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PET/CT in malignant melanoma: contrast-enhanced CT versus plain low-dose CT

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to evaluate the diagnostic value of contrast-enhanced CT (CECT) versus non-enhanced low-dose CT (NECT) in the staging of advanced malignant melanoma with 18F-fluordeoxyglucose (FDG) positron emission tomography (PET)/CT.

Methods

In total, 50 18F-FDG PET/CT examinations were performed in 50 patients with metastasized melanoma. For attenuation correction, whole-body NECT was performed followed by diagnostic CECT with contrast agent. For the whole-body PET, 18F-FDG was applied. Criteria for evaluation were signs of vital tumour tissue (extent of lesions, contrast enhancement, maximum standardized uptake value >2.5). Findings suspicious for melanoma were considered lesions. NECT, CECT and 18F-FDG PET were evaluated separately, followed by combined analysis of PET/NECT and PET/CECT. Findings were verified histologically and/or by follow-up (>6 months).

Results

Overall, 232 lesions were analysed, and 151 proved to be metastases. The sensitivity of NECT, CECT, PET, PET/NECT and PET/CECT was 62, 85, 90, 97 and 100%, and specificity was 52, 63, 88, 93 and 93%, respectively. Compared to CECT, NECT obtained additional false-negative results: lymph node (n = 19) and liver/spleen metastases (n = 9). Misinterpreted physiological structures mainly caused additional false-positive findings (n = 17).

In combined analysis of PET/NECT, six false-positive [other tumours (n = 2), inflammatory lymph nodes (n = 2), inflammatory lung lesion (n = 1), blood vessel (n = 1)] and five false-negative findings [liver (n = 3), spleen (n = 1), lymph node metastases (n = 1)] remained. On PET/CECT, six false-positive [inflammatory lymph nodes (n = 3), other tumours (n = 2), inflammatory lung lesion (n = 1)] and no false-negative findings occurred. However, additional false findings on PET/NECT (6 of 232) did not change staging compared to PET/CECT.

Conclusion

Our results indicate that it is justified to perform PET/NECT instead of PET/CECT for melanoma staging.

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Authors and Affiliations

  1. Department of Nuclear Medicine, LMU, Munich, Germany

    Thomas Pfluger, Vera Schneider, Christian La Fougere, Peter Bartenstein & Mayo Weiss

  2. Department of Nuclear Medicine, University of Munich LMU, Ziemssenstraße 1, 80336, Munich, Germany

    Henriette Ingrid Melzer

  3. Department of Radiology, LMU, Munich, Germany

    Eva Coppenrath

  4. Department of Dermatology, LMU, Munich, Germany

    Carola Berking

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  1. Thomas Pfluger
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Correspondence to Henriette Ingrid Melzer.

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Pfluger, T., Melzer, H.I., Schneider, V. et al. PET/CT in malignant melanoma: contrast-enhanced CT versus plain low-dose CT. Eur J Nucl Med Mol Imaging 38, 822–831 (2011). https://doi.org/10.1007/s00259-010-1702-z

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  • DOI: https://doi.org/10.1007/s00259-010-1702-z

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