Use of F-18 Fluorodeoxyglucose Positron Emission Tomography With Dual-Phase Imaging to Identify Intraductal Papillary Mucinous Neoplasm

Department of Medicine and Clinical Oncology, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: .
Clinical gastroenterology and hepatology: the official clinical practice journal of the American Gastroenterological Association (Impact Factor: 7.9). 11/2012; 11(2). DOI: 10.1016/j.cgh.2012.10.037
Source: PubMed


BACKGROUND & AIMS: We investigated the usefulness of dual-phase, F-18 fluorodeoxyglucose positron emission tomography with computed tomography (FDGPET/CT) to differentiate benign from malignant intraductal papillary mucinous neoplasms (IPMNs) and evaluate branch-duct IPMNs. METHODS: We used FDG-PET/CT to evaluate IPMNs in 48 consecutive patients, from May 2004 to March 2012, who underwent surgical resection. IPMNs were classified as benign (n=16) or malignant (n=32) based on histology analysis. The ability of FDG-PET/CT to identify branch-duct IPMNs was compared with that of the International Consensus Guidelines. RESULTS: The maximum standardized uptake value (SUV(max)) was higher for early-phase malignant IPMNs than that for benign IPMNs (3.5±2.2 vs 1.5±0.4;P <.001). When the SUV(max) cut-off value was set at 2.0, early-phase malignant IPMNs were identified with 88% sensitivity, specificity, and accuracy. The retention index (RI) values for malignant and benign IPMNs were 19.6±17.8 and -2.6±12.9, respectively. When the SUV(max) cut-off was set to 2.0 and the RI value to -10.0, early-phase malignant IPMNs were identified with 88% sensitivity, 94% specificity, and 90%, accuracy. In identification of branch-duct IPMNs, when the SUV(max) cut-off was set to 2.0, the sensitivity, specificity, and accuracy values were 79%, 92%, and 84%, respectively. Using a maximum main pancreatic duct diameter =7 mm, the Guidelines identified branch-duct IPMNs with greater specificity than FDG-PET/CT. The Guideline criteria of maximum cyst size =30 mm and the presence of intramural nodules identified branch-duct IPMNs with almost equal sensitivity to FDGPET/CT. CONCLUSIONS: Dual-phase FDG-PET/CT is useful for preoperative identification of malignant IPMN and for evaluating branch-duct IPMN.

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    • "However, many different acquisition protocols have been proposed to overcome the aforementioned false-negative or false-positive results obtained with 18F-FDG-PET/CT. Saito et al. [15] used a protocol involving early-phase and delayed-phase scans (1 h and 2 h after 18F-FDG administration) in 48 consecutive patients with intraductal papillary mucinous neoplasia of the pancreas. In this study, SUVmax increased further in the delayed phase imaging in 92.3% patients with malignant pancreatic neoplasia, and only 60.0% of those with benign pancreatic neoplasia. "
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    ECAB Clinical Update: Gastroenterology/Hepatology, Edited by Pramod Garg, 09/2013: pages 1-19; Elsevier., ISBN: 978-81-312-3486-0

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