This state-of-the-art, lavishly illustrated atlas is your visual guide to fusion imaging of all parts of the body. It combines CT with molecular imaging modalities such as PET and SPECT, resulting in significantly enhanced resolution of tumors and other disease processes that give you a unique view into their diagnosis, localization, and spread. Edited by the pioneers of fusion imaging, this new resource will help you more accurately diagnose and effectively guide treatment of human malignancies, including head and neck, lung, colon, ovarian, breast, lymphoma, melanoma, and many others, as well as other diseases such as infections.

Table of Contents

1. PREFACE 2. TECHNICAL CONSIDERATIONS FOR PET/CT AND SPECT/CT 3. PET/CT OF THE BRAIN 3.1 Normal pattern 3.2 Benign abnormalities 3.2.1 Congenital encephalomalacia 3.2.2 Post-surgical changes 3.2.3 Radiation necrosis 3.3 Tumors 3.3.1 Primary brain tumor 3.3.2 Metastases 3.3.3 Residual tumor post-surgical changes 3.3.4 Recurrent tumor radiation necrosis 3.3.5 Pituitary adenoma stroke 3.4 Neurological disorders 3.4.1 Epilepsy classic interictal pattern 3.4.2 Epilepsy interictal pattern cerebellar diaschisis 3.4.3 Epilepsy interictal decreased cerebellar uptake 3.4.4 Alzheimers disease diffuse pattern 3.4.5 Alzheimers disease frontal predominance 4. PET/CT OF THE HEAD NECK 4.1 Normal pattern 4.2 Physiologic, Artifacts Pitfalls 4.2.1 Artifact - miss-registration due to patient movement 4.2.2 Physiologic muscles uptake in tongue 4.2.3 Physiologic unilateral muscle uptake, mastication 4.2.4 Physiologic - bilateral muscle uptake, mastication 4.2.5 Physiologic unilateral muscle uptake, neck 4.2.6 Physiologic unilateral muscle uptake, torticollis metal artifact 4.2.7 Pitfall - vocal cord paralysis, left 4.2.8 Pitfall - vocal cord paralysis, right supraclavicular node 4.2.9 Benign - brown fat, neck 4.2.10 Benign - brown fat, neck shoulders 4.2.11 Benign - post-treatment changes, skin subcutaneous tissue 4.2.12 Benign - post-treatment changes, reconstituted lymphoid tissue muscles 4.2.13 Benign - post-surgical changes missing salivary gland 4.2.14 Benign - post-treatment changes FDG-negative salivary gland 4.2.15 Pitfall - post-surgical changes, missing orbit ethmoid air cells 4.3 Inflammation Infection 4.3.1 Inflammation, tracheostomy 4.3.2 Infection, acne 4.3.3 Infection, maxillary sinusitis, partial involvement 4.3.4 Infection, maxillary sinusitis, involvement of whole sinus 4.3.5 Mucus cyst in maxillary sinus, FDG-negative 4.3.6 Inflammation, rheumatoid arthritis, atlanto-dental joint 4.4 Tumors 4.4.1 Scalp, melanoma 4.4.2 Scalp, melanoma 4.4.3 Scalp, FDG-negative 4.4.4 Auditory canal 4.4.5 Parotis peri-parotid nodes 4.4.6 Parotis 4.4.7 Nasopharynx, response to treatment 4.4.8 Lip 4.4.9 Base of tongue 4.4.10 Tongue level II nodes 4.4.11 Tonsil level II nodes 4.4.12 Pharynx 4.4.13 Pharynx cervical nodes 4.4.14 Larynx tracheostomy 4.4.15 Larynx tracheal cartilage destruction 4.4.16 Vocal cord 4.4.17 Cervical esophageal cancer 4.4.18 Neural sheath 4.4.19 Bone, vertebral metastasis 4.5 Lymph Nodes 4.5.1 Level I 4.5.2 Level I II 4.5.3 Level II 