Positron Emission Tomography (PET) plays a central role in the staging and response assessment of most solid tumors and those of the lymphatic system. The use of certain molecular tracers also makes it possible to select patients who will benefit from subsequent radiometabolic treatments (teragnostics). Sentinel lymph node detection and marking has become the method of choice for minimally invasive lymph node staging in breast cancer and other cancer diseases (melanoma, gynecologic cancers, head and neck cancers).
Oncology diagnostics
Oncology currently constitutes the major field of use of nuclear medicine not only in the diagnostic field but, for some cancer diseases, also in the therapeutic one.
Examinations and diagnosis
PET/CT 18F-PSMA
Principal indications.
Prostate carcinoma in biochemical recurrence and staging of prostatic Ca (intermediate and high risk).
Examination procedure.
Intravenous administration of the radiopharmaceutical (18F PSMA) after application of saline infusion to ensure sufficient hydration and rapid excretion of the tracer. After an interval of 60 minutes, the patient will be asked to empty the bladder. Then the patient is placed on the equipment bed and whole-body images are acquired. A second acquisition is performed later after an interval of an additional 60 minutes.
Examination duration.
2:30 to 2:45 hours overall.
PET/CT 18F-fluorodeoxyglucose (FDG)
Principal indications
Staging and evaluation of response to therapy of the most common tumor processes with high aggressiveness and high glucose metabolism.
Examination procedure
Measurement of blood glucose by needle-puncture of the finger. Intravenous administration of the radiopharmaceutical (18F FDG) after application of saline infusion to ensure sufficient hydration and rapid excretion of the tracer. After an interval of 60 minutes required for complete distribution of the radiopharmaceutical, the patient will be asked to empty the bladder. Then the patient is placed on the equipment bed and the investigation is acquired.
Duration of the examination
1:30 to 2 hours overall.
PET/CT 18F-fluoroethyltyrosine (FET)
Principal indications
Brain tumor evaluations.
Examination procedure.
Intravenous administration of the radiopharmaceutical (18F FET) after application of saline infusion to ensure sufficient hydration and rapid excretion of the tracer After an interval of 25 minutes (which the patient spends quietly lying in an armchair), imaging of the brain is performed.
Duration of the examination
1:30 to 2 hours overall.
PET/CT 68Ga-DOTATATE (somatostatin analog)
Principal indications
Staging, restaging, and evaluation of response to therapy of neuroendocrine tumors (NETs) expressing somatostatin receptors. Pre-metabolic therapy (PRRT) evaluation. Search for primary NET in case of known metastasis of unknown neuroendocrine tumor.
Examination procedure.
Intravenous administration of the radiopharmaceutical (68Ga-Dotatate) after application of saline infusion to ensure sufficient hydration and rapid excretion of the tracer. After an interval of about 50 minutes, the patient will be asked to empty the bladder. Then the patient is placed on the equipment bed and images are acquired.
Duration of the examination
1:30 to 2 hours overall.
Bone whole body scintigraphy/SPECT-CT (bone metastases)
Principal indications.
Staging of metastatic bone disease.
Examination procedure.
Fasting not necessary. Intravenous injection of the tracer and performing the examination 2-4 e after the intravenous injection. Good hydration is recommended after injection (drink at least 1 liter of water or tea).
Duration of the examination.
Approximately 1 hour.
Medullary Scintigraphy/SPECT-CT
Principal indications
Confirmation of metastatic localization by bone marrow replacement in a bone segment.
Examination procedure.
Specific preparation and fasting not required. Intravenous injection of the radiopharmaceutical. The investigation includes an early acquisition (10 minutes after injection) and a late acquisition at 1 hour.
Duration of the examination.
Approximately 90 minutes in total.
Lymphoscintigraphy for sentinel lymph node detection
Principal indications.
Preoperative sentinel lymph node localization and marking in certain types of cancers (breast cancer, melanoma, gynecological cancers).
Examination procedure.
No fasting required, no specific preparation. Perilesional injection of tracer (usually subcutaneous). The investigation is performed after a time interval required for migration of the tracer (usually several minutes).
Duration of the examination
15-45 minutes.
Whole body scintigraphy/SPECT-CT of chromaffin tissue
Principal indications
Staging, restaging, and evaluation of treatment response in patients with neural crest-derived tumors (neuroblastomas, pheochromocytomas, paragangliomas).
Examination procedure.
Fasting patient, discontinuation of interfering medication as prescribed. Premedication with Lugol's solution. Intravenous injection of the tracer. Performance of examination after 20minutes and late 2h post injection. In case of oncological indications, the investigation includes an additional imaging session the next day.
Duration of the examination
2h 30min. Additional session on the following day: 45 minutes.
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The original version is the page in Italian.
