The use of 18F-FDG PET/CT in colorectal liver metastases—comparison with CT and liver MRI
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
We compared 18-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography–CT (PETCT) with contrast-enhanced whole-body CT (ceCT) in identifying extrahepatic disease and with manganese dipyridoxyl diphosphate (Mn-DPDP) liver MRI for liver metastases in patients with colorectal liver metastases being considered for surgery.
Sixty-five patients (median age 65 years; 42 men) with colorectal cancer and known or suspicious liver metastases and who underwent a PETCT, ceCT and Mn-DPDP MRI were identified. Results were retrospectively reviewed for extrahepatic disease on PETCT and ceCT, and for the presence and number of liver metastases on PETCT and Mn-DPDP MRI. Proof of metastases was based on histopathology or clinical/imaging follow-up, demonstrating disease progression or response.
PETCT identified unexpected extrahepatic disease not detected on ceCT, leading to change in surgical management in 17%. There were three other false-positive cases on PETCT. For liver metastases on a per-patient basis, the sensitivity and specificity of both PETCT and Mn-DPDP MRI were 98% and 100%, respectively. On a per-lesion basis, PETCT and MRI were discordant in 15% (10/66 scans). MRI correctly identified more sub-centimeter metastases in eight scans. PETCT correctly identified more metastases in one case and confirmed disease in one equivocal MRI.
PETCT has incremental benefit over conventional ceCT in identifying extrahepatic disease in metastatic colorectal cancer. PETCT has high sensitivity and specificity for the presence of liver metastases and should be included early in initial pre-surgical evaluation and could potentially guide the use of Mn-DPDP MRI. However, Mn-DPDP MRI is superior for small liver metastases and remains a prerequisite for surgical planning in patients with confined liver metastases.
- Ferlay J, Autier P, Boniol M, Heanue M, Colombet M, Boyle P. Estimates of the cancer incidence and mortality in Europe in 2006. Ann Oncol. 2007;18(3):581–92. CrossRef
- Erturk SM, Ichikawa T, Fujii H, Yasuda S, Ros PR. PET imaging for evaluation of metastatic colorectal cancer of the liver. Eur J Radiol. 2006;58(2):229–35. CrossRef
- Jenkins LT, Millikan KW, Bines SD, Staren ED, Doolas A. Hepatic resection for metastatic colorectal cancer. Am Surg. 1997;63(7):605–10.
- Fuhrman GM, Curley SA, Hohn DC, Roh MS. Improved survival after resection of colorectal liver metastases. Ann Surg Oncol. 1995;2(6):537–41. CrossRef
- Schima W, Kulinna C, Langenberger H, Ba-Ssalamah A. Liver metastases of colorectal cancer: US, CT or MR? Cancer Imaging. 2005;5(Spec no. A):S149–156. CrossRef
- Ong KO, Leen E. Radiological staging of colorectal liver metastases. Surg Oncol. 2007;16(1):7–14. CrossRef
- Ward J, Robinson PJ, Guthrie JA, et al. Liver metastases in candidates for hepatic resection: comparison of helical CT and gadolinium- and SPIO-enhanced MR imaging. Radiology. 2005;237(1):170–80. CrossRef
- Arulampalam TH, Francis DL, Visvikis D, Taylor I, Ell PJ. FDG-PET for the pre-operative evaluation of colorectal liver metastases. Eur J Surg Oncol. 2004;30(3):286–91. CrossRef
- Zealley IA, Skehan SJ, Rawlinson J, Coates G, Nahmias C, Somers S. Selection of patients for resection of hepatic metastases: improved detection of extrahepatic disease with FDG pet. Radiographics. 2001;21(Spec No):S55–69.
