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The coming age of PET (Part 2)
Seminars in Nuclear Medicine OCTOBER 1998
VOL XXVIII, NO 4
The Coming Age of PET (Part 2) Letter From the Editors
HIS SECOND PART of the Seminars in Nuclear Medicine devoted to PET Imaging and dedicated to Michel Ter-Pogossian takes us from the basic science and physics lalxnatories into the realm of clinical medicine. Few people would debate at this point that this evolution has occurred and that we are now on the threshold of wide clinical applicability of a unique Nuclear Medicine technique. It would be impossible in these two short issues to cover all of PET's impressive achievements especially in its contributions to our understanding of brain function. Marcus Raichle has done a masterful job in providing us with the transition between the first and second issue of this series. Dr. Raichie traces the development of PET Imaging and Michel Ter-Pogossian's incredibly important role in this development. He brings us from early concepts to the practical utilization of PET in providing an understanding of how the brain works. This is put in context with the availability and increasing application of functional MRI. Although Dr. Raichie devotes only a couple of sentences to the unique role of PET Imaging with receptor radiopharmaceuticals, this should not be overlooked. He makes the point quite properly that it is now possible to infer changes in blood flow using MRI in place of PET to study the brain. However, an incredibly important application of PET must lie in its application to diseases of the brain and especially to psychiatric disease. The wide range of drugs that are employed empirically by psychiatrists to treat mental disorders all affect brain receptors and it is likely that PET will someday, in the future, be the diagnostic tool by which psychiatric disorders are defined and by which appropriate therapy is chosen and monitored. The first of the clinical Oncology applications of PET to be FDA approved is in cancer of the lung. This very important disease and the role of PET is fully reviewed in this issue. However, also included is a review of the application of PET in nonneoplastic
T
Seminars in Nuclear Medicine, Vol XXVIII, No 4 (October), 1998: p 277
pulmonary disorders. Although the use of PET imaging in Oncology is of prime importance, we should keep in mind that there are many other human diseases in which PET may be helpful. This is perhaps best emphasized by the article concerning the use of PET in the assessment of myocardial flow, metabolism and function. This in-depth review gives us a very clear perspective on how we may assess several aspects of myocardial disease using a variety of PET radiopharmaceuticals. Finally, as pointed out earlier in this editorial, it is impossible to cover all of the potential uses of PET in Oncology. The results are dramatic in cancer of the colon, lymphoma, ovarian cancers, sarcomas, and a wide variety of other Oncologic disorders. Because all of these cannot be covered, it was necessary to choose one and in view of its great prominence and importance today, the role of breast cancer is used to illustrate another Oncologic process in which PET has a potential role. In the case of breast cancer, the role of PET is not so clear cut as in lung cancer or the many other Oncologic diseases just mentioned. However, work on breast cancer is evolving and it remains to be seen whether the use of single photon techniques such as sestamibi imaging and sentinel node detection with a portable probe can adequately evaluate breast cancer or if the information they provide will be greatly enhanced and of more value and cost efficacy if done in conjunction with PET Imaging. Positron Emission Tomography is clearly here to stay and coming of age. The increasing use and availability of dual headed cameras not only to do SPECT but also to do positron coincidence imaging, promises to make this technology widely available even to centers where the justification for the purchase of a dedicated PET camera is not possible. This technique will be reviewed in depth in the future. Leonard M. Freeman, MD M. Donald Blaufox, MD, PhD 277
VOL XXVIII, NO 4
The Coming Age of PET (Part 2) Letter From the Editors
HIS SECOND PART of the Seminars in Nuclear Medicine devoted to PET Imaging and dedicated to Michel Ter-Pogossian takes us from the basic science and physics lalxnatories into the realm of clinical medicine. Few people would debate at this point that this evolution has occurred and that we are now on the threshold of wide clinical applicability of a unique Nuclear Medicine technique. It would be impossible in these two short issues to cover all of PET's impressive achievements especially in its contributions to our understanding of brain function. Marcus Raichle has done a masterful job in providing us with the transition between the first and second issue of this series. Dr. Raichie traces the development of PET Imaging and Michel Ter-Pogossian's incredibly important role in this development. He brings us from early concepts to the practical utilization of PET in providing an understanding of how the brain works. This is put in context with the availability and increasing application of functional MRI. Although Dr. Raichie devotes only a couple of sentences to the unique role of PET Imaging with receptor radiopharmaceuticals, this should not be overlooked. He makes the point quite properly that it is now possible to infer changes in blood flow using MRI in place of PET to study the brain. However, an incredibly important application of PET must lie in its application to diseases of the brain and especially to psychiatric disease. The wide range of drugs that are employed empirically by psychiatrists to treat mental disorders all affect brain receptors and it is likely that PET will someday, in the future, be the diagnostic tool by which psychiatric disorders are defined and by which appropriate therapy is chosen and monitored. The first of the clinical Oncology applications of PET to be FDA approved is in cancer of the lung. This very important disease and the role of PET is fully reviewed in this issue. However, also included is a review of the application of PET in nonneoplastic
T
Seminars in Nuclear Medicine, Vol XXVIII, No 4 (October), 1998: p 277
pulmonary disorders. Although the use of PET imaging in Oncology is of prime importance, we should keep in mind that there are many other human diseases in which PET may be helpful. This is perhaps best emphasized by the article concerning the use of PET in the assessment of myocardial flow, metabolism and function. This in-depth review gives us a very clear perspective on how we may assess several aspects of myocardial disease using a variety of PET radiopharmaceuticals. Finally, as pointed out earlier in this editorial, it is impossible to cover all of the potential uses of PET in Oncology. The results are dramatic in cancer of the colon, lymphoma, ovarian cancers, sarcomas, and a wide variety of other Oncologic disorders. Because all of these cannot be covered, it was necessary to choose one and in view of its great prominence and importance today, the role of breast cancer is used to illustrate another Oncologic process in which PET has a potential role. In the case of breast cancer, the role of PET is not so clear cut as in lung cancer or the many other Oncologic diseases just mentioned. However, work on breast cancer is evolving and it remains to be seen whether the use of single photon techniques such as sestamibi imaging and sentinel node detection with a portable probe can adequately evaluate breast cancer or if the information they provide will be greatly enhanced and of more value and cost efficacy if done in conjunction with PET Imaging. Positron Emission Tomography is clearly here to stay and coming of age. The increasing use and availability of dual headed cameras not only to do SPECT but also to do positron coincidence imaging, promises to make this technology widely available even to centers where the justification for the purchase of a dedicated PET camera is not possible. This technique will be reviewed in depth in the future. Leonard M. Freeman, MD M. Donald Blaufox, MD, PhD 277