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

  • Thomas Pfluger
  • Henriette Ingrid MelzerEmail author
  • Vera Schneider
  • Christian La Fougere
  • Eva Coppenrath
  • Carola Berking
  • Peter Bartenstein
  • Mayo Weiss
Original Article



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.


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).


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.


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


Non-contrast-enhanced PET/CT Contrast-enhanced PET/CT Malignant melanoma Metastases 


Conflicts of interest



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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Thomas Pfluger
    • 1
  • Henriette Ingrid Melzer
    • 2
    Email author
  • Vera Schneider
    • 1
  • Christian La Fougere
    • 1
  • Eva Coppenrath
    • 3
  • Carola Berking
    • 4
  • Peter Bartenstein
    • 1
  • Mayo Weiss
    • 1
  1. 1.Department of Nuclear MedicineLMUMunichGermany
  2. 2.Department of Nuclear MedicineUniversity of Munich LMUMunichGermany
  3. 3.Department of RadiologyLMUMunichGermany
  4. 4.Department of DermatologyLMUMunichGermany

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