Abstract :
Positron emission tomography (PET) is an important molecular imaging modality in oncology because it provides functional and metabolic information that complements the anatomical information obtained from computed tomography (CT). However, the ability of PET to detect tumors is fundamentally determined by several physical characteristics of the imaging system, including spatial resolution, sensitivity, image contrast, noise, photon attenuation, scatter, random coincidences, and partial-volume effects. This review aims to examine the physical basis of PET for tumor detection and to compare its principal imaging characteristics with those of CT. A comparative narrative review was conducted using relevant literature on PET physics, detector instrumentation, image formation, image-quality determinants, tumor detectability, and the physical principles of CT. The reviewed evidence indicates that PET provides high sensitivity to radiotracer distribution and functional abnormalities, making it particularly valuable for detecting metabolically active tumors. However, its relatively limited spatial resolution and susceptibility to attenuation, scatter, noise, and partial-volume effects can restrict the detection and accurate characterization of small or low-contrast lesions. In contrast, CT provides superior anatomical detail and spatial resolution through X-ray attenuation measurements but offers substantially less direct functional information. The evidence therefore indicates that PET and CT possess complementary physical capabilities: PET is primarily advantageous for functional and metabolic tumor characterization, whereas CT is superior for anatomical localization and structural delineation. Understanding these physical differences is essential for interpreting the respective strengths and limitations of PET and CT in tumor detection and for optimizing their complementary use in hybrid PET/CT imaging.
Keywords :
CT, molecular imaging, Pet, PET physics, spatial resolution, tumor detectionReferences :
- Aide, N., Lasnon, C., Desmonts, C., Armstrong, I. S., Walker, M. D., & McGowan, D. R. (2022). Advances in PET/CT Technology: An Update. Seminars in Nuclear Medicine, 52(3), 286–301. https://doi.org/10.1053/j.semnuclmed.2021.10.005
- Baethge, C., Goldbeck-Wood, S., & Mertens, S. (2019). SANRA—a scale for the quality assessment of narrative review articles. Research Integrity and Peer Review, 4(1), 5. https://doi.org/10.1186/s41073-019-0064-8
- Basu, S., Kwee, T. C., Surti, S., Akin, E. A., Yoo, D., & Alavi, A. (2011). Fundamentals of PET and PET/CT imaging. Annals of the New York Academy of Sciences, 1228, 1–18. https://doi.org/10.1111/j.1749-6632.2011.06077.x
- Blodgett, T. M., Meltzer, C. C., & Townsend, D. W. (2007). PET/CT: Form and function. Radiology, 242(2), 360–385. https://doi.org/10.1148/radiol.2422051113
- Czernin, J., Allen-Auerbach, M., Nathanson, D., & Herrmann, K. (2013). PET/CT in Oncology: Current Status and Perspectives. Current Radiology Reports, 1(3), 177–190. https://doi.org/10.1007/s40134-013-0016-x
- Erdi, Y. E. (2012a). Limits of Tumor Detectability in Nuclear Medicine and PET. Molecular Imaging and Radionuclide Therapy, 21(1), 23–28. https://doi.org/10.4274/Mirt.138
- Erlandsson, K., Buvat, I., Pretorius, P. H., Thomas, B. A., & Hutton, B. F. (2012). A review of partial volume correction techniques for emission tomography and their applications in neurology, cardiology and oncology. Physics in Medicine and Biology, 57(21), R119-159. https://doi.org/10.1088/0031-9155/57/21/R119
- Gonzalez-Montoro, A., Ullah, M. N., & Levin, C. S. (2022). Advances in Detector Instrumentation for PET. Journal of Nuclear Medicine, 63(8), 1138–1144. https://doi.org/10.2967/jnumed.121.262509
- Griffeth, L. K. (2005). Use of PET/CT scanning in cancer patients: Technical and practical considerations. Proceedings (Baylor University. Medical Center), 18(4), 321–330. https://doi.org/10.1080/08998280.2005.11928089
- Histed, S. N., Lindenberg, M. L., Mena, E., Turkbey, B., Choyke, P. L., & Kurdziel, K. A. (2012). Review of functional/anatomical imaging in oncology. Nuclear Medicine Communications, 33(4), 349–361. https://doi.org/10.1097/MNM.0b013e32834ec8a5
- Kubota, K. (2001). From tumor biology to clinical Pet: A review of positron emission tomography (PET) in oncology. Annals of Nuclear Medicine, 15(6), 471–486. https://doi.org/10.1007/BF02988499
- Lee, T. C., Alessio, A. M., Miyaoka, R. M., & Kinahan, P. E. (2016). Morphology supporting function: Attenuation correction for SPECT/CT, PET/CT, and PET/MR imaging. The Quarterly Journal of Nuclear Medicine and Molecular Imaging : Official Publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology (IAR), [and] Section of the Society Of…, 60(1), 25–39.