- Desai DC, Zervos EE, Arnold MW, Burak WE Jr, Mantil J, Martin EW Jr. Positron emission tomography affects surgical management in recurrent colorectal cancer patients. Ann Surg Oncol. 2003;10(1):59–64. CrossRef
- Selzner M, Hany TF, Wildbrett P, McCormack L, Kadry Z, Clavien PA. Does the novel PET/CT imaging modality impact on the treatment of patients with metastatic colorectal cancer of the liver? Ann Surg. 2004;240(6):1027–34. (discussion 1035–26). CrossRef
- Joyce DL, Wahl RL, Patel PV, Schulick RD, Gearhart SL, Choti MA. Preoperative positron emission tomography to evaluate potentially resectable hepatic colorectal metastases. Arch Surg. 2006;141(12):1220–6. (discussion 1227). CrossRef
- Wiering B, Krabbe PF, Jager GJ, Oyen WJ, Ruers TJ. The impact of fluor-18-deoxyglucose-positron emission tomography in the management of colorectal liver metastases. Cancer. 2005;104(12):2658–70. CrossRef
- Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of (18)F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med. 2003;44(11):1797–803.
- Kim JH, Czernin J, Allen-Auerbach MS, et al. Comparison between 18F-FDG PET, in-line PET/CT, and software fusion for restaging of recurrent colorectal cancer. J Nucl Med. 2005;46(4):587–95.
- Khan S, Tan YM, John A, et al. An audit of fusion CT-PET in the management of colorectal liver metastases. Eur J Surg Oncol. 2006;32(5):564–7. CrossRef
- Lubezky N, Metser U, Geva R, et al. The role and limitations of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) scan and computerized tomography (CT) in restaging patients with hepatic colorectal metastases following neoadjuvant chemotherapy: comparison with operative and pathological findings. J Gastrointest Surg. 2007;11(4):472–8. CrossRef
- Flamen P, Stroobants S, Van Cutsem E, et al. Additional value of whole-body positron emission tomography with fluorine-18–2-fluoro-2-deoxy-d-glucose in recurrent colorectal cancer. J Clin Oncol. 1999;17(3):894–901.
- Lejeune C, Bismuth MJ, Conroy T, et al. Use of a decision analysis model to assess the cost-effectiveness of 18F-FDG PET in the management of metachronous liver metastases of colorectal cancer. J Nucl Med. 2005;46(12):2020–8.
- Strasberg SM, Dehdashti F, Siegel BA, Drebin JA, Linehan D. Survival of patients evaluated by FDG-PET before hepatic resection for metastatic colorectal carcinoma: a prospective database study. Ann Surg. 2001;233(3):293–9. CrossRef
- Yang YY, Fleshman JW, Strasberg SM. Detection and management of extrahepatic colorectal cancer in patients with resectable liver metastases. J Gastrointest Surg. 2007;11(7):929–44. CrossRef
- Truant S, Huglo D, Hebbar M, Ernst O, Steinling M, Pruvot FR. Prospective evaluation of the impact of [18F]fluoro-2-deoxy-d-glucose positron emission tomography of resectable colorectal liver metastases. Br J Surg. 2005;92(3):362–9. CrossRef
- Wiering B, Ruers TJ, Krabbe PF, Dekker HM, Oyen WJ. Comparison of multiphase CT, FDG-PET and intra-operative ultrasound in patients with colorectal liver metastases selected for surgery. Ann Surg Oncol. 2007;14(2):818–26. CrossRef
- Bipat S, van Leeuwen MS, Comans EF, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis–meta-analysis. Radiology. 2005;237(1):123–31. CrossRef
- Bartolozzi C, Donati F, Cioni D, et al. Detection of colorectal liver metastases: a prospective multicenter trial comparing unenhanced MRI, MnDPDP-enhanced MRI, and spiral CT. Eur Radiol. 2004;14(1):14–20. CrossRef
- Whiteford MH, Whiteford HM, Yee LF, et al. Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectum. Dis Colon Rectum. 2000;43(6):759–67. (discussion 767–70). CrossRef
- The use of 18F-FDG PET/CT in colorectal liver metastases—comparison with CT and liver MRI
European Journal of Nuclear Medicine and Molecular Imaging
Volume 35, Issue 7 , pp 1323-1329
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Colorectal liver metastases
- Liver MRI
- Industry Sectors
- Author Affiliations
- 1. Department of Nuclear Medicine and PET, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- 2. Gastrointestinal Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
- 3. Department of Radiology, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK