The impact of 18F-FDG PET/CT in patients with liver metastases
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The aim of this study was to assess the performance of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) versus dedicated contrast-enhanced CT (CECT) in the detection of metastatic liver disease.
All patients that presented to our Institution with suspected metastatic liver disease who underwent 18F-FDG PET/CT and CECT within 6 weeks of each other, were retrospectively analyzed, covering a 5-year period. One hundred and thirty-one patients (67 men, 64 women; mean age 62) were identified. Seventy-five had colorectal carcinoma and 56 had other malignancies. The performance of CECT and that of 18F-FDG-PET/CT in detecting liver metastases were compared. The ability of each to detect local recurrence, extrahepatic metastases and to alter patient management was recorded. The final diagnosis was based on histology, clinical and radiological follow-up (mean 23 months).
In detecting hepatic metastases, 18F-FDG-PET/CT yielded 96% sensitivity and 75% specificity, whilst CECT showed 88% sensitivity and 25% specificity. 18F-FDG-PET/CT and CECT were concordant in 102 out of 131 patients (78%). In the colorectal group 18F-FDG-PET/CT showed 94% sensitivity and 75% specificity, whilst CECT had 91% sensitivity and 25% specificity. In the noncolorectal group 18F-FDG-PET/CT showed 98% sensitivity and 75% specificity whilst CECT had 85% sensitivity and 25% specificity. Overall, 18F-FDG-PET/CT altered patient management over CECT in 25% of patients. CECT did not alter patient management over 18F-FDG-PET/CT alone in any patients.
18F-FDG-PET/CT performed better in detecting metastatic liver disease than CECT in both colorectal and noncolorectal malignancies, and frequently altered patient management. The future role of CECT in these patients may need to be re-evaluated to avoid potentially unnecessary duplication of investigation where 18F-PET/CT is readily available.
Keywords18F-FDG-PET/CT Contrast enhanced CT Liver metastases Colorectal carcinoma Noncolorectal carcinoma
This work was undertaken at UCLH/UCL who received a proportion of funding from the UK’s Department of Health’s NIHR Biomedical Research Centres funding scheme.
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