Nuclear Medicine · MU Sofia

12. Application of FDG PET-CT in non-oncological diseases - neurology, cardiology and unclear febrile conditions.

Covers FDG PET/CT in neurology, first explaining normal brain uptake and then patterns in dementia (Alzheimer, frontotemporal, Lewy body and vascular), epilepsy with interictal and ictal findings, and parkinsonian syndromes. It then addresses cardiac viability, contrasting perfusion-metabolism matches and mismatches with a summary table and patient glucose preparation, and closes with fever of unknown origin, covering causes such as vasculitis, osteomyelitis and sarcoidosis and the use of PET-guided biopsy.

Inside: 16 sections · 1 labelled picture · 1 table · 16 flashcards · 10 min

Topic 12 of 50 in the MU Sofia syllabus for Nuclear Medicine (Medicine, Year 4). The free AceMed note covers it in 16 sections, about 1,416 words (10 min of reading), with 16 flashcards.

In this note

  1. NEUROLOGICAL INDICATIONS
  2. CARDIOLOGICAL INDICATIONS
  3. INFECTION AND INFLAMMATION INDICATIONS
  4. Application of FDG PET-CT in non-oncological diseases - neurology, cardiology and unclear febrile conditions.
  5. PART I — FDG PET/CT IN NEUROLOGY
  6. Why does hypometabolism occur?
  7. Frontotemporal Dementia
  8. Dementia with Lewy Bodies
  9. Vascular Dementia
  10. Epilepsy
  11. Interictal FDG PET
  12. Movement Disorders
  13. Brain Tumor Follow-Up as a Neurological Application
  14. PART II — FDG PET/CT IN CARDIOLOGY
  15. Myocardial Viability
  16. PART III — FEVER OF UNKNOWN ORIGIN

NEUROLOGICAL INDICATIONS

1. Epilepsy

Interictal FDG PET may show: Reduced metabolism at the epileptic focus It is useful in patients being assessed for epilepsy surgery.

2. Dementia

Characteristic metabolic patterns may help differentiate:

  • Alzheimer disease
  • Frontotemporal dementia
  • Dementia with Lewy bodies

Alzheimer Disease

Typical reduction in metabolism in:

  • Temporoparietal cortex
  • Posterior cingulate cortex
  • Precuneus

Frontotemporal Dementia

Reduced metabolism mainly in:

  • Frontal lobes
  • Anterior temporal lobes

Dementia with Lewy Bodies

Often shows:

  • Occipital hypometabolism
  • Relative preservation of posterior cingulate activity in some cases

3. Brain Tumors

FDG has limitations because normal brain cortex already has high glucose metabolism.

Other PET tracers such as amino-acid tracers may be more useful in selected brain tumors.

PET can help assess:

  • Tumor recurrence
  • Viable tumor
  • Treatment response
  • Differentiation from radiation necrosis

4. Movement Disorders

Receptor or transporter PET tracers can assess:

  • Dopamine synthesis
  • Dopamine receptor function
  • Parkinsonian syndromes

CARDIOLOGICAL INDICATIONS

1. Myocardial Viability

FDG PET evaluates glucose metabolism in myocardium.

A region with:

  • Reduced perfusion
  • Preserved FDG uptake

may represent viable but dysfunctional myocardium.

This is called a: Perfusion-metabolism mismatch

Such myocardium may recover after revascularization.

2. Myocardial Perfusion

Tracers such as:

  • 13N-ammonia
  • 15O-water
  • Rubidium-82

can be used for quantitative myocardial perfusion imaging.

Special dietary preparation may be required to suppress normal myocardial glucose uptake.

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