Positron Emission Tomography
Positron Emission Tomography
Positron Emission Tomography (PET) is a nuclear medicine imaging technique which produces a three-dimensional image or map of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide (tracer), which is introduced into the body on a biologically active molecule. Images of tracer concentration in 3-dimensional space within the body are then reconstructed by computer analysis. In modern scanners, this reconstruction is often accomplished with the aid of a CT X-ray scan performed on the patient during the same session, in the same machine.
If the biologically active molecule chosen for PET is FDG, an analogue of glucose, the concentrations of tracer imaged then give tissue metabolic activity, in terms of regional glucose uptake. Although use of this tracer results in the most common type of PET scan, other tracer molecules are used in PET to image the tissue concentration of many other types of molecules of interest.
To conduct the scan, a short-lived radioactive tracer isotope, is injected into the living subject (usually into blood circulation). The tracer is chemically incorporated into a biologically active molecule, and eventually decays, emitting a positron. There is a waiting period while the active molecule becomes concentrated in tissues of interest; then the research subject or patient is placed in the imaging scanner. The molecule most commonly used for this purpose is fluorodeoxyglucose (FDG), a sugar, for which the waiting period is typically an hour.
As the radioisotope undergoes positron emission decay (also known as positive beta decay), it emits a positron, a particle with the opposite charge of an electron. After travelling up to a few millimeters the positron encounters and annihilates with an electron, producing a pair of annihilation (gamma) photons moving in opposite directions. These are detected when they reach a scintillator material in the scanning device, creating a burst of light which is detected by photomultiplier tubes or silicon avalanche photodiodes (Si APD). The technique depends on simultaneous or coincident detection of the pair of photons; photons which do not arrive in pairs (i.e. within a timing window of few nanoseconds) are ignored.
Localization of the Positron Annihilation Event
The most significant fraction of electron-positron decays result in two 511 keV gamma photons being emitted at almost 180 degrees to each other; hence it is possible to localize their source along a straight line of coincidence (also called formally the line of response or LOR). In practice the LOR has a finite width as the emitted photons are not exactly 180 degrees apart. If the recovery time of detectors is in the picosecond range rather than the 10’s of nanosecond range, it is possible to localize the event to a segment of a cord, whose length is determined by the detector timing resolution. As the timing resolution improves, the signal-to-noise ratio (SNR) of the image will improve, requiring less events to achieve the same image quality. This technology is not yet common, but it is available on some new systems.
Image Reconstruction Using Coincidence Statistics
More commonly, a technique much like the reconstruction of computed tomography (CT) and single photon emission computed tomography (SPECT) data is used, although the data set collected in PET is much poorer than CT, so reconstruction techniques are more difficult.
Using statistics collected from tens-of-thousands of coincidence events, a set of simultaneous equations for the total activity of each parcel of tissue along many LORs can be solved by a number of techniques, and thus a map of radioactivities as a function of location for parcels or bits of tissue (also called voxels), may be constructed and plotted. The resulting map shows the tissues in which the molecular probe has become concentrated, and can be interpreted by a nuclear medicine physician or radiologist in the context of the patient’s diagnosis and treatment plan.
Combination of PET with CT and MRI
PET scans are increasingly read alongside CT or magnetic resonance imaging (MRI) scans, the combination (“co-registration”) giving both anatomic and metabolic information (i.e., what the structure is, and what it is doing biochemically). Because PET imaging is most useful in combination with anatomical imaging, such as CT, modern PET scanners are now available with integrated high-end multi-detector-row CT scanners. Because the two scans can be performed in immediate sequence during the same session, with the patient not changing position between the two types of scans, the two sets of images are more-precisely registered, so that areas of abnormality on the PET imaging can be more perfectly correlated with anatomy on the CT images. This is very useful in showing detailed views of moving organs or structures with higher anatomical variation, which is more frequent outside of the brain.
Positron Emission Tomography Publication References
Mac Manus M, Hicks RJ. The Use of Positron Emission Tomography (PET) in the Staging/Evaluation, Treatment, and Follow-Up of Patients With Lung Cancer: A Critical Review. Int J Radiat Oncol Biol Phys. Dec 2008 ;172(5):1298-306.
Basu S, Alavi A. Unparalleled contribution of 18F-FDG PET to medicine over 3 decades. J Nucl Med. 2008 Oct;49(10):17N-21N, 37N.
Palumbo B. Brain tumour recurrence: brain single-photon emission computerized tomography, PET and proton magnetic resonance spectroscopy. Nucl Med Commun. Aug 2008;29(8):730-5.
Chen W, Silverman DH. Advances in evaluation of primary brain tumors. Semin Nucl Med. Jul 2008;38(4):240-50.
Suhara T, Higuchi M, Miyoshi M. Neuroimaging in dementia: in vivo amyloid imaging. Tohoku J Exp Med. Jun 2008;215(2):119-24.
Nordberg A. Amyloid plaque imaging in vivo: current achievement and future prospects. Eur J Nucl Med Mol Imaging. Mar 2008;35 Suppl 1:S46-50.
Fischman AJ. PET imaging of brain tumors. Cancer Treat Res. 2008;143:67-92.
Herholz K, Carter SF, Jones M. Positron emission tomography imaging in dementia. Br J Radiol. Dec 2007;80 Spec No 2:S160-7.
Ali Maeed Al-Shehri: Quality Improvement of ENT Routine Diagnosis and Staging of Head and Neck Tumors using 18FDG-PET. The Internet Journal of Otorhinolaryngology. 2003;Vol 2, #1.
Chao ST, Suh JH, Raja S, Lee SY, Barnett G. The sensitivity and specificity of FDG PET in distinguishing recurrent brain tumor from radionecrosis in patients treated with stereotactic radiosurgery. Int J Cancer. 2001;96:191–197.