The combination of FDG PET/CT and contrast enhanced CT in the evaluation of recurrent pancreatic carcinoma and cholangiocarcinoma

Steven Peti, Reza Fardanesh, Sivan Golan, William Simpson, Christopher Chin, Sasan Roayaie, Myron Schwartz, Daniel Labow, Lale Kostakoglu

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

Objectives: The aim of our study was to evaluate the incremental value of of 18F-flouro-2-deoxyglucose (FDG) positron emission tomography (PET) performed with non-contrast enhanced computed tomography (non-ceCT) to the contrast enhanced CT (ceCT), and the advantage of combined evaluation over either modality alone in the detection of recurrent pancreatic carcinoma and cholangiocarcinoma. Methods: A retrospective analysis was done on 47 patients with a history of pancreatic carcinoma (n=24) or cholangiocarcinoma (n=23), all of whom were referred for restaging with a FDG-PET/non-ceCT and a ceCT study during the follow- up period after first-line therapy. Histological and radiological follow-up were used to determine the accuracy of the imaging findings. Results: A lesion-based analysis showed, when equivocal lesions were considered negative, that the sensitivity and specificity of PET/ceCT were 89.1% and 76.9%, respectively, whereas those of PET/non-ceCT were 71.4% and 80.8%, respectively, and those of ceCT were 63.9% and 84.6%, respectively. PET/ceCT had significantly higher sensitivity compared to PET/non-ceCT (p =0.0003) and ceCT alone (p=0.0003). When equivocal lesions were considered positive, the sensitivity and specificity of PET/ceCT were 93.3% and 69.2%, respectively, whereas those of PET/non-ceCT were 77.3% and 80.8%, respectively, and those of ceCT were 76.5% and 55.1%, respectively. Within the PET/ceCT group, negative reading increased specificity from 69.2% to 76.9% (p=0.04), at no significant cost to sensitivity (decrease from 93.3% to 89.1%, p=0.07). Conclusions: PET/non-enhanced CT when interpreted together with ceCT, significantly improves sensitivity of restaging of pancreatic and cholangiocarcinomas at a minor expense to specificity. Our results provide evidence that ceCT and PET/CT are complementary tests that enhance the diagnostic accuracy of restaging in patients with pancreatic and cholangiocarcinomas.

Original languageEnglish
Pages (from-to)53-61
Number of pages9
JournalCurrent Medical Imaging
Volume10
Issue number1
DOIs
StatePublished - 2014

Keywords

  • Cholangiocarcinoma
  • Computed tomography
  • Pancreatic carcinoma
  • Positron emission tomography
  • Recurrence

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