Positron setting [7]. Besides this advantage, other benefits

Positron Emission Tomography- Computer
Tomography (PETCT) utilizing 18F fluoro-2-deoxy-d-glucose (FDG) imaging is a
fusion imaging technique that has emerged as a new diagnostic, screening and
management apparatus for anatomical and physiological evaluation in breast
cancer. This new imaging apparatus that provides valuable insight pertaining precise
lesion detection and localization, lesion characterization, proper staging, and
appropriate treatment. 18 F FDG PETCT generally involves two steps. First, a positron
emission tomography (PET) is performed. This generates images that are
attributed to three-dimensional radioactivity distribution from annihilation
emitted by positron emitter. This mode of imaging allows non-invasive
quantitative assessment of biochemical and physiological processes. The second
part of 18 F FDG PETCT generates computer tomography (CT) images. The produces
images by using x-ray beams. As a result, high resolution anatomic and
morphological structures are displayed6. Thus, functional and morphological
images are attained in one setting 7. Besides this advantage, other benefits
of PET/CT are lesion detection and obtaining lesions physiological attributes.
Studies have shown that comparison PET and CT separately with fusion imaging
PETCT reveals PETCT to be more precise or sensitive in terms of accuracy. FDG
(Flurodeoxyglucose- a glucose analogue) is the routine tracer used in breast
cancer patients . 18 Fluorine is a radionuclide that emits positron that is tagged
onto FDG9. FDG is transferred into cells after intravenous administration. Next,
FDG undergoes phosphorylation by hexokinase it remains trapped in cells as
FDG-6-phosphate. Hence, the accumulation of FDG is in accordance to cellular
glycolytic rate as it shows the cellular glucose transport and hexokinase
activity. This is potentially semi-quantitative with standardized uptake value
(SUV) 11. The detection of phosphorylated 18F-labeled metabolite by PETCT is
the basis of precise lesion detection and localization, obtaining the lesion physiological
attributes. An important note also should be made to factors that influence FDG
uptake for example tumor size and grade. In addition to that certain breast
cancer histological types namely lobular carcinoma have reduced or no FDG
uptake12. These are crucial information that influence the tumour FDG
consumption on 18F FDG PETCT and determines the maximum standardize uptake
value (SUVmax).

 It
is imperative to distinguish normal and abnormal radiotracer uptake in 18 F FDG
PETCT13, 14. Some of the normal or better coined as normally increased FDG
uptake occurs in heart, brain, brown fat, urinary tract, the intestinal tract
and muscles.

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Abnormal or pathological FDG accumulation
is demonstrated in malignant cells as there is an increased membrane glucose
transporter proteins (notably GLUT1 and GLUT3) and enzymes (intracellular
hexokinase and phosphofructokinase) along glycolysis pathway. In addition to
patient preparation, fasting is crucial to promote FDG accumulation in abnormal
tissues and reduce competition of blood glucose with FDG.

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