Molecular Imaging and Biology

, Volume 7, Issue 3, pp 229–235

Clinical Value of Combined Positron Emission Tomography/Computed Tomography Imaging in the Interpretation of 2-Deoxy-2-[F-18]fluoro-d-glucose–Positron Emission Tomography Studies in Cancer Patients

  • Henry W. D. Yeung
  • Heiko Schöder
  • Alex Smith
  • Mithat Gonen
  • Steven M. Larson
Research Article

Abstract

Background

Positron emission tomography (PET)/computed tomography (CT) is a new imaging modality that provides exact coregistration of anatomic and metabolic data. We have investigated to what degree this new technique might affect the interpretation of PET images in a nonselected group of consecutive cancer patients, reflecting routine condition in a busy cancer center.

Methods

Whole-body 2-deoxy-2-[F-18]fluoro-d-glucose (FDG)–PET and PET/CT fusion image sets were compared in 100 consecutive, nonselected patients: 21 with head and neck cancer, 39 with chest malignancies, and 40 with malignancies of the abdomen and pelvis. All studies were performed for primary staging or evaluation of therapy and were interpreted by two nuclear medicine physicians also trained in radiology. Areas of abnormal FDG uptake were identified on PET and graded as likely benign, equivocal, or likely malignant. Positron emission tomography/computed tomography fusion images were then made available, and the initial findings were amended if necessary.

Results

One hundred sixty-six areas with abnormal FDG uptake were identified. Based on PET alone, 51 sites were considered equivocal for malignancy. With PET/CT, the number of equivocal lesions decreased to 24. This difference is more marked in the head and neck as well as the abdomen and pelvis. When the equivocal sites were included in the analysis and grouped with the malignant sites, positive predictive value (PPV) of PET/CT was 89% compared with 75% for PET (p = 0.04).

Conclusion

Combined PET/CT results in increased reader confidence and 53% fewer equivocal readings, as well as improved PPV compared with PET alone.

Key words

PET/CT FDG PET scan in oncology 

References

  1. 1.
    Hustinx, R, Benard, F, Alavi, A 2002Whole-body FDG-PET imaging in the management of patients with cancerSemin Nucl Med323546PubMedGoogle Scholar
  2. 2.
    Bomanji, JB, Costa, DC, Ell, PJ 2001Clinical role of positron emission tomography in oncologyLancet Oncol2157164CrossRefPubMedGoogle Scholar
  3. 3.
    Bombardieri, E, Carrio, I, Gonzalez, P,  et al. 1999Current applications and perspectives of diagnostic nuclear medicine in oncology. Task Group of OncologyInt J Oncol14877890PubMedGoogle Scholar
  4. 4.
    Bettinardi, V, Pagani, E, Gilardi, MC,  et al. 1999An automatic classification technique for attenuation correction in positron emission tomographyEur J Nucl Med26447458CrossRefPubMedGoogle Scholar
  5. 5.
    Beyer, T, Townsend, DW, Brun, T,  et al. 2000A combined PET/CT scanner for clinical oncologyJ Nucl Med4113691379PubMedGoogle Scholar
  6. 6.
    Trojan, A, Jermann, M, Taverna, C, Hany, TF 2002Fusion PET-CT imaging of neurolymphomatosisAnn Oncol13802805CrossRefPubMedGoogle Scholar
  7. 7.
    Makhija, S, Howden, N, Edwards, R, Kelley, J, Townsend, DW, Meltzer, CC 2002Positron emission tomography/computed tomography imaging for the detection of recurrent ovarian and fallopian tube carcinoma: A retrospective reviewGynecol Oncol855358CrossRefPubMedGoogle Scholar
  8. 8.
    Kluetz, P, Meltzer, C, Villemagne, V,  et al. 2000Combined PET/CT imaging in oncology. Impact on patient managementClin Positron Imaging3223230CrossRefPubMedGoogle Scholar
  9. 9.
    Hany, T, Steinert, H, Goerres, G, Buck, A, Schulthess, G 2002PET diagnostic accuracy: Improvement with in-line PET-CT system: Initial resultsRadiology225575581Google Scholar
  10. 10.
    Lardinois, D, Weder, W, Hany, TF,  et al. 2003Staging of non-small-cell lung cancer with integrated positron-emission tomography and computed tomographyN Engl J Med34825002507PubMedGoogle Scholar
  11. 11.
    Gonen, M, Panageas, KS, Larson, SM 2001Statistical issues in analysis of diagnostic imaging experiments with multiple observations per patientRadiology221763767PubMedGoogle Scholar
  12. 12.
    Cohade, C, Osman, M, Nakamoto, Y,  et al. 2003Initial experience with oral contrast in PET/CT: Phantom and clinical studiesJ Nucl Med44412416PubMedGoogle Scholar
  13. 13.
    Goerres, GW, Kamel, E, Seifert, B,  et al. 2002Accuracy of image coregistration of pulmonary lesions in patients with non-small cell lung cancer using an integrated PET/CT systemJ Nucl Med4314691475PubMedGoogle Scholar

Copyright information

© Academy of Molecular Imaging 2005

Authors and Affiliations

  • Henry W. D. Yeung
    • 1
  • Heiko Schöder
    • 1
  • Alex Smith
    • 2
  • Mithat Gonen
    • 2
  • Steven M. Larson
    • 1
  1. 1.Nuclear Medicine Service, Department of RadiologyMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  2. 2.Department of Epidemiology and BiostatisticsMemorial Sloan-Kettering Cancer CenterNew YorkUSA

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