Molecular Imaging and Biology

, Volume 12, Issue 4, pp 452–459 | Cite as

Performance of Integrated FDG-PET/Contrast-enhanced CT in the Diagnosis of Recurrent Pancreatic Cancer: Comparison with Integrated FDG-PET/Non-contrast-enhanced CT and Enhanced CT

  • Kazuhiro Kitajima
  • Koji Murakami
  • Erena Yamasaki
  • Yasushi Kaji
  • Mitsugi Shimoda
  • Keiichi Kubota
  • Narufumi Suganuma
  • Kazuro Sugimura
Research Article

Abstract

Purpose

The purpose of this study is to evaluate the accuracy of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET)/computed tomography (CT) with intravenous contrast for depiction of recurrent pancreatic cancer, compared with PET/non-enhanced CT and CT.

Procedure

Forty-five patients previously treated for pancreatic cancer underwent PET/CT for suspected recurrence. Lesion status was determined on the basis of histopathology and radiological imaging follow-up.

Results

Patient-based analysis showed that sensitivity, specificity, and accuracy of PET/contrast-enhanced CT were 91.7%, 95.2%, and 93.3%, respectively, whereas those of PET/non-enhanced CT were 83.3%, 90.5%, and 86.7%, respectively, and those of enhanced CT were 66.7%, 85.7%, and 75.6%, respectively. In 21 patients whom the final diagnosis was obtained from the histopathologic examination, those figures of PET/contrast-enhanced CT were 94.7%, 50.0%, and 90.4%, respectively. The sensitivity of PET/contrast-enhanced CT in detecting local recurrence, abdominal lymph node metastasis, and peritoneal dissemination were 83.3%, 87.5%, and 83.3%, respectively.

Conclusion

PET/contrast-enhanced CT is an accurate modality for assessing recurrence of pancreatic cancer.

Key words

Pancreatic cancer Recurrence 18F-FDG PET/CT 

Notes

Acknowledgments

We thank Kennichi Kobayashi, Kouichi Asano, Kazufumi Suzuki, Kaoru Ishida, and Tomoyuki Sakamoto for their excellent technical assistance and generous support.

