F-18 Fluorodeoxyglucose (FDG) and C-Reactive Protein (CRP)

Diederichs, C. G.; Staib, Ludger; Glasbrenner, Bernhard; Guhlmann, Albrecht; Glatting, Gerhard; Pauls, Sandra; Beger, Hans G.; Reske, Sven N.

doi:10.1016/s1095-0397(99)00019-9

Cited by 18 publications

(8 citation statements)

References 16 publications

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“…18 F-FDG PET is now an accepted technology for differential diagnosis and staging of various cancers (13). In pancreatic cancer, 18 F-FDG PET has also been shown to be more accurate than other modalities but less specific when acute inflammation is present (14)(15)(16). Expression of the glucose transporter-1 gene and membrane glucose transport is generally increased in pancreatic cancer but not in CP (17).…”

Section: Discussionmentioning

confidence: 99%

“…Accordingly, 18 F-FDG has been reported to accumulate in various inflammatory processes (20,21), including acute pancreatitis (12). Therefore, Diederichs et al (14) recommended excluding patients with evidence of acute-on-chronic pancreatitis by laboratory data to minimize false-positive PET findings. 18 F-FDG PET is also affected by other metabolic conditions such as altered glucose metabolism, causing a decreased sensitivity for detection of pancreatic cancer in patients with elevated plasma glucose levels (22,23).…”

Section: Discussionmentioning

confidence: 99%

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In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

Herrmann

Eckel²,

Schmidt³

et al. 2008

J Nucl Med

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

Herrmann

Eckel²,

Schmidt³

et al. 2008

J Nucl Med

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“…In addition, post‐stenotic pancreatitis can obscure FDG uptake in the tumor itself. False‐positive studies are more frequent in patients with elevated C‐reactive protein and/or acute pancreatitis, with a specificity as low as 50% 45,46. Therefore, screening for acute inflammatory disease with serum C‐reactive protein has been recommended.…”

Section: F‐fluorodexoglucose (Fdg) Positron Emission Tomography (Pementioning

confidence: 99%

Pancreatic tumors: role of imaging in the diagnosis, staging, and treatment

Delbeke

Pinson

2004

Journal of Hepato-Biliary-Pancreatic Surgery

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Because most patients with pancreatic cancer present with biliary obstruction, percutaneous transhepatic cholangiopancreatography (PTC) or endoscopic retrograde cholangiopancreatography (ERCP) is often performed first to relieve obstruction. Fine needle biopsy (FNA) provides a tissue diagnosis, but is often nondiagnostic due to sampling error. Computed tomography (CT) is the workhorse of oncology, but is poor at defining the nature of pancreatic lesions. Small primary tumors are often not visualized. Fast magnetic resonance imaging (MRI) techniques allowing dynamic imaging after IV gadolinium and new contrast agents allow better characterization of the lesions for patients having contraindications for IV CT contrast agents. Magnetic resonance cholangiopancreatography (MRCP) allows noninvasive visualization of the biliary tree. Endoscopic ultrasonography (EUS) allows evaluation of the detailed regional anatomy with the possibility of FNA. 18F-Fluorodeoxyglucose (FDG) is the most common tracer used in positron emission tomography (PET), and most malignant tumors, including pancreatic carcinoma, have increased FDG uptake compared with normal cells. This functional imaging does not replace but is complementary to morphological imaging. FDG PET is particularly helpful: (1) for the diagnosis in patients with suspected pancreatic cancer in whom CT fails to identify a mass, or those in whom FNAs are nondiagnostic; (2) for staging by detecting CT-occult metastases; (3) for detecting recurrence; and (4) for monitoring therapy. Limitations include false-positive inflammatory processes and false-negative carcinoma in patients with diabetes and hyperglycemia, and islet cell tumors.

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“…Second, inflammatory lesions, especially abscesses and massive infiltrations by granulocytes or macrophages, were shown to have a high FDG uptake (33). Acute bouts of pancreatitis may therefore lead to falsepositive PET results (25,27,34,36). The presence of active inflammatory pancreatic lesions correlates with elevated levels of CRP.…”

Section: Fdg-pet In Pancreatic Masses 113mentioning

confidence: 99%

Values and Limitations of 18F-Fluorodeoxyglucose???Positron-Emission Tomography with Preoperative Evaluation of Patients with Pancreatic Masses

et al. 2000

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The aim of this study was to determine the value and limitations of 18F-fluorodeoxyglucose (FDG)-position-emission tomography (PET) for differentiating benign and malignant pancreatic disease and for staging malignant disease. One hundred fifty-nine patients with 89 malignant and 70 benign pancreatic lesions all received PET, computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP) before pancreatic surgery. The original reports were compared for all patients (group I; N = 159), for a subgroup that neither had fasting plasma glucose levels > or =130 mg/dL or known elevated levels of C-reactive protein ([CRP], group II; n = 123), and for the remaining patients (group III; n = 36). For group I, accuracy values (areas under receiver operating characteristic [ROC] curves) for differentiation of benign/malignant masses were 0.86 (PET), 0.93 (ERCP), 0.82 (CT), and 0.95 for ERCP + PET (N = 159). For group II, ROC areas increased to 0.92 (PET), 0.94 (p< 0.05; n = 123) (ERCP), 0.82 (CT), 0.97 (p < 0.05; n = 123) (ERCP + PET). The results for group III were 0.71 (PET), 0.81 (CT), and 0.93 (ERCP); (n = 36). With 54 patients of group II that either had contradictory or indeterminate/technically unsuccessful CT/ERCP, PET was correct in 43 patients (84%). Sensitivity/specificity for lymph node staging was 49%/63%, respectively. For patients with hepatic metastasis, PET was 70% sensitive and 95% specific, missing some metastasis that were <1 cm. PET detected peritoneal metastasis in 25% of patients, missing poorly localized microscopic spread. For selected patients who have indeterminate pancreatic masses but no hyperglycemia or serologic evidence of active inflammation, FDG-PET is an independent functional assay that significantly adds to the diagnostic accuracy of ERCP and CT in the differentiation of benign and malignant pancreatic disease. PET can reliably detect hepatic, peritoneal, and other distant metastases that are > or =1 cm.

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F-18 Fluorodeoxyglucose (FDG) and C-Reactive Protein (CRP)

Cited by 18 publications

References 16 publications

In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

In Vivo Characterization of Proliferation for Discriminating Cancer from Pancreatic Pseudotumors

Pancreatic tumors: role of imaging in the diagnosis, staging, and treatment

Values and Limitations of 18F-Fluorodeoxyglucose???Positron-Emission Tomography with Preoperative Evaluation of Patients with Pancreatic Masses

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