Clinical PET-CT in Radiology: Integrated Imaging in Oncology

The introduction of commercial positron emission tomography–computed tomography (PET-CT) has greatly affected the care of patients with cancer. Clinical PET-CT in Radiology: Integrated Imaging in Oncology is thus highly relevant as a textbook, aiming to “bring together all aspects of PET-CT relevant to clinical body oncology imaging.” The book is intended for imaging physicians with some knowledge of PET-CT.

All of the chapters are richly illustrated with pictures and drawings to aid understanding and illustrate important points, but a distinct editorial stance in the composition of chapters and the layout of drawings and images is lacking, adding to the impression that this is a collection of independent review articles rather than a coherent whole. Accordingly, the advantage is that each chapter can be read independently. Owners of the first edition (2008) might instead consider the broader Positron Emission Tomography (2010), also edited in part by David Townsend, or the second edition of Principles and Practice of PET and PET/CT, edited by Richard L. Wahl (2009).

Clinical PET-CT comprises 437 pages divided into 32 chapters written by almost 50 authors, including well-known experts as well as younger researchers/physicians. The first 15 chapters address technical aspects of PET-CT technology and general aspects of the use of PET-CT in oncology, including patient preparation, radiation protection, image interpretation, and radiotherapy planning. Chapter 5, “Technical Artifacts in PET-CT Imaging,” covers an important topic and includes a table categorizing technical artifacts and pitfalls and their consequence; chapter 7, “Patient Preparation and Management,” is exceptionally instructive and bristling with information, not only for imaging physicians but also for operating personnel as well as referring clinicians.

The second half includes 17 chapters, each covering a disease entity or a specific clinical problem (eg, bone metastases). Most chapters are well written and adequately describe staging, treatment, and prognosis, as well as the role, strengths, and weaknesses of PET and CT, respectively, in the clinical setting. But with a few exceptions (eg, the chapter on pediatric malignancies), the chapters are not current. A comprehensive textbook cannot be up to date in the same manner that individual research articles can, but the field of PET-CT is rapidly developing and a certain degree of topicality must be sought. For example, the majority of the references in the chapter on lymphoma are from before 2001, and the latest is from 2004. A similar tendency is found in the chapters on lung, head and neck, and colorectal cancer, with the most recent reference from 2006. An example of the lack of topicality is found in the chapter on testicular malignancies (p 363): “The results of the recent trial from the UK (TE22) on this subject (staging by PET-CT) are still pending.” The TE22 study examined if fluorodeoxyglucose PET could identify patients without occult metastatic disease and was stopped prematurely because of a high relapse rate in patients with negative PET findings. Preliminary results were published in 2007.

Last, the composition of the index and the choice of keywords do not meet the needs of the reader. For example, the index includes the names of all of the chapter authors, but it does not include important keywords like “Hounsfield Unit” or “brown fat.” On the other hand, a keyword like “standardized uptake value” is included—and readers are directed to 48 different pages.

Clinical PET-CT in Radiology contains several informative and well-written chapters but does have several flaws. The book does include much of the information needed by a physician working with PET-CT—but unless one reads cover to cover while taking notes, information can be hard to find when needed.