Positron Emission Tomography

Sarah M. Don

Chemistry ERT
Semester 4, 2008
Dr Stolarchuk

October 31, 2008

© Sarah Don, Australia, 2008

Positron Emission Tomography (PET) is a type of diagnostic imaging that is used to identify
tumourous growth in specific types of tissue. Depending on the tissue of interest different tracers
may be used, however the most common radioisotopic tracer is 2-fluoro-2-deoxy-D-glucose (FDG).
This extended response task specifically looks at how PET scanning works and its role in the
diagnosis of lymphomas.
Fluorine-18 is manufactured in a cyclotron by bombarding oxygen-18 with protons to cause a
proton-neutron spallation. (see Equation 1) This is a possible equation showing that when a proton
collides with an O18 nucleus, F18 is produced and a neutron is released (notice that the number of
protons and nucleons are equal on both sides of the equation.

18
+ +11𝑝 → 18
+ 10𝑛 Equation 1
8𝑂 9𝐹

When the fluorine-18 in FDG decays, it throws a positron out of the nucleus to return to O18 which is
stable. (see Equation 2) This positron soon collides with an electron and is annihilated, releasing
resultant gamma rays. (see Equation 3) These gamma rays are released approximately 180° to each
other, allowing the gamma camera inside the PET gentry to trace the annihilation back to the tissue
it originated from.
18 18
9𝐹 → 8𝑂 + +10𝛽 Equation 2
0
+1𝛽 + −10𝛽 → 𝛾 Equation 3

The F18 is then bound to glucose molecules to form 2-fluoro-2-

deoxy-D-glucose. (see Figure 1) Fluorine-18 is able to replace
hydroxyl groups on the deoxyglucose molecule because it has
similar polarity. This molecule acts just like any other form of
glucose in the body and thus can be used as a tracer. However, it
is still not exactly the same as a hydroxyl group and this could
possibly cause biochemical problems where the glucose would
normally be absorbed by tissues if the hydroxyl groups were not
Figure 1 – Molecular diagram of 2- replaced with F18 atoms. However there has not yet been a lot of
fluoro-2-deoxy-D-glucose. research in this area.
The process of performing a PET scan involves injecting the patient with FDG and then tracing where
the FDG is most concentrated. Approximately 20 minutes after the patient has been injected with
FDG, they lay horizontally and travel very slowly through the PET scanner’s gamma camera gantry
(the donut-shaped section). F18 has a half-life of 110 minutes, so technicians have to work quickly to
transport the F18 from the cyclotron to the hospital/PET clinic and perform the PET scan. The
resulting 3D computerised model of the patient is generated by positron emission tomography –
registering the resultant gamma rays of electron-positron annihilations from decay where the FDG
has accumulated in the body.
Malignant types of lymphoma have a very fast metabolism and absorb more glucose faster than
other tissues. When FDG is injected into the patient and a PET scan is performed, the areas that
absorb the most FDG show up darker on the computer-generated image. This shows very accurately
the areas of tumourous growth. In Figure 2a, the arrows point to areas of lymphoma, illustrated by
darker areas. Figure 2b shows another scan of the same patient after they had received treatment.
The previously darker areas now show up lighter. The brain, bladder and kidneys always show up
darker because they absorb (or contain) more glucose than other organs, which makes PET scanning
unsuitable for the identification of malignancies in these areas.