4.5.4 Level II 4.5.5 Level II III 4.5.6 Level IV 4.5.7 Level V 4.5.8 Level VI 4.6 Thyroid 4.6.1 Benign - Thyroiditis 4.6.2 Benign Multinodular retrosternal goiter 4.6.3 Benign Adenoma distorted anatomy 4.6.4 Tumor - Primary thyroid cancer 5. PET/CT OF THE CHEST 5.1 Normal Pattern 5.2 Chest wall 5.2.1 Pitfall Gynecomastia 5.2.2 Pitfall - Muscular uptake, asymmetric 5.2.3 Pitfall - Axillary post-injection uptake 5.2.4 Benign Brown fat, shoulder upper chest wall 5.2.5 Benign Post-surgical changes 5.2.6 Tumor Chest wall recurrence, breast cancer 5.3 Breast 5.7.1 Artifact Saline implants, cold lesion 5.7.2 Pitfall - Seroma 5.7.3 Benign Granuloma 5.7.4 Benign Post-radiation changes 5.7.5 Tumor Large primary breast cancer 5.7.6 Tumor - Primary breast cancer axillary nodes 5.7.7 Tumor Recurrent breast cancer axillary nodes 5.4 Skeleton 5.4.1 Benign Rib fractures, varying ages 5.4.2 Benign Fracture, sternum 5.4.3 Benign Osteophyte, thoracic vertebra 5.4.4 Benign Post-radiation cold vertebrae 5.4.5 Tumor Metastasis, rib 5.4.6 Tumor Metastasis, sternum 5.4.7. Tumor Metastases, thoracic vertebrae 5.5 Pleura 5.5.1 Benign Inflammation, pleurodesis, localized pattern 5.5.2 Benign Inflammation, pleurodesis, diffuse pattern 5.5.3 Tumor - Malignant pleural effusion 5.5.4 Tumor Pleural thickening, mesothelioma 5.5.5 Tumor Pleural nodule, malignant implant 5.5.6 Tumor Pleural masses, mesothelioma 5.6 Lung 5.6.1 Pitfall Miss-registration, related to respiration 5.6.2 Benign - Post-radiation changes 5.6.3 Benign - Pneumonia 5.6.4 Benign Pulmonary sarcoidosis 5.6.5 Benign FDG-negative small lung nodule 5.6.6 Benign FDG-negative lung nodule interval shrinkage 5.6.7 Benign Single lung nodule, granuloma 5.6.8 Tumor Single lesion, primary lung cancer 5.6.9 Tumor Single cystic lesion, primary lung cancer 5.6.10 Tumor - Moderate FDG avidity, bronchiolo-alveolar lung cancer 5.6.11 Tumor Pancoast, with chest involvement lung metastasis 5.6.12 Tumor Response to treatment, primary hilar nodes 5.6.13 Tumor Metachronous lung cancer 5.6.14 Tumor Recurrent mesothelioma post-surgical changes 5.6.15 Tumor Multiple lesions, multifocal lung cancer 5.6.16 Tumor Multiple lesions, lymphoma 5.6.17 Tumor Multiple lesions, inhomogeneous pattern, lymphoma 5.6.18 Tumor Multiple lesions, metastases 5.6.19 Tumor Multiple lesions, FDG-negative metastases 5.6.20 Tumor Multiple lesions, treated new metastases 5.7 Thoracic Lymph Nodes 5.7.1 Supraclavicular 5.7.2 Retroclavicular pectoralis 5.7.3 Axillary pectoralis 5.7.4 Axillary 5.7.5 Internal mammary 5.7.6 Supradiaphragmatic 5.8 Mediastinal Lymph Nodes 5.8.1 Anterior mediastinal paratracheal 5.8.2 Prevascular, normal size 5.8.3 Aorto-pulmonary window 5.8.4 Precarinal subcarinal 5.8.5 Paraesophageal 5.8.6 Multiple: pretracheal,paratracheal, tracheo-bronchial hilar 5.8.7 Response to treatment, Retrocaval-paratracheal paraspinal 5.9 Mediastinum 5.9.1 Pitfall Brown fat 5.9.2 Pitfall - Blood clot 5.9.3 Benign Thymus 5.9.4 Tumor - Bulky disease, lymphoma 5.9.5 Tumor Endotracheal lesion, recurrent lung cancer 5.10 Esophagus 5.10.1 Pitfall - Hiatal hernia 5.10.2 Pitfall - Gastric pull-up 5.10.3 