18 F-FDG PET/contrast enhanced CT in the standard surveillance of high risk colorectal cancer patients

Londoño, G.A. Jiménez; Vicente, Ana María García; Pérez, Victoria Sánchez; Aragón, Fátima Jiménez; Martín, A. León; Cano, Juana Maria; Ferreras, Esther Domínguez; López, Ober Van Gómez; Arranz, Javier; Castrejón, Á.M. Soriano

doi:10.1016/j.ejrad.2014.08.016

Cited by 8 publications

(5 citation statements)

References 27 publications

(57 reference statements)

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“…Hybrid imaging has greatly expanded the oncology diagnostics due to the possibility to obtain different information (morphology, structure, metabolism, proliferation) in a one-stop-shop diagnostic procedure. The addition of ceCT to conventional PET/ldCT is useful in some settings as surveillance of high risk colorectal cancer and ovarian cancer, diagnosis of recurrent pancreatic cancer, liver metastases and peritoneal and retroperitoneal lesions 16 – 19 . Indeed, the role of a PET/contrast-enhanced CT is still a controversial topic in evaluation of lymphoproliferative disease 11 , 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

Paone

Raditchkova-Sarnelli

Ruberto-Macchi

et al. 2021

Sci Rep

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Despite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/ldCT and PET/ceCT, respectively, in evaluating FL patients at the end of treatment. Fifty FL consecutive patients who underwent end-of-therapy PET/CT with both ldCT and ceCT were analyzed. Two blinded observers independently assessed PET/ldCT and PET/ceCT applying the Deauville score (DS) and Lugano classification criteria. PET imaging obtained after the end-of-treatment (EoT) was classified as showing PET and ce-CT matched response (concordant imaging group, CIG) or PET and ce-CT unmatched response (discordant imaging group, DIG). Relapse rate and Event-Free Survival (EFS) were compared between CIG and DIG patients. Overall, no differences in metabolic response classification were observed between PET/ldCT and PET/ceCT. In 13 (26%) patients PET/ceCT identified additional FDG-negative nodal lesions in mesenteric, retroperitoneal and iliac regions. However, in all cases, final DS remained unchanged and the additional results did not modify the following therapeutic decision. Among patients, who obtained complete metabolic response a comparable rate of relapse was registered in DIG 3/13 (23%) and CIG subgroups 5/20 (25%) [p = 0.899]. In all 3 DIG cohort patients who relapsed the recurrent disease involved also, but not exclusively, PET negative lymph nodes detected by ceCT. In overall population metabolic response defined by PET/ldCT predicted EFS [76% (group of patients with metabolic response) vs 35% (group of patients with residual disease), p = 0.0013] significantly better than ceCT-Based response assessment [75% (group of patients with complete response) vs 53% (group of patients with residual disease), p = 0.06]. Our study demonstrates a negligible diagnostic and predictive value of ceCT performed in addition to standard 18FDG PET/ldCT for EoT response evaluation in FLs. PET/ldCT should be performed as first-line imaging procedure, also in patients with prevalent abdominal and pelvic involvement, limiting the acquisition of ceCT in selected cases. This tailored approach would contribute to avoid useless radiation exposure and preserve renal function of patients.

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Section: Discussionmentioning

confidence: 99%

Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

Paone

Raditchkova-Sarnelli

Ruberto-Macchi

et al. 2021

Sci Rep

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“…Since FDG-PET is clearly able to accurately stage patients prior to hepatectomy, many patients are also being followed postoperatively ( 37 ), though little data justify the enormous expense of such surveillance. The current study is at least indirect evidence that such a follow-up strategy is not fruitful.…”

Section: Discussionmentioning

confidence: 99%

Prospective evaluation of 18F-FDG positron emission tomography in the preoperative staging of patients with hepatic colorectal metastases

