].

254

2  Atlas and Anatomy of PET/CT

Fig. 2.55 (1) Hypermetabolic LNs in right hilum (2) Hypermetabolic LNs in left hilum

(3) Hypermetabolic LNs in left supraclavicular area (4)  Hypermetabolic LNs in mediastinum

(5) Hypermetabolic LNs at diaphragmatic level (6)  Hypermetabolic LNs in abdominal para-aortic area

2.1 FDG

255

Fig. 2.56 (1) Sternocleidomastoid muscle (2) Internal jugular vein (3) Left supraclavicular LN

(4) Left common carotid artery (5) Anterior scalene muscle (6) Esophagus

(7) Erector spinae muscle

256

2  Atlas and Anatomy of PET/CT

Fig. 2.57 (1) Hypermetabolic station 4R/right lower paratracheal LNs (2) Hypermetabolic station 4 L/left lower paratracheal LN

(3) Pectoralis major muscle (4) Pectoralis minor muscle (5) Aortic arch (6) Infraspinatus muscle

2.1 FDG

257

Fig. 2.58 (1) Hypermetabolic station 4R/right lower paratracheal LN (2)  Large hypermetabolic station 4 L/left lower paratracheal LN

(3) Pectoralis major muscle (4) Pectoralis minor muscle (5) Two hypermetabolic foci at 6 nodal station/para-aortic LN

(6) Aortic arch (7) Infraspinatus muscle (8) Superior vena cava

258

2  Atlas and Anatomy of PET/CT

Fig. 2.59 (1)  Hypermetabolic station 6/para-aortic LN (2) Large hypermetabolic station 5 LN/AP window/subaortic LN

(3)  Large hypermetabolic station 4 L/left lower paratracheal LN (4) Left para-descending aortic LN (5) Subscapularis muscle

(6) Teres major muscle

2.1 FDG

259

Fig. 2.60 (1) Hypermetabolic station 3A/prevascular LN (2) Hypermetabolic station 5/AP window/ subaortic LN

(3)  Large hypermetabolic station 4 L/left lower paratracheal LN (4) Infraspinatus muscle (5) Infraspinatus muscle

(6) Teres major muscle

260

2  Atlas and Anatomy of PET/CT

Fig. 2.61 (1) Hypermetabolic station 4R/right lower paratracheal LN (2) Hypermetabolic station 4 L/left lower paratracheal LN

(3) Hypermetabolic station 5/AP window/ subaortic LN (4) Hypermetabolic bilateral station 10/ hilar LNs

2.1 FDG

261

Fig. 2.62 (1) Hypermetabolic station 7/subcarinal LN (2) Pulmonary trunk (3) Hypermetabolic station 11/interlobar LN

(4)  Hypermetabolic bilateral station 11/ interlobar LNs

262

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Fig. 2.63 (1) Station 7/subcarinal LNs (2) Left upper lobar bronchus

(3) Bilateral station 11/interlobar LNs (4) Left lower lobar bronchus

263

2.1 FDG

Fig. 2.64 (1) Pulmonary trunk (2) Station 7/subcarinal LNs

(3) Station 11 interlobar LNs (4) Left lower lobe bronchus

(5) Bronchus intermedius

264

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Fig. 2.65 (1) Right atrium (2) Right ventricle

(3) Ascending aorta (4) Left atrium

(5) Descending thoracic aorta

2.1 FDG

265

Fig. 2.66 (1) Rectus abdominis muscle (2)  Abdominal preaortic retroperitoneal LNs at the level of the pancreatic body

(3) External oblique muscle (4) Left retrocrural LN (5) Erector spinae muscle

266

2  Atlas and Anatomy of PET/CT

Fig. 2.67 (4) Quadratus lumborum muscle (5) Iliocostalis muscle (6) Longissimus muscle

(1) Rectus abdominis muscle (2) Aortocaval LN (3) External oblique muscle

2.1.3

(7) Spinalis muscle (8) Psoas major muscle (9) Inferior vena cava

Abdomen

2.1.3.1  Case 1 An 83-year-old female patient suffered from anorexia and had a 5-kg weight loss in 6 months. A CT scan showed a 15 cm-sized liver mass with peripheral enhancement in segment 4 and in the right lobe of the liver. Aspiration biopsy of the liver confirmed the mass lesion as a gastrointestinal stromal tumor (GIST). FDG PET/CT was performed for staging work-up of the GIST.

2.1 FDG

267

Fig. 2.68 (1) Rectus abdominis muscle (2) Abdominal para-aortic LN (3) External oblique muscle

(4) Quadratus lumborum muscle (5) Iliocostalis muscle (6) Longissimus muscle

(7) Spinalis muscle (8) Psoas major muscle

On FDG PET/CT, a hypermetabolic focus was found at the lateral border of the tumor with central necrosis at segment 8 of the liver, and a hypo- to iso-metabolic lesion with central necrosis was shown at segment 4 of the liver. Incidental focal uptake was found in the right thyroid gland, which was proved to be thyroid cancer by biopsy. Mild hypermetabolism in bilateral hilar LNs was thought to be reactive LNs (Figs. 2.69, 2.70, 2.71, 2.72, 2.73, 2.74, 2.75, 2.76, 2.77, 2.78, 2.79, 2.80, 2.81, 2.82, and 2.83) [15, 16].

268

2  Atlas and Anatomy of PET/CT

Fig. 2.69 (1) Right thyroid cancer (2) Benign LN in right hilum (3)  Hypermetabolic portion of hepatic gastrointestinal stromal tumor (GIST)

2.1 FDG

269

Fig. 2.70 (1) Tumor at segment 4 with central necrosis and hypo- to isometabolic to the liver

(2) Hypermetabolic focus at the lateral border of the tumor at segment 8 of the liver

(3) Rectus abdominis muscle (4) Spinalis muscle

270

2  Atlas and Anatomy of PET/CT

Fig. 2.71 (1) Tumor at segment 4 with central necrosis and hypo- to isometabolic to the liver

(2) Hypermetabolic focus at the lateral border of the tumor at segment 8 of the liver

(3) Latissimus dorsi muscle (4) Spinalis muscle

2.1 FDG

271

Fig. 2.72 (1) Tumor at segment 4 with central necrosis and hypo- to isometabolic to the liver

(2) Hypermetabolic focus at the lateral border of the tumor at segment 8 of the liver

(3) Longissimus muscle (4) Spinalis muscle

272

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Fig. 2.73 (1) Tumor at segment 4 with central necrosis and isometabolic to the liver

(2) Tumor at segment 8 with central necrosis and hypometabolic to the liver

(3) Longissimus muscle (4) Spinalis muscle

2.1 FDG

Fig. 2.74 (1) Hypermetabolic focus at segment 8 of the liver, above the central necrosis

273

274

Fig. 2.75 (1) Hypermetabolic focus at segment 8 of the liver, above the central necrosis

2  Atlas and Anatomy of PET/CT

275

2.1 FDG

Fig. 2.76 (1) Tumor with central necrosis at segment 4 (2) Tumor with central necrosis at segment 8

(3) Gallbladder

276

2  Atlas and Anatomy of PET/CT

Fig. 2.77 (1)  Focal hypermetabolic, hypodense (on CT) nodule in the right thyroid lobe (2) Thyroid cartilage

(3) Sternocleidomastoid muscle (4) Internal jugular vein (5) Left common carotid artery

(6) C6 vertebral body

2.1 FDG

277

Fig. 2.78 (1)  Focal hypermetabolic, hypodense (on CT) nodule in the right thyroid lobe

(2) Sternocleidomastoid muscle (3) Internal jugular vein

(4) Left common carotid artery (5) C6 vertebral body

278

2  Atlas and Anatomy of PET/CT

Fig. 2.79 (1)  Focal hypermetabolic, hypodense (on CT) nodule in the right thyroid lobe

(2) Sternocleidomastoid muscle (3) Internal jugular vein

(4) Left common carotid artery (5) C7 vertebral body

2.1 FDG

279

Fig. 2.80 (1)  Focal hypermetabolic, hypodense (on CT) nodule in the right thyroid lobe

(2) Internal jugular vein (3) Left common carotid artery

(4) First rib

280

2  Atlas and Anatomy of PET/CT

Fig. 2.81 (1) Sternocleidomastoid muscle (2) Focal hypermetabolic, hypodense (on CT) nodule on the upper pole of the right thyroid lobe

(3) Internal jugular vein

281

2.1 FDG

Fig. 2.82 (1) Focal hypermetabolic, hypodense (on CT) nodule on the upper pole of the right thyroid lobe

(2) Sternocleidomastoid muscle (3) Left lobe of thyroid gland

282

2  Atlas and Anatomy of PET/CT

Fig. 2.83 (1) Right common carotid artery

(2) Left thyroid lobe

2.1.3.2  Case 2 A 16-month-old male patient showed abdominal distention. Hypertension and elevated renin and aldosterone levels were also found. Ultrasonography of the abdomen showed renal masses, and these were diagnosed to be Wilms tumors by biopsy. FDG PET/CT was done for initial staging of the tumors. On FDG PET/CT, a huge hypermetabolic mass in the left kidney and another hypermetabolic mass in the right kidney were found; these were consistent with Wilms tumors. Intense uptake in the anterior mediastinum was seen, which was thought to be physiologic thymus uptake. Mild hypermetabolic LNs were found in both neck areas, which were thought to be reactive LNs (Figs. 2.84, 2.85, 2.86, 2.87, 2.88, 2.89, 2.90, 2.91, 2.92, 2.93, 2.94, 2.95, and 2.96) [17, 18].

2.1 FDG

283

Fig. 2.84 (1) Thymus

(2) Wilms tumor in left kidney

(3) Wilms tumor in right kidney

284

2  Atlas and Anatomy of PET/CT

Fig. 2.85 (1) Nasopharynx (2) Eye (3) Zygomatic bone

(4) Maxillary sinus (5) Temporal bone (6) External auditory canal

(7) Mastoid process (8) Occipital condyle

2.1 FDG

285

Fig. 2.86 (1) Nasopharynx (2) Eye (3) Zygomatic arch (4) Maxillary sinus

(5) Left mandible (6) Right mandible (7) Parotid gland (8) Atlas C1 bone

  (9) Axis C2 bone (10) Level 2B lymph node, right

286

2  Atlas and Anatomy of PET/CT

Fig. 2.87 (1) Maxilla (2) Mandible

(3) Palatine tonsils (4) Level 2B lymph node, left

(5) Axis C2 bone

2.1 FDG

287

Fig. 2.88 (1) Maxilla (2) Mandible

(3) Palatine tonsils (4) Parotid gland

(5) Level II lymph node (6) C3 bone

288

2  Atlas and Anatomy of PET/CT

Fig. 2.89 (1) Mandible (2) Palatine tonsils

(3) Parotid gland (4) Level 2A lymph node, left

(5) Pharynx (6) C4 bone

2.1 FDG

289

Fig. 2.90 (1) Mandible (2) Hyoid cartilage

(3) Vocal cord (4) C5 bone

(5) Spinal cord

290

2  Atlas and Anatomy of PET/CT

Fig. 2.91 (1) Right and left clavicles (2)  Mandible (patient’s head tilted and bowed down toward anterior chest)

(3) Left supraclavicular lymph node (4) First rib (5) Head of the humerus

(6) Infraspinatus muscle (7) Scapula (8) Trapezius muscle

2.1 FDG

291

Fig. 2.92 (1) Thymus (2) Sternum (3) Pectoralis major muscle

(4) Pectoralis minor muscle (5) Second rib (6) T2 vertebral body

(7) Third rib (8) Scapula

292

2  Atlas and Anatomy of PET/CT

Fig. 2.93 (1) Thymus (2) Third rib, bilateral (3) Left ventricle (4) Right ventricle

(5) Left atrium (6) Fourth rib (7) Scapula (8) T3 vertebral body

  (9) Subscapularis muscle (10) Infraspinatus muscle

2.1 FDG

293

Fig. 2.94 (1) Spleen that has been pushed upward by the huge abdominal mass

(2) Liver (3) Seventh rib

(4) Eighth rib (5) T8 vertebral body

294

2  Atlas and Anatomy of PET/CT

Fig. 2.95 (1) Wilms tumor of the left kidney (2) Gallbladder

(3) Segment 5 of the liver (4) Tenth rib

(5) Eleventh rib (6) T11 vertebral body

2.1 FDG

295

Fig. 2.96 (1) Wilms tumor in the left kidney (2) Colon (3) Gallbladder

(4) Segment 5 of the liver (5) Wilms tumor in the lower pole of the right kidney

(6) Right kidney pelvis (7) L1 vertebral body

2.1.3.3  Case 3 A 56-year-old male patient was diagnosed with stomach cancer by endoscopic biopsy. The histologic type of the cancer was poorly differentiated carcinoma. FDG PET/CT was done for the staging work-up. FDG PET/CT revealed a hypermetabolic lesion in the lower body of the stomach, which was the known malignancy. In addition, hypermetabolic LNs in perigastric, retropancreatic, aortocaval, and retrocaval areas were found that were suggestive of regional and retroperitoneal metastatic LNs (distant metastasis) (Figs. 2.97, 2.98, 2.99, 2.100, 2.101, 2.102, 2.103, 2.104, and 2.105) [19–22].

296

2  Atlas and Anatomy of PET/CT

Fig. 2.97 (1) Hypermetabolic mass in the lower body of the stomach

297

2.1 FDG

Fig. 2.98 (1) Liver (2) Thoracic duct

(3) Esophagus (4) Descending aorta

(5) Fundus of stomach (6) Diaphragm

2  Atlas and Anatomy of PET/CT

298

Fig. 2.99 (1) Caudate lobe of the liver (2) Cardia of the stomach

(3) Spleen (4) Descending aorta

(5) Diaphragm

299

2.1 FDG

Fig. 2.100 (1) Neck of the gallbladder (2) Body of the gallbladder (3) Part of the heterogeneously hypermetabolic mass in the pyloric antrum

(4) Body of the stomach (5) Probable left gastric lymph node metastasis (6) Spleen

300

2  Atlas and Anatomy of PET/CT

Fig. 2.101 (1) Gallbladder (2) Part of the heterogeneously hypermetabolic mass in the pyloric antrum

(3) Body of the stomach (4) Probable retropancreatic lymph node metastasis

(5) Pancreas (6) Spleen (7) Right kidney

301

2.1 FDG

Fig. 2.102 (1) Gallbladder (2) Heterogeneously hypermetabolic mass in the pyloric antrum

(3) Body of the stomach (4) Pancreas (5) Splenic vein

(6) Spleen (7) Left adrenal gland (8) Right kidney

302

2  Atlas and Anatomy of PET/CT

Fig. 2.103 (1) Inferior vena cava (2)  Probable aortocaval metastasis

lymph

node

(3) Body of the stomach (4) Jejunum (5) Left renal vein

(6) Abdominal aorta with calcification

303

2.1 FDG

Fig. 2.104 (1) Ascending colon (2) Transverse colon (3) Inferior vena cava

(4) Body of the stomach (5) Transverse colon (6) Descending colon

(7) Abdominal aorta (8) Probable retrocaval lymph node metastasis

304

2  Atlas and Anatomy of PET/CT

Fig. 2.105 (1) Ascending colon (2) Transverse colon (3) Inferior vena cava

(4) Body of the stomach (5) Transverse colon (6) Descending colon

(7) Abdominal aorta (8) Probable retrocaval lymph node metastasis

2.1.3.4  Case 4 An 80-year-old male patient suffered a 14-kg weight loss over 3 months and had jaundice for 1 month. Abdominal CT demonstrated a pancreatic head mass, and biopsy proved this mass to be pancreatic cancer. FDG PET/CT was performed for the staging work-up. On FDG PET/CT, a hypermetabolic mass was found in the pancreatic head, which was indicative of pancreatic cancer. There was also involvement of the duodenal bulb. There were no abnormal hypermetabolic lesions in the rest of the imaged body (Figs. 2.106, 2.107, 2.108, 2.109, 2.110, 2.111, 2.112, 2.113, and 2.114) [23–26].

2.1 FDG

305

Fig. 2.106 (1) Pancreatic head cancer

306

2  Atlas and Anatomy of PET/CT

Fig. 2.107 (1) Inferior vena cava (2) Hepatic portal vein (3) Abdominal aorta

(4) Left gastric artery (5) Stomach (6) Spleen

(7) Pancreatic head cancer

307

2.1 FDG

Fig. 2.108 (1) Right kidney (2) Gallbladder (3) Inferior vena cava

(4) Abdominal aorta (5) Celiac trunk (6) Left kidney

(7) Pancreatic head cancer

308

2  Atlas and Anatomy of PET/CT

Fig. 2.109 (1) Gallbladder (2) Hepatic duct (3) Round ligament of the liver (4) Superior mesenteric artery

(5) Left adrenal gland (6) Stomach (7) Splenic vein (8) Descending colon

(9) Inferior vena cava (10) Crura (11) Pancreatic head cancer

309

2.1 FDG

Fig. 2.110 (1) Distended gallbladder (2) Duodenum (3) Inferior vena cava

(4) Superior mesenteric artery (5) Splenic vein (6) Distended pancreatic duct

(7) Left adrenal gland

310

2  Atlas and Anatomy of PET/CT

Fig. 2.111 (1) Distended gallbladder (2)  Duodenal bulb posterior wall tumor invasion (3) Upper part of the pancreatic head tumor

(4) Pancreatic body (5) Superior mesenteric artery (6) Left renal vein (7) Abdominal aorta

(8) Left renal artery (9) Inferior vena cava

311

2.1 FDG

Fig. 2.112 (1) Distended gallbladder (2)  Duodenal bulb posterior wall tumor invasion (3) Upper part of the pancreatic head tumor

(4) Superior mesenteric artery (5) Splenic vein (6) Left renal vein (7) Abdominal aorta

(8) Left renal artery (9) Inferior vena cava

312

2  Atlas and Anatomy of PET/CT

Fig. 2.113 (1) Distended gallbladder (2)  Duodenal bulb posterior wall tumor invasion

(3) Pancreatic head cancer (4) Superior mesenteric artery (5) Inferior vena cava

(6) Abdominal aorta (7) Left renal vein (8) Left renal artery

2.1 FDG

313

Fig. 2.114 (1) Ascending colon (2) Lower part of tumor at pancreatic head

(3) Superior mesenteric artery (4) Inferior vena cava

(5) Abdominal aorta (6) Descending colon

2.1.3.5  Case 5 A 76-year-old female patient was diagnosed with hepatocellular carcinoma. FDG PET/CT was done for the initial staging. FDG PET/CT demonstrated hypermetabolic nodular lesions in segments 4 and 6 of the liver, pointing to hepatocellular carcinoma. There were no abnormal hypermetabolic lesions in the rest of the imaged body (Figs. 2.115, 2.116, 2.117, 2.118, 2.119, 2.120, and 2.121) [27–31].

