Positron emission tomography
Positron emission tomography (PET) is a test that uses a special type of
camera and a tracer (radioactive chemical) to look at organs in the body.
The tracer usually is a special form of a substance (such as glucose) that
collects in cells that are using a lot of energy, such as cancer cells.
During the test, the tracer liquid is put into a vein (intravenous, or IV) into
the arm. The tracer moves throughout the body, where much of it collects in
the specific organ or tissue. The tracer gives off tiny positively charged
particles (positrons). The camera records the positrons and turns the
recording into pictures on a computer.
Radionuclides used in PET scanning are typically isotopes with short half-
lives such as carbon-11 (~20 min), nitrogen-13 (~10 min), oxygen-15 (~2
min), fluorine-18 (~110 min)., or rubidum-82(~1.27 min). These
radionuclides are incorporated either into compounds normally used by the
body such as glucose (or glucose analogues), water, or ammonia, or into
molecules that bind to receptors or other sites of drug action.
PET scan pictures do not show as much detail as computed tomography
(CT) scans or magnetic resonance imaging (MRI) because the pictures show
only the location of the tracer. The PET picture may be matched with those
from a CT scan to get more detailed information about where the tracer is
located.
A PET scan is often used to evaluate cancer, check blood flow, or evaluate
how organs are working.
Purpose
A positron emission tomography (PET) scan is done to:
Study the brain's blood flow and metabolic activity. A PET scan is
useful in indentifying nervous system problems, such as Alzheimer's
disease, Parkinson's disease, multiple sclerosis, transient ischemic
attack (TIA), amyotrophic lateral sclerosis (ALS), Huntington's
disease, stroke, and schizophrenia.
Identify the changes in the brain that may cause epilepsy.
Evaluate certain cancers, especially lymphoma or cancers of the head
and neck, brain, lung, colon, or prostate. In its early stages, cancer
may show up more clearly on a PET scan than on a CT scan or an
MRI.
To evaluate the advanced stage of cancer and metastasis to other
parts of the body. It is often necessary to do both CT and PET scans to
evaluate cancer.
To determine the best treatment for cancer or to evaluate the
prognosis.
PET scans may also be done to assess whether surgery can be done to
remove a tumor.
Study the poor blood flow to the heart, which may mean coronary
artery disease.
Study the damaged heart tissue, especially after a heart attack.
Evaluate the mode of treatment such as coronary artery bypass graft
surgery, for heart disease.
Preparation
Incase of diabetes, the oral hypoglycemic medicine may need to be
reduce less than normal dose.
Smoking or drinking caffeine or alcohol should be stopped for 24
hours before the test.
Fasting for at least 6 hours before the test.
The test is inappropriate for patients who are pregnant or
breastfeeding.
Procedure
A positron emission tomography (PET) scan is done with the patient lying on
a table that is hooked to a large scanner, camera, and computer. The
radioactive tracer is usually given in a vein (IV). A waiting period of 30 to 60
minutes is given for the tracer to move through out the body. During this
period, avoid movement and talking of the patient.
The PET scanner, which is shaped like a doughnut, moves around the
patient. The scanned pictures are sent to a computer screen. Many scans
are done to make a series of pictures. It is very important to lie still while
each scan is being done.
For a PET scan of the brain, patient lie on a bed. Patient is advised to read
name, letters, or tell a story, depending on whether speech, reasoning, or
memory is being tested. During the scan, the patient may be given earplugs
and a blindfold (if reading is not required during the test) to wear for
comfort.
When PET scan is done for heart, electrodes for an electrocardiogram (EKG,
ECG) is fixed on the body.
The duration of the test is 1 to 3 hours.
After the test, patient is advised to drink lots of fluids for the next 24 hours
to help flush the tracer out of the body.
Clinical Significance
Normal Blood flow is normal and organs are working well. The
flow and pattern of the tracer shows normal
distribution in the body.
Abnorm Heart Decreased blood flow and increased glucose
al metabolism may show that the blood vessels are
blocked. This indicates coronary artery disease
(CAD) is present.
Decreased blood flow and glucose metabolism
may mean that heart tissue is scarred and
damaged, such as from a heart attack.
Brain Areas of increased glucose metabolism or lower
oxygen use and blood flow may mean you have
epilepsy.
Decreased oxygen use and blood flow may mean
a stroke has occurred.
Decreased glucose metabolism may mean a form
of dementia. Dementia may be caused by
Alzheimer's disease, Parkinson's disease,
Huntington's disease, or mental illness, such as
schizophrenia.
Patterns of blood flow and oxygen use that are
not normal may mean a brain tumor is present.
Tumor
detecti Areas of increased glucose metabolism may mean a
on tumor is present.
Precautions
Reasons you may not be able to have the test or why the results may not be
helpful include:
Being pregnant. A PET scan is not usually done during pregnancy
because the radiation could harm the fetus.
Using caffeine, tobacco, or alcohol for 24 hours before the
investigation.
Being too anxious.
Using sedatives.
Taking medicines, such as insulin, that change metabolism.
Having recently had surgery, a biopsy, chemotherapy, or radiation
therapy.
Safety
PET scanning is non-invasive, but it does involve exposure to ionizing
radiation. The total dose of radiation is significant, usually around 5–7 mSv.
However, when combined PET/CT scan is performed, and the radiation
exposure may be substantial—around 23–26 mSv (for a 70 kg person—dose
is likely to be higher for higher body weights).