Comparison between 18F-FDG PET, in-line PET/CT, and software fusion for restaging of recurrent colorectal cancer

Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Center, UCLA David Geffen School of Medicine, Los Angeles, California 90095-6942, USA.
Journal of Nuclear Medicine (Impact Factor: 6.16). 04/2005; 46(4):587-95.
Source: PubMed


The aim of this study was to compare PET with (18)F-FDG PET, in-line PET/CT, and software fusion of independently acquired CT and PET scans for staging of recurrent colorectal cancer (CRC).
Fifty-one patients with suspected recurrent CRC were studied with in-line PET/CT. Thirty-four of these patients underwent an additional CT scan of the chest or abdomen within 4 wk of PET/CT. Software fusion of PET and CT was performed using a fully automated, intensity-based algorithm. The accuracy of the coregistration of PET and CT scans was evaluated by measuring the distance between landmarks visible in the PET and CT images. Histologic evaluation and follow-up for 6 mo served as the gold standard for the presence or absence of recurrent CRC.
On a patient basis, the accuracy of staging was significantly higher for in-line PET/CT than for PET (88% vs. 71%, P = 0.01). Software fusion of the independently acquired PET and CT images was unsuccessful in 8 patients (24%). In the remaining patients, the mean distance between 62 landmarks visible in PET and CT was 12.9 +/- 7.9 mm, whereas it was only 7.7 +/- 4.7 mm for in-line PET/CT (P < 0.001).
In patients with suspected recurrent CRC, in-line PET/CT significantly improves staging compared with PET alone. Due to its high failure rate, software fusion of independently acquired PET and CT studies cannot be considered to represent an alternative to in-line PET/CT.

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Available from: Barbara Füger, Jul 09, 2014
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    • "CT information also improves detectability of small metastatic lung nodules or lymph nodes. Published data demonstrated the superior performance of PET/CT over PET in detection, differential diagnosis, and staging of cancers,27-30 including pancreatic cancer.9,31,32 On the other hand, discrepancy with measured SUV between the two modalities may exist due to different attenuation correction methods, and a new cutoff value specific for PET/CT needs to be established for this reason. "
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    ABSTRACT: Purpose We evaluated the prognostic value of 18F-2-fluoro-2-deoxyglucose positron emission tomography (FDG PET) in patients with resectable pancreatic cancer. Materials and Methods We retrospectively reviewed the medical records of pancreatic cancer patients who underwent curative resection, which included 64 consecutive patients who had preoperative FDG PET scans. For statistical analysis, the maximal standardized uptake value (SUVmax) of primary pancreatic cancer was measured. Survival time was estimated by the Kaplan-Meier method, and Cox's proportional hazard model was used to determine whether SUVmax added new predictive information concerning survival together with known prognostic factors. p<0.05 indicated statistical significance. Results Overall survival (OS) and disease-free survival (DFS) were respectively 42.9 months (27.6-58.2; 95% CI) and 14.9 months (10.1-19.7; 95% CI). When subjects were divided into two groups according to SUVmax with a cutoff value of 3.5, the high SUVmax group (n=32; SUVmax >3.5) showed significantly shorter OS and DFS than the low SUVmax group. Multivariate analysis of OS and DFS showed that both high SUVmax and poor tumor differentiation were independent poor prognostic factors. Conclusion Our study showed that degree of FDG uptake was an independent prognostic factor in pancreatic cancer patients who underwent curative resection.
    Yonsei medical journal 11/2013; 54(6):1377-83. DOI:10.3349/ymj.2013.54.6.1377 · 1.29 Impact Factor
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    • "A PET/CT ezzel szemben teljestest-vizsgálat, amely a kóros glükózmetabolizmust kimutatja még azelőtt, hogy a morfológiai változások megjelennének. Ezért a PET/CT hatékony és pontos nem invazív képalkotó módszernek tartható a vastagbélrák utánkövetésében is [41]. "
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    ABSTRACT: Modern imaging techniques have an important role in the diagnostic procedures of malignancies, and assessing response to therapy. The 18F-FDG PET/CT revolutionized the evaluation of colorectal cancer in terms of preoperative staging and monitoring of recurrence. Conventional imaging techniques have limitations in early assessment of response to therapy. 18F-FDG PET has been shown to allow earlier treatment monitoring, because the metabolic change appears before any anatomic change occurs. The Response Evaluation Criteria in Solid Tumours (RECIST) are widely applied, but they have some limitations. There are new international guidelines for treatment response assessment using PET/CT in solid tumours. The authors review indications and the role of hybrid PET/CT in colorectal cancer. Orv. Hetil., 2013, 154, 1447-1453.
    Orvosi Hetilap 09/2013; 154(37):1447-53. DOI:10.1556/OH.2013.29700
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    • "Differences in study designs between the PET and PET/CT studies could have influenced the results and this may have favoured the performance of PET. The results of the three studies that did compare PET with PET/CT in the same study population showed a superior performance for PET/CT, especially in the patient based analyses [7, 58, 61]. In our subgroup analyses of patient based study results we could confirm the higher performance of PET/CT over PET on a patient basis (AUC 0.95 for PET/CT vs 0.92 for PET, Fig. 4). "
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    ABSTRACT: The objective of this study was to compare the diagnostic performance of positron emission tomography (PET), PET/CT, CT and MRI as whole-body imaging modalities for the detection of local and/or distant recurrent disease in colorectal cancer (CRC) patients who have a (high) suspicion of recurrent disease, based on clinical findings or rise in carcinoembryonic antigen (CEA). A meta-analysis was undertaken. PubMed and Embase were searched for studies on the accuracy of whole-body imaging for patients with suspected local and/or distant recurrence of their CRC. Additionally, studies had to have included at least 20 patients with CRC and 2 × 2 contingency tables had to be provided or derivable. Articles evaluating only local recurrence or liver metastasis were excluded. Summary receiver-operating characteristic (ROC) curves were constructed from the data on sensitivity and specificity of individual studies and pooled estimates of diagnostic odds ratios (DORs) and areas under the ROC curve (AUCs) were calculated. To test for heterogeneity the Cochran Q test was used. Fourteen observational studies were included which evaluated PET, PET/CT, CT and/or MRI. Study results were available in 12 studies for PET, in 5 studies for CT, in 5 studies for PET/CT and in 1 study for MRI. AUCs for PET, PET/CT and CT were 0.94 (0.90-0.97), 0.94 (0.87-0.98) and 0.83 (0.72-0.90), respectively. In patient based analyses PET/CT had a higher diagnostic performance than PET with an AUC of 0.95 (0.89-0.97) for PET/CT vs 0.92 (0.86-0.96) for PET. Both whole-body PET and PET/CT are very accurate for the detection of local and/or distant recurrent disease in CRC patients with a (high) suspicion of recurrent disease. CT has the lowest diagnostic performance. This difference is probably mainly due to the lower accuracy of CT for detection of extrahepatic metastases (including local recurrence). For clinical practice PET/CT might be the modality of choice when evaluating patients with a (high) suspicion of recurrent disease, because of its best performance in patient based analyses and confident prediction of disease status.
    European Journal of Nuclear Medicine 04/2011; 38(8):1560-71. DOI:10.1007/s00259-011-1785-1 · 5.38 Impact Factor
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