314

2  Atlas and Anatomy of PET/CT

Fig. 2.115 (1) Hypermetabolic hepatic nodular lesion in segment 4

(2) Hypermetabolic hepatic nodular lesion in segment 6

315

2.1 FDG

Fig. 2.116 (1) Hepatic segment 7 (2) Hepatic segment 8 (3) Inferior vena cava

(4) Hepatic segment 4 (5) Right ventricle (6) Esophagus

(7) Descending aorta (8) Spleen

316

2  Atlas and Anatomy of PET/CT

Fig. 2.117 (1) Hepatic segment 7 (2) Hepatic segment 8 (3) Inferior vena cava

(4) Lesion in hepatic segment 4 (5) Hepatic segment 1 (6) Hepatic segment 2

(7) Lesser curvature of the stomach (8) Greater curvature of the stomach (9) Spleen

317

2.1 FDG

Fig. 2.118 (1) Hepatic segment 6 (2) Hepatic segment 5 (3) Gallbladder (4) Hepatic segment 4

(5) Round ligament of the liver (6) Hepatic portal vein (7) Hepatic segment 3 (8) Stomach

(9) Splenic vein (10) Left adrenal gland

318

2  Atlas and Anatomy of PET/CT

Fig. 2.119 (1) Upper part of lesion in hepatic segment 6 (2) Hepatic segment 5 (3) Gallbladder (4) Hepatic segment 4

(5) Round ligament of the liver (6) Superior mesenteric vein (7) Hepatic segment 3 (8) Stomach

(9) Splenic vein (10) Left adrenal gland

319

2.1 FDG

Fig. 2.120 (1) Lesion in hepatic segment 6 (2) Hepatic segment 5 (3) Gallbladder

(4) Hepatic segment 4 (5) Superior mesenteric vein (6) Hepatic segment 3

(7) Stomach (8) Pancreas

320

2  Atlas and Anatomy of PET/CT

Fig. 2.121 (1)  Reactive/inflammatory axillary lymph node

(2) Right brachiocephalic vein (3) Left brachiocephalic vein

(4) Aortic arch

2.1.3.6  Case 6 A 76-year-old female patient showed a positive result on the fecal occult blood test in her health check-up. Abdominal CT demonstrated a mass in the cecum/proximal ascending colon area. FDG PET/CT was done for the staging work-up.

2.1 FDG

321

Fig. 2.122 (1) Hypermetabolic lesion in the ascending colon

On FDG PET/CT, a hypermetabolic mass was found in the cecum/ascending colon area, which was suspicious for malignancy. Hypermetabolic LNs were found in the right supraclavicular, right upper mediastinal, and subcarinal and bilateral hilar areas, which were thought to be reactive LNs. The hypermetabolic ascending colon mass was diagnosed as mucinous adenocarcinoma (T3 stage) after right hemicolectomy and right supraclavicular LNs were determined to be reactive LNs after biopsy (Figs. 2.122, 2.123, 2.124, 2.125, 2.126, 2.127, 2.128, 2.129, 2.130, and 2.131) [32–36].

322

2  Atlas and Anatomy of PET/CT

Fig. 2.123 (1) Ascending colon (2) Psoas major (3) Lumbar spine

(4) Inferior vena cava (5) Abdominal aorta (6) Transverse colon

(7) Descending colon

323

2.1 FDG

Fig. 2.124 (1) Ascending colon cancer (2) Psoas major

(3) Inferior vena cava (4) Aortic bifurcation

(5) Descending colon

324

2  Atlas and Anatomy of PET/CT

Fig. 2.125 (1) Ascending colon cancer (2) Regional LN metastasis (3) Psoas major

(4) Left common iliac vein (5) Left common iliac artery (6) Physiologic uptake in the ileum

(7) Descending colon

325

2.1 FDG

Fig. 2.126 (1) Jejunum (2) Sigmoid colon

(3) Sacrum (4) External iliac artery

(5) Internal Iliac artery

326

2  Atlas and Anatomy of PET/CT

Fig. 2.127 (1) Inflammatory right supraclavicular LN (2) Internal jugular vein

(3) Right subclavian artery (4) Right common carotid artery

(5) Esophagus (6) Left common carotid artery

327

2.1 FDG

Fig. 2.128 (1) Right brachiocephalic vein (2) Inflammatory right upper paratracheal LN

(3) Brachiocephalic trunk (4) Left common carotid artery (5) Left internal jugular vein

(6) Left subclavian vein (7) Left subclavian artery

328

2  Atlas and Anatomy of PET/CT

Fig. 2.129 (1) Superior vena cava (2) Inflammatory right hilar LN (3) Ascending aorta

(4) Pulmonary trunk (5) Left upper lobe lobar bronchus (6) Esophagus

(7) Inflammatory left hilar LN (8) Descending aorta

329

2.1 FDG

Fig. 2.130 (1) Inflammatory right hilar LN (2) Superior vena cava (3) Ascending aorta

(4) Pulmonary trunk (5) Esophagus (6) Inflammatory left hilar LN

(7) Descending aorta

330

2  Atlas and Anatomy of PET/CT

Fig. 2.131 (1) Inflammatory right hilar LN (2) Superior vena cava

(3) Inflammatory subcarinal LN (4) Pulmonary trunk

2.1.4

(5) Left pulmonary artery (6) Descending aorta

Others

2.1.4.1  Case 1 A 39-year-old female patient had suffered abdominal pain for several years. Multiple retroperitoneal masses were found by abdominal CT. She was diagnosed with follicular lymphoma by mesenteric LN biopsy. FDG PET/CT was performed for staging work-up of lymphoma. On FDG PET/CT, multiple hypermetabolic lesions were found in the mesenteric, peritoneal, left iliac, and inguinal LNs that indicated lymphoma involvement. Multiple LNs were involved only below the diaphragm (stage II by Ann Arbor staging) (Figs. 2.132, 2.133, 2.134, 2.135, 2.136, 2.137, 2.138, 2.139, 2.140, 2.141, and 2.142) [37–40].

2.1 FDG

331

Fig. 2.132 (1) Large hypermetabolic mass in the retrocrural region, anterior to T10-12 vertebrae

332

2  Atlas and Anatomy of PET/CT

Fig. 2.133 (1) Liver (2) Costal cartilage (3) Esophagus

(4) Sternum (5) Descending aorta (6) Heart

(7) Fundus of stomach (8) Diaphragm (9) T9 vertebra

333

2.1 FDG

Fig. 2.134 (1)  Lymphoma mass in the retrocrural region, anterior to T10-T12 vertebrae (2) Descending aorta

(3) Transverse colon (4) Body of stomach (5) Descending colon

(6) Spleen (7) T10 vertebra

334

2  Atlas and Anatomy of PET/CT

Fig. 2.135 (1)  Lymphoma mass in the retrocrural region, anterior to T10-T12 vertebrae (2) Descending aorta

(3) Pancreas (4) Splenic vein (5) Stomach

(6) Left kidney (7) T11 vertebra

335

2.1 FDG

Fig. 2.136 (1) Superior mesenteric vein

(2) Superior mesenteric artery

(3) Lymphoma involving mesenteric LNs

336

2  Atlas and Anatomy of PET/CT

Fig. 2.137 (1) Inferior vena cava (2)  Lymphoma involvement in aortocaval LNs

(3) Abdominal aorta (4) Lymphoma involvement in para-­aortic LNs

2.1 FDG

337

Fig. 2.138 (1) Aorta

(2) Lymphoma involving mesenteric LNs

(3) Descending colon

338

2  Atlas and Anatomy of PET/CT

Fig. 2.139 (1)  Lymphoma involving right iliocolic LNs

(2) Right common iliac vein (3) Right common iliac artery

(4) Left common iliac vein (5) Left common iliac artery

339

2.1 FDG

Fig. 2.140 (1) Psoas major muscle (2) Right common iliac vein

(3) Right common iliac artery (4) Left common iliac vein

(5) Left common iliac artery (6) Lymphoma involving common iliac LN

340

2  Atlas and Anatomy of PET/CT

Fig. 2.141 (1) Iliacus muscle (2) Psoas major muscle (3) External iliac vein (4) Internal iliac vein

(5) Lymphoma involving mesenteric lymph node (6) Ileum (7) Gluteus medius muscle

(8) Gluteus maximus muscle (9) Sacrum

2.1.4.2  Case 2 A 16-year-old male patient had had a left thigh mass and pain for three months. An MRI of the left thigh showed a mass in the left distal femur with small satellite lesions. Biopsy proved this mass to be chondroblastic osteosarcoma. FDG PET/CT was used for the staging work-up.

341

2.1 FDG

Fig. 2.142 (1) Pectineus muscle (2) Adductor brevis muscle (3) Adductor longus muscle

(4) Lymphoma involving femoral LNs (5) Femoral vein and artery (6) Sartorius muscle

(7) Rectus femoris muscle (8) Gluteus maximus muscle (9) Urethra

FDG PET/CT demonstrated a hypermetabolic mass in the left distal femur that was consistent with osteosarcoma. Another hypermetabolic small mass in the medial metaphyseal side of the left distal femur was thought to be a skip metastasis. One additional focal hypermetabolic lesion was found in the right shoulder joint, and this lesion was considered to be a traumatic one (Figs. 2.143, 2.144, 2.145, 2.146, 2.147, 2.148, 2.149, 2.150, 2.151, and 2.152) [41–44].

Fig. 2.143 (1) Left distal femur osteosarcoma (2) Small left distal femoral skip metastatic lesion

343

2.1 FDG

Fig. 2.144 (1) Adductor longus (2) Sartorius (3) Vastus medialis (4) Rectus femoris

(5) Vastus intermedius (6) Vastus lateralis (7) Left femur (8) Biceps femoris long head

(9) Semitendinosus (10) Semimembranosus (11) Gracilis (12) Adductor magnus

344

2  Atlas and Anatomy of PET/CT

Fig. 2.145 (1) Sartorius (2) Vastus medialis (3) Rectus femoris (4) Vastus intermedius

(5) Vastus lateralis (6) Left femur (7) Biceps femoris short head (8) Biceps femoris long head

(9) Semitendinosus (10) Semimembranosus (11) Gracilis (12) Adductor magnus

345

2.1 FDG

Fig. 2.146 (1) Vastus medialis (2) Soft tissue component of osteosarcoma (3) Rectus femoris (4) Femoral bone component of osteosarcoma (5) Vastus lateralis

(6) Vastus intermedius (7) Biceps femoris short head (8) Biceps femoris long head (9) Semitendinosus (10) Semimembranosus

(11) Adductor magnus (12) Gracilis (13) Sartorius

346

2  Atlas and Anatomy of PET/CT

Fig. 2.147 (1) Vastus medialis (2) Soft tissue component of osteosarcoma with central necrosis (3) Rectus femoris (4) Femoral bone component of osteosarcoma

(5) Vastus lateralis (6) Vastus intermedius (7) Biceps femoris short head (8) Biceps femoris long head (9) Semitendinosus

(10) Semimembranosus (11) Gracilis (12) Sartorius

347

2.1 FDG

Fig. 2.148 (1) Vastus medialis (2) Soft tissue component of osteosarcoma (3) Rectus femoris (4) Left femur

(5) Vastus intermedius (6) Biceps femoris short head (7) Biceps femoris long head (8) Semitendinosus

(9) Semimembranosus (10) Gracilis (11) Sartorius

348

2  Atlas and Anatomy of PET/CT

Fig. 2.149 (1) Vastus medialis (2) Vastus intermedius (3) Distal left femur

(4) Biceps femoris long head (5) Adductor magnus (6) Semitendinosus

(7) Semimembranosus (8) Gracilis (9) Sartorius

2.1 FDG

Fig. 2.150 (1) Small hypermetabolic lesion at the medial aspect of left distal femur (skip metastasis)

349

350

2  Atlas and Anatomy of PET/CT

Fig. 2.151 (1) Deltoid muscle (2) Right humerus (3) Humeral head

(4) Spine of the scapula (5) Hypermetabolic region at the right shoulder joint capsule

(6) Subscapularis (7) Triceps (8) Biceps

2.1 FDG

351

Fig. 2.152 (1) Hypermetabolic focus in shoulder joint (2) Head of the right humerus (3) Pectoralis major (4) Pectoralis minor

(5) Trapezius (6) Subscapularis (7) Spine of scapula (8) Supraspinatus

(9) Infraspinatus (10) Deltoid muscle

2.1.4.3  Case 3 A 42-year-old female patient had suffered right foot pain for 1 month. On MRI, a soft tissue mass was found in the right fourth metatarsophalangeal joint area. FDG PET/CT was performed for initial staging. On FDG PET/CT, a hypermetabolic lesion was detected in the right fourth metatarsophalangeal joint mass, which was diagnosed as a soft tissue sarcoma. Hypermetabolic LNs were also found in the right popliteal and inguinal areas, which were suspicious for metastatic LNs but proved to be inflammatory LNs (Figs. 2.153, 2.154, 2.155, 2.156, 2.157, 2.158, 2.159, and 2.160) [45, 46].

352

2  Atlas and Anatomy of PET/CT

Fig. 2.153 (1) Primary malignancy of right fourth metatarsal joint

(2) Popliteal LN metastases (3) Inguinal LN metastases

2.1 FDG

Fig. 2.154 (1) Primary malignancy at right fourth metatarsal joint

353

354

Fig. 2.155 (1) Primary malignancy of right fourth metatarsal joint

2  Atlas and Anatomy of PET/CT

2.1 FDG

Fig. 2.156 (1) Primary malignancy of right fourth metatarsal joint

355

356

2  Atlas and Anatomy of PET/CT

Fig. 2.157 (1) Popliteal LNs

(2) Inguinal LNs

2.1 FDG

357

Fig. 2.158 (1) Popliteal LNs

(2) Inguinal LNs

358

Fig. 2.159 (1) Inguinal LNs

2  Atlas and Anatomy of PET/CT

359

2.2 Non-FDG

Fig. 2.160 (1) Inguinal LNs

2.2 2.2.1

Non-FDG  C-Acetate 11

2.2.1.1  Case 1 A 56-year-old male patient suffered from flank pain. A left renal mass was found on CT, and biopsy revealed the renal mass to be renal cell carcinoma. 11C-acetate PET/CT was performed for initial staging. 11 C-acetate PET/CT demonstrated an increased uptake mass in the inferior pole of the left kidney. Enlarged LNs with increased uptake were found in both retrocrural LNs and multiple conglomerated retroperitoneal LNs, which appeared to be metastatic LNs (Figs. 2.161, 2.162, 2.163, 2.164, 2.165, and 2.166) [47, 48].

360

2  Atlas and Anatomy of PET/CT

Fig. 2.161 (1) Multiple LN metastases in retroperitoneum

Fig. 2.162 (1) Liver

(2) Spleen

(2) Left renal cell carcinoma

2.2 Non-FDG

361

Fig. 2.163 (1) Pancreas

(2) Adrenal gland metastasis, right

(3) Retrocrural lymph node metastases, both

362

2  Atlas and Anatomy of PET/CT

Fig. 2.164 (1) Multiple conglomerated retroperitoneal LN metastases

(2) Kidney, both

2.2 Non-FDG

363

Fig. 2.165 (1) Multiple conglomerated retroperitoneal LN metastases

(2) Renal cell carcinoma, left

364

2  Atlas and Anatomy of PET/CT

Fig. 2.166 (1) Multiple conglomerated retroperitoneal LN metastases

(2) Renal cell carcinoma, left

2.2.1.2  Case 2 A 69-year-old female was given a routine health check-up, and a lung nodule was found on a chest X-ray. 11C-acetate PET/CT was used for differential diagnosis of the lung nodule. 11 C-acetate PET/CT revealed increased uptake in the partly solid lung nodule in the right lower lobe. There were no abnormal lesions with increased uptake in the rest of the imaged body. The lung nodule was proved to be adenocarcinoma after lobectomy of right lower lobe (Figs. 2.167, 2.168, 2.169, 2.170, 2.171, 2.172, and 2.173) [49].

2.2 Non-FDG

365

Fig. 2.167 (1) Lung cancer (no definite focal uptake)

366

2  Atlas and Anatomy of PET/CT

Fig. 2.168 (1) Mandible

(2) Tonsil, right

(3) Parotid gland, both

367

2.2 Non-FDG

Fig. 2.169 (1) Submandibular gland, right

(2) Hyoid bone

368

2  Atlas and Anatomy of PET/CT

Fig. 2.170 (1) Septal wall, left ventricle

(2) Descending aorta

369

2.2 Non-FDG

Fig. 2.171 (1) Liver

(2) Spleen

370

2  Atlas and Anatomy of PET/CT

Fig. 2.172 (1) Pancreas

(2) Liver

(3) Kidney, left

2.2 Non-FDG

371

Fig. 2.173 (1) Left ventricle (2) Part solid lung nodule in right lower lobe with mild uptake (adenocarcinoma)

2.2.2

 C-methionine 11

2.2.2.1  Case 1 A 5-year-old male patient visited the hospital because of dizziness and vomiting. A tumorous condition in the brain was suspected on brain CT and MRI. 11C-methionine PET/CT was used for differential diagnosis of the brain mass. 11 C-methionine PET/CT demonstrated an increased uptake in the right cerebellar mass. There were no abnormal lesions with increased uptake in the rest of the brain image. The brain mass was proved to be pilocytic astrocytoma (WHO grade I) after tumor removal (Figs. 2.174, 2.175, 2.176, 2.177, 2.178, 2.179, 2.180, and 2.181) [50–52].

Fig. 2.174 (1) Brain tumor in right cerebellum (pathology: pilocytic astrocytoma)

Fig. 2.175 (1) Skull

(2) Frontal cortex, left

373

2.2 Non-FDG

Fig. 2.176 (1) Periventricular white matter

(2) Lateral ventricle

374

2  Atlas and Anatomy of PET/CT

Fig. 2.177 (1) Putamen

(2) Midbrain

2.2 Non-FDG

Fig. 2.178 (1) Midbrain (2) Brain tumor in right cerebellum (pathology: pilocytic astrocytoma)

375

376

2  Atlas and Anatomy of PET/CT

Fig. 2.179 (1) Mild uptake in pituitary gland (physiologic uptake)

(2) Brain tumor in right cerebellum (pathology: pilocytic astrocytoma)

2.2 Non-FDG

377

Fig. 2.180 (1) Intense uptake in lacrimal gland (physiologic uptake)

(2) Cerebellum

378

2  Atlas and Anatomy of PET/CT

Fig. 2.181 (1) High uptake in posterior nasopharyngeal wall, probable inflammatory process

(2) Moderate uptake in parotid gland (physiologic uptake)

2.2.2.2  Case 2 A 14-year-old male patient suffered from vomiting, tremor, and recent memory loss. On MRI, brain masses were found, and 11C-methionine PET/CT was performed for brain mass characterization. On 11C-methionine PET/CT, increased uptake was found on the pineal gland with calcification, and the suprasellar and septum pellucidum areas, which was suggestive of a brain tumor. These brain masses were diagnosed as germ cell tumors after biopsy (Figs. 2.182, 2.183, 2.184, 2.185, 2.186, 2.187, 2.188, and 2.189).

379

2.2 Non-FDG

Fig. 2.182 (1) Germ cell tumor

Fig. 2.183 (1) Skull

(2) Frontal cortex, left

380

2  Atlas and Anatomy of PET/CT

Fig. 2.184 (1) Ventricular drain

(2) Lateral ventricle, left

381

2.2 Non-FDG

Fig. 2.185 (1) Lateral ventricle (anterior horn) (2) Brain tumor (germ cell tumor) with calcification in pineal gland

(3) Lateral ventricle (posterior horn)

382

2  Atlas and Anatomy of PET/CT

Fig. 2.186 (1) Brain tumor (germ cell tumor) in septum pellucidum

(2) Interpeduncular fossa (3) Midbrain

383

2.2 Non-FDG

Fig. 2.187 (1) Brain tumor (germ cell tumor) in suprasellar area

(2) Midbrain

384

Fig. 2.188 (1) Brain tumor (germ cell tumor) in suprasellar area (2) Cerebellum

2  Atlas and Anatomy of PET/CT

385

2.2 Non-FDG

Fig. 2.189 (1) Maxillary sinus (2) Increased uptake in parotid gland, both (physiologic uptake)

2.2.3

 C-PIB 11

2.2.3.1  Case 1 A 66-year-old female was seen for a dementia work-up. 11C-­PIB PET/CT was done for a diagnosis of dementia. 11 C-PIB PET/CT demonstrated normal findings, i.e., diffusely increased uptake in the white matter while no definite uptake was found in the gray matter (Figs. 2.190, 2.191, 2.192, 2.193, 2.194, and 2.195) [53, 54].

