Important Roles of PET-CT in Cancer Management

Important Roles of PET-CT in Cancer Management


Proper management of cancer requires accurate diagnosis and staging of the cancer.

This is to ensure there is no

  • Under-treatment, for example, missing potential curative treatment in oligometastatic (primary cancer with limited metastatic disease) cancer or small lymph nodes not clearly noticed from CT images.
  • Over-treatment in widely disseminated cancer, saving patients from unnecessary radical or mutilating surgery.
ct pet petct
CT, PET and the latest intergrated PET-CT. The images are so much clearer and more meaningful using PET-CT

Integrated PET-CT had been increasingly used for the pre-operative or pre-treatment staging of solid malignancies, such as lung, colorectal, breast and others solid tumors.

It’s more superior than CT images alone for clear anatomic delineation and sensitive identification of cancerous lesions.

pet ct lung ca.jpg
CT image from the left (A), tumor might be hard to differentiate from normal lung tissues from collapsed lung. From the PET CT image on the right side (B), the tumor can easily identified and targeted with radiotherapy and thus reducing damages to normal lung tissues. Pic by Bruno H.

Also, PET-CT is increasingly used to for assessment of treatment response chemotherapy or radiotherapy.


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PET-CT used in assessment of treatment response, shown here liver metastasis response to SIRT treatment. Pic by Andrew FC.

In certain solid tumor like GIST tumor, PET-CT imaging is more important because GIST tumor change in tumor metabolic first before changes in tumor size, which takes much longer time.

pet ct gist
PET-CT in GIST tumor after treatment with Imatinib. If CT scan is taken after 3 months, the size of the tumor will be fairly similar size. However, with PET-CT,  treatment response can be clearly seen from the metabolic response, i.e decrease in value of SUVmax. EORTC guidelines for the use of 18FDG-PET as a bio-marker of response suggest that a 25% reduction in SUVmax should be considered as the threshold for partial metabolic response. Pic by Annick D.

Why Is It Not Used More Widely?

It comes down to long waiting list and cost of PET-CT imaging.

The price for a 18F-FDG PET-CT at Beacon Hospital is currently one of the lowest and most affordable in Malaysia; RM2000 inclusive of everything.

This is because the hospital reduces the cost by buying its own cyclotron to produce radioactive component of the tracer used in PET-CT imaging.

Other benefits are shorter scanning time  and same day quality reporting by experienced radiologist.

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