Imaging Pearls ❯ Pancreas ❯ PET CT
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- Purpose We aim to compare FDG-PET/CT and cross-sectional imaging (contrast enhanced CT/MRI) diagnostic abilities in detecting recurrence/progression of pancreaticobiliary system tumors and to reveal the clinical impact of integrated FDG PET/ CT to CT/MRI on patient management.
Conclusion FDG-PET/CT and cross-sectional imaging have different advantages and shortcomings. In recurrence/progression, recognition of early changes is more feasible by CT/MRI. However, inconsistency of morphologic and metabolic findings is important reason of cross-sectional imaging failure. FDG-PET/CT is superior in showing extraabdominal metastases, but missing small-volume lesions and misinterpreting inflammatory changes are still a problem lowering its sensitivity. Nevertheless FDGPET/CT is good option for guiding undetermined imaging findings or clinic-radiologic mismatch.
Integrated FDG‑PET/CT contribution over cross‑sectional imaging in recurrence or progression of pancreaticobiliary neoplasms
Banu Karaalioglu · Tansel Cakir · Yasin Kutlu · Mehmet Seker · Ahmet Bilici
Abdominal Radiology (2024) 49:131–140 - “In Kumar et al. study with 24 patients, FDG-PET/CT was found more sensitive, specific, and accurate in detecting recurrent GB carcinoma (93.7% vs 87.5%, 100% vs 50%, 95.8% vs 75%, respectively). However, they compared PET findings with quite diverse radiological modalities (contrast enhanced CT, MRI, ultrasonography, endoscopic retrograde cholangiopancreatography), which significantly reduces the reliability of the results, especially from a radiological point of view. In Lee et al. study with recurrent biliary tract carcinoma, they found FDG-PET/CT and CT equally sensitive in detecting locoregional disease (88%). In Corvera et al. study of 33 patients with suspected biliary tumors recurrence, they found FDG-PET only confirmatory in biliary cancer recurrence with 95% true concordant results with cross-sectional imaging.”
Integrated FDG‑PET/CT contribution over cross‑sectional imaging in recurrence or progression of pancreaticobiliary neoplasms
Banu Karaalioglu · Tansel Cakir · Yasin Kutlu · Mehmet Seker · Ahmet Bilici
Abdominal Radiology (2024) 49:131–140 - “We think that our study is the most comprehensive one comparing to previous studies on the topic so far. FDG-PET/ CT and cross-sectional imaging have different advantages and shortcomings in evaluating the recurrence and progression of pancreaticobiliary system tumors. Cross-sectional imaging is superior to FDG-PET/CT in detecting recurrence/ progression of local disease and intra-abdominal metastases. High spatial resolution and the advantage of comparability with previous images makes recognition of early changes more feasible by cross-sectional imaging. Lesion size and metabolic activity inconsistency was important reason of its failure in this regard. FDG-PET/CT is superior in showingextra-abdominal distant metastases. However, its limitations in small volume lesions and misinterpretation of inflammatory changes are still a problem lowering its sensitivity. Nevertheless, FDG-PET/CT is a good option for guiding CT/MRI undetermined findings or clinic-radiologic mismatches and especially in such situations it has a crucial role in patient management.”
Integrated FDG‑PET/CT contribution over cross‑sectional imaging in recurrence or progression of pancreaticobiliary neoplasms
Banu Karaalioglu · Tansel Cakir · Yasin Kutlu · Mehmet Seker · Ahmet Bilici
Abdominal Radiology (2024) 49:131–140
- “ Early data suggest that contrast-enhanced PET/CT performed with modern PET/CT scanners yields high-resolution anatomic information for surgical and radiotherapeutic planning and functional information for whole body staging in the care of patients with this disease.”
PET/CT of Cancer Patients: Part 1, Pancreatic Neoplasms
Dibble EH et al.
AJR 2012; 199:952-967
- “ The negative predictive value PET/CT in pancreatic lesions suggestive of pancreatic cancer was 75%. A negative PET/CT does not exclude pancreatic cancer, and further workup of these PET-negative lesions is warranted.”
Negative Predictive Value of Positron Emission Tomography/Computed Tomography in Patients With a Clinical Suspicion of Pancreatic Cancer
Lin JL et al.
Pancreas July 2011; Vol 40;5: 653-656