386

2  Atlas and Anatomy of PET/CT

Fig. 2.190 (1) Skull (2) Frontal lobe (gray matter)

(3) Frontal lobe (white matter) (4) Parietal lobe (white matter)

(5) Parietal lobe (gray matter)

2.2 Non-FDG

387

Fig. 2.191 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Parietal lobe (white matter) (4) Parietal lobe (gray matter)

388

2  Atlas and Anatomy of PET/CT

Fig. 2.192 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Lateral ventricle (4) Parietal lobe (white matter)

(5) Parietal lobe (gray matter)

2.2 Non-FDG

389

Fig. 2.193 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Temporal lobe (gray matter) (4) Temporal lobe (white matter)

(5) Lateral ventricle

390

2  Atlas and Anatomy of PET/CT

Fig. 2.194 (1) Temporal lobe (gray matter)

(2) Temporal lobe (white matter)

(3) Midbrain

2.2 Non-FDG

391

Fig. 2.195 (1) Temporal lobe

(2) Pons

(3) Cerebellum

2.2.3.2  Case 2 A 71-year-old female showed memory loss symptoms. 11C-­PIB PET/CT was performed for a diagnosis of dementia. On 11C-PIB PET/CT, diffusely increased uptake of gray matter and basal ganglia was found, which was consistent with a diagnosis of Alzheimer disease (Figs. 2.196, 2.197, 2.198, 2.199, 2.200, 2.201, 2.202, 2.203, and 2.204) [55].

392

2  Atlas and Anatomy of PET/CT

Fig. 2.196 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Parietal lobe (white matter) (4) Parietal lobe (gray matter)

393

2.2 Non-FDG

Fig. 2.197 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Parietal lobe (white matter) (4) Parietal lobe (gray matter)

394

2  Atlas and Anatomy of PET/CT

Fig. 2.198 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Parietal lobe (white matter) (4) Parietal lobe (gray matter)

2.2 Non-FDG

395

Fig. 2.199 (1) Frontal lobe (gray matter) (2) Frontal lobe (white matter)

(3) Parietal lobe (white matter) (4) Parietal lobe (gray matter)

396

2  Atlas and Anatomy of PET/CT

Fig. 2.200 (1) Frontal cortex

(2) Caudate nucleus

(3) Lateral ventricle

2.2 Non-FDG

397

Fig. 2.201 (1) Frontal cortex

(2) Caudate putamen

(3) Posterior cingulate

398

2  Atlas and Anatomy of PET/CT

Fig. 2.202 (1) Orbitofrontal cortex

(2) Midbrain

(3) Temporal cortex

2.2 Non-FDG

399

Fig. 2.203 (1) Arachnoid cysts

(2) Pons

(3) Cerebellum

400

2  Atlas and Anatomy of PET/CT

Fig. 2.204 (2) Cerebellar cortex

(1) White matter of cerebellum

2.2.4

 F-FP-CIT 18

2.2.4.1  Case 1 A 66-year-old male patient had been suffering from tremor for 2 months. 18F-FP-CIT PET/CT was used for differential diagnosis of the disorder. On 18F-FP-CIT PET/CT, intensely increased uptake of the caudate nucleus, putamen, and midbrain was found. The patient was diagnosed with essential tremor (Figs. 2.205, 2.206, 2.207, 2.208, 2.209, 2.210, 2.211, and 2.212) [56, 57].

2.2.4.2  Case 2 A 54-year-old male patient underwent 18F-FP-CIT PET/CT. He had been diagnosed with Parkinson disease previously. On 18F-FP-CIT PET/CT, uptake was decreased in the bilateral putamina and more profoundly in the dorsal posterior part; these were the characteristic findings of Parkinson disease (Figs. 2.213, 2.214, 2.215, 2.216, 2.217, 2.218, 2.219, 2.220, 2.221, and 2.222) [58].

Fig. 2.205 (1) Caudate nucleus

(2) Putamen

Fig. 2.206 (1) Frontal cortex (2) Falx cerebri

(3) Parietal cortex (4) Superior sagittal sinus

402

2  Atlas and Anatomy of PET/CT

Fig. 2.207 (1) Body of caudate nucleus

(2) Lateral ventricle

403

2.2 Non-FDG

Fig. 2.208 (1) Head of caudate nucleus

(2) Putamen

404

2  Atlas and Anatomy of PET/CT

Fig. 2.209 (1) Putamen

(2) Lateral ventricle

405

2.2 Non-FDG

Fig. 2.210 (1) Midbrain (substantia nigra)

(2) Quadrigeminal plate cistern

406

2  Atlas and Anatomy of PET/CT

Fig. 2.211 (1) Dorsum sella

(2) Pons

2.2 Non-FDG

407

Fig. 2.212 (1) Moderate uptake in parotid gland (physiologic uptake)

Fig. 2.213 (1) Caudate nucleus

(2) Putamen (decreased uptake)

408

2  Atlas and Anatomy of PET/CT

Fig. 2.214 (1) Frontal cortex (2) Falx cerebri

(3) Parietal cortex (4) Superior sagittal sinus

2.2 Non-FDG

Fig. 2.215 (1) Lateral ventricle (central portion)

409

410

2  Atlas and Anatomy of PET/CT

Fig. 2.216 (1) Cingulum

(2) Body of caudate nucleus

2.2 Non-FDG

411

Fig. 2.217 (1) Lateral ventricle (anterior horn)

(2) Head of caudate nucleus

(3) Lateral ventricle (posterior horn)

412

2  Atlas and Anatomy of PET/CT

Fig. 2.218 (1) Head of caudate nucleus (2) Putamen (decreased uptake in posterior part)

(3) Lateral ventricle (posterior horn)

413

2.2 Non-FDG

Fig. 2.219 (1) Putamen (decreased uptake in posterior part)

(2) Lateral ventricle (posterior horn)

414

2  Atlas and Anatomy of PET/CT

Fig. 2.220 (1) Midbrain (substantia nigra)

(2) Quadrigeminal plate cistern

415

2.2 Non-FDG

Fig. 2.221 (1) Orbit

(2) Dorsum sellae

(3) Pons

416

2  Atlas and Anatomy of PET/CT

Fig. 2.222 (2) Cerebellum

(1) Maxillary sinus

2.2.5

 F-Flumazenil 18

2.2.5.1  Case 1 A 39-year-old male had a history of epilepsy since he was 3 years old. He was on medication. An 18F-Flumazenil PET/CT was performed for an epileptic focus evaluation. 18 F-Flumazenil PET/CT showed normal findings. Diffusely increased uptake of the whole cerebral cortex and relatively mildly increased uptake of the basal ganglia were identified, which is a normal distribution of 18F-Flumazenil in the brain (Figs. 2.223, 2.224, 2.225, 2.226, 2.227, and 2.228).

2.2 Non-FDG

417

Fig. 2.223 (1) Skull

(2) Frontal cortex

(3) Parietal cortex

418

2  Atlas and Anatomy of PET/CT

Fig. 2.224 (1) Caudate nucleus

(2) Lateral ventricle

2.2 Non-FDG

419

Fig. 2.225 (1) Caudate putamen

(2) Thalamus

(3) Occipital cortex

420

2  Atlas and Anatomy of PET/CT

Fig. 2.226 (1) Temporal cortex

(2) Midbrain

(3) Occipital cortex

2.2 Non-FDG

421

Fig. 2.227 (1) Temporal cortex

(2) Cerebellum

422

2  Atlas and Anatomy of PET/CT

Fig. 2.228 (1) Parotid gland

2.2.6

 Ga-Arginine-Glycine-Aspartic Acid (RGD) 66

2.2.6.1  Case 1 A 50-year-old female patient visited the hospital because of a palpable breast mass. The breast mass was proved to be breast cancer after biopsy. 68Ga-arginine-glycine-aspartic acid (RGD) PET/CT was done for the staging work-up of breast cancer. On 68Ga-RGD PET/CT, increased uptake was found in the left breast lesion. Another increased uptake was in an enlarged LN in the left axillary level I area, which was suggestive of metastatic cancer. These lesions were diagnosed as infiltrating duct carcinoma and metastatic LN. Mild uptake was found in the right thyroid gland, which was proved to be a benign nodule (Figs. 2.229, 2.230, 2.231, 2.232, 2.233, 2.234, 2.235, 2.236, 2.237, and 2.238) [59, 60].

2.2 Non-FDG

423

Fig. 2.229 (1) Left axillary LN metastasis

(2) Left breast cancer

424

2  Atlas and Anatomy of PET/CT

Fig. 2.230 (1) Temporal lobe, right

(2) Cerebellum, left

2.2 Non-FDG

Fig. 2.231 (1) Thyroid nodule, right

425

426

2  Atlas and Anatomy of PET/CT

Fig. 2.232 (1) Axillary LN metastasis, left

(2) Descending aorta

2.2 Non-FDG

427

Fig. 2.233 (1) Breast cancer, left

(2) Myocardium

428

2  Atlas and Anatomy of PET/CT

Fig. 2.234 (1) Liver

(2) Spleen (physiologic uptake)

2.2 Non-FDG

429

Fig. 2.235 (1) Head of pancreas

(2) Kidney, both (physiologic uptake)

430

Fig. 2.236 (1) Ureter, both (physiologic uptake)

2  Atlas and Anatomy of PET/CT

2.2 Non-FDG

Fig. 2.237 (1) Uterus (physiologic uptake)

431

432

2  Atlas and Anatomy of PET/CT

Fig. 2.238 (1) Bladder

2.2.7

 Ga-DOTA-TOC 68

2.2.7.1  Case 1 A 54-year-old female patient suffered general weakness and headache. On brain MRI, two masses were found in the cerebellum, which were thought to be hemangioblastomas. On abdominal CT, multiple masses in both the kidneys and the pancreas head were found. 68 Ga-DOTA-TOC PET/CT was performed for evaluation of the masses. On 68Ga-DOTA-TOC PET/CT images, increased uptake was found in cerebellar masses and a pancreas head mass, which were suggestive of hemangioblastoma and a neuroendocrine tumor. However, no definite uptake was found in the multiple kidney masses. The pancreatic lesion was proved to be a neuroendocrine tumor, and the kidney lesions were diagnosed as renal cell carcinoma after surgery. Finally, the patient was diagnosed with von Hippel-Lindau disease (Figs. 2.239, 2.240, 2.241, 2.242, 2.243, 2.244, and 2.245) [61, 62].

2.2 Non-FDG

433

Fig. 2.239 (1)  Hemangioblastoma of right cerebellum (2)  Hemangioblastoma of left cerebellum

(3) Liver (physiologic uptake) (4) Spleen (physiologic uptake) (5)  Neuroendocrine tumor of pancreas head

(6) Renal cell carcinoma of left kidney lower pole

434

2  Atlas and Anatomy of PET/CT

Fig. 2.240 (1) Hemangioblastoma of right cerebellum

(2) Hemangioblastoma of left cerebellum

2.2 Non-FDG

435

Fig. 2.241 (1) Hemangioblastoma of right cerebellum

(2) Hemangioblastoma of left cerebellum

436

2  Atlas and Anatomy of PET/CT

Fig. 2.242 (1) Liver (physiologic uptake) (2) Spleen (physiologic uptake)

(3) Neuroendocrine tumor of pancreas head

(4)  Renal cell carcinoma of left kidney lower pole

2.2 Non-FDG

437

Fig. 2.243 (1) Liver (physiologic uptake) (2) Spleen (physiologic uptake)

(3) Neuroendocrine tumor of pancreatic head

(4)  Renal cell carcinoma of left kidney lower pole

438

2  Atlas and Anatomy of PET/CT

Fig. 2.244 (1) Liver (physiologic uptake) (2) Spleen (physiologic uptake) (3)  Neuroendocrine tumor of pancreatic head

(4)  Renal cell carcinoma of left kidney lower pole

439

2.2 Non-FDG

Fig. 2.245 (1) Liver (physiologic uptake) (2) Spleen (physiologic uptake)

(3) Neuroendocrine tumor of pancreatic head

(4)  Renal cell carcinoma of left kidney lower pole

440

2  Atlas and Anatomy of PET/CT

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441 25. Epelbaum R, Frenkel A, Haddad R, Sikorski N, Strauss LG, Israel O et al (2013) Tumor aggressiveness and patient outcome in cancer of the pancreas assessed by dynamic 18F-FDG PET/CT. J Nucl Med 54:12–8 26. Heinrich S, Goerres GW, Schäfer M, Sagmeister M, Bauerfeind P, Pestalozzi BC et al (2005) Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 242:235 27. Tsurusaki M, Okada M, Kuroda H, Matsuki M, Ishii K, Murakami T (2014) Clinical application of 18F-fluorodeoxyglucose positron emission tomography for assessment and evaluation after therapy for malignant hepatic tumor. J Gastroenterol 49:46–56 28. Song MJ, Bae SH, Lee SW, Kim HY, Yoo IR, Choi J-I et al (2013) 18F-fluorodeoxyglucose PET/CT predicts tumour progression after transarterial chemoembolization in hepatocellular carcinoma. Eur J Nucl Med Mol Imaging 40:865–73 29. Talbot J-N, Fartoux L, Balogova S, Nataf V, Kerrou K, Gutman F et al (2010) Detection of hepatocellular carcinoma with PET/CT: a prospective comparison of 18F-fluorocholine and 18F-FDG in patients with cirrhosis or chronic liver disease. J Nucl Med 51:1699–706 30. Schierz J-H, Opfermann T, Steenbeck J, Lopatta E, Settmacher U, Stallmach A et al (2013) Early dynamic 18F-FDG PET to detect hyperperfusion in hepatocellular carcinoma liver lesions. J Nucl Med 54:848–54 31. Sun L, Guan Y-S, Pan W-M, Luo Z-M, Wei J-H, Zhao L et al (2009) Metabolic restaging of hepatocellular carcinoma using whole-body 18F-FDG PET/CT. World J Hepatol 1:90 32. Kijima S, Sasaki T, Nagata K, Utano K, Lefor AT, Sugimoto H (2014) Preoperative evaluation of colorectal cancer using CT colonography, MRI, and PET/CT. World J Gastroenterol 20:16964–74 33. Engelmann BE, Loft A, Kjær A, Nielsen HJ, Gerds TA, Benzon EV et al (2014) Positron emission tomography/computed tomography and biomarkers for early treatment response evaluation in metastatic colon cancer. Oncologist 19:164–72 34. Bipat S, Niekel M, Comans E, Nio C, Bemelman W, Verhoef C et al (2012) Imaging modalities for the staging of patients with colorectal cancer. Neth J Med 70:26–34 35. Brush J, Boyd K, Chappell F, Crawford F, Dozier M, Fenwick E et al (2011) The value of FDG positron emission tomography/computerised tomography (PET/CT) in pre-operative staging of colorectal cancer: a systematic review and economic evaluation. Health Technol Assess 15:1–192 36. Grassetto G, Capirci C, Marzola MC, Rampin L, Chondrogiannis S, Musto A et al (2012) Colorectal cancer: prognostic role of 18F-FDG-PET/CT. Abdom Imaging 37:575–9 37. Metser U, Hussey D, Murphy G (2014) Impact of 18F-FDG PET/CT on the staging and management of follicular lymphoma. Br J Radiol 87:1042 38. Gallamini A, Borra A (2014) Role of PET in lymphoma. Curr Treat Options Oncol 15:248–61 39. Chavdarova LI, Tzonevska AD, Piperkova EN (2012) Discrepancies and priorities in staging and restaging malignant lymphoma by SPET, SPET/CT, PET/CT and PET/MRI. Hell J Nucl Med 16:223–9 40. Le Dortz L, De Guibert S, Bayat S, Devillers A, Houot R, Rolland Y et al (2010) Diagnostic and prognostic impact of 18F-FDG PET/CT in follicular lymphoma. Eur J Nucl Med Mol Imaging 37:2307–14 41. Quartuccio N, Fox J, Kuk D, Wexler LH, Baldari S, Cistaro A et al (2015) Pediatric bone sarcoma: diagnostic performance of 18F-­FDG PET/CT versus conventional imaging for initial staging and follow-up. Am J Roentgenol 204:153–60 42. Costelloe CM, Chuang HH, Madewell JE (2014) FDG PET/CT of primary bone tumors. Am J Roentgenol 202:W521–31 43. Quartuccio N, Treglia G, Salsano M, Mattoli MV, Muoio B, Piccardo A et al (2013) The role of Fluorine-18-Fluorodeoxyglucose positron emission tomography in staging and restaging of patients with osteosarcoma. Radiol Oncol 47:97–183 44. Walter F, Federman N, Apichairuk W, Nelson S, Phelps ME, Allen-Auerbach M et al (2011) 18F-fluorodeoxyglucose uptake of bone and soft tissue sarcomas in pediatric patients. Pediatr Hematol Oncol 28:579–87 45. Charest M, Hickeson M, Lisbona R, Novales-Diaz J-A, Derbekyan V, Turcotte RE (2009) FDG PET/ CT imaging in primary osseous and soft tissue sarcomas: a retrospective review of 212 cases. Eur J Nucl Med Mol Imaging 36:1944–51 46. Fuglø HM, Jørgensen SM, Loft A, Hovgaard D, Petersen MM (2012) The diagnostic and prognostic value of 18F-FDG PET/CT in the initial assessment of high-grade bone and soft tissue sarcoma: a retrospective study of 89 patients. Eur J Nucl Med Mol Imaging 39:1416–24 47. Oyama N, Okazawa H, Kusukawa N, Kaneda T, Miwa Y, Akino H et al (2009) 11C-Acetate PET imaging for renal cell carcinoma. Eur J Nucl Med Mol Imaging 36:422–7

