Principles and Practice of Positron Emission Tomography

Abstract

AJR:180, May 2003 If you would like to review books for AJR , please send a cover letter stating your interest with a current curriculum vitae to Assistant Editor for Book Reviews, AJR , 101 S. Stratford Rd., Ste. 303, Winston-Salem, NC 27104. his book, written by Richard Wahl from the Department of Nuclear Medicine at Johns Hopkins University and assisted by multiple coauthors from other institutions, amply fulfills its goals of serving as both a reference and a starting point for physicians engaged in the performance of positron emission tomography (PET). In general, the text is well written and concise. With a few exceptions, the book is amply illustrated with well-labeled images of excellent quality. Each chapter concludes with extensive references for those interested in additional information regarding certain topics. The first four chapters deal exclusively with the production of PET radionuclides, the chemistry of radiopharmaceuticals, instrumentation, and data analysis and image processing. These chapters provide the basics in nuclear physics, radiopharmacy, and biochemistry that are crucial to understanding why PET works. The reader will also be introduced to how PET works in regard to the essential equipment, data acquisition, and analysis in the formation of the images. For the most part, this information is conveyed in an easy-to-understand manner to those who have limited recall of their basic science knowledge, although some of the mathematics regarding radiopharmaceutical kinetics is somewhat cumbersome. Chapter 5, which is divided into 14 sections, forms a major portion of the book and concerns oncologic applications of PET. Twelve sections deal with imaging of specific tumors and specific organ systems to which PET is applied. Protocols for imaging are described, and specific examples of positive findings are well illustrated, as are false-positive and false-negative findings, both of which are crucial to appropriate interpretation. The other sections describe using PET to determine tumor response to therapy and subsequent prognostic implications, both of which are becoming increasingly important in clinical practice. Also discussed is the adoption of CT–PET fusion techniques that allow more detailed localization of the abnormal radiotracer activity and more precise tumor staging. Chapters 6 and 7 describe the use of PET techniques in the diagnosis of both neurologic and psychiatric disorders. The general principles and rationale for performing these studies are described, including the use of FDG and other radiotracers such as carbon11 tagged to multiple ligands. This chapter is intellectually stimulating although primarily of academic interest at this time because of the current lack of reimbursement for these applications. These two chapters, although well written, are not as well illustrated as the prior chapters related to oncologic imaging. Chapter 8 consists of four sections devoted to different aspects of cardiac imaging. The first two sections describe the specific protocols, radiopharmaceuticals, physiologic principles, and interpretation of clinical imaging of myocardial perfusion and viability. The third section is devoted to oxidative metabolism and cardiac efficiency, and the final section deals with myocardial neurotransmitter imaging, an area of intense research at many institutions. In general, the cardiac sections are well written and informative but are also limited by relatively few clinical images. Chapter 9 is a short but important discussion of the applications of PET to inflammatory diseases and, more important, how to differentiate increased radiotracer uptake in inflammatory processes from tumors. This chapter is both well written and well illustrated. Chapter 10 focuses on the pediatric applications of PET, which, not surprisingly, is predominantly used for diagnosis and therapy of neoplasms. Protocols are described and multiple tumor applications are well illustrated. The final chapters, 11 and 12, are interesting and describe future applications related to PET drug development, the expected future imaging of gene expression and subsequent use in gene therapy planning, follow-up studies of treated tumors, and indicators of prognosis. In summary, I congratulate Dr. Wahl and his associates for creating, in my opinion, the most comprehensive and informative reference book on PET to date. This volume will serve well as both a reference work and a book that can be used on a daily basis by both novices and more experienced PET practitioners.