© Sarah Don, Australia, 2008

 Many people fear the concept of being
injected with radioactive material. This is
mostly due to misinformation and lack of
education in the area of nuclear
diagnostic imaging. Because of the
mysteriousness of radioactivity, some
people choose not to have the PET
scanning that could potentially diagnose a
lymphoma in its early stages which would
allow them to start treatment that could
save their life.
Fluorine-18 has a relatively short half-life
of 110 minutes. This means that after 110
minutes, only half of the original
radioactive material (F18) remains while
Figure 2 – a) Scan used to diagnose patient with malignant the other half has decayed to stable O18.
lymphoma; b) scan of patient after treatment showing the Also, glucose is naturally excreted in urine
elimination of the lymphoma (AI, 2008)
and so after about 24hrs, almost all the F18
has decayed or been excreted. (RxList, 2008) The amount of radiation the patient receives from one
injection of FDG is little more than a single x-ray.
Although PET scanning is not useful for the detection of lymphomas in the brain, bladder and
kidneys, it is 95% accurate for other tissues in the body (Chengazi, 2003). PET scanning can detect a
lymphoma before any other type of scanning can. This is because scans such as MRI (magnetic
Resonance Imaging), x-rays and CT (Computed Tomography) scans look at tissue shape and density
in order to identify abnormalities. PET is a scan of chemical abnormalities – where glucose is being
absorbed most due to the high metabolism of a malignancy – so a lymphoma can be detected even
when it is only made up of several cells.
CT scanning involved a series of x-rays that form a computerised 3D model of the body. Before the
scan, the patient is injected with iodine which acts as a contrast agent (to make it easier to
distinguish between tissues). (Rapkins, 2004) Over the course of one CT scan, the patient
experiences approximately 300 times the radiation of a single x-ray. Because CT scans only show
macroscopically physical deformities and growths, in order to identify a tumour’s nature (malignant
or benign) a biopsy has to be taken and pathologically analysed. This increases risk of infection as
well as causes discomfort to the patient. Also, lymph nodes can become swollen due to viral and
bacterial infection, and so detection of a lymphoma exclusively by its shape and density is not
accurate.
Gallium-67 scintigraphy (another nuclear imaging technique) works similarly to PET, however zinc-68
is bombarded with protons to produce G67 (see Equation 4) and the gamma rays are possibly
produced by the emission of an electron to form stable Zn67. (see Equation 5)
68
30 𝑍𝑛 + +11𝑝 → 67
31 𝐺𝑎 Equation 4
67 0 67
31 𝐺𝑎 + −1𝛽 → 30 𝑍𝑛 Equation 5

Ga67 binds to proteins in place of iron molecules due to its ferric-like chemical and physical
properties. With a half-life of 72 hours, Ga67 stays in the body much longer than F18 from a PET scan.
(Mauch, 2003) This increases the risk of tissue damage due to radiation and prevents the patient
from interacting with other people too closely for a number of days. Also, Ga67 must be injected 24-
48hrs before the scan, and because the Ga67 binds to proteins, as opposed to glucose, it is not as
suited to identifying malignant lymphoma as PET scanning is. This type of scanning is not suitable for

© Sarah Don, Australia, 2008

staging and restaging lymphoma during and after treatment as residual chemotherapy can interfere
with the imaging more so than with PET.
PET imaging is able to identify malignancies even before they become macroscopically visible, and
also assist the tracing of where any cancerous cells have spread around the patient’s entire
lymphatic system. Although the patient receives a small amount of radiation, the benefits of
receiving the diagnostic scans far outweigh any biological damage that may be caused by the
radiation from FDG.

Bibliography
Alliance Imaging (2008) Lymphomas: Case Study, PET Alliance Imaging,
http://www.petforcancer.com/lymphomas/casestudies/case_01.html (27/10/08)
V. Chengazi, J.W. Friedberg (2003) “PET Scans in the Staging of Lymphoma: Current Status”, The Oncologist,
Vol.8, p.438-447.
67
P.M. Mauch (2003) Non-Hodgkin's Lymphomas: A Self-Study Program, Ga Citrate Imaging, Lippincott Williams
& Wilkins, USA.
G. Rapkins et al. (2004) Medical Physics, New Century Senior Physics: Concepts in Context, Oxford University
Press, Singapore.
RxList (2008) Fludeoxyglucose F-18 Injection – Drug Description, RxList Inc.
http://www.rxlist.com/fludeoxyglucose-drug.htm (29/10/08)

© Sarah Don, Australia, 2008