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2  Atlas and Anatomy of PET/CT 48. Grassi I, Nanni C, Allegri V, Morigi JJ, Montini GC, Castellucci P et al (2012) The clinical use of PET with (11)C-acetate. Am J Nucl Med Mol Imaging 2:33–47 49. Higashi K, Ueda Y, Matsunari I, Kodama Y, Ikeda R, Miura K et al (2004) 11C-acetate PET imaging of lung cancer: comparison with 18F-FDG PET and 99mTc-MIBI SPET. Eur J Nucl Med Mol Imaging 31:13–21 50. Ogawa T, Shishido F, Kanno I, Inugami A, Fujita H, Murakami M et al (1993) Cerebral glioma: evaluation with methionine PET. Radiology 186:45–53 51. Singhal T, Narayanan TK, Jacobs MP, Bal C, Mantil JC (2012) 11C-Methionine PET for grading and prognostication in gliomas: a comparison study with 18F-FDG PET and contrast enhancement on MRI. J Nucl Med 53:1709–15 52. Kato T, Shinoda J, Nakayama N, Miwa K, Okumura A, Yano H et al (2008) Metabolic assessment of gliomas using 11C-methionine, [18F] fluorodeoxyglucose, and 11C-choline positron-emission tomography. Am J Neuroradiol 29:1176–82 53. Ikonomovic MD, Klunk WE, Abrahamson EE, Mathis CA, Price JC, Tsopelas ND et al (2008) Postmortem correlates of in vivo PiB-PET amyloid imaging in a typical case of Alzheimer’s disease. Brain 131(Pt 6):1630–45 54. Zhang S, Smailagic N, Hyde C, Noel-Storr AH, Takwoingi Y, McShane R et al (2014) (11)C-PIBPET for the early diagnosis of Alzheimer's disease dementia and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev 7:CD010386 55. Cohen AD, Klunk WE. Early detection of Alzheimer’s disease using PiB and FDG PET. Neurobiol Dis. 2014;72, Part A(0):117–22. 56. Wang J, Zuo C-T, Jiang Y-P, Guan Y-H, Chen Z-P, Xiang J-D et al (2007) 18F-FP-CIT PET imaging and SPM analysis of dopamine transporters in Parkinson’s disease in various Hoehn & Yahr stages. J Neurol 254:185–90 57. Song I-U, Chung Y-A, Oh J-K, Chung S-W (2014) An FP-CIT PET comparison of the difference in dopaminergic neuronal loss in subtypes of early Parkinson’s disease. Acta Radiol 55:366–71 58. Lorberboym M, Treves TA, Melamed E, Lampl Y, Hellmann M, Djaldetti R (2006) [123I]‐FP/CIT SPECT imaging for distinguishing drug‐induced parkinsonism from Parkinson’s disease. Mov Disord 21:510–14 59. Yoon H-J, Kang K, Chun I, Cho N, Im S-A, Jeong S et al (2014) Correlation of breast cancer subtypes, based on estrogen receptor, progesterone receptor, and HER2, with functional imaging parameters from 68Ga-RGD PET/CT and 18F-FDG PET/CT. Eur J Nucl Med Mol Imaging ­ 41:1534–43 60. Beer AJ, Haubner R, Sarbia M, Goebel M, Luderschmidt S, Grosu AL et al (2006) Positron emission tomography using [18F]Galacto-­RGD identifies the level of integrin αvβ3 expression in man. Clin Cancer Res 12:3942–9 61. Kroiss A, Putzer D, Decristoforo C, Uprimny C, Warwitz B, Nilica B et al (2013) 68Ga-DOTA-TOC uptake in neuroendocrine tumour and healthy tissue: differentiation of physiological uptake and pathological processes in PET/CT. Eur J Nucl Med Mol Imaging 40:514–23 62. Oh J-R, Kulkarni H, Carreras C, Schalch G, Min J-J, Baum RP (2012) Ga-68 Somatostatin receptor PET/CT in von Hippel-Lindau disease. Nucl Med Mol Imaging 46:129–33

3

Atlas and Anatomy of SPECT/CT

The successful application of computer algorithms to radiographic imaging in computed tomography (CT) has led to their use to radionuclide technique and to the advent of singlephoton emission computed tomography (SPECT), which offers many advantages over twodimensional planar images. SPECT permits precise three-dimensional (3D) localization of radiopharmaceutical distribution with the possibility of quantification and also cinematic representation of the organ or pathology imaged. It shows improved image contrast and characterizes the pathologic lesion based on CT findings. The hybrid SPECT/CT is capable of performing anatomic and functional imaging sequentially and improves the accuracy of SPECT interpretation, quantifies radiation dosimetry, and leads to improved patient management. Anatomic CT maps facilitate precise localization of the SPECT findings, allow for exclusion of pathology in sites of physiologic tracer uptakes, and can be used for attenuation and scatter correction of the emission data. SPECT is relatively simple to perform, is widely available, allows multiple time-pointed imaging to better study biological processes, and is less expensive than positron emission tomography (PET). SPECT is also expected to have a better spatial contrast resolution using cadmium-zinc-telluride (CZT) multiple detectors. This chapter illustrates SPECT/CT images mostly in oncologic cases to point out crosssectional anatomy as well as 3D demonstration of common pathologies. It is anticipated that SPECT/CT will be more utilized in neurology and cardiology, as well as in bone and joint diseases.

3.1

Tumors

3.1.1

Hepatocellular Carcinoma

3.1.1.1 Case 1 A 51-year-old man presented with hepatocellular carcinoma. Selected SPECT (top) and SPECT/CT (bottom) of the liver with 99mTc-MAA particles injected into a hepatic arterial catheter showed several focal areas of slightly to moderately increased activity in the right and left hepatic lobes corresponding to multicentric hepatoma. Only 50 % of hepatomas can be imaged with FDG-PET because of the high levels of phosphatase that dephosphorylate FDG and allow it to diffuse out of cells (Fig. 3.1) [1, 2].

© Springer International Publishing Switzerland 2016 E.E. Kim et al., Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT, DOI 10.1007/978-3-319-28652-5_3

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3.1.2

Liver Metastases

3.1.2.1 Case 1 A 68-year-old female was seen with hepatic metastasis of breast cancer. Selected SPECT (top) and SPECT/CT (bottom) of the liver with 99mTc-MAA into the hepatic arterial catheter showed a markedly heterogeneous activity in the liver caused by known metastases. There was no extra hepatic activity (Fig. 3.2) [3].

3.1.2.2 Case 2 Selected SPECT (top) and SPECT/CT (bottom) of the upper abdomen with 99mTc-MAA particles into a hepatic arterial catheter showed curvilinear activity along the gastric wall, indicating the suboptimal position of the hepatic arterial catheter (Fig. 3.3) [4].

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Fig. 3.2

99m

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Tc-MAA SPECT/CT

3.1.2.3 Case 3 A 57-year-old female with hepatic metastasis of breast cancer was evaluated. Selected PET (top) and PET/CT (bottom) images of the liver with 90Y microspheres injected into a hepatic arterial catheter showed radioactivity in the right and left hepatic lobes, corresponding to metastatic lesions (Fig. 3.4) [5].

3.1.3

Neuroendocrine Tumor

3.1.3.1 Case 1 A 51-year-old male presented with chest tightness and dyspnea. 111In-octreotide SPECT/CT was done. Focal increased activity in the pericardium is shown by arrow 8. The surgical diagnosis was metastatic pancreatic neuroendocrine tumor (Fig. 3.5) [6].

3.1.3.2 Case 2 A 72-year-old male presented with a history of midgut carcinoid and pain in the right shoulder and the right abdomen. 111In-octreotide SPECT/CT was performed. Focal increased activity in the glenoid portion of right scapula is denoted by 2, and the right hepatic lobe with a donut shape is denoted by 9.

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Fig. 3.3

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Tc-MAA SPECT/CT

The clinical diagnosis was metastatic neuroendocrine tumors in the right scapula and the right side of the liver (Fig. 3.6) [7].

3.1.3.3 Case 3 A 71-year-old male with abdominal pain and diarrhea was examined. 111 In-octreotide SPECT/CT was done. Markedly increased activity in the distal pancreas denoted by 1 and focal increased activity in the portal vein denoted by 4 were noted. There was also an Increased serum level of chromogranin-A. The clinical diagnosis was a probable nonfunctioning pancreatic neuroendocrine tumor with invasion into the portal vein (Fig. 3.7) [8].

3.1.3.4 Case 4 A 62-year- old female presented with a history of midgut carcinoid, cough, dyspnea, and abdominal pain. 111 In-octreotide SPECT/CT was done. A large mass in the right adrenal gland was found denoted by 5 on CT with no uptake of the activity, and there was focal increased activity in the right upper lung denoted by 3.

3.1

Tumors

Fig. 3.4

90

447

Y PET/CT

The surgical diagnosis was right adrenal carcinoma and metastatic neuroendocrine tumor in the right upper lung (Fig. 3.8) [9].

3.1.3.5 Case 5 A 54-year-old female with a history of rectal carcinoid and the development of abdominal pain was seen. Elevated serum levels of chromogranin-A were found. 111 In-octreotide SPECT/CT was done. There was focal increased activity in the right hepatic lobe (segment V denoted by 5, segment 6 denoted by 4). The clinical diagnosis was metastatic neuroendocrine tumors in the right hepatic lobe (Fig. 3.9) [10].

3.1.3.6 Case 6 A 53-year-old female patient had a history of small bowel carcinoid and the development of abdominal pain. 111 In-octreotide SPECT/CT was done. Focal increased activity was found in the right hepatic lobe between segments VII and VIII denoted by 4 as well as segments II and III denoted by 5. The clinical diagnosis was metastatic neuroendocrine tumors in the right hepatic lobe (Fig. 3.10) [11].

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Fig. 3.5 (1) Paraspinalis muscle (2) Transverse process (3) Vertebral body (4) Rib

(5) Liver (6) Sternum (7) Left ventricle (8) Metastasis in pericardium

(9) Left lower lobe of lung (10) Descending aorta (11) Left kidney

3.1.3.7 Case 7 A 70-year-old male with abdominal pain and diarrhea was evaluated. 111 In-octreotide SPECT/CT was done. Focal increased activity was seen in the distal pancreatic body denoted by 6. The clinical diagnosis was a pancreatic neuroendocrine tumor (Fig. 3.11) [12].

3.1.3.8 Case 8 A 74-year-old female presented with abdominal pain and diarrhea. 111 In-octreotide SPECT/CT was done. Focal increased activity in the area of pancreatic head was observed. The surgical diagnosis was a pancreatic neuroendocrine tumor (Fig. 3.12) [13].

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449

Fig. 3.6 (1) Right subscapularis muscle (2) Metastasis in right scapula neck (3) Right supraspinatus muscle

(4) Right humerus (5) Right clavicle (6) Left pectoralis minor muscle

(7) Left pectoralis major muscle (8) Vertebral body (9) Liver metastasis with central necrosis

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Atlas and Anatomy of SPECT/CT

Fig. 3.7 (1) NE tumor in pancreatic tail (2) Abdominal aorta (3) Vertebral body (4) NE tumor in portal vein

(5) Liver, S6 (6) Liver, S5 (7) Liver, S4 (8) Liver, S1

(9) Stomach (10) Spleen

3.1

Tumors

451

Fig. 3.8 (1) Aortic arch (2) Vertebral body

(3) NE tumor in RUL (4) Trachea

(5) Right adrenal cancer

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Fig. 3.9 (1) Left kidney (2) Vertebral body

(3) Right kidney (4) NE tumor in liver S6

(5) NE tumor in liver S5 (6) Abdominal aorta

3.1

Tumors

453

Fig. 3.10 (1) Spleen (2) Left kidney

(3) Vertebral body (4) NE metastasis in liver right lobe

(5) NE metastasis in liver left lobe

3

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Fig. 3.11 (1) Spleen (2) Left adrenal gland

(3) Abdominal aorta (4) Right kidney

(5) Gall bladder (6) NE tumor in pancreatic tail

3.1

455

Tumors

Fig. 3.12 (1) Spleen (2) Abdominal aorta

(3) Liver (4) Gall bladder

(5) NE tumor in pancreatic body (6) Stomach

3.1.3.9 Case 9 A 67-year-old male with hypertension, abdominal pain, and palpitations was seen. He had elevated urinary catecholamines. 123 I-MIBG SPECT/CT was done. The left adrenal gland was nodular and showed markedly increased activity denoted by 8. The surgical diagnosis was a pheochromocytoma of the left adrenal gland (Fig. 3.13) [14].

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Fig. 3.13 (1) Spleen (2) Abdominal aorta (3) Liver, S6

(4) Liver, S5 (5) IVC (6) Portal vein

(7) Stomach (8) Left adrenal pheochromocytoma

3.1.3.10 Case 10 A 74-year-old male presented with hypertension, headache, and anxiety. Elevated urinary catecholamines were found. On 123I-MIBG SPECT/CT, markedly increased activity was seen in the right adrenal mass denoted by 2 and focal increased activity in the T2 vertebral body.

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457

Fig. 3.14 (1) Left kidney (2) Right adrenal pheochromocytoma (3) Liver

(4) Ascending colon (5) Right kidney (6) Transverse colon

(7) Abdominal aorta (8) Descending colon (9) Metastasis in T2 spine

The surgical diagnosis was pheochromocytoma in the right adrenal gland with metastasis in the T2 vertebral body (Fig. 3.14) [15].

3.1.3.11 Case 11 A 77-year-old male with a history of left adrenalectomy for pheochromocytoma and the development of palpitations and uncontrolled hypertension showed elevated urinary catecholamines.

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Fig. 3.15 (1) Left kidney (2) Right kidney (3) Liver

(4) Gall bladder (5) Pancreas (6) Abdominal aorta

(7) Left adrenal pheochromocytoma (8) Spleen

123

I-MIBG SPECT/CT was done. Focal increased activity was found in the left adrenal bed. The surgical diagnosis was recurrent pheochromocytoma (Fig. 3.15) [16].

3.1.3.12 Case 12 A 68-year-old female with history of midgut carcinoid and melanoma developed cheat pain and dyspnea. She had elevated serum levels of chromogranin-A.

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Fig. 3.16 (1) Left main bronchus (2) Right main bronchus (3) Rib

(4) NE metastasis in right lung (5) Ascending aorta (6) Pulmonary trunk

(7) Descending aorta

An 111In-octreotide SPECT/CT was done. Focal increased activity was found in the right upper lung, denoted by 4. The surgical diagnosis was metastatic neuroendocrine tumor (Fig. 3.16) [17].

3.1.3.13 Case 13 A 76-year-old-male with a history of midgut carcinoid and the development of abdominal and right hip pain was seen.

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Elevated serum levels of chromogranin-A were found. An 111In-octreotide SPECT/CT was done. Focal increased activity was found in the right and left hepatic lobes denoted by 1 and in the right sacrum denoted by 4. The clinical diagnosis was metastatic neuroendocrine tumors in the liver and right sacrum (Fig. 3.17) [18].

3.1.3.14 Case 14 A 64-year-old female presented with a neuroendocrine tumor in the pancreatic tail. Selected SPECT (top) and SPECT/CT (bottom) images of the upper abdomen with 111In-octreotide showed a focal area of slightly increased activity in the pancreatic tail. Neuroendocrine cells are in the intestine, stomach, and lungs and are a cross between hormone-producing endocrine and nerve cells. Neuroendocrine tumors are usually benign, but some are malignant. The sensitivity for detecting neuroendocrine tumors using octreoscan is 82–95 %. Physiologic uptake of the agent is in the pituitary gland, thyroid, liver, spleen, urinary tract, or bowel. False positive findings can occur in activated lymphocytes of inflammatory lesions such as those in sarcoidosis or thyroiditis (Fig. 3.18) [19, 20].

3.1.3.15 Case 15 A 52-year-old male with carcinoid was seen. Selected 111In-octreotide SPECT (top) and SPECT/CT (bottom) images of the liver show a focal area of moderately increased activity in the posteroinferior segment of the right hepatic lobe. Carcinoid is a slow-growing type of neuroendocrine tumor and most often develops in the small intestine. It can also occur in the lungs, stomach, pancreas, testicle, or ovary. It can make neuropeptides such as serotonin and amines such as chromogranin A. Patients often present with abdominal pain, flushing, and diarrhea (Fig. 3.19) [21, 22].

3.1.3.16 Case 16 A 46-year-old female presented with a neuroendocrine tumor in the pancreatic head. Selected SPECT (top) and SPECT/CT (bottom) images of the upper and mid-abdomen with 111 In-octreotide showed a focal area of slightly to moderately increased activity in the right mid-abdomen anteriorly, just behind the rectus abdominis, due to omental metastasis. Also noted are several metastatic lesions in the superior segment of the right hepatic lobe (Fig. 3.20) [23, 24].

3.1.3.17 Case 17 A 41-year-old male was seen with a history of carcinoid. SPECT (top) and SPECT/CT (bottom) Images of the mid-abdomen with 111In-octreotide showed a focal area of moderately increased activity in the middle to lower abdomen caused by mesenteric metastasis. Also noted were two metastatic lesions in the right hepatic lobe (Fig. 3.21) [25].

3.1.3.18 Case 18 A 49-year-old male patient with a neuroendocrine tumor in the pancreatic body and tail was seen. Selected SPECT (top) and SPECT/CT (bottom) images of the upper abdomen with 111 In-octreotide showed markedly increased activity in the primary tumor as well as metastases in the perigastric lymph node and the right side of the liver (Fig. 3.22) [26].

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Tumors

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Fig. 3.17 (1) Multiple liver metastases (2) Stomach

(3) Spleen (4) Metastasis in sacrum

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Fig. 3.18

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In-Octreotide SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.19

111

In-Octreotide SPECT/CT

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Fig. 3.20

3

111

In-Octreotide SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.21

111

In-Octreotide SPECT/CT

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Fig. 3.22

3

Atlas and Anatomy of SPECT/CT

111

In-Octreotide SPECT/CT

3.1.3.19 Case 19 A 39-year-old male with lung carcinoid was evaluated. Selected SPECT (top) and SPECT/CT (bottom) images of the chest with 111In-octreotide showed a focal area of moderately increased activity in the right hilar carcinoid. Also noted was postobstructive atelectasis in the superior segment of the right lower lobe (Fig. 3.23) [27, 28].

3.1.3.20 Case 20 A 51-year-old female with a neuroendocrine tumor in the proximal transverse colon was examined. SPECT (top) and SPECT/CT (bottom) images of the upper-mid abdomen with 111 In-octreotide showed a focal area of moderately increased activity in the proximal transverse colon (Fig. 3.24) [29].

3.1.3.21 Case 21 A 47-year-old male presented with a history of carcinoid. Selected 111In-octreotide SPECT (top) and SPECT/CT (bottom) images of the pelvis showed focal increased activity in the left obturator lymph node as a result of a metastatic neuroendocrine tumor (Fig. 3.25) [30].

3.1

Tumors

Fig. 3.23

111

In-Octreotide SPECT/CT

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Fig. 3.24

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Atlas and Anatomy of SPECT/CT

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In-Octreotide SPECT/CT

3.1.4

Neuroblastoma

3.1.4.1 Case 1 A 3-year-old female with neuroblastoma was seen. SPECT (top) and SPECT/CT (bottom) images of the abdomen with 123I-MIBG showed a focal area of moderately increased activity in the left lower abdomen, abutting the left psoas muscle. Neuroblastoma is a neural crest cell tumor arising from the sympathetic chain, commonly in the adrenal gland, and the mean age at the diagnosis is 2 years old. Metastases maybe found in 75 % of these patients. Calcification is seen in 50 %. The tumor tends to encase vessels. Metaiodobenzylguanidine (MIBG) is similar to norepinephrine and is taken up by chromaffin granules that are in neuroblastoma and pheochromocytoma (Fig. 3.26) [31, 32].

3.1.5

Paraganglioma

3.1.5.1 Case 1 A 59-year-old male with hypertension and perspiration was examined. Elevated levels of urinary catecholamines were found. On 123I-MIBG SPECT/CT, focal increased activity was found in the left kidney and the aortocaval area. The surgical diagnosis was paraganglioma (Fig. 3.27) [23].

3.1

Tumors

Fig. 3.25

111

In-Octreotide SPECT/CT

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Fig. 3.26

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Atlas and Anatomy of SPECT/CT

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I-MIBG SPECT/CT

3.1.5.2 Case 2 A 57-year-old female with a history of paraganglioma in the left adrenal gland was seen. SPECT (top) and SPECT/CT (bottom) images of upper abdomen including the lower chest with 123I-MIBG showed focal areas of moderately increased activity in the inferior segment of the right hepatic lobe and also a T8 body due to metastases (Fig. 3.28) [33, 34].

3.1.6

Thyroid Cancer

3.1.6.1 Case 1 Thyroid cancer and multiple lung metastases were suspected from coronary CT, which was done because of chest pain in a 59-year-old male patient. Total thyroidectomy and videoassisted thoracoscopic biopsy for a lung nodule proved the diagnosis. After the surgery, to treat lung metastases, 200 mCi of 131I was administered. At the time of the treatment, the stimulated serum Tg level was 515.6 ng/mL. On 131I SPECT/CT, multiple round nodules with moderately to intensely increased iodine uptake were found in both lungs, suggesting iodine-avid metastases (Figs. 3.29, 3.30, 3.31, 3.32, 3.33, 3.34, 3.35, 3.36, 3.37, 3.38, and 3.39) [35, 36].