References

  1. 1.
    Li D, Xie K, Wolff R, Abbruzzese JL (2004) Pancreatic cancer. Lancet 363:1049–1057CrossRefPubMedGoogle Scholar
  2. 2.
    Neoptolemos JP, Stocken DD, Friess H, et al (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350:1200–1210CrossRefPubMedGoogle Scholar
  3. 3.
    Pakzad F, Groves AM, Ell PJ (2006) The role of positron emission tomography in the management of pancreatic cancer. Semi Nucl Med 36:248–256CrossRefPubMedGoogle Scholar
  4. 4.
    Koninger J, Wente M, Muller MW, Gutt CN, Friess H, Buchler MW (2007) Surgical palliation in patients with pancreatic cancer. Langenbeck’s Arch Surg 392:13–21CrossRefGoogle Scholar
  5. 5.
    Kleeff F, Reiser C, Hinz U, et al (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Am Surg 245:566–572Google Scholar
  6. 6.
    Cook GJ, Maisey MN, Fogelman I (1999) Normal variants, artifacts and interpretative pitfalls in PET imaging with 18-fluoro-2-deoxyglucose and carbon-11 methionine. Eur J Nucl Med 26:1363–1378CrossRefPubMedGoogle Scholar
  7. 7.
    Kostakoglu L, Agress Jr H, Goldsmith SJ (2003) Clinical role of FDG PET in evaluation of cancer patients. Radiographics 23:315–340CrossRefPubMedGoogle Scholar
  8. 8.
    Beyer T, Townsend DW, Brun T, et al (2000) A combined PET/CT scanner for clinical oncology. J Nucl Med 41:1369–1379PubMedGoogle Scholar
  9. 9.
    Bar-Shalom R, Yefremov N, Guralnik L, et al (2003) Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 44:1200–1209PubMedGoogle Scholar
  10. 10.
    Heinrich S, Goerres GW, Schafer M, et al (2005) Positron emission tomography/computed tomography influences on the management of respectable pancreatic cancer and its cost-effectiveness. Ann Surg 242:235–243CrossRefPubMedGoogle Scholar
  11. 11.
    Casneuf V, Delrue L, Kelles A, et al (2007) Is combined 18F-fluorodeoxyglucose-positron emission tomography/computed tomography superior to positron emission tomography or computed tomography alone for diagnosis, staging and restaging of pancreatic lesions? Acta Gastroenterol Belg 70:330–338Google Scholar
  12. 12.
    Saif MW, Cornfeld D, Modarresifar H, Ojha B (2008) 18F-FDG positron emission tomography CT (FDG PET-CT) in the management of pancreatic cancer: initial experience in 12 patients. J Gastrointestin Liver Dis 17:173–178PubMedGoogle Scholar
  13. 13.
    Strobel K, Heinrich S, Bhure U, et al (2008) Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the respectability of pancreatic cancer. J Nucl Med 49:1408–1413CrossRefPubMedGoogle Scholar
  14. 14.
    Wakabayashi H, Nishiyama Y, Otani T, et al (2008) Role of 18F-fluorodeoxyglucose positron emission tomography imaging in surgery for pancreatic cancer. World J Gastroenterol 14:64–69CrossRefPubMedGoogle Scholar
  15. 15.
    Antoch G, Stattaus J, Nemat AT, et al (2003) Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology 229:526–533CrossRefPubMedGoogle Scholar
  16. 16.
    Kitajima K, Murakami K, Yamasaki E, et al (2008) 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. Eur J Nucl Med Mol Imaging 35:1439–1448CrossRefPubMedGoogle Scholar
  17. 17.
    Antoch G, Saoudi N, Kuehl H, et al (2004) 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 22:4357–4368CrossRefPubMedGoogle Scholar
  18. 18.
    Sironi S, Buda A, Picchio M, et al (2006) Lymph node metastasis in patients with clinically early stage cervical cancer: detection with integrated FDG PET/CT. Radiology 238:272–279CrossRefPubMedGoogle Scholar
  19. 19.
    Kitajima K, Murakami K, Yamasaki E, et al (2008) Accuracy of FDG PET/CT in detecting pelvic and paraortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol 190:1652–1658CrossRefPubMedGoogle Scholar
  20. 20.
    Sironi S, Messa C, Mangili G, et al (2004) Integrated FDG PET/CT in patients with persistent ovarian cancer: correlation with histologic findings. Radiology 233:433–440CrossRefPubMedGoogle Scholar
  21. 21.
    Pannu HK, Cohade C, Bristow RE, Fishman EK, Wahl RL (2004) PET-CT detection of abdominal recurrence of ovarian cancer: radiologic-surgical correlation. Abdom Imaging 39:398–403Google Scholar
  22. 22.
    Coleman ER, Delbeke D, Guiberteau MJ, et al (2005) 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 46:1225–1239PubMedGoogle Scholar
  23. 23.
    Cohade C, Wahl RL (2003) Applications of positron emission tomography/computed tomography image fusion in clinical positron emission tomography: clinical use, interpretation methods, diagnostic improvements. Semi Nucl Med 33:228–237CrossRefPubMedGoogle Scholar
  24. 24.
    Schaefer NG, Hany TF, Taverna C, et al (2004) Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG-PET and CT at staging and restaging—do we need contrast-enhanced CT? Radiology 232:823–829CrossRefPubMedGoogle Scholar
  25. 25.
    Rodriguez-Vigil B, Gomez-Leon N, Pinilla I, et al (2006) PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med 47:1643–1648PubMedGoogle Scholar
  26. 26.
    Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF (2004) To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med 45:56–65Google Scholar
  27. 27.
    Mawlawi O, Erasmus JJ, Munden RF, et al (2006) Quantifying the effect of IV contrast media on integrated PET/CT: clinical evaluation. AJR Am J Roentgenol 186:308–319CrossRefPubMedGoogle Scholar
  28. 28.
    Pfannenberg AC, Aschoff P, Brechtel K, et al (2007) 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 34:36–44CrossRefPubMedGoogle Scholar
  29. 29.
    Pfannenberg AC, Aschoff P, Brechtel K, et al (2007) Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging. Br J Radiol 80:437–445CrossRefPubMedGoogle Scholar

Copyright information

© Academy of Molecular Imaging 2009

Authors and Affiliations

  • Kazuhiro Kitajima
    • 1
    • 2
    • 5
  • Koji Murakami
    • 2
  • Erena Yamasaki
    • 2
  • Yasushi Kaji
    • 1
  • Mitsugi Shimoda
    • 3
  • Keiichi Kubota
    • 3
  • Narufumi Suganuma
    • 4
  • Kazuro Sugimura
    • 5
  1. 1.Department of RadiologyDokkyo University School of MedicineMibuJapan
  2. 2.PET CenterDokkyo Medical University HospitalMibuJapan
  3. 3.Second Department of SurgeryDokkyo University School of MedicineMibuJapan
  4. 4.Department of Environmental MedicineKochi University Medical SchoolKochiJapan
  5. 5.Department of RadiologyKobe University Graduate School of MedicineKobeJapan

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