Performance of integrated FDG–PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG–PET/non-contrast-enhanced CT and enhanced CT
The aim of this study was to evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18F-fluorodeoxyglucose with IV contrast for depiction of suspected recurrent ovarian cancer and to assess the impact of PET/contrast-enhanced CT findings on clinical management, compared with PET/non-contrast-enhanced CT and CT component.
One hundred thirty-two women previously treated for ovarian cancer underwent PET/CT consisting of non-enhanced and contrast-enhanced CT for suspected recurrence. PET/contrast enhanced CT, PET/non-contrast-enhanced CT, and enhanced CT were interpreted by two experienced radiologists by consensus for each investigation. Lesion status was determined on the basis of histopathology, radiological imaging, and clinical follow-up for longer than 6 months.
Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET/contrast-enhanced CT were 78.8% (52 of 66), 90.9% (60 of 66), and 84.8% (112 of 132), respectively, whereas those of PET/non-contrast-enhanced CT were 74.2% (49 of 66), 90.9% (60 of 66), and 82.6% (109 of 132), respectively, and those of enhanced CT were 60.6% (40 of 66), 84.8% (56 of 66), and 72.7% (96 of 132), respectively. Sensitivity, specificity, and accuracy differed significantly among the three modalities (Cochran Q test: p = 0.0001, p = 0.018, and p < 0.0001, respectively). The findings of PET/contrast-enhanced CT resulted in a change of management for 51 of the 132 patients (39%) and had an effect on patient management in 16 patients (12%) diagnosed by enhanced CT alone and three patients (2%) diagnosed by PET/non-contrast-enhanced CT.
Integrated PET/contrast-enhanced CT is an accurate modality for assessing ovarian cancer recurrence and led to changes in the subsequent appropriate therapy.
KeywordsOvarian cancer Recurrence 18F-FDG PET/CT
- 13.Forstner R, Hricak H, Occhipinti KA, Powell CB, Frankel SD, Stern JL. Ovarian cancer: staging with CT and MR imaging. Radiology. 1995;19:619–26.Google Scholar
- 23.Chang WC, Hung YC, Kao CH, Yen RF, Shen YY, Lin CC. Usefulness of whole body positron emission tomography (PET) with 18F-fluoro-2-deoxyglucose (FDG) to detect recurrent ovarian cancer based to asymptomatically elevated serum levels of tumor marker (CA-125 antigen). Neoplasma. 2002;49:329–33.PubMedGoogle Scholar
- 26.Pannu HK, Cohade C, Bristow RE, Fishman EK, Wahl RL. PET-CT detection of abdominal recurrence of ovarian cancer: radiologic-surgical correlation. Abdom Imaging. 2004;39:398–403.Google Scholar
- 34.Antoch G, Saoudi N, Kuehl H, Dahmen G, Muller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18–2-fluoro-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol. 2004;22:4357–68.PubMedCrossRefGoogle Scholar
- 36.Coleman ER, Delbeke D, Guiberteau MJ, Conti PS, Royal HD, Weinreb JC, et al. Concurrent PET/CT with an integrated imaging system: intersociety dialogue from the joint working group of the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance. J Nucl Med. 2005;46:1225–39.PubMedGoogle Scholar
- 41.Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF. To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med. 2004;45:56–65.Google Scholar
- 42.Pfannenberg AC, Aschoff P, Brechtel K, Muller M, Bares R, Paulsen F, et al. Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging. 2007;34:36–44.PubMedCrossRefGoogle Scholar