3.1

Tumors

471

Fig. 3.27 (1) Abdominal aorta (2) Metastatic paraganglioma in aortacaval area

(3) IVC (4) Right kidney (5) Liver, left lobe

(6) Pancreas (7) Stomach (8) Renal paraganglioma

472

Fig. 3.28

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I-MIBG SPECT/CT

Fig. 3.29 (1) Lung metastases

(2) Physiologic colonic uptake

Atlas and Anatomy of SPECT/CT

3.1

Tumors

473

Fig. 3.30 (1) Left neck LN level Ib (2) Left submandibular gland

(3) Left neck LN level IIa (4) Left sternocleidomastoid muscle

(5) Left neck LN level IIb

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3

Fig. 3.31 (1) Hyoid bone (2) Left sternocleidomastoid muscle

(3) Left neck level IIb (4) Left neck level Va

Atlas and Anatomy of SPECT/CT

3.1

Tumors

475

Fig. 3.32 (1) Cricoid cartilage (2) Left sternocleidomastoid muscle

(3) Left neck level III (4) Left neck level Va

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Fig. 3.33 (1) Thyroid bed (2) Left neck level VI

(3) Left sternocleidomastoid muscle (4) Left neck level IV

Atlas and Anatomy of SPECT/CT

3.1

Tumors

477

Fig. 3.34 (1) Trachea

(2) Esophagus

(3) Left lung upper lobe

478

3

Fig. 3.35 (1) Trachea (2) Left upper lobe

(3) Left oblique fissure (4) LLL superior segment metastatic nodule

Atlas and Anatomy of SPECT/CT

3.1

Tumors

479

Fig. 3.36 (1) RML anterior segment metastatic nodule (2) Right lung minor fissure

(3) Right lung major fissure (4) Right bronchus intermedius

(5) RLL superior segment metastatic nodule

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Fig. 3.37 (1) Left lower lung lobe superior segment metastatic nodule

(2) Left lower lung lobe lateral basal segment metastatic nodule

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.38 (1) Left lower posterior basal segment metastatic nodule

481

482

3

Atlas and Anatomy of SPECT/CT

Fig. 3.39 (1) Liver, right lobe (2) Stomach

(3) Colon (4) Spleen

3.1.6.2 Case 2 A 34-year-old female patient with thyroid cancer underwent a total thyroidectomy and central neck dissection. On 131I ablation scan, bone metastasis was revealed. 250 mCi of 131I treatment for bone metastasis was done and a post-treatment iodine scan and SPECT/CT were taken. Intense focal iodine uptakes were found in T4 and T6, suggesting iodine-avid bone metastases (Figs. 3.40, 3.41, 3.42, 3.43, 3.44, 3.45, and 3.46) [37, 38].

3.1.6.3 Case 3 A 52-year-old female who had a total thyroidectomy for follicular thyroid cancer returned for treatment with a rising level of serum thyroglobulin. Selected SPECT (top) and SPECT/CT (bottom) images of the neck and chest with 131I show intensely increased activity in the right

3.1

Tumors

483

Fig. 3.40 (1) Submandibular glands (2) Body of mandible (3) Genioglossus

(4) Trachea (5) Sternocleidomastoid muscle (6) C2 spine

(7) Obliquus capitis inferior muscle

484

3

Atlas and Anatomy of SPECT/CT

Fig. 3.41 (1) Right scapula (2) Right lung apex (3) Right subclavian artery

(4) Right clavicle (5) Right common carotid artery (6) Trachea

(7) Left internal jugular vein (8) Left subclavian vein (9) T2 spine

3.1

Tumors

485

Fig. 3.42 (1) Lung (2) Breast (3) Superior vena cava

(4) Ascending aorta (5) Left pulmonary artery (6) Left forth rib

(7) Vertebral arch of T4 spine (metastasis)

486

3

Atlas and Anatomy of SPECT/CT

Fig. 3.43 (1) Lung parenchyme (2) Right fourth rib (3) Right atrium

(4) Sternum (5) Left breast parenchyme (6) Left ventricle

(7) Descending aorta (8) Vertebral body of T6 (Metastasis)

3.1

Tumors

487

Fig. 3.44 (1) Liver (2) Descending aorta

(3) Transverse colon (4) Stomach

(5) Diaphragm

488

3

Atlas and Anatomy of SPECT/CT

Fig. 3.45 (1) Right kidney (2) Liver (3) Inferior vena cava

(4) Transverse colon (5) Body of pancreas (6) Descending aorta

(7) Jejunum (8) Left kidney (9) Spleen

thoracic inlet as well as slightly increased activity in the left lower lung caused by to metastases (Fig. 3.47) [39].

3.1.6.4 Case 4 A 47-year-old female who had had a total thyroidectomy for papillary thyroid cancer returned for treatment with a rising level of serum thyroglobulin. Selected SPECT (top) and SPECT/CT (bottom) images of the neck and chest with 123I showed a focal area of moderately increased activity in the right thoracic inlet due to metastasis (Fig. 3.48).

3.1.6.5 Case 5 A 62-year-old female had a thyroidectomy for cancer 6 months earlier and returned for a routine follow-up. She did not have rising serum levels of thyroglobulin. Selected SPECT (top) and SPECT/CT (bottom) with 131I demonstrated a focal area of moderately increased activity in the left thyroid bed due to residual functioning thyroid tissue (Fig. 3.49).

3.1

Tumors

489

Fig. 3.46 (1) Right kidney (2) Ascending colon (3) Transverse colon

(4) Inferior vena cava (5) Descending aorta (6) Jejunum

(7) Left kidney

490

Fig. 3.47

3

131

I SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.48

123

I SPECT/CT

491

492

Fig. 3.49

3

Atlas and Anatomy of SPECT/CT

131

I SPECT/CT

3.1.7

Parathyroid Adenoma

3.1.7.1 Case 1 A 63-year-old male patient presented with hypercalcemia and weight loss. In his laboratory examination, his serum calcium, phosphorus, and parathyroid hormone levels were 12.1, 2.3, and 112 pg/mL, respectively. Because of suspicion of primary hyperparathyroidism, a 99mTcMIBI parathyroid adenoma scan and SPECT/CT were done. In the image, focal delayed uptake was found in lower aspect of right thyroid gland suggesting parathyroid adenoma (Figs. 3.50, 3.51, 3.52, 3.53, 3.54, 3.55, 3.56, 3.57, 3.58, and 3.59) [40–43].

3.1.7.2 Case 2 A 63-year-old female who had been diagnosed with a parathyroid adenoma (type F) was seen. Selected SPECT (top) and SPECT/CT (bottom) of the neck and chest with 99mTc-MIBI showed a focal area of moderately increased activity in the right lower anterior mediastinum. The parathyroid glands are located near or at the back of the thyroid and produce parathyroid hormone to control calcium and phosphorus balance. Parathyroid adenoma is a benign tumor and causes hyperparathyroidism (Fig. 3.60) [44, 45].

3.1

Tumors

493

Fig. 3.50 (1) Temporal lobe of brain (2) Ocular muscles

(3) Ethmoid sinus (4) Eye ball

(5) Temporalis muscle (6) Skull

494

3

Atlas and Anatomy of SPECT/CT

Fig. 3.51 (1) Maxillary sinus (2) Nose tip (3) Nasal septum

(4) Zygomatic bone (5) Masseter muscle (6) Sphenoidal sinus

(7) Mastoid process

3.1

Tumors

495

Fig. 3.52 (1) Posterior arc of C1 spine (2) Parotid glands (3) Mandibular ramus (4) Pharyngeal space

(5) Body of mandible (6) Body of tongue (7) Palatine tonsil (8) Masseter muscle (superficial part)

(9) Trapezius muscle (10) Spinal cord

496

3

Atlas and Anatomy of SPECT/CT

Fig. 3.53 (1) Spinous process of C4 spine (2) Submandibular glands

(3) Body of mandible (4) Greater horn of hyoid bone

(5) C4 spine

3.1

Tumors

497

Fig. 3.54 (1) Submandibular glands (2) Body of hyoid bone

(3) Digastric muscle anterior belly (4) Epiglottis

498

3

Atlas and Anatomy of SPECT/CT

Fig. 3.55 (1) Spinal cord (2) Sternocleidomastoid muscle

(3) Thyroid cartilage (4) Vocalis muscle

(5) Semispinalis cervicis

3.1

Tumors

499

Fig. 3.56 (1) Internal jugular vein (2) Trapezius muscle

(3) External jugular vein (4) Common carotid artery

(5) Thyroid glands (6) Trachea

500

3

Atlas and Anatomy of SPECT/CT

Fig. 3.57 (1) Right common carotid artery (2) Parathyroid gland (3) Trachea

(4) Thyroid Left lobe (5) Left clavicle (6) Left scapular

(7) Head of Left humerus (8) Left lung apex (9) Esophagus

3.1

Tumors

501

Fig. 3.58 (1) Right pectoralis major muscle (2) Subclavian artery (3) Common carotid artery (4) Sternum

(5) Trachea (6) Humeral shaft (7) Scapular (8) Left Lung

(9) Esophagus (10) Spinous process of T3 spine

502

3

Atlas and Anatomy of SPECT/CT

Fig. 3.59 (1) Right superior pulmonary vein (2) Right pectoralis minor (3) Lung

(4) Sternum (5) Aortic arch (6) Left humeral shaft

(7) Left Scapular (8) Trachea

3.1

Tumors

Fig. 3.60

503

99m

Tc-MIBI SPECT/CT

3.1.7.3 Case 3 The patient was a 71-year-old female with a parathyroid adenoma (type F). SPECT (top) and SPECT/CT (bottom) images of the neck and chest with 99mTc-MIBI showed a focal moderately increased activity in the right paraesophageal area at the level of the thoracic inlet (Fig. 3.61).

3.1.7.4 Case 4 A 57-year-old female was seen with parathyroid adenoma (type E). SPECT (top) and SPECT/ CT (bottom) images of the neck and chest with 99mTc-MIBI showed a focal area of slightly increased activity just behind the inferior pole of right thyroid lobe (Fig. 3.62).

3.1.7.5 Case 5 A 56-year-old male had a parathyroid adenoma (type E). Selected SPECT (top) and SPECT/ CT (bottom) of the neck and chest with 99mTc-MIBI showed a focal moderately increased activity in the right paratracheal area at the level of right inferior thyroid bed (Fig. 3.63).

504

Fig. 3.61

3

99m

Tc-MIBI SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.62

99m

Tc-MIBI SPECT/CT

505

506

Fig. 3.63

3

Atlas and Anatomy of SPECT/CT

99m

Tc-MIBI SPECT/CT

3.1.7.6 Case 6 A 63-year-old female had a parathyroid adenoma (type C). Selected SPECT (top) and SPECT/ CT images of the neck and chest with 99mTc-MIBI showed a focal moderately increased activity in the right paraesophageal area (Fig. 3.64).

3.1.7.7 Case 7 A 73-year-old male had a parathyroid adenoma (type D). Selected SPECT (top) and SPECT/ CT (bottom) images of neck and chest with 99mTc-MIBI showed a moderately increased activity abutting the medial border of the middle right thyroid lobe (Fig. 3.65).

3.1.8

Mesothelioma

3.1.8.1 Case 1 A 69-year-old male presented with mesothelioma in the right side of the chest. Selected SPECT (top) and SPECT/CT (bottom) images of the lungs with 99mTc-MAA particles showed slightly decreased activity in the right upper and middle lobes as well as moderately decreased activity

3.1

Tumors

Fig. 3.64

507

99m

Tc-MIBI SPECT/CT

in the right lower lobe. Also noted were perfusion defects along the posterolateral periphery of the right lower lobe owing to nodular pleural tumors. Mesothelioma is a highly aggressive tumor arising from the pleura and mostly associated with asbestos exposure. CT scans typically show nodular pleural thickening, often with pleural effusion (Fig. 3.66) [46, 47].

3.1.8.2 Case 2 A 58-year-old man had a mesothelioma in the chest with pneumothorax. Selected SPECT (top) and SPECT/CT (bottom) images of the lungs with 99mTc-MAA particles showed slightly decreased activity in the right upper lobe as well as moderately decreased activity in the right lower lobe caused by a pleural tumor encasing the lung (Fig. 3.67) [48].

3.1.9

Bone Tumor

3.1.9.1 Case 1 A 10-year-old girl was seen with ossifying fibroma. Selected SPECT (top) and SPECT/CT (bottom) images of the head with 99mTc-MDP showed moderately increased activity in the bilateral maxillary sinuses and right mandible.

508

Fig. 3.65

3

99m

Tc-MIBI SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.66

99m

Tc-MAA SPECT/CT

509

510

Fig. 3.67

3

Atlas and Anatomy of SPECT/CT

99m

Tc-MAA SPECT/CT

Ossifying fibroma (osteofibrous dysplasia) is a benign bone tumor and occurs often in children under 10 years old in the tibia, femur, mandible, maxilla, and nasal areas. It usually shows an expansile lesion with central lucency and peripheral ossification. Fibrous dysplasia shows no osteoblastic rim (Fig. 3.68) [49].

3.1.10 Bone Metastases 3.1.10.1 Case 1 A 38-year-old female with a history of breast cancer and pain in the right shoulder was seen. Selected SPECT (top) and SPECT/CT (bottom) images of the chest with 99mTc-MDP showed a focal area of moderately increased activity in the right scapular body caused by metastasis. Bone metastases are over ten times more common than primary bone tumors. Most metastases occur in the red bone marrow, most commonly in the axial skeleton. Osteoblastic metastases often occur with prostate cancer, transitional cell carcinoma, mucinous tumor, and carcinoid, whereas lytic metastases mostly occur with lung, thyroid, and renal cancers. Breast, stomach, and colon cancers can show osteolytic or osteoblastic lesions (Fig. 3.69) [50].

3.1

Tumors

Fig. 3.68

99m

Tc-MDP SPECT/CT

511

512

Fig. 3.69

3

Atlas and Anatomy of SPECT/CT

99m

Tc-MDP SPECT/CT

3.1.10.2 Case 2 The patient was a 65-year-old female with a history of breast cancer and pain in the right knee. Select SPECT (top) and SPECT/CT (bottom) images of knees with 99mTc-MDP showed markedly increased activity in the lateral posterior condyle of the right distal femur caused by metastasis (Fig. 3.70).

3.1.10.3 Case 3 A 67-year-old male presented with a history of lung cancer and pain in the left posterior part of the head. Selected SPECT (top) and SPECT/CT (bottom) images of the head with 99mTcMDP showed moderately increased activity in the left occipital skull caused by metastasis (Fig. 3.71).

3.1.10.4 Case 4 A 65-year-old male with a history of osteosarcoma and pain in the right ear was examined. SPECT (top) and SPECT/CT (bottom) images of the head with 99mTc-MDP showed markedly increased activity in the right posteroinferior temporal skull caused by metastasis (Fig. 3.72).

3.1

Tumors

Fig. 3.70

99m

Tc-MDP SPECT/CT

513

514

Fig. 3.71

3

99m

Tc-MDP SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.72

515

99m

Tc-MDP SPECT/CT

3.1.10.5 Case 5 A 64-year-old male with a history of cystectomy for bladder cancer and pain in the right perineal area was examined. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis with 99mTc-MDP showed moderately increased activity in the inferior ramus of right pubic bone (Fig. 3.73).

3.1.10.6 Case 6 A 47-year-old female with a history of breast cancer presented with pain in the lower back. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis with 99mTc-MDP showed markedly increased activity in the left sacral ala, abutting the sacroiliac joint (Fig. 3.74).

3.1.10.7 Case 7 A 31-year-old male with a history of neuroblastoma was seen for pain in the left buttock. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis with 123I-MIBG showed moderately increased activity in the left iliac tuberosity caused by metastasis (Fig. 3.75) [51].

516

Fig. 3.73

3

99m

Tc-MDP SPECT/CT

Atlas and Anatomy of SPECT/CT

3.1

Tumors

Fig. 3.74

99m

Tc-MDP SPECT/CT

517

518

Fig. 3.75

3

Atlas and Anatomy of SPECT/CT

123

I-MIBG SPECT/CT

3.1.10.8 Case 8 A 38-year-old male with a history of neuroblastoma and pain in the left hip area was examined. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis with 123I-MIBG showed a focal area of markedly increased activity in the anterior left iliac ala as well as slightly increased activity in the right iliac wing attributable to metastases (Fig. 3.76) [52].

3.1.10.9 Case 9 A 66-year-old female with a history of non-Hodgkin lymphoma and pain in the lower back was seen. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis with 99mTc-MDP, including the lower abdomen, showed focal areas of slightly increased activity in the bilateral iliac alae and tuberosities as well as L3-S1 vertebral bodies because of lymphoma involvement (Fig. 3.77).

3.1

Tumors

Fig. 3.76

123

I-MIBG SPECT/CT

519

520

Fig. 3.77

3

Atlas and Anatomy of SPECT/CT

99m

Tc-MDP SPECT/CT

3.2

Bone

3.2.1

Trauma

3.2.1.1 Case 1 A 71-year-old female patient suffered from right knee pain for weeks. The clinical diagnosis was a medial meniscus tear in the right knee. Knee 99mTc-MDP SPECT/CT was done. Focal uptake was found in the right medial meniscus area, which supports the clinical diagnosis (Figs. 3.78, 3.79, 3.80, 3.81, 3.82, 3.83, 3.84, 3.85, and 3.86) [53, 54].

3.2.1.2 Case 2 A 56-year-old female with a history of breast cancer complained of a pain in her right lower posterior chest after a fall. Selected SPECT (top) and SPECT/CT (bottom) images of the lower chest with 99mTc-MDP showed a focal area of moderately increased activity in the right posterior 11th rib, corresponding to a callus formation at the fracture seen on CT (middle).

3.2

Bone

521

Fig. 3.78 (1) Active lesion at right medial condyle

522

Fig. 3.79 (1) Left distal femur

3

Atlas and Anatomy of SPECT/CT

3.2

Bone

523

Fig. 3.80 (1) Patella

(2) Right medial epicondyle

(3) Right lateral epicondyle

524

3

Atlas and Anatomy of SPECT/CT

Fig. 3.81 (1) Patella (2) Articular surface (3) Right medial epicondyle

(4) Right medial condyle (5) Right lateral condyle (6) Right lateral epicondyle

(7) Intercondylar fossa

3.2

Bone

525

Fig. 3.82 (1) Right medial condyle (2) Anterior intercondylar area

(3) Superior articular surface (4) Posterior intercondylar

526

3

Fig. 3.83 (1) Active lesion at right medial meniscus

(2) Right tibial lateral condyle

Atlas and Anatomy of SPECT/CT

3.2

Bone

527

Fig. 3.84 (1) Tibial tuberosity (2) Active lesion at right medial meniscus

(3) Tibial lateral condyle (4) Fibular articular facet

(5) Fibular head

528

3

Atlas and Anatomy of SPECT/CT

Fig. 3.85 (1) Tibial tuberosity

(2) Fibula

An acute fracture (up to 3–4 weeks after initial injury) will show increased radiotracer uptake surrounding the fracture site. Ninety-five percent of fractures are positive in patients under 65 years old, but skull fractures rarely show an activity. In the subacute (until 2–3 months) phase, radiotracer uptake becomes more focal at the fracture site. In the healing phase with a variable time course, there is a gradual decrease in radiotracer activity, but 40 % of fractures remain abnormal after 1 year (Fig. 3.87) [55].

