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| 18F-fluorodeoxyglucose positron emission tomography | |
|---|---|
| Name | 18F-fluorodeoxyglucose positron emission tomography |
| Purpose | Functional imaging with radiotracer uptake |
18F-fluorodeoxyglucose positron emission tomography is a molecular imaging modality that uses the radiotracer 2-deoxy-2-[18F]fluoro-D-glucose with positron emission tomography to visualize metabolic activity in vivo. Developed from advances in radiochemistry and imaging physics, it is widely applied across oncology, neurology, and cardiology for diagnosis, staging, therapy response assessment, and research. Major centers and institutions implement standardized protocols informed by regulatory agencies and professional societies.
18F-fluorodeoxyglucose positron emission tomography emerged from collaborations among researchers at institutions such as Brookhaven National Laboratory, Lawrence Berkeley National Laboratory, Massachusetts General Hospital, and Johns Hopkins Hospital, and was shaped by technologies from firms like General Electric, Siemens, and Philips. Clinically, it interfaces with departments and organizations including American College of Radiology, Society of Nuclear Medicine and Molecular Imaging, European Association of Nuclear Medicine, and tertiary care centers such as Mayo Clinic, Cleveland Clinic, and MD Anderson Cancer Center. Research networks and funding agencies such as the National Institutes of Health, European Commission, Wellcome Trust, and Bill & Melinda Gates Foundation have supported methodological and translational studies. Its deployment in health systems involves hospital radiology, nuclear medicine, and multidisciplinary tumor boards at centers like Dana-Farber Cancer Institute and Memorial Sloan Kettering Cancer Center.
The radiopharmaceutical 2-deoxy-2-[18F]fluoro-D-glucose is synthesized in cyclotrons operated by facilities including Fermilab partners and institutional radiochemistry units; quality control follows standards from organizations such as the United States Pharmacopeia and regulatory oversight by agencies like the Food and Drug Administration and European Medicines Agency. The tracer is labeled with fluorine-18 produced via the 18O(p,n)18F reaction in targets common to manufacturers such as IBA RadioPharma and GE Healthcare. Positron annihilation photons detected by PET scanners designed by companies like Siemens Healthineers and Canon Medical Systems are reconstructed using algorithms developed by academic groups at Massachusetts Institute of Technology, Stanford University, and University College London. Physics concepts include positron range, annihilation photon coincidence detection, time-of-flight developed by researchers affiliated with University of Pennsylvania and detector materials such as lutetium oxyorthosilicate pioneered in collaborations with Saint-Gobain. Radiochemistry and tracer kinetics draw on methods from investigators at Karolinska Institutet, University of Oxford, and University of Cambridge.
FDG-PET is integral to oncologic workflows at cancer centers like Royal Marsden Hospital, Gustave Roussy, and Institut Curie for staging malignancies including lung, colorectal, lymphoma, melanoma, and head and neck cancers; tumor board decisions often reference guidelines from National Comprehensive Cancer Network and European Society for Medical Oncology. Neurology applications at institutions such as Johns Hopkins Hospital and Charité – Universitätsmedizin Berlin include evaluation of epilepsy, dementia, and encephalitis, complementing work at centers like Mayo Clinic and Cleveland Clinic. Cardiac viability studies reference practice from laboratories at University of Toronto and Imperial College London. FDG-PET influences management in trials sponsored by entities including National Cancer Institute and industry partners like Roche and Novartis.
Acquisition protocols are standardized across academic centers such as Memorial Sloan Kettering Cancer Center and Massachusetts General Hospital, with fasting, blood glucose checks, and uptake periods coordinated per guidelines from Society of Nuclear Medicine and Molecular Imaging and European Association of Nuclear Medicine. Hybrid systems combining PET with CT or MRI from manufacturers GE Healthcare, Siemens Healthineers, and Philips enable attenuation correction and anatomical correlation used in reporting at hospitals like UCLA Medical Center and Johns Hopkins Hospital. Interpretation integrates pattern recognition informed by atlases and multicenter studies involving teams from Harvard Medical School, Yale School of Medicine, University of California, San Francisco, and Stanford University School of Medicine.
Quantitative PET analysis uses standardized uptake values (SUV) developed and validated in multicenter trials coordinated by entities such as European Organisation for Research and Treatment of Cancer, National Cancer Institute, and academic groups at University of Michigan and Vanderbilt University Medical Center. SUV metrics, partial-volume correction, and kinetic modeling utilize software from vendors and research labs at Johns Hopkins University and Rutherford Appleton Laboratory, with cross-calibration efforts led by organizations like International Atomic Energy Agency and National Physical Laboratory (United Kingdom). Clinical trials at MD Anderson Cancer Center and Karolinska University Hospital have refined thresholds for response criteria used in oncology endpoints.
Radiation dosimetry assessments were advanced by investigators at University of Cambridge, Massachusetts Institute of Technology, and Centre Hospitalier Universitaire Vaudois (CHUV), informing regulatory limits enforced by Nuclear Regulatory Commission and European Commission. Patient safety protocols developed at Johns Hopkins Hospital and Mayo Clinic address pregnancy considerations, breastfeeding, and glucose management referencing guidance from American College of Radiology and Society of Nuclear Medicine and Molecular Imaging. Contraindications, pre-scan screening, and emergency preparedness are integrated into institutional policies at hospitals such as Cleveland Clinic and Royal Free Hospital.
Limitations identified in studies from University of Oxford, University College London, and University of Toronto include false positives from inflammatory processes seen in cohorts from King's College Hospital and false negatives in small lesions discussed in trials at Memorial Sloan Kettering Cancer Center and MD Anderson Cancer Center. Technical pitfalls such as motion artifact, attenuation correction errors, and misregistration between PET and anatomical images are addressed in quality programs at Radiological Society of North America meetings and standards proposed by International Electrotechnical Commission.