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Published in: European Journal of Nuclear Medicine and Molecular Imaging 9/2009

01-09-2009 | Original Article

Performance of integrated FDG PET/contrast-enhanced CT in the diagnosis of recurrent colorectal cancer: Comparison with integrated FDG PET/non-contrast-enhanced CT and enhanced CT

Authors: Kazuhiro Kitajima, Koji Murakami, Erena Yamasaki, Yasushi Domeki, Masahiro Tsubaki, Masakatsu Sunagawa, Yasushi Kaji, Narufumi Suganuma, Kazuro Sugimura

Published in: European Journal of Nuclear Medicine and Molecular Imaging | Issue 9/2009

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Abstract

Purpose

The aim of our study was to evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) with IV contrast for depiction of suspected recurrent colorectal cancer and to assess the impact of PET/contrast-enhanced CT findings on clinical management compared with PET/non-contrast-enhanced CT and CT component.

Methods

One hundred seventy patients previously treated for colorectal cancer underwent PET/CT consisting of non-enhanced and contrast-enhanced CT for suspected recurrence. PET/contrast-enhanced CT, PET/non-contrast-enhanced CT and enhanced CT were interpreted by two experienced radiologists by consensus for each investigation. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months.

Results

Patient-based analysis showed that the sensitivity, specificity and accuracy of PET/contrast-enhanced CT were 93.2 (69/74), 95.8 (92/96) and 94.7% (161/170), respectively, whereas those of PET/non-contrast-enhanced CT were 89.2 (66/74), 94.8 (91/96) and 92.4% (157/170), respectively, and those of enhanced CT were 79.7 (59/74), 93.8 (90/96) and 87.6% (149/170), respectively. Sensitivity and accuracy differed significantly among the three modalities (Cochran’s Q test: p = 0.0004 and p = 0.0001, respectively).The findings of PET/contrast-enhanced CT resulted in a change of management for 64 of the 170 patients (38%) and had an effect on patient management in 12 patients (7%) diagnosed by enhanced CT alone and 4 patients (2%) diagnosed by PET/non-contrast-enhanced CT.