3.2.1.3 Case 3 A 65-year-old male with a history of lung cancer developed a backache following a car accident. Selected SPECT (top) and SPECT/CT (bottom) images of the lower back with Tc-99m MDP showed a focal area of markedly increased activity in the spinous process of L4, corresponding to a fracture shown on CT (middle). Also noted was slightly increased activity in the bilateral facet joints of L4 caused by degenerative changes (Fig. 3.88) [56].

3.2

Bone

Fig. 3.86 (1) Active lesion at right medial meniscus

529

530

Fig. 3.87

3

99m

Tc-MDP SPECT/CT

Atlas and Anatomy of SPECT/CT

3.2

Bone

Fig. 3.88

531

99m

Tc-MDP SPECT/CT

3.2.1.4 Case 4 A 57-year-old female with a history of cancer complained of pain in the right upper chest following an automobile accident. Selected SPECT (top) and SPECT/CT (bottom) images of the chest with 99mTc-MDP showed moderately increased activity in the right posterior sixth and seventh ribs as well as slightly increased activity in the left anterior sixth rib end; these signs corresponded to callus formations of healing old fractures seen on the CT (middle) (Fig. 3.89) [57].

3.2.2

Degenerative Disease

3.2.2.1 Case 1 A 61-year-old female patient was seen who had suffered from both shoulder pain and especially difficulty in internal rotation for 2 years. On 99mTc-MDP SPECT/CT, diffuse mildly increased uptake was found in the joint capsule of the right humerus head and glenoid cavity area. The clinical diagnosis was adhesive capsulitis, both R > L (Figs. 3.90, 3.91, 3.92, 3.93, 3.94, 3.95, and 3.96) [58, 59].

532

Fig. 3.89

3

99m

Tc-MDP SPECT/CT

Fig. 3.90 (1) Degenerative change in C5 spine

Atlas and Anatomy of SPECT/CT

3.2

Bone

Fig. 3.91 (1) Degenerative change in C5 spine

533

534

3

Fig. 3.92 (1) Acromion

(2) Clavicle

Atlas and Anatomy of SPECT/CT

3.2

Bone

535

Fig. 3.93 (1) Clavicle (2) Coracoid process

(3) Supraglenoid tubercle (4) Greater tubercle of humerus

(5) Humerus head (6) Scapula

536

3

Atlas and Anatomy of SPECT/CT

Fig. 3.94 (1) Clavicle (2) Coracoid process (3) Lesser tubercle of humerus

(4) Greater tubercle of humerus (5) Diffuse uptake in joint capsule of humeral head

(6) Scapula (7) Acromion

3.2

Bone

537

Fig. 3.95 (1) Clavicle (2) Lesser tubercle

(3) Intertubercular sulcus (4) Greater tubercle

(5) Increased uptake in glenoid cavity (6) Scapula neck

538

3

Atlas and Anatomy of SPECT/CT

Fig. 3.96 (2) Humerus

(1) Scapula

3.2.2.2 Case 2 A 72-year-old female patient who suffered from low back pain was seen. 99mTc- MDP SPECT/ CT was done. A Schmorl node was found in the vertebral body of L4, and the lesion showed focal uptake, suggesting an active degenerative lesion (Figs. 3.97, 3.98, 3.99, 3.100, 3.101, 3.102, 3.103, 3.104, 3.105, 3.106, and 3.107) [60, 61].

3.2.3

Avascular Necrosis (AVN)

3.2.3.1 Case 1 A 16-year-old male with a history of leukemia developed left hip pain after completion of chemotherapy. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis with 99m Tc-MDP showed a curvilinear moderately increased activity in the anterior head as well as the neck of the left femur. CT images (middle) revealed a slightly increased density along the anterior left femoral neck caused by a healing microfracture in avascular necrosis (AVN).

3.2

Bone

539

Fig. 3.97 (1) Schmorl’s node

540

3

Fig. 3.98 (1) L1 spine vertebra body (2) L1 spine transverse process

(3) L1 spine spinous process (4) Left 12th rib

Atlas and Anatomy of SPECT/CT

3.2

Bone

541

Fig. 3.99 (1) L2 vertebra body

(2) Vertebral foramen

(3) Superior articular process

542

3

Fig. 3.100 (1) L2 vertebral body

(2) L2 transverse process

Atlas and Anatomy of SPECT/CT

3.2

Bone

Fig. 3.101 (1) L3 vertebral body

543

544

3

Fig. 3.102 (1) L4 vertebral body

(2) Schmorl’s node

Atlas and Anatomy of SPECT/CT

3.2

Bone

545

Fig. 3.103 (1) Bony spur with uptake

(2) L4 Vertebral body

546

3

Fig. 3.104 (1) Right iliac bone

(2) L5 Vertebral body

Atlas and Anatomy of SPECT/CT

3.2

Bone

547

Fig. 3.105 (1) Sacrum

(2) Ilium

(3) Left sacroiliac joint

548

3

Fig. 3.106 (1) Left pubic bone (2) Left acetabulum

(3) Left ischium (4) Coccyx

Atlas and Anatomy of SPECT/CT

3.2

Bone

549

Fig. 3.107 (1) L1 vertebra (2) L2 vertebra (3) L3 vertebra

(4) Schmorl’s node (5) L4 vertebra (6) L5 vertebra

(7) Sacrum (8) Coccyx

AVN is cellular death of bone components caused by interruption of the blood supply. It often leads to destruction of the joint articular surface. The classic sites are the head of the femur, the neck of the talus, and the waist of the scaphoid. Proposed risk factors include chemotherapy, alcoholism, steroid treatment, trauma, sickle cell anemia, rheumatoid arthritis. and lupus erythematous. AVN initially shows decreased radiotracer activity in the affected region, followed by a hyperemic phase with increased uptake. SPECT reveals a rim of increased activity with central photopenia (Fig. 3.108) [62].

550

Fig. 3.108

3

Atlas and Anatomy of SPECT/CT

99m

Tc-MDP SPECT/CT

3.3

Others

3.3.1

Gastrointestinal Bleeding

3.3.1.1 Case 1 A 10-year-old male patient with anaplastic large cell lymphoma was suffering from hematochezia caused by acute graft-versus-host disease (GVHD) after peripheral blood stem cell treatment. 99mTc-labeled red blood cell (99mTc-RBC) gastrointestinal bleeding SPECT/CT was done to find the bleeding source. A focal uptake was found in third portion of the duodenum, suggesting gastrointestinal bleeding (Figs. 3.109, 3.110, 3.111, 3.112, 3.113, 3.114, 3.115, 3.116, and 3.117) [63, 64].

3.3

Others

551

Fig. 3.109 (1) Liver (2) Inferior vena cava (3) Right ventricle

(4) Interventricular septum (5) Left ventricle (6) Aorta

(7) Left lung (8) Vertebral body

552

3

Atlas and Anatomy of SPECT/CT

Fig. 3.110 (1) Inferior vena cava (2) Right hepatic vein (3) Liver

(4) Diaphragm (5) Abdominal aorta (6) Fundus of stomach

(7) Spleen (8) Vertebral canal

3.3

Others

553

Fig. 3.111 (1) Renal cortex (2) Inferior vena cava (3) Right lobe of liver (4) Head of pancreas

(5) Left adrenal gland (6) Tail of pancreas (7) Body of stomach (8) Spleen

(9) Renal pelvis (10) Abdominal aorta

554

3

Atlas and Anatomy of SPECT/CT

Fig. 3.112 (1) Vertebral canal (2) Liver (3) Gall bladder (4) Inferior vena cava

(5) Superior part (first) of duodenum (6) Pancreatic head (7) Stomach lower body (8) Transverse colon

(9) Abdominal aorta (10) Spleen (11) Renal pelvis (12) Renal cortex

3.3

Others

555

Fig. 3.113 (1) Right kidney (2) Liver (3) Hepatic flexure of colon (4) Third portion of duodenum (Bleeding focus)

(5) Transverse colon (6) Superior mesenteric vessels (7) Abdominal aorta (8) Mesenteric vessels (9) Ileum

(10) Left kidney

556

3

Atlas and Anatomy of SPECT/CT

Fig. 3.114 (1) Liver tip (2) Hepatic flexure of colon (3) Transverse colon

(4) Third portion of duodenum (5) Superior mesenteric vessels (6) Abdominal aorta

(7) Ileum (8) Descending colon (9) Left kidney

3.3

Others

557

Fig. 3.115 (1) Right ilium (2) Right psoas muscle (3) Ileocecal valve

(4) Right common iliac vessels (5) Mesenteric vessels (6) Inferior vena cava

(7) Transverse colon (8) left common iliac vessels (9) Left psoas muscle

558

3

Atlas and Anatomy of SPECT/CT

Fig. 3.116 (1) Sacrum (2) Right internal iliac vessels (3) Right ilium

(4) Ileum (5) Sigmoid colon (6) Left external iliac vessels

(7) Rectosigmoid colon (8) Sacral lymph nodes

3.3

Others

559

Fig. 3.117 (1) Coccyx (2) Vesical vessels (3) Acetabulum (4) Right femoral head

(5) Right external iliac vessels (6) Urinary bladder (7) Rectus abdominis (8) Left external iliac vessels

(9) Rectovesicular pouch (10) Rectum

3.3.1.2 Case 2 A 68-year-old male with a history of cystectomy for bladder cancer was seen after he developed a pain in the right lower abdomen and also noticed a bloody stool. Selected SPECT (top) and SPECT/CT images of the lower abdomen with 99mTc-RBC demonstrated a curvilinear moderately increased activity in the ileal conduit as well as the pouch and bag shown on CT (middle), indicating active bleeding. 99m Tc-RBC is useful in detecting active gastrointestinal bleeding and is prepared in vitro by mixing 1–3 mL of anticoagulated blood with stannous chloride and an oxidizing agent. The labeling procedure takes more than 20 min. Bleeding rates as low as 0.2 mL/min can be detected with a tagged red blood cell study compared to 1 mL/min for angiography. 99mTcsulfur colloid requires a significant preparation time and is useful only for acute active bleeding with 2–3 min of vascular half-time. A positive study shows an activity that changes shape and position over time due to the peristalsis of intraluminal blood (Fig. 3.118) [65].

560

Fig. 3.118

3

Atlas and Anatomy of SPECT/CT

99m

Tc-RBC SPECT/CT

3.3.2

Abscess

3.3.2.1 Case 1 A 78-year-old female with a history of multiple myeloma was seen for backache and fever. Selected SPECT and SPECT/CT (bottom) images of the head and neck with 111In-WBC showed a focal area of markedly increased activity in the left semi-spinalis muscle of the lower neck adjacent to the spinous process of C6, corresponding to an ill-defined low-density nodular lesion seen on CT (middle). Paraspinal abscess or phlegmon is often associated with vertebritis and/or discitis and shows a displacement of paraspinal lines on graphs. Sagittal T1 and T2 reveal loss of disc space height and marrow edema. A 111In leukocyte scan is helpful in detecting acute infection or inflammation. Its advantages compared to 99mTc-HMPAO scan include the absence of interfering bowel and renal activity and the ability to perform delayed 24-h imaging as well as simultaneous 99mTc-sulfur colloid or MDP scan. 67Ga citrate scan is useful for detecting chronic infection or inflammation with lymphocytes or macrophages (Fig. 3.119) [66].

3.3

Others

Fig. 3.119

561

111

In-WBC SPECT/CT

3.3.3

Ectopic Thyroid

3.3.3.1 Case 1 A 57-year-old female presented with hypothyroidism. Selected SPECT (top) and SPECT/CT (bottom) images of the neck and chest with 131I showed a focal area of moderately increased activity in the midline of the tongue base caused by ectopic thyroid or thyroid tissue in the thyroglossal duct. Ectopic thyroid refers to the presence of thyroid tissue in locations other than the normal anterior neck between the second and fourth tracheal cartilages. It is the most frequent form of thyroid dysgenesis; 7–8 % of adults may harbor asymmetric thyroid tissue along the path of the thyroglossal duct. Lingual thyroid is the most common type. Ectopic thyroid tissue co-existing with eutopic thyroid may be equal to that without a normally located gland (Fig. 3.120) [67].

3.3.4

Cerebrospinal Fluid (CSF)

3.3.4.1 Case 1 A 66-year-old male with a history of head trauma was seen. Selected SPECT (top) and SPECT/ CT (bottom) images of the head at 24 h after injection of 111In-DTPA into the L3–L4 spinal canal showed basal as well as Sylvian cisterns. No significant activity in the lateral ventricle was noted, indicating no communicating hydrocephalus.

562

Fig. 3.120

3

Atlas and Anatomy of SPECT/CT

131

I SPECT/CT

Communicating hydrocephalus is a ventricular enlargement without an obstructing lesion such as a third ventricular colloid cyst or posterior fossa mass obstructing the fourth ventricle. Subarachnoid hemorrhage can cause communicating hydrocephalus by impeding arachnoid granulation reabsorption of CSF. Normal pressure hydrocephalus is a form of communicating hydrocephalus with a clinical triad of dementia, ataxia, and incontinence. Imaging typically shows a panventricular enlargement (Fig. 3.121) [68, 69].

3.3.4.2 Case 2 A 72-year-old male with gait disturbance, urinary incontinence, and dementia was seen. Selected SPECT (top) and SPECT/CT (bottom) images of the head at 24 h after injection of 111 In-DTPA into the L3–L4 spinal canal showed moderately increased activity in the lateral ventricles but no significant activity had migrated over to the convexity beyond the Sylvian cistern, indicating normal pressure hydrocephalus (Fig. 3.122).

3.3

Others

Fig. 3.121

563

111

In-DTPA SPECT/CT

3.3.5

Central Venous Line Obstruction

3.3.5.1 Case 1 A 46-year-old male with a left central venous line complained of pain in the substernal area. Selected SPECT (top) and SPECT/CT (bottom) images of the chest after injection of 99mTcDTPA showed a focal area of increased activity in the distal left innominate vein. Venous obstruction is often caused by the body’s natural response to foreign bodies, such as a central venous line and pacing leads. It occurs when blood clots or vascular tissues develop and narrow the channel for flow. More than 40 % of patients with a central venous line usually develop a venous obstruction, and they may experience a swollen arm, neck pain, facial swelling, or shortness of breath. A nuclear dynamic venous flow study using 99mTc-DTPA showed a stasis or collateral channels of the activity representing a hemodynamically significant obstruction (Fig. 3.123) [70].

564

Fig. 3.122

3

Atlas and Anatomy of SPECT/CT

111

In-DTPA SPECT/CT

3.3.6

Lymph Node

3.3.6.1 Case 1 A 45-year-old male with diagnosed melanoma in the left ear was seen. Selected SPECT (top) and SPECT/CT (bottom) images of the neck, including the lower head, after intradermal injection of 99mTc filtered sulfur colloidal particles around the tumor, demonstrated focal areas of slightly increased activity accumulated in the left upper jugular lymphatic chain (level II-b), indicating sentinel lymph nodes. The sentinel lymph node is hypothetically the first lymph node or group of nodes to drain the cancer. It is postulated that sentinel lymph nodes are the target organs primarily reached by metastasizing cancer cells from the tumor. The spread of some forms of cancer usually follows an orderly progression (Fig. 3.124) [71].

3.3.6.2 Case 2 The patient was a 62-year-old male with melanoma in the upper mid-back. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis after intradermal injection of 99mTc-sulfur colloid around the tumor showed a focal area of moderately increased activity in the left posterior cervical triangle just above the level of the cricoid cartilage (level V-a) (Fig. 3.125).

3.3

Others

Fig. 3.123

565

99m

Tc-DTPA SPECT/CT

3.3.6.3 Case 3 The patient was a 59-year-old female with uterine cervical cancer. Selected SPECT (top) and SPECT/CT (bottom) images of the pelvis after subcutaneous injection of 99mTc-filtered sulfur colloid particles around the tumor demonstrated moderately increased activity in the left external iliac lymph node and slightly increased activity in the left inguinal superficial lymph node, indicating sentinel lymph nodes (Fig. 3.126).

3.3.6.4 Case 4 The patient was a 53-year-old female with melanoma of the right anterior chest wall. Selected SPECT (top) and SPECT/CT (bottom) images of the chest after intradermal injection of 99mTcfiltered sulfur colloid showed a focal area of slightly increased activity in the right superficial axillary lymph node (level I), indicating a sentinel lymph node (Fig. 3.127).

3.3.6.5 Case 5 The patient was a 64-year-old male with squamous cell carcinoma in the right tongue base. Selected SPECT (top) and SPECT/CT (bottom) images of the neck, including the lower head, after subcutaneous injection of 99mTc lymphoseek showed a focal area of slightly increased activity in the right carotid space, indicating a sentinel lymph node. Lymphoseek is a radioactive diagnostic agent for lymphatic mapping and guiding sentinel lymph node biopsy (Fig. 3.128) [72].

566

Fig. 3.124

3

99m

Tc-sulfur colloid SPECT/CT

Atlas and Anatomy of SPECT/CT

3.3

Others

Fig. 3.125

567

99m

Tc-sulfur colloid SPECT/CT

568

Fig. 3.126

3

99m

Tc-sulfur colloid SPECT/CT

Atlas and Anatomy of SPECT/CT

3.3

Others

Fig. 3.127

569

99m

Tc-sulfur colloid SPECT/CT

570

Fig. 3.128

3

Atlas and Anatomy of SPECT/CT

99m

Tc-lymphoseek SPECT/CT

3.3.7

Lung (V/Q)

3.3.7.1 Case 1 A 58-year-old male with non-small cell lung carcinoma was the patient. Selected SPECT (top) and SPECT/CT (bottom) images of the lungs with 99mTc-MAA particles demonstrated a nonuniform perfusion with moderately decreased activity in the right upper, middle, and lower lobes. Lung cancer is the leading cause of cancer death in the United States, with a 15 % 5-year survival. Pulmonary nodules are very common, and the vast majority are benign. Non-rounded or cavitary shape, calcification, subpleural location, and clustering nodules are often benign. Adenocarcinoma is the most common subtype and occurs in the peripheral lung. It is associated with smoking, but nonsmoker’s lung cancer is almost always adenocarcinoma. Bronchoalveolar carcinoma is a well-differentiated adenocarcinoma with lepidic growth. Cavitation is more common with squamous cell carcinoma, which arises centrally. FDG-PET/ CT plays a role both in the initial staging and in evaluating the therapeutic response. A MAA lung perfusion scan is helpful in assessing operability of lung cancer. Forced expiratory volume at 1 s is the most frequently used index for assessing airway obstruction. Patients with less than 1 L/s FEV1 will develop a pulmonary insufficiency [73–75].

3.3

Others

Fig. 3.129

571

99m

Tc-MAA SPECT/CT

Lobar pneumonia is usually bacterial and causes air bronchograms. Interstitial pneumonia is caused by inflammatory cells in the alveolar septa and causes patchy or diffuse ground glass opacification. Round pneumonia is commonly caused by Streptococcus and seen in children. 99m Tc-MAA particles are 10–100 μm in size and 3–5 mCi comprises 200,000–600,000 particles in number. Two or more large perfusion defects without an associated radiographic abnormality points to a high probability for pulmonary embolism (Figs. 3.129, 3.130, 3.131, 3.132, and 3.133) [76, 77].

3.3.8

Accessory Spleen

3.3.8.1 Case 1 A 50-year-old male was found to have an enhancing mass in the pancreatic tail on an abdominal CT done for a routine health check. A 99mTc-denatured RBC spleen scan was done for differential diagnosis. A nodular lesion in the pancreatic tail showed focally increased uptake, suggesting accessory spleen (Figs. 3.134, 3.135, 3.136, 3.137, 3.138, 3.139, 3.140, and 3.141) [78, 79].

