PET/CT in Pancreatic Cancer

  • Thomas F. Hany
  • Klaus Strobel
Part of the Medical Radiology book series (MEDRAD)


Hardware- fused positron emission tomography (PET) and computed tomography (CT) to PET/CT as a single-step procedure improves the diagnostic accuracy in many oncological diseases. PET/CT using the most applied tracer F-18 fluorodeoxyglucose (FDG) helps in the differentiation malignant from benign pancreatic mass lesions. In proven exocrine pancreatic cancer, additional use iodinated, intravenous contrast in PET/CT combines the considerable advantages of both imaging modalities in detecting distant metastases as well as local staging regarding vascular invasion. Since FDG-uptake in tumor is correlated with tumor viability, FDG-PET/CT can be used for therapy response assessment in a neo-adjuvant, curative setting as well in monitoring radio-chemotherapy in a palliative setting. Further, FDG-PET/CT is able to detect local as well as distant recurrence rather reliably. For neuroendocrine pancreatic ancer, newly developed tracers like F18-DOPA and 68Ga-DOTA-NOC may revolutionize the diagnostic work-up by combining diagnostic as well as therapy related informations into a single exam.


Positron Emission Tomography Pancreatic Cancer Chronic Pancreatitis Peritoneal Carcinomatosis Pancreatic Ductal Adenocarcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. Ambrosini V, Tomassetti P, Castellucci P, Campana D, Montini G, Rubello D, Nanni C, Rizzello A, Franchi R, Fanti S (2008) Comparison between 68Ga-DOTA-NOC and 18F-DOPA PET for the detection of gastro-entero-pancreatic and lung neuro-endocrine tumours. Eur J Nucl Med Mol Imaging 35(8): 1431-1438PubMedCrossRefGoogle Scholar
  2. Bang S, Chung HW, Park SW, Chung JB, Yun M, Lee JD, Song SY (2006) The clinical usefulness of 18-fluorodeoxyglucose positron emission tomography in the differential diagnosis, staging, and response evaluation after concurrent chemoradiotherapy for pancreatic cancer. J Clin Gastroenterol 40(10):923–929PubMedCrossRefGoogle Scholar
  3. Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, Jerin J, Young J, Byars L, Nutt R (2000) A combined PET/CT scanner for clinical oncology. J Nucl Med 41(8):1369–1379PubMedGoogle Scholar
  4. Brix G, Lechel U, Glatting G, Ziegler SI, Munzing W, Muller SP, Beyer T (2005) Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations. J Nucl Med 46(4):608–613PubMedGoogle Scholar
  5. Chang L, Stefanidis D, Richardson WS, Earle DB, Fanelli RD (2009) The role of staging laparoscopy for intraabdominal cancers: an evidence-based review. Surg Endosc 23(2): 231-241PubMedCrossRefGoogle Scholar
  6. Delbeke D, Rose DM, Chapman WC, Pinson CW, Wright JK, Beauchamp RD, Shyr Y, Leach SD (1999) Optimal interpretation of FDG PET in the diagnosis, staging and management of pancreatic carcinoma. J Nucl Med 40(11):1784–1791PubMedGoogle Scholar
  7. Farma JM, Santillan AA, Melis M, Walters J, Belinc D, Chen DT, Eikman EA, Malafa M (2008) PET/CT fusion scan enhances CT staging in patients with pancreatic neoplasms. Ann Surg Oncol 15(9):2465–2471PubMedCrossRefGoogle Scholar
  8. Gibril F, Reynolds JC, Doppman JL, Chen CC, Venzon DJ, Termanini B, Weber HC, Stewart CA, Jensen RT (1996) Somatostatin receptor scintigraphy: its sensitivity compared with that of other imaging methods in detecting primary and metastatic gastrinomas. A prospective study. Ann Intern Med 125(1): 26-34PubMedCrossRefGoogle Scholar
  9. Hany TF, Steinert HC, Goerres GW, Buck A, von Schulthess GK (2002) PET diagnostic accuracy: improvement with in-line PET-CT system: initial results. Radiology 225(2):575–581PubMedCrossRefGoogle Scholar
  10. Heinrich S, Goerres GW, Schafer M, Sagmeister M, Bauerfeind P, Pestalozzi BC, Hany TF, von Schulthess GK, Clavien PA (2005) Positron emission tomography/computed tomography influences on the management of resectable pancreatic cancer and its cost-effectiveness. Ann Surg 242(2): 235–243PubMedCentralPubMedCrossRefGoogle Scholar
  11. Heinrich S, Schafer M, Weber A, Hany TF, Bhure U, Pestalozzi BC, Clavien PA (2008) Neoadjuvant chemotherapy generates a significant tumor response in resectable pancreatic cancer without increasing morbidity: results of a prospective phase II trial. Ann Surg 248(6):1014–1022PubMedCrossRefGoogle Scholar
  12. Jerusalem G, Beguin Y, Najjar F, Hustinx R, Fassotte MF, Rigo P, Fillet G (2001) Positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) for the staging of low-grade non-Hodgkin’s lymphoma (NHL). Ann Oncol 12(6):825–830PubMedCrossRefGoogle Scholar
