Hybrid PET/CT enhanced with intravenous CT contrast deserves wider acceptance and adoption, as diagnostically optimized CT can complement PET—and vice versa—for a variety of potential indications.
Not so fast. In too many clinical contexts, the literature to date has shown PET/CT with IV contrast wanting for enough benefits to justify the risks.
That’s the gist of a point/counterpoint debate published as two opinion pieces in the American Journal of Roentgenology May 25.
Point: Contrast-Enhanced Computed Tomography Can Provide Valuable Information in Combination With Positron Emission Tomography
Making the case in favor of IV contrast material for PET/CT, Duke University radiologists Colm Kelleher, MD and Terence Wong, MD, PhD, note the integrated modality’s primary clinical application—oncology [1].
Contrast-enhanced CT, they point out, adds much value to radiologists and oncologists when using PET/CT to characterize primary tumors, evaluate metastatic disease and assess therapy responses.
And that’s only the start. Among other indications Kelleher and Wong name as calling for PET/CT with IV contrast, citing studies to back up each, include detecting and characterizing metastatic lymph nodes, identifying imaging biomarker for predicting lesion-specific therapy response, and finding all disease sites that may be receptor-positive or receptor-negative on concurrent PET scans.
“While IV contrast material is not needed for every PET/CT examination, fully diagnostic CT can provide valuable information in combination with PET and should be used when indicated,” the authors comment. “Patients and physicians benefit from the improved accuracy and confidence provided by a comprehensive PET/CT examination that fully harnesses the synergistic diagnostic capabilities of the CT and PET components.”
Looking ahead, they add, the diagnostic CT component of PET/CT will have “even greater importance” thanks to the arrival of new targeted PET tracers.
Kelleher and Wong conclude:
As we move into an era of personalized medicine, it is crucial that we obtain the most accurate anatomic and functional information possible so that we can make informed treatment decisions for each patient. It is time for us to put the full diagnostic power of CT into PET/CT.”