Benign - Esophagitis, post-radiation 5.10.4 Tumor - Esophageal cancer, proximal 5.10.5 Tumor - Esopageal cancer, distal 5.10.6 Tumor - Response to treatment, distal 5.11 Cardio-vascular 5.11.1 Benign - Takayasus aortitis 5.11.2 Benign - Coronary calcifications pericardial effusion 5.11.3 Assessment of myocardium - Scar 5.11.4 Assessment of myocardium - Viability apical scar 5.11.5 Assessment of myocardium - Cardiomyopathy 5.11.6 Cardiac PET/CT Normal myocardial perfusion coronary anatomy 5.11.7 Cardiac PET/CT Ischemia coronary calcifications, narrowing 6. PET/CT OF THE ABDOMEN 6.1 Normal pattern 6.2 Abdominal wall 6.2.1 Pitfall Colostomy 6.2.2 Pitfall Pararenal brown fat 6.2.3 Pitfall Anterior abdominal brown fat, 6.2.4 Pitfall Paracolic brown fat 6.2.5 Benign - Surgical scar 6.2.6 Benign Rib fracture 6.2.7 Tumor - Metastasis 6.3 Liver spleen 6.3.1 Pitfall Intracholdedocal stent 6.3.2 Pitfall Lesions at liver/lung interface 6.3.3 Benign Chronic cholecystitis 6.3.4 Tumor Primary hepatocellular carcinoma 6.3.5 Tumor Single liver metastasis at lower pole 6.3.6 Tumor Multiple liver metastases 6.3.7 Tumor Recurrent metastasis at site of surgery 6.3.8 Tumor Single spleen metastasis 6.3.9 Tumor Multiple lesions in spleen 6.3.10 Tumor Spelnomegaly diffuse involvement by lymphoma 6.4 Pancreas 6.4.1 Tumor Cancer in head of pancreas 6.4.2 Tumor Cancer in tail of pancreas 6.4.3 Tumor inflammatory process Multiple pancreatic lesions 6.5 Stomach 6.5.1 Physiologic gastric uptake 6.5.2 Tumor - Lymphoma in distal antrum 6.5.3 Tumor - Gastric cancer, diffuse involvement 6.5.4 Tumor Large mass, GIST 6.5.5 Tumor Recurrence in gastric stump 6.6 Bowel 6.6.1 Benign Colon adenoma 6.6.2 Tumor Primary colon cancer 6.6.3 Tumor Metastasis in small intestine 6.7 Peritoneum 6.7.1 Benign - Granulomatotic nodule 6.7.2 Tumor - Single metastatic nodule 6.7.3 Tumor - Multiple metastatic nodules 6.7.4 Tumor Diffuse pattern, peritoneal seeding 6.7.5 Tumor Peritoneal masses, GIST 6.8 Kidney Adrenals 6.8.1 Pitfall Regional lymphadenopathy near renal pelvis 6.8.2 Pitfall Single kidney 6.8.3 Pitfall Ectopic kidney 6.8.4 Pitfall Horseshoe kidney 6.8.5 Pitfall Distorted renal pelvis 6.8.6 Tumor - Single renal metastasis 6.8.7 Tumor Multiple renal lesions, lymphoma 6.8.9 Tumor Single adrenal metastasis 6.8.10 Tumor - Bilateral adrenal involvement, lymphoma 6.9 Lymph Nodes 6.9.1 Gastro-hepatic ligament 6.9.2 Hepatic hilum 6.9.3 Splenic hilum 6.9.4 Mesenteric retroperitoneal 6.9.5 Root of mesentery 6.9.6 Para-aortic 6.9.7 Aorto-caval 6.9.8 Iliac 6.10 Vascular 6.10.1 Pitfall - Aortic wall calcifications 6.10.2 Pitfall - Aortic aneurysm 6.10.3 Benign - Aortic graft infection psoas muscle abscess 6.11 Bone (Lumbar spine) 6.11.1 Benign - Degenerative changes, vertebral body 6.11.2 Benign - Degenerative changes, articular facets 6.11.3 Benign - Degenerative changes, intervertebral disc 6.11.4 Tumor - Lytic FDG-avid metastasis 6.11.5 Tumor Sclerotic FDG-negative metastases 6.11.6 Tumor Bone soft tissue metastasis 7 PET/CT OF THE PELVIS 7.1.1 Normal pattern - Male pelvis 7.1.2 Normal pattern - Female pelvis 7.2 Pelvic wall, Soft