American Journal of Roentgenology, Vol 171, 1103-1110, Copyright © 1998 by American Roentgen Ray Society

ARTICLES

Imaging of oncologic patients: benefit of combined CT and FDG PET in the diagnosis of malignancy

WB Eubank, DA Mankoff, UP Schmiedl, TC Winter 3rd, ER Fisher, AB Olshen, MM Graham and JF Eary
Department of Radiology, University of Washington School of Medicine, Seattle 98195-7115, USA.

OBJECTIVE: The purpose of this study was to assess the benefit of combined CT and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in diagnosing malignancy. MATERIALS AND METHODS: The records of 26 patients with intraabdominal and intrathoracic neoplasms who underwent CT and FDG PET between January 1995 and September 1996 were retrospectively reviewed. Most of these patients had inconclusive findings on prior CT for the diagnosis of malignancy. Only sites of potential malignant disease were included in the data analysis. Presence or absence of malignancy was confirmed by histopathology or follow-up CT. Three observers experienced in abdominal imaging used CT findings alone to estimate level of suspicion (1 = definitely not malignant to 5 = definitely malignant) for primary or recurrent neoplasms (n = 21), distant metastases (n = 25), and neoplastic nodal involvement (n = 18). Six weeks later the three observers reviewed the same CT examinations supplemented with FDG PET and reestimated suspicion of malignancy. Receiver operating characteristic methodology was used to analyze the results. Sensitivity, specificity, positive and negative predictive values, and accuracy in diagnosis of malignant disease were calculated using level 4 (probable malignancy) as the cutoff for the presence of disease. RESULTS: The mean area under the receiver operating characteristic curve, indicating successful diagnosis of malignancy, was .82 for CT alone and .92 for CT with FDG PET (p < .05). The accuracies for diagnosis of primary or recurrent neoplasms, distant metastases, and neoplastic nodal involvement were 62%, 68%, and 83%, respectively, for CT alone and 81% (p = .06), 88% (p = .03), and 89% (p > .25), respectively, for CT with FDG PET. Also, supplemental FDG PET imaging improved observer confidence and accuracy in diagnosing recurrent neoplasm in four (36%) of 11 patients who had undergone surgery or chemoradiation and in diagnosing four (29%) of 14 extrahepatic sites that had potential metastases. CONCLUSION: Diagnosis of malignancy in oncologic patients is significantly improved when CT is supplemented with FDG PET. Combined imaging is particularly helpful in the evaluation of potential recurrence in previously treated patients and for diagnosing extrahepatic lesions that may be distant metastases.
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				E. L. Rosen, W. B. Eubank, and D. A. Mankoff FDG PET, PET/CT, and Breast Cancer Imaging RadioGraphics, October 1, 2007; 27(suppl_1): S215 - S229. [Abstract] [Full Text] [PDF]

				A. Suzuki, Y. Nakamoto, T. Terauchi, M. Kawamoto, Y. Okumura, Y. Suzuki, T. Sato, N. Takahashi, J. Lee, M. Senda, et al. Inter-observer Variations in FDG-PET Interpretation for Cancer Screening Jpn. J. Clin. Oncol., August 18, 2007; (2007) hym064v1. [Abstract] [Full Text] [PDF]

				D. A. Mankoff, J. F. Eary, J. M. Link, M. Muzi, J. G. Rajendran, A. M. Spence, and K. A. Krohn Tumor-Specific Positron Emission Tomography Imaging in Patients: [18F] Fluorodeoxyglucose and Beyond Clin. Cancer Res., June 15, 2007; 13(12): 3460 - 3469. [Abstract] [Full Text] [PDF]

				M. Horger, S. M. Eschmann, C. Pfannenberg, R. Vonthein, H. Besenfelder, C. D. Claussen, and R. Bares Evaluation of Combined Transmission and Emission Tomography for Classification of Skeletal Lesions Am. J. Roentgenol., September 1, 2004; 183(3): 655 - 661. [Abstract] [Full Text] [PDF]

				W. B. Eubank, D. Mankoff, M. Bhattacharya, J. Gralow, H. Linden, G. Ellis, S. Lindsley, M. Austin-Seymour, and R. Livingston Impact of FDG PET on Defining the Extent of Disease and on the Treatment of Patients with Recurrent or Metastatic Breast Cancer Am. J. Roentgenol., August 1, 2004; 183(2): 479 - 486. [Abstract] [Full Text] [PDF]

				V. Kapoor, B. M. McCook, and F. S. Torok An Introduction to PET-CT Imaging RadioGraphics, March 1, 2004; 24(2): 523 - 543. [Abstract] [Full Text] [PDF]

				G. Antoch, G. M. Kaiser, A. B. Mueller, K. A. Metz, H. Zhang, H. Kuehl, S. Westermann, C. E. Broelsch, S. P. Mueller, A. Bockisch, et al. Intraoperative Radiation Therapy in Liver Tissue in a Pig Model: Monitoring with Dual-Modality PET/CT Radiology, March 1, 2004; 230(3): 753 - 760. [Abstract] [Full Text] [PDF]

				W. B. Eubank, D. A. Mankoff, H. J. Vesselle, J. F. Eary, E. K. Schubert, L. K. Dunnwald, S. K. Lindsley, J. R. Gralow, M. M. Austin-Seymour, G. K. Ellis, et al. Detection of Locoregional and Distant Recurrences in Breast Cancer Patients by Using FDG PET RadioGraphics, January 1, 2002; 22(1): 5 - 17. [Abstract] [Full Text] [PDF]