Conclusion

Integrated PET/contrast-enhanced CT is an accurate modality for assessing colorectal cancer recurrence and led to changes in the subsequent appropriate therapy.
Literature
1.
go back to reference Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57:43–66.PubMedCrossRef Jemal A, Siegel R, Ward E, Murray T, Xu J, Thun MJ. Cancer statistics, 2007. CA Cancer J Clin 2007;57:43–66.PubMedCrossRef
2.
go back to reference Arriola E, Navarro M, Pares D, Munoz M, Pareja L, Figueras J, et al. Imaging techniques contribute to increased surgical rescue of relapse in the follow-up of colorectal cancer. Dis Colon Rectum 2006;49:478–84. doi:10.1007/s10350-005-0280-9.PubMedCrossRef Arriola E, Navarro M, Pares D, Munoz M, Pareja L, Figueras J, et al. Imaging techniques contribute to increased surgical rescue of relapse in the follow-up of colorectal cancer. Dis Colon Rectum 2006;49:478–84. doi:10.​1007/​s10350-005-0280-9.PubMedCrossRef
4.
go back to reference Fernandes LC, Kim SB, Saad SS, Matos D. Value of carcinoembryonic antigen and cytokeratins for the detection of recurrent disease following curative resection of colorectal cancer. World J Gastroenterol 2006;12:3891–4.PubMed Fernandes LC, Kim SB, Saad SS, Matos D. Value of carcinoembryonic antigen and cytokeratins for the detection of recurrent disease following curative resection of colorectal cancer. World J Gastroenterol 2006;12:3891–4.PubMed
5.
go back to reference Engstorm PF. NCCN clinical practice guidelines in oncology: colon cancer. National Comprehensive Cancer Network; 2007:2. Available at http://www.nccn.org. Accessed 28 Jan 2008. Engstorm PF. NCCN clinical practice guidelines in oncology: colon cancer. National Comprehensive Cancer Network; 2007:2. Available at http://​www.​nccn.​org. Accessed 28 Jan 2008.
6.
go back to reference Stueckle CA, Adams S, Stueckle KF, Szpakowski M, Schneider O, Friedrich C, et al. Multi-detector CT in the evaluation of patients with recurrence of rectal cancer. Technol Cancer Res Treat 2006;5:285–9.PubMed Stueckle CA, Adams S, Stueckle KF, Szpakowski M, Schneider O, Friedrich C, et al. Multi-detector CT in the evaluation of patients with recurrence of rectal cancer. Technol Cancer Res Treat 2006;5:285–9.PubMed
9.
go back to reference Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 2003;44:1200–9.PubMed Bar-Shalom R, Yefremov N, Guralnik L, Gaitini D, Frenkel A, Kuten A, et al. Clinical performance of PET/CT in evaluation of cancer: additional value for diagnostic imaging and patient management. J Nucl Med 2003;44:1200–9.PubMed
10.
go back to reference Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of 18F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003;44:1797–803.PubMed Cohade C, Osman M, Leal J, Wahl RL. Direct comparison of 18F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med 2003;44:1797–803.PubMed
11.
go back to reference Kim JH, Crernin J, Allen-Auerbach MS, Halpern BS, Fueger BJ, Hecht JR, et al. Comparison between 18F-FDG PET, in-line PET/CT, and software fusion for restaging of recurrent colorectal cancer. J Nucl Med 2005;46:587–95.PubMed Kim JH, Crernin J, Allen-Auerbach MS, Halpern BS, Fueger BJ, Hecht JR, et al. Comparison between 18F-FDG PET, in-line PET/CT, and software fusion for restaging of recurrent colorectal cancer. J Nucl Med 2005;46:587–95.PubMed
13.
14.
15.
go back to reference Chen LB, Tong JL, Song HZ, Zhu H, Wang YC. 18F-FDG PET/CT in detection of recurrence and metastasis of colorectal cancer. World J Gastroenterol 2007;13:5025–9.PubMed Chen LB, Tong JL, Song HZ, Zhu H, Wang YC. 18F-FDG PET/CT in detection of recurrence and metastasis of colorectal cancer. World J Gastroenterol 2007;13:5025–9.PubMed
16.
go back to reference Soyka JD, Veit-Haibach P, Strobel K, Breitenstein S, Tschopp A, Mende KA, et al. Staging pathways in recurrent colorectal carcinoma: is contrast-enhanced 18F-FDG PET/CT the diagnostic tool of choice. J Nucl Med 2008;49:354–61. doi:10.2967/jnumed.107.048249.PubMedCrossRef Soyka JD, Veit-Haibach P, Strobel K, Breitenstein S, Tschopp A, Mende KA, et al. Staging pathways in recurrent colorectal carcinoma: is contrast-enhanced 18F-FDG PET/CT the diagnostic tool of choice. J Nucl Med 2008;49:354–61. doi:10.​2967/​jnumed.​107.​048249.PubMedCrossRef
18.
go back to reference Antoch G, Saoudi N, Kuehl H, Dahmen G, Muller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004;22:4357–68. doi:10.1200/JCO.2004.08.120.PubMedCrossRef Antoch G, Saoudi N, Kuehl H, Dahmen G, Muller SP, Beyer T, et al. Accuracy of whole-body dual-modality fluorine-18-2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (FDG-PET/CT) for tumor staging in solid tumors: comparison with CT and PET. J Clin Oncol 2004;22:4357–68. doi:10.​1200/​JCO.​2004.​08.​120.PubMedCrossRef
19.
go back to reference Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Fukasawa I, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging 2008;35:1439–48. doi:10.1007/s00259-008-0776-3.PubMedCrossRef Kitajima K, Murakami K, Yamasaki E, Domeki Y, Kaji Y, Fukasawa I, et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent ovarian cancer: comparison with integrated FDG-PET/non-contrast-enhanced CT and enhanced CT. Eur J Nucl Med Mol Imaging 2008;35:1439–48. doi:10.​1007/​s00259-008-0776-3.PubMedCrossRef
21.
go back to reference Kitajima K, Murakami K, Yamasaki E, Fukasawa I, Inaba N, Kaji Y, et al. Accuracy of FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol 2008;190:1652–8. doi:10.2214/AJR.07.3372.PubMedCrossRef Kitajima K, Murakami K, Yamasaki E, Fukasawa I, Inaba N, Kaji Y, et al. Accuracy of FDG PET/CT in detecting pelvic and paraaortic lymph node metastasis in patients with endometrial cancer. AJR Am J Roentgenol 2008;190:1652–8. doi:10.​2214/​AJR.​07.​3372.PubMedCrossRef
22.