572

Fig. 3.130

3

99m

Tc-MAA SPECT/CT

Atlas and Anatomy of SPECT/CT

3.3

Others

Fig. 3.131

573

99m

Tc-MAA SPECT/CT

574

Fig. 3.132

3

99m

Tc-MAA SPECT/CT

Atlas and Anatomy of SPECT/CT

3.3

Others

Fig. 3.133

575

99m

Tc-MAA SPECT/CT

576

3

Atlas and Anatomy of SPECT/CT

Fig. 3.134 (1) Liver dome (2) Right atrium of the heart (3) Right Ventricle

(4) Left ventricle (5) Descending aorta (6) Lung parenchyme

(7) Vertebral body

3.3

Others

577

Fig. 3.135 (1) Right lobe of Liver (2) Inferior vena cava (3) Descending aorta

(4) Left lobe of liver (5) Subdiaphragmatic space (6) Stomach cardia

(7) Spleen

578

3

Atlas and Anatomy of SPECT/CT

Fig. 3.136 (1) Liver (2) Gall bladder (3) Hepatic flexure of transverse colon

(4) Left diaphragm (5) Left gastroepiploic vessels (6) Spleen

(7) Vertebral body

3.3

Others

579

Fig. 3.137 (1) Right kidney (2) Liver (3) Transverse colon (4) Second portion of the duodenum

(5) Inferior vena cava (6) Retropancreatic lymph node (7) Lower body of stomach (8) Body of the pancreas

(9) Spleen (10) Descending aorta

580

3

Atlas and Anatomy of SPECT/CT

Fig. 3.138 (1) Inferior vena cava (2) Right kidney (3) Liver tip (4) Second portion of duodenum

(5) Transverse colon (6) Small bowels (7) Left adrenal gland (8) Tail of the pancreas

(9) Intrapancreatic accessory spleen (10) Spleen (11) Descending aorta

3.3

Others

581

Fig. 3.139 (1) Inferior vena cava (2) Right kidney (3) Liver tip (4) Second portion of duodenum

(5) Transverse colon (6) Small bowels (7) Left adrenal gland (8) Tail of the pancreas

(9) Intrapancreatic accessory spleen (10) Spleen (11) Descending aorta

582

3

Atlas and Anatomy of SPECT/CT

Fig. 3.140 (1) Right kidney (2) Ascending colon (3) Duodenum

(4) Uncinate process of the pancreas (5) Descending aorta (6) Small bowels

(7) Left adrenal gland (8) Intrapancreatic accessory spleen

3.3

Others

583

Fig. 3.141 (1) Right kidney (2) Ascending colon (3) Duodenum

(4) Uncinate process of the pancreas (5) Descending aorta (6) Small bowels

3.3.9

(7) Left adrenal gland (8) Intrapancreatic accessory spleen

Adrenal Hyperplasia

3.3.9.1 Case 1 A 52-year-old male presented with right flank pain. On 123I-MIBG SPECT/CT, moderately increased activity was found in the bilateral adrenal glands, but there was no uptake in a large soft tissue mass in the right kidney on CT. The surgical diagnosis was right renal cell carcinoma and bilateral adrenal hyperplasia (Fig. 3.142) [80].

584

3

Atlas and Anatomy of SPECT/CT

Fig. 3.142 (1) Left adrenal gland hyperplasia (2) Abdominal aorta (3) Inferior vena cava (4) Right adrenal gland hyperplasia

(5) Renal cell carcinoma in right kidney (6) Gall bladder (7) Liver, S4 (8) Liver, left lobe

(9) Stomach (10) Spleen

References

585

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77. Duran-Mendicuti A, Sodickson A. Imaging evaluation of the pregnant patient with suspected pulmonary embolism. Int J Obstet Anesth. 2011;20(1):51–9. 78. Kim SH, Lee JM, Han JK, Lee JY, Kim KW, Cho KC, et al. Intrapancreatic accessory spleen: findings on MR Imaging, CT, US and scintigraphy, and the pathologic analysis. Korean J Radiol. 2008;9(2):162–74. 79. Front D, Israel O, Groshar D, Weininger J. Technetium-99m-labeled red blood cell imaging. Semin Nucl Med. 1984;14(3):226–50. 80. Sundin A. Imaging of adrenal masses with emphasis on adrenocortical tumors. Theranostics. 2012;2(5):516–22.

Index

A Abdomen, 54–115 Abdominal aorta liver, 452 PET/CT, 56, 57, 72, 76–83, 87, 90–93, 124–130, 302–304, 306, 307, 310–313, 322, 336 SPECT/CT, 450, 454–458, 471, 552–556, 584 Abdominal para-aortic LN, 267 Abdominal preaortic retroperitoneal LNs, 265 Abscess, SPECT/CT, 560–561 Accessory spleen intrapancreatic, 580–583 SPECT/CT, 571–583 Acetabulum, 151, 152, 159, 548, 559 Acromion, 534, 536 Adductor brevis muscle, 168, 341 Adductor longus muscle, 169, 343 Adductor magnus muscle, 168, 170, 343–345, 348 Adenocarcinoma, 570 Adnexa, 150 Adrenal cancer, 451 Adrenal gland hyperplasia, 583–585 metastasis, 361 PET/CT, 308, 309 PET/CT, 48, 49, 68, 69, 86, 129, 301, 317, 318 SPECT/CT, 454, 553, 580–583 Adrenal pheochromocytoma, 456–458 Ampula of Vater, 93 Anterior intercondylar area, 525 Anterior scalene muscle, 35, 255 Aorta, 40–44, 46–49, 60–71, 75, 95–101, 103–105, 107, 110, 132, 133, 192–194, 233–238, 264, 297, 298, 315, 328–330, 332–334, 337, 368, 426, 551 Aortacaval area, 471 Aortic arch PET/CT, 38, 39, 52, 232, 256, 257, 320 SPECT/CT, 451, 502

Aortic bifurcation, 323 Aortocaval LN metastasis, 116, 124, 125, 266, 336 Apical segmental bronchus, 243 Apicoposterior segmental bronchus, 243 Aqueduct, 215 Arachnoid cysts, 399 Artery, 341 Articular surface, 524 Ascending colon, 126, 127, 321 Ascites, 115 Atlas C1 bone, 285 Atrium PET/CT, 45, 60, 110, 237, 264, 292 SPECT/CT, 486 Auditory canal, 24 Avascular necrosis (AVN), 538–550 Axillary lymph node, 50, 232, 233, 423, 426 with fatty hilum, 52 PET/CT, 51, 52 Axis C2 bone, 285, 286 Azygos vein, 40

B Biceps, 350 Biceps femoris muscle, 170–173, 178–182, 343–348 Bilateral parametrial invasion, 157 Bile duct dilated, 80, 86, 89, 90 PET/CT, 81, 85, 91, 92 Bladder cancer, 162, 432 Blue duct, 87 Body of mandible, 483, 495, 496 Body of pancreas, 488, 579 Body of tongue, 495 Bone metastasis cervical spine, 10 lumbar spine, 10 L5 vertebral body, 22 SPECT/CT, 510–520 transverse process, 22 Bone tumor, 507–511 Brachiocephalic artery, 37–39, 134

Brachiocephalic trunk, 51, 327 Brachiocephalic vein, 37–39, 134, 230, 232, 320, 327 Brain, 1–22, 372, 375, 376, 381–384 Breast cancer, 54, 231, 423, 427, 485 Breast mass, 233–235 Breast parenchyme, 0, 487 Bronchoalveolar carcinoma, 570 Bronchus, 41–43, 133 anterior segmental bronchus, 243–245 anteromedial segment bronchus, 252 apical segmental bronchus, 243 apicoposterior segmental bronchus, 243 inferior lingula segmental bronchus, 245, 247, 248 Bronchus intermedius PET/CT, 236, 248–251, 263 SPECT/CT, 479

C C5 bone, 289 11 C-acetate PET/CT, 359–371 Calcaneus, 176 Carcinoid, 445, 460, 466 Carina, 40, 245 Carotid artery, 33, 34, 36–39, 51, 134, 227, 228, 230, 255, 276, 279, 326, 327 external, 25 internal, 24–26 PET/CT, 36, 230, 326 Caudate nucleus, 8, 16 body of, 402, 410 head of, 403, 411, 412 PET/CT, 209–211, 396, 401, 407, 418 Caudate putamen, 397, 419 Celiac trunk, 68, 80, 307 Central nervous system lymphoma corpus callosum, 6, 7 PET/CT, 2 white matter, 5, 6 Central sulcus, 200, 201 Central venous line obstruction, 563–565 Cerebellar cortex, 400 Cerebellar hemisphere, 220, 221

© Springer International Publishing Switzerland 2016 E.E. Kim et al., Atlas and Anatomy of PET/MRI, PET/CT and SPECT/CT, DOI 10.1007/978-3-319-28652-5

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590 Cerebellar tonsil, 221 Cerebellar vermis, 9, 18–21, 215–220, 391, 399, 416, 421 Cerebellum, 19, 21, 377, 384, 391, 421, 424 brain tumor, 0, 372, 375, 376 hemangioblastoma, 0, 433–435 PET/CT, 21 white matter of, 400 Cerebral artery, 19 Cerebral fossa, 211 Cerebrospinal fluid (CSF), 561–564 Cervical cancer lower vaginal extension, 164 PET/CT, 136–138, 142, 148–152, 155, 156 posterior vaginal fornix, 141 Cervix, 139 Chest, 32–54 Cingulate gyrus, 209, 212 Cingulum, 410 Cisternal magna, 221 Clavicles, 51, 290, 449, 484, 500, 534–537 11 C-methionine PET/CT, 371–385 Coccyx PET/CT, 151, 152 SPECT/CT, 548, 549, 559 Colon cancer ascending, 124, 125, 128, 457, 459, 485, 489, 582, 583 descending, 48, 81, 127–129, 457, 459, 486–489, 556, 576, 577, 579–583 PET/CT, 56, 238, 295, 303, 304, 308, 313, 322–324, 333, 337 SPECT/CT, 482 transverse, 48 Common carotid artery, 484, 499–501 Common iliac vessels, 557 Condyloid process, 223 Coracoid process, 535, 536 Coronal suture, 11–14 Corona radiata, 207, 208 Corpus callosum, 8 Cortical gray matter, 200 Costal cartilage, 332 11 C-PIB PET/CT, 385–400 Cricoid cartilage PET/CT, 33, 34, 228 SPECT/CT, 475 Crura, 48, 49, 57, 308 Cystectomy, 559 Cystic duct, 78, 79

D Daughter nodules, 105 Degenerative disease PET/CT, 228 SPECT/CT, 531–538, 540–546, 548, 549 Deltoid muscle, 350, 351 Dermoid cyst, 58 Descending aorta, 111 Diaphragm PET/CT, 297, 298, 332 SPECT/CT, 487, 552, 578

Index Digastric muscle anterior belly, 497 Dilated ureter, 22 Distal femur, 342, 348, 522 Dorsum sellae, 218, 406, 415 Duodenal bulb, 0, 304, 310–312 Duodenum PET/CT, 88–91, 93, 114, 309 portions, 78–83, 554–556, 579–581

E Ear, 220 Eardrum, 221 Ectopic thyroid, 561, 562 Edema, 201–211 Eighth rib, 293 Eleventh rib, 294 Epiglottis, 497 Erector spinae muscle, 35–41, 232–237, 255, 265 Esophagus PET/CT, 35, 46, 60, 75, 95–98, 111, 134, 230, 232–237, 241–244, 255, 297, 315, 326, 329, 332 SPECT/CT, 477, 500, 501 Ethmoid sinus PET/CT, 18–20, 218–220 SPECT/CT, 493 External auditory canal, 284 External auditory meatus, 221 External iliac artery, 325 External iliac vein, 340 External iliac vessels, 137 External jugular vein PET/CT, 35 SPECT/CT, 499 External oblique muscle, 238, 265–267 Eye lateral rectus muscle, 19 PET/CT, 215, 284, 285 Eye ball PET/CT, 18–20, 218, 219 SPECT/CT, 493

F Falciform ligament, 238 Falx cerebri, 3, 11–13, 200–211, 401, 408 Femoral artery, 121, 151, 152, 178 Femoral head, 58, 118–121, 139, 151, 152, 157–160, 167–173, 178–182, 191, 559 Femoral LNs, 341 Femoral vein, 121, 151, 152, 178, 341 Femoral vessel, 139, 179–182 Femur, 343, 344, 347 18 F-Fludeoxyglucose (FDG) uptake, 49 18 F-Flumazenil PET/CT, 416–422 18 F-FP-CIT PET/CT, 400–416 Fibrous dysplasia, 510 Fibula PET/CT, 174, 175 SPECT/CT, 528 Fibular articular facet, 527 Fibular head, 527 Fibularis longus muscle, 174

Fissure, 40, 42 Focal hypermetabolic foci in leiomyosarcoma, 109 PET/CT, 281 Foramen magnum, 224 Fourth ventricle, 219 Frontal air sinus, 216 Frontal bone, 11–14 Frontal cortex, 16, 17, 372, 379, 396, 397, 401, 408, 417 Frontal lobe, 12, 13, 15, 18, 201, 386–389, 392–395 Frontal sinus, 17 Fundus of stomach, 552

G 68 Ga-DOTA-TOC PET/CT, 432 Gall bladder PET/CT, 48, 57, 68–71, 76, 77, 86–89, 113, 129, 275, 294, 295, 299–301, 307–312, 317–319 SPECT/CT, 454, 455, 458, 554, 584 Gastric artery, 306 Gastric cancer, 59 Gastric lymph node metastasis, 299 Gastrocnemius muscle, 173, 174 Gastroduodenal artery, 68 Gastroepiploic vessels, 578 Gastrointestinal bleeding, 550–560 Gastrointestinal stromal tumor (GIST), 268 Genioglossus, 483 Germ cell tumor, 379 Glenohumeral joint, 36 Glenoid, 36, 37, 537 Globus pallidus, 212 Gluteus maximus muscle, 58, 73, 117, 154, 160–162, 167–169, 340, 341 Gluteus medius muscle, 73, 160, 340 Gluteus minimus muscle, 73 Gracilis, 169–171, 173, 178–182, 343–348

H Hard palate, 26 Head and neck, FDG PET/CT, 22–34 Head of pancreas PET/CT, 429 SPECT/CT, 553 Heart PET/CT, 132, 332 PECT/CT, 576 Hemangioblastoma, 433–439 Hepatic artery, 68, 88 Hepatic cyst, 61 Hepatic duct, 76–79, 308 Hepatic flexure, 555, 556, 578 Hepatic portal vein, 306, 317 Hepatic segments, 315–319 Hepatic vein PET/CT, 47, 62, 63, 75, 97, 98, 103, 104, 131 SPECT/CT, 552 Hepatocellular carcinoma, 443–444 Heterogeneously hypermetabolic mass, 299–301

591

Index Hilum, 268 Humeral shaft, 501, 502 Humerus head, 500 PET/CT, 36, 290, 350, 351 SPECT/CT, 449, 535, 536, 538 Hydronephrosis, 116, 127, 128 Hydroureterosis, 123, 124 Hyoid bone PET/CT, 227, 367 SPECT/CT, 474, 496, 497 Hyoid cartilage, 289 Hypermetabolic hepatic nodular lesion, 314 Hypopharynx, 227 Hypothalamus, 215

I Ileocecal valve, 557 Ileum PET/CT, 324, 340 SPECT/CT, 555, 556, 558 Iliac area, 148, 149 Iliac artery, 143–150, 184–190, 324, 338, 339 Iliac LN, 146, 147, 165, 166, 339 Iliac vein, 146–150, 184–190, 324, 338, 339 Iliac vessels, 123, 137, 138, 140, 166, 558, 559 Iliacus muscle, 73, 123, 160, 340 Iliocolic LNs, PET/CT, 338 Iliocostalis muscle, 266, 267 Ilium metastasis, 183, 185, 187, 188 osteosarcoma, 190 PET/CT, 73, 122, 123, 140, 154–157, 160, 161, 166, 185 SPECT/CT, 546, 547, 558 123 I-MIBG SPECT/CT adrenal hyperplasia, 583–585 bone metastases, 515–519 neuroblastoma, 468, 470 neuroendocrine tumor, 455–458 paraganglioma, 468, 470, 472 111 In-DTPA SPECT/CT, 561–564 Inferior temporal gyrus, 219, 220 Inferior vena cava (IVC) PET/CT, 46, 48, 49, 61, 62, 64, 66, 67, 77–80, 82, 83, 85–90, 92, 95, 96, 99–101, 103–105, 124, 125, 127, 129–131, 266, 302–304, 306–313, 315, 316, 322, 323, 336 SPECT/CT, 471, 488, 489, 551, 552, 554, 557, 577, 579–581, 584 Infraspinatus muscle, 232–236, 256, 257, 259, 290, 292, 351 Inguinal LN, 119, 165, 167, 168, 352, 356–359 111 In-octreotide SPECT/CT, 445–455, 459, 460, 462–469 Insular cortex, 8, 15, 16 Intercondylar fossa, 524 Intercostal muscle, 238 Interlobar LNs metastasis, 245 Internal Iliac artery, 325 Internal iliac vein, 340 Internal iliac vessels, 137, 340

Internal jugular vein, 327 PET/CT, 227, 228, 255, 276, 278–280, 326 SPECT/CT, 484, 499 Internal mammary lymph node metastasis, 236 Internal mammary vessels, 53 Interpeduncular fossa, 382 Interstitial pneumonia, 571 Intertubercular sulcus, 537 Interventricular septum PET/CT, 60 SPECT/CT, 551 Intrahepatic bile duct, 75 Intrapancreatic accessory spleen, 580–583 Intussusception, with FDG uptake, 49 111 In-WBC SPECT/CT, 560, 561 Ischial bone metastasis, 231, 239 Ischium, 117–120, 153, 155, 156, 160, 161, 167, 548 123 I SPECT/CT, 488 131 I SPECT/CT ectopic thyroid, 561, 562 thyroid cancer, 470–492

J Jejunum PET/CT, 114, 302, 325 SPECT/CT, 488, 489 Jugular artery, 35 Jugular vein, 21, 27, 32–35

K Kidney pelvis, 295 PET/CT, 49, 68–71, 81–83, 100, 101, 114, 115, 126, 283, 295, 300, 301, 307, 334, 370, 429 SPECT/CT, 448, 452, 454, 457, 458, 471, 488, 489, 555, 556, 579–583

L Lacrimal gland, 377 Lateral condyle, 524 Lateral epicondyle, 524 Lateral rectus muscle, 9, 20 Lateral sulcus, 216 Lateral ventricle, 7 PET/CT, 14–17, 215, 373, 380, 381, 396, 402, 404, 409, 411–413, 418 trigone, 8 Latissimus dorsi muscle, 60–67, 237, 270 PET/CT, 60–67, 132, 237, 270 Left lower lobe (LLL), 35 lung cancer in, 44 SPECT/CT, 478 Leiomyosarcoma, IVC, 111–115 Lingual thyroid, 561 Lingual tonsil, 28 Liposarcoma, 61, 73 descending aorta, 115 in psoas major muscle, 73 PET/CT, 68–72, 177, 179–182 recurred, 62 in retrocrural area, 63–67

