Clinical Presentation

A 56-year-old woman presents with a palpable mass in the right breast and nipple inversion. Ultra-sound-guided biopsy reveals a poorly differentiated invasive ductal carcinoma. After radical mastectomy, 13 of 15 axillary lymph nodes are involved by tumor. PET/CT with ¹⁸F-FDG is performed postoperatively for further staging.

Fig. 80.1

Fig. 80.2

Technique

• The patient is instructed to avoid vigorous exercise for 24 hours prior to the scan, fast for at least 4 hours before the study, drink water during the fasting and uptake periods, and void prior to the scan

• A venous serum glucose sample is obtained prior to the injection of ¹⁸F-FDG (reference range is < 120 mg/dl for non-diabetic patients and < 200 mg/dl for diabetic patients), and the patient’s height and weight are recorded

• Most PET scans are now acquired on a hybrid PET/CT scanner, and a low dose spiral CT is acquired for attenuation correction of the PET images and for anatomic localization. Some centers may choose to perform oral and/or intravenous contrast-enhanced diagnostic CT as part of the PET/CT examination

• Sixty minutes following the ¹⁸