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PET-CT Center Introduction
     Shuang Ho Hospital PET-CT Center was established on August 7th, 2009. Outstanding experts from the health care system of Taipei Medical University are recruited to the Center to provide the best medical services. The instruments used in the Center are the most advanced instruments from the world renowned manufacturer, GE.
    The Center is equipped with a Positron Emission Tomography – Computed Tomography (PET-CT) scanner which is selected as one of the most valuable medical inventions in the 21st century by TIMES magazine. The radiopharmaceutical used in PET is FDG (Fluorodeoxyglucose (18F)). Many clinical experiments have shown it has breakthrough contributions to the diagnoses and treatment planning of cancers. The clinical applications of PET in cancer diagnosis and treatment planning include:
     1. Early diagnosis of primary or recurrent tumor;
     2. Accurate staging;
     3. Evaluation of treatment efficiency.
Special Features
PET-CT combines the advantages of Positron Emission Tomography and Computed Tomography in that functional images and anatomic images are acquired sequentially by one device. Moreover, with high-resolution and high-sensitivity whole body scan, the locations of the cancers can be detected accurately. During the last few years, PET-CT has been applied in cancer screening for the general public in Taiwan. It is our firm belief the medical services provided by the Center will be highly beneficial for early diagnosis and early treatment of cancers.
Principles of PET-CT
*  Positron Emission Tomography (PET) is a high-tech medical instrument that is to detect the accumulation of FDG
    (Fluorodeoxyglucose) injected into the body. FDG is a glucose analog molecule that emits positron. Through blood
    circulation, FDG enters tissues and organs in the body. With PET-CT scan, the images of the whole body are
*  After the positron emitting solution is injected into the body through intravenous injection, positrons are released
    during the decaying process. The positrons come in contact with the negative electrons in body tissues. As a result, the
    electrons are annihilated and energy is released. The energy released is split into two gamma rays that go in opposite
    directions. Moreover, the energy of each gamma ray is 511 keV.
*  The half-life of FDG is 2 hours.
*  Therefore, FDG must be ordered in advance and produced on the day of the scheduled scan. Moreover, once it is
    delivered by the producer, it cannot be returned.
*  As for the CT scanner in PET-CT, low radiation model is applied which means it is safe and not harmful to the human
*  PET-CT Scan not only discovers the primary cancer in early stage, but it can also discover metastatic lesions as early
    as possible.
*  Currently, the most advanced PET-CT can provide a high resolution of 5mm.
Why PET-CT is able to diagnose early stage cancer?
As cancer cells divide fast, metabolize quickly and consume 2 to 10 times of FDG than normal cells, they are shown as hot spots on the images. Therefore, there is no need to wait until the tumor has caused structural changes that enable us to see it. Hidden tumor cells can be detected in the early stage when they are still very small. Its sensitivity reaches 92 ~ 98%.
Disease diagnosed by PET-CT
*  PET is currently the most important breakthrough in terms of diagnostic tools for cancers, cardiovascular diseases and neural diseases. It also plays a very important role in the state-of-art medicine such as gene therapy.
*  The key to the cure of malignant tumor lies in early detection and early treatment. However, as there is generally no obvious discomfort in the early stage of pathological changes, when most patients seek medical advices, their cancers are already in advanced stages. Those patients thus lose the chance to undergo early treatment.
Clinical application of PET-CT in cancers
*  After FDG is injected in the body, most of the malignant tumors will absorb it at a fast speed. The PET scanner detects cancer cells from outside the body by acquiring positron emitting images. If there are focuses that absorb FDG at an abnormal speed, the possibility of a malignant tumor is high. *  PET-CT can differentiate malignant lesions from benign ones, determine stage of cancer, detect metastasis and recurrence, and evaluate treatment responses.
Medical Staff
Dr. Che-Ming Yang
• Nuclear Medicine Imaging
• Myocardial Perfusion Scan
• Whole Body Bone Scan
• Positron Emission Tomography Scan (PET Scan)
• Whole Body Tumor Scan
• Radio-immunal Assay
• Health Management and Medical Quality Management
• PhD, Johns Hopkins University Bloomberg School of Public Health, U.S.A. • MD, Taipei Medical University
Teaching Appointment
• Professor, Taipei Medical University
Work Experience
• Director of Nuclear Medicine Department, Taipei Medical University - Wan Fang Hospital • Director General, Bureau of International Cooperation, Department of Health
Dr. Chien-Mu Lin
• Nuclear Medicine Imaging
• Myocardial Perfusion Scan
• Whole Body Bone Scan
• Positron Emission Tomography Scan (PET Scan)
• Whole Body Tumor Scan
• Radio-immunal Assay
• Epidemiology and Biostatistics
• PhD, London School of Hygiene and Tropical Medicine
• MS, Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University
• MD, Taipei Medical University
Work Experience
• Chief Resident, Department of Nuclear Medicine, Taichung Veterans General Hospital
• Resident, Department of Nuclear Medicine, Taichung Veterans General Hospital Resident, Department of Internal Medicine, NTUH
Case Report
A nodule was found in an elderly man’s right lung from his chest X-ray. He then underwent F-18 FDG PET/CT scan. PET images indicated there was a 2cm irregular nodule (pointed by a white arrow) in the right lung. Moreover, in the initial images, the nodule showed slight increase in the uptake of FDG with a standardized uptake value (SUVmax) at 1.2. The SUVmax for the delayed PET images was 2.3, which demonstrates an increasing trend. In view of the above analyses, it was suspected the nodule in the right lung was a malignant tumor. After surgical resection, the pathological report proved the nodule in the right lung to be adenocarcinoma.
From a meta-analysis of 40 researches, the sensitivity and specificity of F-18 FDG PET in diagnosing 1474 solitary pulmonary nodules as lung cancer are close to 9o% respectively. This means F-18 FDG PET is valuable for solitary pulmonary nodules. However, granulomatous diseases such as tuberculosis, mycotic infection, sarcoidosis and silicosis in F-18 FDG PET may mimic malignant nodules. Detailed history taking, physical examinations and other clinical data in conjunction with the application of SUVmax in sequential PET imagings is very useful for diagnosis. This technique is called dual-time-point PET imaging. Basically, malignant tumors would accumulate more and more FDG as time goes by but inflammations and infections are totally the opposite.
The other thing that is worth noticing is that F-18 FDG PET is not as sensitive to bronchioalveolar cell carcinoma and carcinoid tumor as the high negative predictive value it has for solitary pulmonary nodules. In other words, if the result of F-18 FDG PET is negative, it means the possibility of malignant tumor is very low. So, patients do not need to undergo invasive procedures and can consider regular follow-up. According to several economic research studies, using F-18 FDG PET for solitary pulmonary nodules has the highest cost-effectiveness.
F-18 FDG PET-CT is a whole body scan. It has high diagnostic value for possible sites of lung cancer metastases (like liver, adrenal glands, bone, etc). Moreover, it has high accuracy for cancer staging, which helps doctors and patients to choose the most appropriate treatments. As for the detection of recurrent lung cancer and the evaluation of treatment efficacy, PET also plays a very important role. Thus, many scholars have suggested PET-CT is an important diagnostic tool both before and after lung cancer treatment.

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