Gerbaudo VH, ed. A Case-Based Approach to PET/CT in Oncology. Cambridge Medicine; 2012; 532 pgs.; $195.00
A Case-Based Approach to PET/CT in Oncology, edited by Dr. Victor Gerbaud (Director of the Nuclear Medicine and Molecular Imaging Program at Brigham and Women’s Hospital in Boston, Harvard Medical School), with contributing physicians from around the world, is an introduction text for PET/CT in oncologic applications. As the title suggests, this is its primary focus, told through case-based presentations.
The book is divided into two main sections. Section One provides a detailed but not overly complex overview of PET concepts. The first chapter begins with the obligatory refresher of radioactive decay and positron formation, followed by a description of the basic physics of PET and PET/CT acquisition and image generation, with a helpful explanation of attenuation correction, artifacts, and SUV indexes. The second chapter describes in further detail the different PET probes in oncology, primarily FDG, but also provides an introduction to other labeling agents used in research, or to a lesser degree, in clinical practice. The third chapter is a rather detailed discourse on PET/CT information systems, data storage, DICOM basics, and image registration. By far the most useful and relevant chapter in this section for general radiologists is the fourth chapter, describing the physiologic distribution of FDG in normal and abnormal states. This chapter provides a nice table and examples of normal images detailing the normal uptake and SUV values for the different organs of the body, and it explains the common imaging variances in uptake one can observe in day-to-day clinical practice (such as cardiac activity, skeletal activity, and brown adipose tissue).
Section Two is the “case-based” section of the book. Each chapter of this section is broken up into organ-specific (such as brain, esophagus) or site-specific (head and neck, gastrointestinal tract) areas. Every case is presented in the order of a clinical scenario, acquisition and processing parameters, imaging findings, diagnosis and follow up, discussion and teaching points, and take home messages. Each clinical case has accompanying images related primarily to the PET images and fused PET/CT images, with other imaging modalities such as MRI making an occasional appearance when relevant to the case. There are over 120 cases presented in the book, and while it is clear a lot of effort and research went into creating this section, with many educational cases and teaching points throughout the book, there are issues within each case that can make finding the key teaching points somewhat of a search mission. For instance, the acquisition and processing parameters take up one to two paragraphs in each case, including full disclosure of the FDG dose, CT parameters, reconstruction parameters, and so on. In this reader’s opinion, this is somewhat distracting from the primary focus of the case, and this information might have been better served in an appendix or index at the end of the book. Secondly, the imaging findings are presented in the form of a fully dictated report, which in many cases contains discussion of imaging findings not presented in the images or related to a different body part, or sometimes, a list of vague differentials that appear out of place in a case presentation. The discussion and teaching points sections are of variable quality, likely due to multiple author contributions, with some cases discussing outcomes and follow-up imaging studies never visualized in the case, while other cases provide educational discussions on staging classifications, prognosis, and pitfalls, which are very informative. The take-home message section provides 3 or 4 bullet points packed with clinically relevant information helpful not just for the interpretation of the images but also for enhancing the reader’s knowledge of when PET imaging can improve patient care.
For neuroradiologists, the 2 chapters relating to “PET imaging of the Brain” and the “Head, Neck and Thyroid” are of most relevance. While there are interesting topics, such as dynamic PET imaging of the brain for tumor recurrence, and a few cases on other PET radiotracers in brain imaging, there is just not enough content in this book to justify addition to the neuroradiology library. This begets the question, who is this book aimed at?
The preface states it is a useful resource for practicing radiologists, nuclear medicine physicians, and in-training residents and fellows. Certainly, that statement would be true for Section One of the book. However, there are design elements in the case-based section of the book that serve to limit its target audience. For instance, many other case-based review books present the imaging findings at the start of the case, with or without a brief history, allowing the reader to self-examine the case. However, in this book the images are unpredictably spread across pages, displacing text such that cases cannot be taken as unknowns, which hinders its practicality as a self-assessment tool. Secondly, as mentioned above, each case image description and discussion can be unnecessarily long, with many teaching points embedded in the text, which also serves to prevent the book’s serving its potential as a quick-read study aid/board preparation book. As PET/CT plays such an important part in nuclear medicine training programs at present, it would be surprising to find a program that did not encounter many of these cases as part of their standard training, although, this would be a very good refresher for those who do not actively practice oncologic imaging. This book therefore probably offers the highest yield for the general radiologist who is commencing, or is currently involved in, PET/CT imaging and is looking for a brief reference source, and this may be one group of people who would benefit from the “dictation style” of the findings section.
