PET-CT 适应症与不适应症临床决策指南

©2009MedSolutions,Inc.PETImagingGuidelinesPage1of19PETGUIDELINES©2009MedSolutions,IncMedSolutions,Inc.ClinicalDecisionSupportToolforAdvancedDiagnosticImagingCommonsymptomsandsymptomcomplexesareaddressedbythistool.Imagingrequestsforpatientswithatypicalsymptomsorclinicalpresentationsthatarenotspecificallyaddressedwillrequirephysicianreview.Consultationwiththereferringphysicianmayprovideadditionalinsight.ThisversionincorporatesMSIacceptedrevisionspriorto11/30/08MedSolutions,Inc.Thistooladdressescommonsymptomsandsymptomcomplexes.ImagingrequestsforpatientswithatypicalClinicalDecisionSupportToolsymptomsorclinicalpresentationsthatarenotspecificallyaddressedwillrequirephysicianreview.DiagnosticStrategiesConsultationwiththereferringphysician,specialistand/orpatient’sPrimaryCarePhysician(PCP)mayprovideadditionalinsight.©2009MedSolutions,Inc.PETImagingGuidelinesPage2of19ABBREVIATIONSforPETGUIDELINESCA-125cancerantigen125testCEAcarcinoembryonicantigenCNScentralnervoussystemCTcomputedtomographyESRerythrocytesedimentationrateFDGfluorodeoxyglucoseGIgastrointestinalGISTgastrointestinalstromaltumorLFTliverfunctiontestsMALTMucosa-AssociatedLymphoidTissue(rareformofNon-Hodgkin’slymphoma)MGUSMonoclonalGammopathyofUnknownSignificanceMIBGI-123metaiodobenzylguanidinescintigraphyMMmultiplemyelomaNHLNon-Hodgkin’slymphomaNSCLCNon-SmallCellLungCancerNSGCTNonSeminomatousGermCellTumorPETpositronemissiontomographyPSAprostatespecificantigenRCCrenalcellcarcinoma©2009MedSolutions,Inc.PETImagingGuidelinesPage3of19TABLEOFCONTENTS2009PETIMAGINGGUIDELINESPAGEABBREVIATIONSFORPETGUIDELINES2PET-1GENERALGUIDELINES4PET-2CARDIACPETSCAN4PET-3PETINNEUROLOGY4PET-4CANCERSOFTHEHEAD&NECK5PET-5PRIMARYBRAINTUMORS6PET-6MELANOMA6PET-7THYROIDCANCER6PET-8LUNGCANCERANDPULMONARYNODULES7PET-9BREASTCANCER8PET-10ESOPHAGEALCANCER9PET-11GASTROINTESTINALTUMORS9PET-12UROLOGICandTESTICULARCANCERS11PET-13GYNECOLOGICCANCERS13PET-14LEUKEMIA13PET-15LYMPHOMAS14PET-16MULTIPLEMYELOMAandPLASMACYTOMAS15PET-17MISCELLANEOUS15PETGUIDELINEREFERENCES17©2009MedSolutions,Inc.PETImagingGuidelinesPage4of19PETIMAGINGGUIDELINESPET-1~GENERALGUIDELINES•TheusefulnessofPETisnowwellestablishedinmanycardiac,neurological,andoncologicsituations.•AlloftheindicationsforPETalsoapplytoPET/CTfusionscan.oIngeneral,theanatomicdetailacquiredinPET/CTisreasonablefortheevaluationofmanyoncologicconditions;however,thediagnosticqualitymaybeinconsistent.oForinitialdiagnosisorstaging,adiagnosticCTmaybeappropriateinadditiontoaPET/CT.oForrestaging,therapymonitoring,andevaluationofrecurrence,eitherPET/CTordiagnosticCT,butnotboth,shouldbechosenbytheclinicianastheinitialimagingmodality.•ForOncologicapplications,theskullbasetomid-femur(“eyes-tothighs”)procedurecodeforPET(CPT78812or78815)isusuallythemostappropriateproceduretoorder.oExceptions(useCPT78813or78816).includethefollowing:¾Malignantmelanoma¾Someunusualpresentationsofsarcomasandlymphomas•PETisapoorchoiceforimagingmetastaticdiseaseinthecentralnervoussystem(CNS).•PETisunreliableforimaginglesionslessthan7mminsize.•PETisinappropriateforuseasasurveillancetestintheabsenceofclinicalorotherimagingevidencetosuggestpossiblerecurrence.•PETguidelinesforcancersshouldbeappliedinconjunctionwiththecorrespondingOncologyguidelines(ONC-1throughONC28).PET-2~CARDIACPETSCAN•SeeCD-7CardiacPETScanintheCardiacguidelines.PET-3~PETINNEUROLOGY•SeeintheHeadGuidelines:oHD-1GeneralGuidelinesoHD-13DementiaoHD-14AdultEpilepsy/SeizureoHD-21MovementDisordersoHD-24.13PETinbraintumor•SeeinthePediatricandCongenitalHeadGuidelines:oPACHD-5PediatricEpilepsy/Seizure©2009MedSolutions,Inc.PETImagingGuidelinesPage5of19PET-4~CANCERSOFTHEHEAD&NECK•SeeONC-2SquamousCellCarcinomasoftheHeadandNeckandONC-3SalivaryGlandCancersintheOncologyGuidelines.•PETisnotindicatedforsuspectedcancersoftheheadandneckpriortobiopsy,exceptifneededtoguidedirectionofdecisionsconcerningbiopsyindiagnosticallychallengingcases.oApatientwhopresentswithasuspiciousneckmassrequiresdirectlaryngoscopy/examunderanesthesiatoattemptbiopsy.oPETisnotintendedtobeasubstituteforpanendoscopy•PETisnotindicatedforroutineinitialstagingofHeadandNeckcancersinceitisnotsuperiortoconventionalimagingforinitialstaging.1oHowever,PETmaybeindicatedforthefollowing:¾ToexplainradiographicfindingssuggestiveofdiseaseoutsidetheheadandneckareaandifapositivePETdemonstratingmetastaticdiseasewillchangemanagement.¾Todefinetheextentoflymphadenopathyifsuchinformationisneededtodetermineextentoftherapy.2¾Toprovideinformationfordirectingbiopsyforpatientswhopresentwithaneckmasswheninitialattemptstofindaprimarysourcearedifficult.1JNatlCancerInst2008;100(10):688-6892RadioGraphics2005;25:913-930•PETishelpfulinassessingresponsetochemoradiotherapy,ifclinicalexaminationremainsabnormalorequivocal.oRequestsforPETshouldbeaccompaniedbydescriptionofrecentclinicalexaminationofpreviouslyinvolvedsites.oPETshouldbedelayedaminimumof90daysfollowingradiotherapyduetoriskoffalsepositiveFDGuptakeinlethallyirradiatedcells,unlesstheclinicalsituationrequiresevaluationofdiseaseoutsidetheirradiatedvolume.¾E