All Title Author
Keywords Abstract


Combined 18F-FDG PET/CT with Enhanced CT Perform One-Stop Shop Imaging for Assessing Pancreatic Carcinoma

DOI: 10.4236/jct.2012.35070, PP. 546-552

Keywords: Pancreas, Carcinoma, Computed Tomography, Positron Emission Tomography, Enhanced CT

Full-Text   Cite this paper   Add to My Lib

Abstract:

Objective: To evaluate the role of PET/CT with contrast enhanced CT in diagnosing and staging for pancreatic diseases and optimize the use of enhanced PET/CT as one-stop imaging modality. Methods: Fifty-six patients who presented with suspected pancreatic carcinoma underwent whole-body 18F-FDG PET/CT and enhanced CT imaging. Images were interpreted and compared with the histopathology findings. The sensitivity, specificity and accuracy of enhanced CT, PET/CT and combined PET/CT with contrast enhanced CT diagnosis were analyzed. The vascular invasion and distant metastases of pancreatic lesions on different imaging modality were analyzed and compared. Results: Among the fifty-six patients evaluated for primary tumor, thirty-nine patients had malignant diseases and seventeen had benign lesions. Sensitivity, specificity and accuracy of enhanced CT were 87.5%, 75% and 83.9%, those of non-enhanced PET/CT were 89.7%, 88.2% and 89.2%, of PET/CT with enhanced CT were 100%, 94.1% and 98.2%. Combined PET/CT with enhanced CT had highest sensitivity, specificity and accuracy in diagnosing pancreatic carcinoma. Average SUVmax of malignant lesions was 6.72 ± 3.84, compared with 2.56 ± 1.22 for patients with benign disease (P < 0.01). Combined PET/CT with enhanced CT can help to make accurate staging especially in assessing metastases and vascular invasion. Seven patients deemed surgical candidates were changed to non-surgical treatment. SUVmax didn’t correlate with distant metastases and survival time (Pearson = –0.243, P = 0.136). Distant metastases correlate with survival time (Pearson = –0.447, P = 0.004). Conclusion: PET/CT with contrast enhanced CT is of greater value in the diagnosis of pancreatic lesions as well as preoperative staging especially in assessing vascular invasion and distant metastasis. It is feasible to perform one-stop shop imaging by combining PET/CT with enhanced CT, supplying more accurate assessment before operation and help to select optimal therapeutic plan.

