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Abdominal Imaging

, Volume 29, Issue 6, pp 663–668 | Cite as

Incremental value of CT in PET/CT of patients with colorectal carcinoma

  • I. R. Kamel
  • C. Cohade
  • E. Neyman
  • E. K. Fishman
  • R. L. Wahl
Original article

Abstract

Background: We assessed the contribution of dedicated computed tomographic (CT) interpretation to the accuracy of positron emission tomography (PET) plus CT in imaging patients with suspected primary or metastatic colorectal carcinoma.

Methods: One hundred PET/CT scans in 90 consecutive patients were evaluated retrospectively. Imaging was performed on a GE Discovery LS PET/CT scanner. PET images were obtained from the skull base through the midthigh after intravenous administration of 15 to 20 mCi of [18F] fluorine-18-fluoro-2-deoxyglucose. Noncontrast axial CT images were obtained at the same anatomic locations, with 140 kV, 80 mA, 0.8 s/CT rotation, a pitch of 6, and a table speed of 22.5 mm/s. The CT component of the PET/CT study was reviewed independently by consensus of two blinded readers. Scans were evaluated for the presence of primary disease, local recurrence, and distant metastases. Results were compared with the PET/CT report. The gold standard was clinical and imaging follow-up for at least 6 months, surgery, or biopsy.

Results: The study included 40 males and 50 females, with a mean age of 63 years (range, 31–92 years). The indications for the examination were to evaluate for recurrence of colorectal cancer in 83 cases, determine disease spread in 15 cases, and evaluate for possible primary malignancy in two cases with rising carcinoembryonic antigen. Sensitivity, specificity, and accuracy of the PET/CT report and of the combined PET/CT with dedicated CT interpretation were 0.914, 0.633, and 0.830 and 0.986, 1.000, and 0.980, respectively. The difference between PET/CT and the combined PET/CT with dedicated CT interpretation with respect to accuracy was statistically significant (p < 0.05).

Conclusion: The CT portion of PET/CT provides valuable anatomic and pathologic information to the functional information provided by PET and helps improve the overall accuracy of the combined study.

Positron emission tomography Computed tomography Colon cancer 

References

  1. Sugarbaker, PH 1990Surgical decision making for large bowel cancer metastatic to the liverRadiology174621626PubMedGoogle Scholar
  2. Paley, MR, Ros, PR 1998Hepatic metastasesRadiol Clin North Am36349363PubMedGoogle Scholar
  3. Jenkins, LT, Millikan, KW, Bines, SD,  et al. 1997Hepatic resection for metastatic colorectal cancerAm Surg63605610PubMedGoogle Scholar
  4. Holm, A, Bradley, E, Aldrete, JS 1989Hepatic resection of metastasis from colorectal carcinoma. Morbidity, mortality, and pattern of recurrenceAnn Surg209428434PubMedGoogle Scholar
  5. Huebner, RH, Park, KC, Shepherd, JE,  et al. 2000A meta-analysis of the literature for whole-body FDG PET detection of recurrent colorectal cancerJ Nucl Med4111771189PubMedGoogle Scholar
  6. Shreve, PD, Anzai, Y, Wahl, RL 1999Pitfalls in oncologic diagnosis with FDG PET imaging: physiologic and benign variantsRadiographics196177PubMedGoogle Scholar
  7. Whiteford, MH, Whiteford, HM, Yee, LF,  et al. 2000Usefulness of FDG-PET scan in the assessment of suspected metastatic or recurrent adenocarcinoma of the colon and rectumDis Colon Rectum43759767PubMedGoogle Scholar
  8. Wahl, RL, Quint, LE, Greenough, RL,  et al. 1994Staging of mediastinal non-small cell lung cancer with FDG PET, CT, and fusion images: preliminary prospective evaluationRadiology191371377PubMedGoogle Scholar
  9. Wahl, RL, Quint, LE, Cieslak, RD,  et al. 1993“Anatometabolic” tumor imaging: fusion of FDG PET with CT or MRI to localize foci of increased activityJ Nucl Med3411901197PubMedGoogle Scholar
  10. Kalki, K, Blankespoor, SC, Brown, JK,  et al. 1997Myocardial perfusion imaging with a combined x-ray CT and SPECT systemJ Nucl Med3815351540PubMedGoogle Scholar
  11. Beyer, T, Townsend, DW, Brun, T,  et al. 2000A combined PET/CT scanner for clinical oncologyJ Nucl Med4113691379PubMedGoogle Scholar
  12. Steinert, HC, von Schulthess, GK 2002Initial clinical experience using a new integrated in-line PET/CT systemBr J Radiol75S36S38PubMedGoogle Scholar
  13. Ruers, TJ, Langenhoff, BS, Neeleman, N,  et al. 2002Value of positron emission tomography with [F-18]fluorodeoxyglucose in patients with colorectal liver metastases: a prospective studyJ Clin Oncol20388395CrossRefPubMedGoogle Scholar
  14. Kalff, V, Hicks, RJ, Ware, RE,  et al. 2002The clinical impact of (18)F-FDG PET in patients with suspected or confirmed recurrence of colorectal cancer: a prospective studyJ Nucl Med43492499PubMedGoogle Scholar
  15. Arulampalam, T, Costa, D, Visvikis, D,  et al. 2001The impact of FDG-PET on the management algorithm for recurrent colorectal cancerEur J Nucl Med2817581765CrossRefPubMedGoogle Scholar
  16. Cohade, C, Osman, M, Pannu, HK, Wahl, RL 2003Uptake in supraclavicular area fat (“USA-Fat”): description on 18F-FDG PET/CTJ Nucl Med44170176PubMedGoogle Scholar

Copyright information

© Springer-Verlag New York, Inc. 2004

Authors and Affiliations

  • I. R. Kamel
    • 1
  • C. Cohade
    • 2
  • E. Neyman
    • 1
  • E. K. Fishman
    • 1
  • R. L. Wahl
    • 2
  1. 1.Diagnostic Imaging SectionJohns Hopkins HospitalBaltimoreUSA
  2. 2.Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological SciencesJohns Hopkins HospitalBaltimoreUSA

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