go back to reference Pannu HK, Cohade C, Bristow RE, Fishman EK, Wahl RL. PET-CT detection of abdominal recurrence of ovarian cancer: radiologic-surgical correlation. Abdom Imaging 2004;39:398–403. Pannu HK, Cohade C, Bristow RE, Fishman EK, Wahl RL. PET-CT detection of abdominal recurrence of ovarian cancer: radiologic-surgical correlation. Abdom Imaging 2004;39:398–403.
23.
go back to reference Bipat S, van Leeuwen MS, Comans EFI, Piji ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 2005;237:123–31.PubMedCrossRef Bipat S, van Leeuwen MS, Comans EFI, Piji ME, Bossuyt PM, Zwinderman AH, et al. Colorectal liver metastases: CT, MR imaging, and PET for diagnosis—meta-analysis. Radiology 2005;237:123–31.PubMedCrossRef
25.
26.
go back to reference Hammerstingl R, Huppertz A, Breuer J, Balzer T, Blakeborough A, Carter R, et al. Diagnostic efficacy of gadoxetic acid (primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2008;18:457–67. doi:10.1007/s00330-007-0716-9.PubMedCrossRef Hammerstingl R, Huppertz A, Breuer J, Balzer T, Blakeborough A, Carter R, et al. Diagnostic efficacy of gadoxetic acid (primovist)-enhanced MRI and spiral CT for a therapeutic strategy: comparison with intraoperative and histopathologic findings in focal liver lesions. Eur Radiol 2008;18:457–67. doi:10.​1007/​s00330-007-0716-9.PubMedCrossRef
27.
go back to reference Coleman ER, Delbeke D, Guiberteau MJ, Conti PS, Royal HD, Weinreb JC, et al. Concurrent PET/CT with an integrated imaging system: intersociety dialogue from the joint working group of the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance. J Nucl Med 2005;46:1225–39.PubMed Coleman ER, Delbeke D, Guiberteau MJ, Conti PS, Royal HD, Weinreb JC, et al. Concurrent PET/CT with an integrated imaging system: intersociety dialogue from the joint working group of the American College of Radiology, the Society of Nuclear Medicine, and the Society of Computed Body Tomography and Magnetic Resonance. J Nucl Med 2005;46:1225–39.PubMed
28.
go back to reference Cohade C, Wahl RL. Applications of positron emission tomography/computed tomography image fusion in clinical positron emission tomography—clinical use, interpretation methods, diagnostic improvements. Semin Nucl Med 2003;33:228–37. doi:10.1053/snuc.2003.127312.PubMedCrossRef Cohade C, Wahl RL. Applications of positron emission tomography/computed tomography image fusion in clinical positron emission tomography—clinical use, interpretation methods, diagnostic improvements. Semin Nucl Med 2003;33:228–37. doi:10.​1053/​snuc.​2003.​127312.PubMedCrossRef
29.
go back to reference Schaefer NG, Hany TF, Taverna C, Taverna C, Seifert B, Stumpe KD, et al. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging—do we need contrast-enhanced CT? Radiology 2004;232:823–9. doi:10.1148/radiol.2323030985.PubMedCrossRef Schaefer NG, Hany TF, Taverna C, Taverna C, Seifert B, Stumpe KD, et al. Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging—do we need contrast-enhanced CT? Radiology 2004;232:823–9. doi:10.​1148/​radiol.​2323030985.PubMedCrossRef
30.
go back to reference Rodríguez-Vigil B, Gómez-León N, Pinilla I, Hernández-Maraver D, Coya J, Martín-Curto L, et al. PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med 2006;47:1643–8.PubMed Rodríguez-Vigil B, Gómez-León N, Pinilla I, Hernández-Maraver D, Coya J, Martín-Curto L, et al. PET/CT in lymphoma: prospective study of enhanced full-dose PET/CT versus unenhanced low-dose PET/CT. J Nucl Med 2006;47:1643–8.PubMed
31.
go back to reference Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF. To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med 2004;45:56–65. Antoch G, Freudenberg LS, Beyer T, Bockisch A, Debatin JF. To enhance or not to enhance? 18F-FDG and CT contrast agents in dual-modality 18F-FDG PET/CT. J Nucl Med 2004;45:56–65.
32.
go back to reference Mawlawi O, Erasmus JJ, Munden RF, Pan T, Knight A, Macapinlac HA, et al. Quantifying the effect of IV contrast media on integrated PET/CT: clinical evaluation. AJR Am J Roentgenol 2006;186:308–19. doi:10.2214/AJR.04.1740.PubMedCrossRef Mawlawi O, Erasmus JJ, Munden RF, Pan T, Knight A, Macapinlac HA, et al. Quantifying the effect of IV contrast media on integrated PET/CT: clinical evaluation. AJR Am J Roentgenol 2006;186:308–19. doi:10.​2214/​AJR.​04.​1740.PubMedCrossRef
33.
go back to reference Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Bares R, Paulsen F, et al. Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2007;34:36–44. doi:10.1007/s00259-006-0186-3.PubMedCrossRef Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Bares R, Paulsen F, et al. Low dose non-enhanced CT versus standard dose contrast-enhanced CT in combined PET/CT protocols for staging and therapy planning in non-small cell lung cancer. Eur J Nucl Med Mol Imaging 2007;34:36–44. doi:10.​1007/​s00259-006-0186-3.PubMedCrossRef
34.
go back to reference Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Klein M, Bares R, et al. Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging. Br J Radiol 2007;80:437–45. doi:10.1259/bjr/34082277.PubMedCrossRef Pfannenberg AC, Aschoff P, Brechtel K, Müller M, Klein M, Bares R, et al. Value of contrast-enhanced multiphase CT in combined PET/CT protocols for oncological imaging. Br J Radiol 2007;80:437–45. doi:10.​1259/​bjr/​34082277.PubMedCrossRef
Metadata
Title
Performance of integrated FDG PET/contrast-enhanced CT in the diagnosis of recurrent colorectal cancer: Comparison with integrated FDG PET/non-contrast-enhanced CT and enhanced CT
Authors
Kazuhiro Kitajima
Koji Murakami
Erena Yamasaki
Yasushi Domeki
Masahiro Tsubaki
Masakatsu Sunagawa
Yasushi Kaji
Narufumi Suganuma
Kazuro Sugimura
Publication date
01-09-2009
Publisher
Springer-Verlag
Published in
European Journal of Nuclear Medicine and Molecular Imaging / Issue 9/2009
Print ISSN: 1619-7070
Electronic ISSN: 1619-7089
DOI
https://doi.org/10.1007/s00259-009-1081-5

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