PET-CT scan

• 92.061 – Positron Emission Tomography (PET) using [18F]FDG for oncological indications – FDG in oncology
• 92.062 – Positron Emission Tomography (PET) using other radiopharmaceuticals for oncological indications – Ga68 DOTA neuroendocrine tumours; Prostate and clear-cell renal cell carcinoma with choline; Lung carcinoid; Medullary thyroid carcinoma; Adrenal tumour of the pheochromocytoma type (chromaffin); Prostate with Ga68 PSMA
• 92.063 – Positron Emission Tomography (PET) using [18F]FDG for cardiological indications
• 92.064 – Positron Emission Tomography (PET) using other radiopharmaceuticals for cardiological indications
• 92.065 – Positron Emission Tomography (PET) using [18F]FDG for neurological indications
• 92.066 – Positron Emission Tomography (PET) using other radiopharmaceuticals for neurological indications
• 92.067 – Positron Emission Tomography (PET) in the diagnosis of inflammatory processes
• 92.0671 – Positron Emission Tomography (PET) using [18F]FDG in the diagnosis of inflammatory processes – inflammatory processes with FDG
• 92.068 – Positron Emission Tomography (PET-MRI)
• 92.0681 – Positron Emission Tomography (PET-MRI) for oncological indications in children and adolescents using labelled radiopharmaceuticals
• 92.069 – Positron Emission Tomography (PET) – other indications
• 92.0691 – Positron Emission Tomography (PET) using [18F]F-choline in the diagnosis of hyperparathyroidism – parathyroid glands with choline

• a single lung nodule with a diameter of > 1 cm, in order to distinguish between benign and malignant lesions, where no diagnosis can be made using other available methods;
• non-small cell lung cancer, to assess its stage prior to planned resection or radical radiotherapy, if other investigations do not provide a clear assessment of the stage (with the exception of bronchioloalveolar carcinoma and neuroendocrine tumours, or previously diagnosed distant metastases)
• Hodgkin’s lymphoma and non-Hodgkin’s lymphomas, for the purpose of an initial assessment of the stage of the disease, or to assess the effectiveness of chemotherapy, or for the early detection of a relapse, where other imaging tests do not provide a clear assessment of the stage of the disease;
• colorectal cancer, for the purpose of pre-operative staging or the early detection of recurrence following radical treatment (in the event of rising marker levels or inconclusive imaging results); 
• oesophageal cancer, to assess the stage of the disease prior to treatment and to detect recurrence at an early stage following radical treatment (in cases where imaging results are inconclusive);
• assessment of a pathological lesion raising suspicion of cancer located in the pancreas or liver, where a diagnosis cannot be made using other available methods;
• breast cancer, to rule out distant metastases, when the results of other tests are inconclusive, or in the case of metastases to the axillary lymph nodes from a site of unknown location and where a primary tumour in the breast is suspected;
• melanomas with clinical metastases to regional lymph nodes, in order to rule out metastases to distant organs, with potentially resectable metastases to distant organs, or with metastases without a defined primary site; 
• ovarian cancer, for the early detection of recurrence following radical treatment (in the event of rising CA 125 levels or inconclusive imaging results);
• epithelial tumours of the head and neck, for the early detection of recurrence and to assess local-regional stage, where the results of other tests are inconclusive;
• malignant brain tumours, for the early detection of recurrence or to determine the site of a biopsy;
• thyroid cancer, to localise the site of recurrence in the event of an increase in thyroglobulin levels, if other tests fail to localise the site of recurrence (a 131I scan must be performed beforehand); 
• suspected bone metastases, if other investigations fail to localise the site of tumour recurrence (18F tracer preferred);
• planning of radical intensity-modulated radiotherapy to assess the distribution of viable tumour cells, hypoxia or tumour proliferation, where other investigations do not allow for such an assessment;
• testicular tumours(excluding mature teratomas), in order to assess their extent and the effectiveness of treatment (including the presence of residual tumour and the diagnosis of recurrence), where other investigations do not allow for such an assessment;
• prostate cancer and kidney cancer, for the purpose of detecting recurrence (metastases) following radical treatment (using only PET with choline or acetate tracers), if other tests do not allow for such an assessment;
• sarcomas, in order to assess the effectiveness of chemotherapy (after 1–3 courses, compared with the baseline examination) and to detect recurrence at an early stage, if other tests do not allow for such an assessment;
• gastrointestinal stromal tumours (GISTs), to monitor response to molecularly targeted therapy;
• metastases of unknown primary origin, n order to locate the primary tumour, if this cannot be achieved using other available tests.
• in paediatric and adolescent oncology for initial diagnosis and monitoring of treatment – PET-MRI scan
  Indications: Initial diagnosis, staging and monitoring of cancer treatment.
• Major neoplasms (ICD-10): Lymphomas (C81–C85), neoplasms of the head and neck, neoplasms of the lesser pelvis (e.g. ovary C56, prostate C61), liver tumours.
• prostate cancer in patients at high risk of metastatic disease prior to radical treatment (Gleason score ≥ 7 or PSA ≥ 20 ng/ml or T2c), provided that the results of other imaging studies are normal or inconclusive – tracer: labelled PSMA derivatives;
• prostate cancer in patients in whom, following surgical treatment (radical prostatectomy), so-called biochemical recurrence of the cancer is detected (an increase in PSA concentration of ≥0.2 ng/ml, or in patients who have undergone radiotherapy and in whom an increase in PSA concentration of ≥2 + nadir ng/ml is detected), if the results of other imaging studies are normal or inconclusive – labelled PSMA derivatives;
• prostate cancer in patients scheduled to undergo radioisotope therapy using PSMA labelled with beta- or alpha-emitting radionuclides – marker: labelled PSMA derivatives;
• invasive cervical cancer (stage above IB2 according to FIGO) with suspected lymph node metastases – tracer: (18F) FDG 
• cervical cancer in patients scheduled to undergo combined chemotherapy and radiotherapy – tracer: (18F) FDG
• recurrence of cervical cancer in patients whose results from other tests are inconclusive – tracer: (18F)FDG;
• cervical and endometrial cancer in patients whose results from other tests are inconclusive – tracer: (18F)FDG;  
• neuroendocrine tumours:
  • before starting treatment, in order to determine the stage of the disease and select the appropriate treatment method (including PRRT),
  • during treatment – to monitor the effects of treatment,
  • after treatment has finished – if a recurrence of the disease is suspected
  • tag: labelled somatostatin analogues;
• Neuroendocrine tumours with metastases or progression, where a change in treatment is being considered, including planned treatment with radiolabelled somatostatin analogues (PRRT) – tracer: (18F) FDG
  Malignant neuroendocrine tumours
  More recent updates (such as ICD-10-CM) have introduced specific codes from the C7A group, which allow for more accurate reporting of these cancers.