Liver hypermetabolic focus, 269–274 malignant mass in, 102, 103 metastasis with central necrosis, 449 lobe, 112 PET/CT, 55, 57, 94, 96, 97, 100 99m Tc-MAA SPECT/CT, 444–446 SPECT/CT, 444–445 90 Y PET/CT, 445, 447 NE tumor in, 452 PET/CT, 69–72, 129, 132, 238, 270, 272, 293–295, 297, 298, 308, 317, 318, 332, 360, 369, 370, 428, 433, 436–439 Schwannoma in, 106 SPECT/CT, 448, 455, 457, 458, 487, 488, 551, 552, 554, 555, 578, 579, 584 tip, 556, 580, 581 Liver dome PET/CT, 45, 95, 111 SPECT/CT, 576 Liver metastasis with central necrosis, 449 lobe, 112 PET/CT, 55, 57, 94, 96, 97, 100 99m Tc-MAA SPECT/CT, 444–446 tip, 556, 580, 581 SPECT/CT, 444–445 90 Y PET/CT, 445, 447 Lobar bronchus, 43, 44, 244, 249, 250 Lobe of liver, 244, 249, 250 Longissimus muscle, 266, 267, 271, 272 Longitudinal cerebral fissure, 202 Longus capitis, 26 Longus capitis muscle, 223 Lumbar spine, 322 Lung apex, 484, 500 LLL, 132, 193, 195 PET/CT, 116, 192, 194 RLL, 60, 195 RML, 61, 193 RUL, 36–39 SPECT/CT, 448, 477, 485, 486, 501, 502, 551, 576 V/Q, 570–575 Lung cancer in left lower lobe, 35, 44 PET/CT, 240, 365 Lung left upper lobe (LUL), 38, 39, 133, 195 Lymph node (LN) abdominal para-aortic, 267 abdominal preaortic retroperitoneal, 265 hilar, 328–330 iliac, 146, 147, 165, 166, 339 metastases, 27, 65, 67 lesser curvature, 66 PET/CT, 27, 59, 65, 67 paratracheal, 327 SPECT/CT, 564–570 subcarinal, 330 supraclavicular, 326

592 M Magnetic resonance artefact, 56 Main bronchus, 56 Malignant liver mass, 104 Mammary gland, 192 Mammary vessels, 53, 54 Mandible, 24–28, 30, 31, 226, 227, 285–290, 366 Mandible ramus PET/CT, 223–225 SPECT/CT, 495 Manubrium, 37 Masseter muscle, 24–28, 30, 31 PET/CT, 24–28, 30, 31, 224–226 SPECT/CT, 494, 495 Mastoid process PET/CT, 219, 220, 284 SPECT/CT, 494 Maxilla, 286, 287 Maxillary sinus PET/CT, 21, 24, 25, 221–223, 284, 285, 385, 416 SPECT/CT, 494 Maxillary sinus cancer, 223–225 Medial condyle, 521, 524, 525 Medial epicondyle, 523, 524 Medial frontal gyrus, 210, 211 Medial meniscus, 526, 527, 529 Medial pterygoid muscle, 27, 223, 225, 226, 526, 527, 529 Medial rectus muscle, 9 Medulla oblongata, 21, 221 Meningioma, corpus callosum, 204–210 Mesencephalon, 217 Mesenteric lymph node, 335, 337, 340 Mesenteric vessels, 555, 557 Mesothelioma, 506–507, 509, 510 Metatarsal joint, 352–355 Midbrain, PET/CT, 9, 218, 374, 375, 390, 398, 405, 414, 420 Middle cerebral artery, 18 Middle frontal gyrus, 207, 208 Middle temporal gyrus, 214, 218 Molar teeth, 27, 30, 31 Multiple liver metastases, 231 Musculoskeletal system, FDG PET/CT, 164–196 Myocardium, 107

N Nasal septum PET/CT, 24, 25 SPECT/CT, 494 Nasal turbinate, 223 Nasopharyngeal cancer, 23–26 Nasopharyngeal wall, 378 Nasopharynx, 221, 224, 225, 284, 285 Neck PET/CT, 23, 29–32, 34 SPECT/CT, 473, 475, 476, 537 Neuroblastoma, 468, 470 Neuroendocrine tumor, 433, 436–439 111 In-octreotide SPECT/CT, 445–455, 459, 460, 462–469 123 I-MIBG SPECT/CT, 455–458

Index in pancreatic body, 455 in pancreatic tail, 454 SPECT/CT, 445–468 Nose tip, 494

O Oblique fissure, 494 Obliquus capitis inferior muscle, 483 Obturator artery, 188, 189 Obturator externus muscle, 117, 153, 160, 161, 167 Obturator internus muscle, 117, 120, 167 Obturator LN metastasis, 121 Occipital bone, 15–20 Occipital condyle, 284 Occipital cortex, 9, 15–18, 208, 419, 420 Occipital gyrus, 205, 206, 215, 218 Occipital lobe, 214 Occipital sinus, 217 Octreoscan, 460 Ocular muscles, 493 Optic nerve, 9, 218 Orbit, PET/CT, 415 Orbitofrontal cortex, 398 Ossifying fibroma, 510 Osteoblastic metastases, 510 Osteofibrous dysplasia, 510 Osteosarcoma left sacral ala involvement of, 187–189 PET/CT, 345–347 sacral ala involvement of, 186 Ovary, 158

P Palatine tonsil, 27, 31 PET/CT, 225, 226 SPECT/CT, 495 Palatine tonsils, 286–288 Pancreas, 81, 82 body, 69 head, 81–83, 93, 305–308, 311–313, 554 PET/CT, 48, 80, 101, 113, 129, 300, 301, 319, 334, 361, 370 SPECT/CT, 458, 471 tail NE tumor, 450, 454 PET/CT, 68, 69, 238 uncinate process, 582, 583 Pancreatic body, 310 Pancreatic cancer in pancreatic head, 91 PET/CT, 74, 81, 84, 92 Pancreatic duct, 88 dilated, 86, 87, 89, 90 PET/CT, 80, 92, 309 Para-aortic LNs, 336 Paraganglioma, 472 Paraspinalis muscle, 448 Parathyroid adenoma, 492–508 Parathyroid gland, 500 Parietal bone, 11–16 Parietal cortex, 401, 408, 417 Parietal lobe, 201, 386, 392–395 Parotid gland, 26, 27, 225, 226, 285, 287, 288, 366, 378, 385, 407, 422, 495

Patella PET/CT, 173 SPECT/CT, 523, 524 Pectineus muscle, 117, 153, 167, 341 Pectoralis major muscle, 133, 134 PET/CT, 36, 51–53, 133, 134, 232–236, 256, 257, 291, 351 SPECT/CT, 449, 501 Pectoralis minor muscle, 36, 51–53, 133, 134 PET/CT, 36, 51–53, 133, 134, 232, 233, 256, 291, 351 SPECT/CT, 449, 502 Pelvis bone osteosarcoma, 183 FDG PET/CT, 115–164 PET/CT, 116, 142, 156–158 Penis, PET/CT, 58 Pericardium PET/CT, 58 Perirectal LN metastasis, 118–121, 154 Peritumoral edema, 4–7, 13, 14, 200 Periureteral metastasis, 116, 122 Periventricular white matter, 373 Pharyngeal space, 495 Pharynx, 27, 288 Pheochromocytoma, 455 Pituitary gland, 20, 376 Popliteal LNs, 165, 172, 173, 352, 356, 357 Portal vein, 48, 49, 65–68, 76–80, 85, 87, 99, 105, 108, 130, 238 Positron emission tomography/computed tomography (PET/CT), 199–433 FDG abdomen, 54–115 brain/head and neck, 1–34 chest, 32–54 hypermetabolic lesion, 352–359 hypermetabolic mass, 341–351 multiple hypermetabolic lesions, 330–341 musculoskeletal system, 164–196 pelvis, 115–164 non-FDG 11 C-acetate, 359–371 11 C-methionine, 371–385 11 C-PIB, 385–400 18 F-Flumazenil, 416–422 18 F-FP-CIT, 400–416 66 Ga-RGD, 422–432 68 Ga-DOTA-TOC, 432, 433 Postcentral gyrus, 3–7, 11–14, 200, 201 Posterior cingulate, 397 Posterior intercondylar, 525 Posterior segmental bronchus, 244 Postobstructive atelectasis, 240 Precentral gyrus, 3–7, 13, 14, 200, 201 Promontory, sacrum, 141 Psoas major muscle PET/CT, 73, 124, 125, 266, 267, 322–324, 339, 340 Psoas muscle, 123, 143–145, 159, 557 Pterygoid muscle, 24–26, 28, 30, 31 Pterygoid process, 223, 224 Pubic bone PET/CT, 117–119, 141, 153, 161–164, 239 SPECT/CT, 548

593

Index Pulmonary artery PET/CT, 41–43, 110, 193, 194, 234–236, 330 SPECT/CT, 485 Pulmonary trunk, 42–44, 133, 192, 193, 235, 236, 261, 263, 328–330, 459 Pulmonary vein, 236, 237 Putamen, 8, 16, 17, 209–212, 374, 401, 403, 404, 407, 412, 413 Pylorus, 78, 79

Q Quadratus lumborum muscle, 124, 125, 266, 267 Quadrigeminal plate cistern, 215–217

R Reactive/inflammatory axillary lymph node, 320 Rectal cancer PET/CT, 116, 118–120 posterior wall of vagina, 117–119 Rectosigmoid colon, 558 Rectovesicular pouch, 559 Rectum PET/CT, 117, 121, 137–141, 148–150, 153–156, 163, 164, 166, 191 SPECT/CT, 559 Rectus abdominis muscle PET/CT, 140, 143, 161–163, 238, 265–267, 269 SPECT/CT, 559 Rectus femoris muscle, 167–170, 172, 178–182, 341, 343–347 Recurred liposarcoma, 59, 60 Renal artery, 93, 310–312 Renal cell carcinoma, 433, 436–439 in right kidney, 584 PET/CT, 360, 363, 364 Renal cortex, 553, 554 Renal paraganglioma, 471 Renal pelvis, 128 PET/CT, 72 SPECT/CT, 553, 554 Renal vein, 81–83, 93, 115, 302, 310–312 Retrocrural lymph node metastases, 265, 361 PET/CT, 361 Retromolar trigone cancer, 29–31 Retropancreatic lymph node, 300, 579 Retroperitoneum, 360 Rib, SPECT/CT, 448, 459 Right upper lobe (RUL), 0, 36–39, 192, 247, 248, 452 Round pneumonia, 571

S Sacral canal, 187 Sacral lymph nodes, 558 Sacral plexus, 188 Sacroiliac joint, 547 Sacrum metastasis in, 461 PET/CT, 73, 122, 123, 141, 144, 145, 154–156, 162–164, 325, 340 SPECT/CT, 547, 549, 558 Sagittal suture, 12–14

Sartorius, 343–348 Sartorius muscle, 167–173, 178–182, 341, 343–348 Scapula PET/CT, 232–237, 290–292 SPECT/CT, 449, 484, 535–538 Scapular, 500, 502 Schmorl’s node, 539, 549 Schwannoma internal necrotic portion in, 107, 108 in liver, 106 Semimembranosus, 170–173, 343–348 Semispinalis cervicis, 498 Semitendinosus muscle, 169–173, 343–348 Septal wall, 368 Serratus anterior muscle, 132, 237 Seventh rib, 293 Shoulder joint capsule, hypermetabolic region, 0, 350 PET/CT, 351 Sigmoid colon cancer PET/CT, 10, 22, 122, 123, 148, 149, 166, 325 SPECT/CT, 558 Sigmoid sinus, 10, 22, 25 Skull PET/CT, 10, 22, 372, 379, 386, 417 SPECT/CT, 493 Small bowels, 580–583 Small cell lung cancer, 241–245, 247, 248, 250–253 Small hypermetabolic lesion, 349 SPECT/CT, 443 abscess, 560–561 accessory spleen, 571–583 adrenal hyperplasia, 583–585 AVN, 538–550 bone metastases, 510–520 bone tumor, 507–511 central venous line obstruction, 563–565 CSF, 561–564 degenerative disease, 531–538, 540–546, 548, 549 ectopic thyroid, 561, 562 gastrointestinal bleeding, 550–560 hepatocellular carcinoma, 443–444 liver metastases, 444–445 lung (V/Q), 570–575 lymph node, 564–570 mesothelioma, 506–507, 509, 510 neuroblastoma, 468, 470 neuroendocrine tumor, 445–468 paraganglioma, 468–470 parathyroid adenoma, 492–508 99m Tc-MAA (see 99mTc-MAA SPECT/CT) thyroid cancer, 470–492 trauma, bone, 520–532 Sphenoidal bone, 220 Sphenoidal sinus PET/CT, 218–220 SPECT/CT, 494 Sphincter of Oddi, 82, 83 Spinae muscle, 42–45 Spinal cord PET/CT, 27, 28, 33, 34, 135, 232–234, 289 SPECT/CT, 495, 498 Spinalis muscle, 68–72, 266, 267, 269–272 Spine of scapula, 351

Spinous process, 496, 501, 540 Spleen, 129, 571 accessory (see Accessory spleen) PET/CT, 48, 49, 56, 57, 63–69, 75–80, 97–101, 103–105, 113, 130, 238, 293, 298–301, 306, 315, 316, 333, 360, 369, 428, 433, 436–439 SPECT/CT, 450, 453–456, 458, 461, 482, 488, 552–554, 577–580, 584 Splenic artery, 85, 86 Splenic vein, 87, 301, 308, 309, 311, 317, 318, 334 Splenic vessel, 78, 79 Sternal bone metastasis, 231 Sternocleidomastoid muscle PET/CT, 30–35, 224–228, 255, 276, 280, 281 SPECT/CT, 473–476, 483, 498 Sternum PET/CT, 53, 54, 132, 133, 192, 237, 291, 332 SPECT/CT, 448, 486, 501, 502 Stomach, 297–304, 332, 333, 554, 579 body, 64–67 hypermetabolic mass in, 0, 296 PET/CT, 76–79, 85, 97–99, 105, 113, 129, 130, 297–304, 306, 308, 316–319, 332–334 SPECT/CT, 450, 455, 461, 471, 482, 487, 554, 579, 584 Stomach cancer, 56, 69, 70 antrum, 69, 70 in lesser curvature, 56 PET/CT, 55, 57, 68 Straight sinus, 209–211, 214 Subarachnoid space, 202 Subcarina, 247 Subcarinal LN metastasis, 248–250 subclavian artery, 230 Subclavian artery, 36, 51, 134, 230, 326, 327 PET/CT, 36, 51, 134, 230, 326, 327 SPECT/CT, 484, 501 Subclavian artery, left, 37, 38 Subclavian vein, 327 PET/CT, 36, 327 SPECT/CT, 484 Submandibular gland PET/CT, 32, 367 SPECT/CT, 483, 496, 497 Subscapularis muscle PET/CT, 232–236, 258, 292, 350, 351 SPECT/CT, 449 Superior articular process, 525, 541 Superior frontal gyrus, 4–6, 202, 207, 208, 214 Superior mesenteric artery first branch of, 91 PET/CT, 70, 81–83, 90–92, 308–313, 335 Superior mesenteric vein encased by the tumor, 92 PET/CT, 81–83, 318, 319, 335 Superior mesenteric vessels, 555, 556 Superior pulmonary vein, 502 Superior sagittal sinus, 11–17, 200–211, 401, 408 Superior segmental bronchus, 250, 251 Superior temporal gyrus, 215–218

594 Superior vena cava (SVC) PET/CT, 40, 41, 233–237, 257, 328–330 SPECT/CT, 485 Supraclavicular lymph node, 290 Supraglenoid tubercle, 535 Supraspinatus, 351 Synovial sarcoma, 165, 174–176

T Tail of pancreas, 553, 580, 581 Talus, 176 99m Tc-denatured RBC spleen scan, 571 99m Tc-DTPA SPECT/CT, central venous line obstruction, 563–565 99m Tc-labeled red blood cell (99mTc-RBC) SPECT/CT, 550–560 99m Tc-lymphoseek SPECT/CT, 565, 570 99m Tc-MAA SPECT/CT hepatocellular carcinoma, 443–444 liver metastases, 444–446 lung (V/Q), 570–575 mesothelioma, 506–507, 509, 510 99m Tc-MDP SPECT/CT AVN, 538, 550 bone metastases, 510–518, 520 bone tumor, 507, 511 degenerative disease, 531–538 trauma, bone, 520–532 99m Tc-MIBI SPECT/CT, 492–508 99m Tc-sulfur colloid SPECT/CT abscess, 560 lymph node, 564–570 Temporal bone, 219, 284 Temporal cortex, 9, 15–20, 398, 420, 421 Temporal lobe, 15, 16, 217, 387–391, 424, 493 Temporal muscle, 218–220 Temporalis muscle, 24, 25, 493 Tensor fasciae latae muscle, 167, 168 Tenth rib, 294 Teres major muscle, 232–236, 259 Thalamus, 8, 16, 17, 209–211, 419 Thoracic aorta, 131, 264 Thoracic duct, 297 Thymus, 283, 291, 292 Thyroid bed, 476 Thyroid cancer, 268 PET/CT, 268 SPECT/CT, 470–492 Thyroid cartilage PET/CT, 33, 228, 276 SPECT/CT, 498

Index Thyroid glands PET/CT, 35, 135, 281 SPECT/CT, 499 Thyroid left lobe, 500 SPECT/CT, 500 Thyroid nodule, 425 Thyroiditis, 425 Tibia, 174–176 Tibial lateral condyle, 526, 527 Tibial tuberosity, 527, 528 Tibialis anterior muscle, 174 Tongue, 27, 28, 32 Tonsil, 366 Total thyroidectomy, 470 Trachea PET/CT, 34–39, 134, 232, 233, 241–244 SPECT/CT, 451, 477, 478, 483, 484, 499–502 Transverse colon, 489 PET/CT, 127, 238, 303, 304, 322, 333 SPECT/CT, 487, 488, 540, 542, 554–557, 578–581 Transverse sinus, 19, 20, 219, 220 Trapezius muscle PET/CT, 33–35, 228, 235–237, 290, 351 SPECT/CT, 495, 499 Triceps, 350 Tubercle of humerus, 535–537 Tumor vessel, intratumoral aneurysmal change of, 186–190

V Vagina, 117–120, 141 Vastus intermedius muscle, 168, 171, 178–182, 343–348 Vastus lateralis, 343–346 Vastus lateralis muscle, 168–172, 178–182, 343–346 Vastus medialis muscle, 178–182 Vena cava, 553 Venous obstruction, 563 Ventricle, 45, 46, 60, 237, 292, 448, 486, 551, 576 PET/CT, 45, 46, 60, 111, 237, 292, 371 SPECT/CT, 45, 111, 371, 448, 486, 551, 576 Ventricular drain, 380 Vertebral arch, 485 Vertebral artery, 28 Vertebral body, 41 PET/CT, 35–40, 42–46, 56, 57, 60–67, 124–128, 184, 291–295, 332–334, 486, 541 SPECT/CT, 448–453, 542–546, 549, 551, 576, 578 Vertebral canal, 552, 554 Vertebral foramen, 541 Vesical vessels, 559 Video-assisted thoracoscopic biopsy, 470 Vocal cord, 289 Vocalis muscle, 498

W Wilms tumor, 283, 294, 295 U Uncinate process of pancreas, 582, 583 Upper lobe lobar bronchus, 328 Ureter, 126, 127, 430 Urethra, 117, 153, 341 Urinary bladder PET/CT, 116, 118–121, 138, 139, 141, 151, 152, 158, 159, 161, 163, 164, 191 SPECT/CT, 559 Uterine body, 141 Uterine cervical cancer, 140, 162, 163 Uterine fundus, 141 Uterus body, 150, 162, 163 fundus, 148, 149, 151, 162–164 PET/CT, 121, 150, 157, 159, 162, 163, 166, 191, 431

Y Y PET/CT, liver metastases, 445, 447

90

Z Zygomatic arch, 221, 223, 285 Zygomatic bone PET/CT, 218, 219, 284 SPECT/CT, 494