tissues Peritoneum 7.2.1 Pitfall Focal uptake, Colostomy 7.2.2 Pitfall Focal uptake, Inguinal hernia 7.2.3 Pitfall Focal uptake, Urinary catheter 7.2.4 Benign Skin granuloma 7.2.5 Benign Infection, pilonidal sinus 7.2.6 Benign Infection, pelvic abscess 7.2.7 Tumor - Presacral recurrence, rectal cancer 7.2.8 Tumor Metastasis, psoas muscle 7.2.9 Tumor Metastases, focal peritoneal nodule 7.2.10 Tumor - Diffuse peritoneal involvement 7.3 Gastro-intestinal tract 7.3.1 Pitfall Physiologic bocal uptake in bowel 7.3.2 Benign Rectal polyp 7.3.3 Benign Inflammatory bowel disease 7.3.4 Tumor Primary rectal cancer 7.3.5 Tumor Primary recto-sigmoid cancer para-rectal nodes 7.3.6 Tumor Response to treatment, Metastatic rectal cancer 7.3.7 Tumor - Recurrence, rectal cancer 7.3.8 Tumor Recurrence, rectal cancer iliac nodes 7.4 Urinary tract 7.4.1 Pitfall - Ectopic pelvic kidney 7.4.2 Pitfall - Renal transplant 7.4.3 Pitfall Focal uptake in ureter 7.4.4 Pitfall Focal uptake in obstructed ureter 7.4.5 Pitfall - Dilated prostatic urethra 7.4.6 Pitfall - Bladder diverticulum 7.4.7 Pitfall - Bladder herniation 7.4.8 Tumor Carcinoma of ureter 7.4.9 Tumor- Carcinoma of urinary bladder 7.5 Ovary, Cervix, Uterus 7.5.1 Pitfall - Ovulating ovary 7.5.2 Pitfall Menstruation 7.5.3 Tumor- Lymphoma in ovary 7.5.4 Tumor Primary ovarian cancer 7.5.5 Tumor Ovarian cancer, recurrence at site of previous surgery 7.5.6 Tumor Primary cervical cancer 7.5.7 Tumor Primary cervical cancer, inhomogeneous uptake pattern 7.5.8 Tumor Primary cervical cancer iliac nodes 7.5.9 Tumor Recurrence, cervical cancer 7.6 Prostate, Testis 7.6.1 Benign - Prostatic hypertrophy 7.6.2 Benign Infection, Orchi-epidydimitis 7.6.3 Tumor - Lymphoma in testis 7.7 Lymph Nodes 7.7.1 Common external iliac lymph nodes 7.7.2 Internal iliac lymph nodes 7.7.3 Internal iliac lymph nodes, lower pelvis 7.7.4 Inguinal lymph nodes cervical cancer 7.7.5 Inguinal lymph nodes metastatic gluteal mass 7.8 Vascular 7.8.1 Pitfall Non-infected aorto-bifemoral bypass 7.8.2 Benign - Infected vascular graft 7.9 Bone 7.9.1 Pitfall Post-radiation Cod sacrum 7.9.2 Benign - Sacral fracture 7.9.3 Benign Pagets disease 7.9.4 Tumor Metastasis in sacrum epidural space 7.9.5 Tumor Metastasis in ilium soft tissue 8. PET/CT OF EXTREMITIES 8.1 Skin 8.1.1 Benign - Surgical scar 8.1.2 Benign - Infected surgical scar 8.1.3 Benign - Infected ulcers 8.1.4 Tumor Nodules, malignant melanoma 8.2 Soft tissue 8.2.1 Benign - Abscess 8.2.2 Tumor - Subcutaneous nodule, lymphoma 8.2.3 Tumor - Subcutaneous nodule, melanoma 8.2.4 Tumor Sarcoma bone involvement 8.3 Joints 8.3.1 Artifact - Periprosthetic uptake, metal-induced reactive process 8.3.2 Benign - Periarticular uptake, bursitis 8.3.3 Benign - Periarticular uptake, synovitis 8.3.4 Benign Teno-synovitis tendon tear 8.3.5 Benign - Periprosthetic uptake, low grade infection 8.4 Muscles 8.4.1 Physiologic Tense muscles 8.4.2 Tumor Metastasis, breast cancer 8.4.3 Tumor Metastases, rhabdo-myosarcoma 8.5 Lymph Nodes 8.5.1 Epitrochlear 8.5.2 Popliteal 8.5.3 Popliteal, large node 8.6 Vascular 8.6.1 Pitfall Vascular uptake peri-calcifications 8.6.2 Benign - Infected vascular graft 8.7 Bone bone marrow 8.7.1 Benign - Osteomyelitis 8.7.2 Tumor Metastasis in scapula 8.7.3 Tumor Metastasis in humerus 8.7.4 Tumor Metastasis in femur 8.7.5 Tumor - Bone soft tissue involvement, lymphoma 8.7.6 Tumor - Bone marrow involvement, multiple myeloma 8.7.7 Tumor - Bone marrow soft tissue involvement, lymphoma 8.7.8 Tumor - Bone marrow soft tissue involvement, lymphoma 9. SPECT/CT 9.1 Indium111-Pentetreotide SPECT/CT 9.1.1 Physiologic - Bowel kidney uptake 9.1.2 Pitfall - Uptake in gallbladder 9.1.3 Tumor Residual carcinoid 9.1.4 Tumor Metastatic carcinoid 9.1.5 Tumor Disseminated carcinoid 9.1.6 Tumor Vertebral metastasis of neuroendocrine tumor 9.2 Iodine131 SPECT/CT 9.2.1 Physiologic Remnant thyroid 9.2.2 Physiologic Bowel uptake 9.2.3 Pitfall Thymic uptake 9.2.4 Pitfall Dental uterine inflammatory process 9.2.5 Pitfall Uptake in ectopic stomach 9.2.6 Tumor Mediastinal nodal metastasis, thyroid cancer 9.2.7 Tumor Cervical supraclavicular nodal metastases, thyroid cancer 9.2.8 Tumor Lung metastasis, Thyroid cancer 9.2.9 Tumor Bone metastasis, Thyroid cancer 9.2.10 Tumor Bone metastases, Thyroid cancer 9.3 Iodine123-MIBG SPECT/CT 9.3.1 Physiologic - Cardiac uptake 9.3.2 Physiologic Inhomogeneous cardiac uptake pheochromocytoma 9.3.3 Physiologic Renal uptake 9.3.4 Physiologic Adrenal uptake 9.3.5 Tumor Bilateral pheochromocytoma 9.3.6 Tumor Neuroblastoma bone marrow involvement 9.4 Gallium67 SPECT/CT 9.4.1 Pitfall Thymic uptake 9.4.2 Benign Infection, osteomyelitis 9.4.3 Benign Infection, bone soft tissue; Bowel uptake 9.4.4 Benign Infection, paravertebral abscess 9.4.5 Benign Infection, liver abscess 9.4.6 Tumor Lymphoma involving the head and neck mediastinum 9.4.7 Tumor Lymphoma in pelvic mass 9.4.8 Tumor Lymphoma in muscle Pitfalls: rib fracture lung infiltrate 9.5 In111-capromab pendetide (Prostascint(R)) SPECT/CT 9.5.1 Normal study 9.5.2 Tumor Abdominal lymphadenopathy, prostate cancer 9.6. Tc99m-MIBI SPECT/CT (Parathyroid Imaging) 9.6.1 Pitfall Asymmetric salivary gland uptake parathyroid adenoma 9.6.2 Tumor - Parathyroid adenoma in right lower neck 9.6.3 Tumor Parathyroid adenoma in left lower neck 9.6.4 Tumor Ectopic parathyroid adenoma 9.7. Tc99m-MDP SPECT/CT 9.7.1 Pitfall Uptake related to renal calculus 9.7.2 Benign - Facet joint disease 9.7.3 Benign Osteoarthritis in hip 9.7.4 Benign - Fibrous dysplasia 9.7.5 Benign - Myositis ossificans 9.7.6 Benign - Hematoma at injection site 9.8. In111 labeled Leucocytes SPECT/CT 9.8.1 Diabetic foot - Osteomyelitis soft tissue 9.8.2 Diabetic foot - Soft tissue involvement 9.8.3 Diabetic foot - Soft tissue involvement 9.8.4 Bacteremia - Infected aortic plaque 9.9 Tc99m-MIBI SPECT/CT (Cardiac) 9.9.1 SPECT, myocardial perfusion/CT, attenuation correction - Normal study 9.9.2 SPECT, myocardial perfusion/CT, attenuation correction - Breast artifact 9.9.3 SPECT, myocardial perfusion/CT, attenuation correction - Diaphragm artifact 9.9.4 SPECT, myocardial perfusion/CT, attenuation correction - Scar ischemia 9.9.5 SPECT/CT Normal perfusion coronary anatomy 9.9.6 SPECT/CT Myocardial ischemia coronary lesions