Akhurst¹,

Gönen²,

Baser³

et al. 2021

Hepatobiliary Surg Nutr

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Background: Despite considerable advances in preoperative imaging, up to one-third of patients operatively explored for hepatic colorectal metastases are unexpectedly found to harbor unresectable intrahepatic or extrahepatic disease. Methods:The current study is a prospective, blinded study comparing utility of [ 18 F]2-fluoro-2deoxyglucose positron emission tomography ( 18 F-FDG-PET) to computed tomography (CT) and CT arterial portography (CTAP) as preoperative staging. Results:The 125 planned subjects were enrolled. Findings seen on FDG-PET alone changed therapy for 23 of 125 patients (18%). FDG-PET confirmed other radiologic findings in 16 cases (13%), for an overall influence on therapy in 39 cases (31%). FDG-PET was the most sensitive diagnostic imaging test for extrahepatic cancer; it was 80-90% sensitive for extrahepatic cancer and 70-90% specific. For the 28 cases of unresectable disease due to extrahepatic disease, FDG-PET findings solely changed therapies in 16 cases (57%) and influenced therapy in seven other cases (25%). Of the 21 unresectable cases due to extent of intrahepatic disease, FDG-PET did not solely change therapy in any. Overall, FDG-PET had the lowest sensitivity for hepatic sites compared with CT or CTAP. In particular, small (<1 cm) liver tumors were particularly poorly detected by FDG-PET. The area under the receiver operating characteristic (ROC) curve for small tumors was 0.58 and for patients on chemotherapy it was 0.66, a modest improvement over no imaging.Conclusions: FDG-PET is an important test for preoperative staging of patients with hepatic colorectal metastases, affecting treatment decisions in nearly one-third of patients. The high yield is due mainly to detection of extrahepatic disease. It is therefore recommended in patients with extrahepatic lesions suspected to be disseminated cancer or those with high risk for extrahepatic disease. It is not a good test for identification of small tumors in the liver.

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“…18 F-FDG PET and ceCT seemed to have similar value in the detection of unsuspected recurrence of high-risk colorectal cancer in a patient-based analysis: sensitivity and specificity of 86 and 88%, 86 and 92%, 86 and 85%, respectively for PET, ceCT and cePET/CT ( 57 ). However, the combined assessment of cePET/CT improved the accuracy in the lesion-based analysis: sensitivity of 56, 71 and 97%, respectively for PET, ceCT and cePET/CT.…”

Section: Clinical Added Value Of Cepet/ctmentioning

confidence: 97%

Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward?

Metrard,

Cohen,

Bailly

2024

Front. Med.

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The integration of diagnostic CT scans into PET/CT facilitates a comprehensive single examination, presenting potential advantages for patients seeking a thorough one-shot check-up. The introduction of iodinated contrast media during PET scanning raises theoretical concerns about potential interference with uptake quantification, due to the modification of tissue density on CT. Nevertheless, this impact appears generally insignificant for clinical use, compared to the intrinsic variability of standardized uptake values. On the other hand, with the growing indications of PET, especially 18F-FDG PET, contrast enhancement increases the diagnostic performances of the exam, and provides additional information. This improvement in performance achieved through contrast-enhanced PET/CT must be carefully evaluated considering the associated risks and side-effects stemming from the administration of iodinated contrast media. Within this article, we present a comprehensive literature review of contrast enhanced PET/CT, examining the potential impact of iodinated contrast media on quantification, additional side-effects and the pivotal clinically demonstrated benefits of an all-encompassing examination for patients. In conclusion, the clinical benefits of iodinated contrast media are mainly validated by the large diffusion in PET protocols. Contrary to positive oral contrast, which does not appear to offer any major advantage in patient management, intravenous iodine contrast media provides clinical benefits without significant artifact on images or quantification. However, studies on the benefit–risk balance for patients are still lacking.

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18 F-FDG PET/contrast enhanced CT in the standard surveillance of high risk colorectal cancer patients

Cited by 8 publications

References 27 publications

Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

Prospective evaluation of 18F-FDG positron emission tomography in the preoperative staging of patients with hepatic colorectal metastases

Comprehensive literature review of oral and intravenous contrast-enhanced PET/CT: a step forward?

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