References

[1]  D. Li, K. Xie, R. Wolff, et al., “Pancreatic Cancer,” The Lancet, Vol. 363, No. 9414, 2004, pp. 1049-1057. doi:10.1016/S0140-6736(04)15841-8
[2]  F. Pakzad, A. M. Groves and P. J. Ell, “The Role of Positron Emission Tomography in the Management of Pancreatic Cancer,” Seminars in Nuclear Medicine, Vol. 36, No. 3, 2006, pp. 248-256. doi:10.1053/j.semnuclmed.2006.03.005
[3]  K. Strobel, S. Heinrich, U. Bhure, J. Soyka, P. Veit-Haibach, B. C. Pestalozzi, P. A. Clavien and T. F. Hany, “Contrast-Enhanced 18F-FDG PET/CT: 1-Stop-Shop Imaging for Assessing the Resectability of Pancreatic Cancer,” Journal of Nuclear Medicine, Vol. 49, No. 9, 2008, pp. 1408-1413. doi:10.2967/jnumed.108.051466
[4]  O. W. Hamer and S. Feuerbach, “How Useful Is Integrated PET and CT for the Management of Pancreatic Cancer?” Nature Reviews Gastroenterology & Hepatology, Vol. 3, No. 2, 2006, pp. 74-75.
[5]  C. M. Parsons, J. L. Sutcliffe and R. J. Bold, “Preoperative Evaluation of Pancreatic Adenocarcinoma,” Journal of Hepato-Biliary-Pancreatic Surgery, Vol. 15, No. 4, 2008, pp. 429-435. doi:10.1007/s00534-007-1240-7
[6]  C. Sperti, C. Pasquali, F. Chierichetti, et al., “18-Fluorodeoxyglucose Positron Emission Tomography in Predicting Survival of Patients with Pancreatic Carcinoma,” Journal of Gastrointestinal Surgery, Vol. 7, No. 8, 2003, pp. 539-959. doi:10.1016/j.gassur.2003.09.002
[7]  V. Casneuf, L. Delrue, A. Kelles, N. Van Damme, J. Van Huysse, F. Berrevoet, M. De Vos, P. Duyck and M. Peeters, “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 Gastro-Enterologica Belgica, Vol. 70, No. 4, 2007, pp. 331-338.
[8]  J. C. Slollfuss, G. Glatting, H. T. Friess, et al., “F-(Fluorine-fluoro-2-deoxy-d-glucose PET in Detection of Pancreatic Cancer: Value Quantitative Image Interpretation,” Radiology, Vol. 175, No. 2, 1995, pp. 339-344.
[9]  H. Saisho and T. Yamaguchi, “Diagnostic Imaging for Pancreatic Cancer: Computed Tomography, Magnetic Resonance Imaging, and Positron Emission Tomography,” Pancreas, Vol. 28, No. 3, 2004, pp. 273-278.doi:10.1097/00006676-200404000-00011
[10]  C. L. Ho, F. Dehdashti, L. K. Griffeth, et al., “F-18 FDG-PET Evaluation of Indeterminate Pancreatic Masses,” Journal of Computer Assisted Tomography, Vol. 20, No. 3, 1996, pp. 363-369. doi:10.1097/00004728-199605000-00006
[11]  C. Sperti, S. Bissoli, C. Pasquali, L. Frison, G. Liessi, F. Chierichetti and S. Pedrazzoli, “18-Fluorodeoxyglucose Positron Emission Tomography Enhances Computed Tomography Diagnosis of Malignant Intraductal Papillary Mucinous Neoplasms of the Pancreas,” Annals of Surgery, Vol. 246, No. 6, 2007, pp. 932-939.doi:10.1097/SLA.0b013e31815c2a29
[12]  J. M. Farma, A. A. Santillan, M. Melis, J. Walters, D. Belinc, D. T. Chen, E. A. Eikman and M. Malafa, “PET/CT Fusion Scan Enhances CT Staging in Patients with Pancreatic Neoplasms,” Annals of Surgical Oncology, Vol. 15, No. 9, 2008, pp. 2465-2471.doi:10.1245/s10434-008-9992-0
[13]  H. Minn, K. R. Zasadny, L. E. Quint and R. L. Wahl, “Lung Cancer: Reproducibility of Quantitative Measurements for Evaluating 2-[F-18]-Fluoro-2-deoxy-d-glucose Uptake at PET,” Radiology, Vol. 196, No. 1, 1995, pp. 167-173.
[14]  T. Higashi, T. Saga, Y. Nakamoto, I T. shimori, K. Fujimoto, R. Doi, M. Imamura and J. Konishi, “Diagnosis of Pancreatic Cancer Using Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography (FDG PET)—Usefulness and Limitations in Clinical Reality,” Annals of Nuclear Medicine, Vol. 17, No. 4, 2003, pp. 261-279.doi:10.1007/BF02988521
[15]  M. Zimny, U. Buell, C. G. Diedrichs, et al., “False-positive FDG-PET in Patients with Pancreatic Masses: An Issue of Proper Patient Selection?” European Journal of Nuclear Medicine and Molecular, Vol. 25, No. 1325, 1998, p. 1352.
[16]  H. E. J. Offman, S. C. Huang, M. E. Phelps, et al., “Quantitation in Positron Emission Computed Tomography: Effect of Object Size,” Journal of Computer Assisted Tomography, Vol. 3, No. 3, 1979, pp. 299-308.
[17]  S. Bang, H. W. Chung, S. W. Park, et al., “The Clinical Usefulness of 18-Fluorodeoxyglucose Positron Emission Tomography in the Differential Diagnosis, Staging, and Response Evaluation after Concurrent Chemoradiotherapy for Pancreatic Cancer,” Journal of Clinical Gastroenterology, Vol. 40, No. 10, 2006, pp. 923-929.doi:10.1097/01.mcg.0000225672.68852.05
[18]  C. G. Diederichs, L. Staib, J. Vogel, et al., “Values and Limitations of 18F-Fluorodeoxyglucose-Positron-Emission Tomography with Preoperative Evaluation of Patients with Pancreatic Masses,” Pancreas, Vol. 20, No. 2, 2000, pp. 109-116. doi:10.1097/00006676-200003000-00001

Full-Text

comments powered by Disqus