  13. Koopmans KP, de Vries EG, Kema IP, Elsinga PH, Neels OC, Sluiter WJ, van der Horst-Schrivers AN, Jager PL (2006) Staging of carcinoid tumours with 18F-DOPA PET: a prospective, diagnostic accuracy study. Lancet Oncol 7(9): 728-734PubMedCrossRefGoogle Scholar
  14. Long EE, Van Dam J, Weinstein S, Jeffrey B, Desser T, Norton JA (2005) Computed tomography, endoscopic, laparoscopic, and intra-operative sonography for assessing resectability of pancreatic cancer. Surg Oncol 14(2): 105-113PubMedCrossRefGoogle Scholar
  15. Maisey NR, Webb A, Flux GD, Padhani A, Cunningham DC, Ott RJ, Norman A (2000) FDG-PET in the prediction of survival of patients with cancer of the pancreas: a pilot study. Br J Cancer 83(3):287–293PubMedCentralPubMedCrossRefGoogle Scholar
  16. Nehmeh SA, Erdi YE, Pan T, Yorke E, Mageras GS, Rosenzweig KE, Schoder H, Mostafavi H, Squire O, Pevsner A, Larson SM, Humm JL (2004) Quantitation of respiratory motion during 4D-PET/CT acquisition. Med Phys 31(6):1333–1338PubMedCrossRefGoogle Scholar
  17. Palazzo L, Roseau G, Gayet B, Vilgrain V, Belghiti J, Fekete F, Paolaggi JA (1993) Endoscopic ultrasonography in the diagnosis and staging of pancreatic adenocarcinoma. Results of a prospective study with comparison to ultrasonography and CT scan. Endoscopy 25(2): 143-150PubMedCrossRefGoogle Scholar
  18. Pasquali C, Rubello D, Sperti C, Gasparoni P, Liessi G, Chierichetti F, Ferlin G, Pedrazzoli S (1998) Neuroendocrine tumor imaging: can 18F-fluorodeoxyglucose positron emission tomography detect tumors with poor prognosis and aggressive behavior? World J Surg 22(6): 588-592PubMedCrossRefGoogle Scholar
  19. Ruf J, Lopez Hanninen E, Oettle H, Plotkin M, Pelzer U, Stroszczynski C, Felix R, Amthauer H (2005) Detection of recurrent pancreatic cancer: comparison of FDG-PET with CT/MRI. Pancreatology 5(2–3):266–272PubMedCrossRefGoogle Scholar
  20. Schick V, Franzius C, Beyna T, Oei ML, Schnekenburger J, Weckesser M, Domschke W, Schober O, Heindel W, Pohle T, Juergens KU (2008) Diagnostic impact of 18F-FDG PET-CT evaluating solid pancreatic lesions versus endosonography, endoscopic retrograde cholangio-pancreatography with intraductal ultrasonography and abdominal ultrasound. Eur J Nucl Med Mol Imaging 35(10):1775–1785PubMedCrossRefGoogle Scholar
  21. Smith SL, Rajan PS (2004) Imaging of pancreatic adenocarcinoma with emphasis on multidetector CT. Clin Radiol 59(1): 26-38PubMedCrossRefGoogle Scholar
  22. Soriano A, Castells A, Ayuso C, Ayuso JR, de Caralt MT, Gines MA, Real MI, Gilabert R, Quinto L, Trilla A, Feu F, Montanya X, Fernandez-Cruz L, Navarro S (2004) Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol 99(3): 492-501PubMedCrossRefGoogle Scholar
  23. Strobel K, Heinrich S, Bhure U, Soyka J, Veit-Haibach P, Pestalozzi BC, Clavien PA, Hany TF (2008) Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med 49(9):1408–1413PubMedCrossRefGoogle Scholar
  24. Strobel K, Rudy M, Treyer V, Veit-Haibach P, Burger C, Hany TF (2007) Objective and subjective comparison of standard 2-D and fully 3-D reconstructed data on a PET/CT system. Nucl Med Commun 28(7):555–559PubMedCrossRefGoogle Scholar
  25. Strobel K, Thuerl CM, Hany TF (2005) How much intravenous contrast is needed in FDG-PET/CT? Nuklearmedizin 44(suppl 1):S32–S37PubMedGoogle Scholar
  26. von Schulthess GK, Steinert HC, Hany TF (2006) Integrated PET/CT: current applications and future directions. Radiology 238(2):405–422CrossRefGoogle Scholar
  27. Wray CJ, Ahmad SA, Matthews JB, Lowy AM (2005) Surgery for pancreatic cancer: recent controversies and current practice. Gastroenterology 128(6): 1626-1641PubMedCrossRefGoogle Scholar
  28. Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, Zahurak ML, Dooley WC, Coleman J, Sauter PK, Pitt HA, Lillemoe KD, Cameron JL (1997) Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg 225(5): 621-633; discussion 633-636PubMedCentralPubMedCrossRefGoogle Scholar
  29. Yoshioka M, Sato T, Furuya T, Shibata S, Andoh H, Asanuma Y, Hatazawa J, Koyama K (2003) Positron emission tomography with 2-deoxy-2-[(18)F] fluoro- d-glucose for diagnosis of intraductal papillary mucinous tumor of the pancreas with parenchymal invasion. J Gastroenterol 38(12):1189–1193PubMedCrossRefGoogle Scholar
  30. Zimny M, Bares R, Fass J, Adam G, Cremerius U, Dohmen B, Klever P, Sabri O, Schumpelick V, Buell U (1997) Fluorine-18 fluorodeoxyglucose positron emission tomography in the differential diagnosis of pancreatic carcinoma: a report of 106 cases. Eur J Nucl Med 24(6):678–682PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  1. 1.Department Medical Radiology, Division of Nuclear MedicineUniversity HospitalZurichSwitzerland

Personalised recommendations