- Miles, K. A. (2008a). PET-CT in oncology: Making the most of CT. Cancer Imaging: The Official Publication of the International Cancer Imaging Society, 8 Spec No A(Spec Iss A), S87-93. https://doi.org/10.1102/1470-7330.2008.9015
- Moses, W. W. (2011). Fundamental Limits of Spatial Resolution in PET. Nuclear Instruments & Methods in Physics Research. Section A, Accelerators, Spectrometers, Detectors and Associated Equipment, 648 Supplement 1, S236–S240. https://doi.org/10.1016/j.nima.2010.11.092
- Peng, H., & Levin, C. S. (2010). Recent Developments in PET Instrumentation. Current Pharmaceutical Biotechnology, 11(6), 555–571. https://doi.org/10.2174/138920110792246555
- Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., Koffel, J. B., PRISMA-S Group, Blunt, H., Brigham, T., Chang, S., Clark, J., Conway, A., Couban, R., De Kock, S., Farrah, K., Fehrmann, P., Foster, M., Fowler, S. A., … Young, S. (2021). PRISMA-S: An extension to the PRISMA Statement for Reporting Literature Searches in Systematic Reviews. Systematic Reviews, 10(1), 39. https://doi.org/10.1186/s13643-020-01542-z
- S, S., & Js, K. (2016). Advances in time-of-flight PET. Physica Medica : PM : An International Journal Devoted to the Applications of Physics to Medicine and Biology : Official Journal of the Italian Association of Biomedical Physics (AIFB), 32(1). https://doi.org/10.1016/j.ejmp.2015.12.007
- Slomka, P. J., Pan, T., & Germano, G. (2016). Recent Advances and Future Progress in PET Instrumentation. Seminars in Nuclear Medicine, 46(1), 5–19. https://doi.org/10.1053/j.semnuclmed.2015.09.006
- Soret, M., Bacharach, S. L., & Buvat, I. (2007). Partial-volume effect in PET tumor imaging. Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine, 48(6), 932–945. https://doi.org/10.2967/jnumed.106.035774
- Tong, S., Alessio, A. M., & Kinahan, P. E. (2010). Image reconstruction for PET/CT scanners: Past achievements and future challenges. Imaging in Medicine, 2(5), 529–545. https://doi.org/10.2217/iim.10.49
- Torres Espallardo, I. (2017). PET/CT: Underlying physics, instrumentation, and advances. Radiologia, 59(5), 431–445. https://doi.org/10.1016/j.rx.2016.10.010
- van der Vos, C. S., Koopman, D., Rijnsdorp, S., Arends, A. J., Boellaard, R., van Dalen, J. A., Lubberink, M., Willemsen, A. T. M., & Visser, E. P. (2017). Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET. European Journal of Nuclear Medicine and Molecular Imaging, 44(Suppl 1), 4–16. https://doi.org/10.1007/s00259-017-3727-z

