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PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences

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Abstract

Positron emission tomography–computed tomography (PET-CT) has gained widespread acceptance as a staging investigation in the diagnostic workup of malignant tumours and may be used to visualize metabolic changes before the evolution of morphological changes. To make histology of PET findings without distinctive structural changes available for treatment decisions, we developed a protocol for multimodal image-guided interventions using an integrated PET-CT machine. We report our first experience in 12 patients admitted for staging and restaging of breast cancer, non-small cell lung cancer, cervical cancer, soft tissue sarcoma, and osteosarcoma. Patients were repositioned according to the findings in PET-CT and intervention was planned based on a subsequent single-bed PET-CT acquisition of the region concerned. The needle was introduced under CT guidance in a step-by-step technique and correct needle position in the centre of the FDG avid lesion was assured by repetition of a single-bed PET-CT acquisition before sampling. The metabolically active part of lesions was accurately targeted in all patients and representative samples were obtained in 92%. No major adverse effects occurred. We conclude that PET-CT guidance for interventions is feasible and may be promising to optimize the diagnostic yield of CT-guided interventions and to make metabolically active lesions without morphological correlate accessible to percutaneous interventions.

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Acknowledgements

B.K., T.K. and J.W. were supported by a local quality assurance project.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Bernd Klaeser, Thomas Krause & Jakub Wiskirchen

  2. Department of Obstetrics and Gynaecology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Michel D. Mueller

  3. Department of Thoracic Surgery, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland

    Ralph A. Schmid

  4. Institute of Pathology, University of Bern, Bern, Switzerland

    Carlos Guevara

  5. Department of Radiology, Neuroradiology, and Nuclear Medicine, University Hospital Tuebingen, Tuebingen, Germany

    Jakub Wiskirchen

Authors
  1. Bernd Klaeser
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  2. Michel D. Mueller
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  3. Ralph A. Schmid
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  4. Carlos Guevara
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  5. Thomas Krause
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  6. Jakub Wiskirchen
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Corresponding author

Correspondence to Thomas Krause.

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Klaeser, B., Mueller, M.D., Schmid, R.A. et al. PET-CT-guided interventions in the management of FDG-positive lesions in patients suffering from solid malignancies: initial experiences. Eur Radiol 19, 1780–1785 (2009). https://doi.org/10.1007/s00330-009-1338-1

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  • DOI: https://doi.org/10.1007/s00330-009-1338-1

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