• cardiac perfusion studies:
  • suspected ischaemic heart disease in patients at intermediate risk, where other diagnostic tests (including, in particular, SPECT perfusion imaging) do not allow for a definitive diagnosis – as a definitive diagnostic test;
  • suspected ischaemic disease in patients at intermediate risk, where objective factors suggest the possibility of a false result in standard SPECT scans (obesity, mastectomy, large breasts, implants, etc.) – as the primary investigation;
• a test to assess the viability of the heart muscle.
  Suspected coronary artery disease (CAD) in the context of a PET-CT scan (assessment of myocardial viability).

Diagnosed drug-resistant epilepsy with planned surgical treatment. The healthcare provider is required to comply with the national consultant’s ‘Guidelines on the use of positron emission tomography (PET) scans in oncology’ and ‘Guidelines on the use of PET scans in neurology and cardiology’.
Paraneoplastic syndromes in patients with neurological disorders (autoimmune and limbic encephalitis, cerebellitis, polyneuropathy), where cancer is suspected but the results of previous investigations (CT, MRI, EEG) do not allow the primary tumour to be localised – tracer: (18F) FDG;

• diagnosis of infective endocarditis of a prosthetic or native valve, or endocarditis associated with a CIED – tracer: (18F) FDG;
• diagnosis of inflammation of the walls of large blood vessels; suspected Takayasu’s disease or giant-cell arteritis – tracer: (18F) FDG;
  
  
  

• hyperparathyroidism in patients eligible for surgical treatment for primary hyperparathyroidism, in whom other imaging studies ((99Tc)-MIBI and ultrasound) have proved ineffective in localising the hyperactive parathyroid gland(s) – tracer: (18F) F-choline;
• Hyperparathyroidism in patients eligible for reoperation due to persistent or recurrent hyperparathyroidism, in whom other imaging studies ((99Tc)-MIBI and ultrasound) have proved ineffective in localising the hyperactive parathyroid gland(s) – tracer: (18F)F-choline.