Imaging Pearls ❯ PET-CT ❯ Pancreas
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- • [18F] Fluorodeoxyglucose18F-FDG) PET/CT can improve the staging accuracy and clinical management of patients with hepatobiliary and pancreatic cancers, by detection of unsuspected metastases.
• 18F-FDG PET/CT metabolic parameters are valuable in predicting treatment response and survival.
• Metabolic response on 18F-FDG PET/CT can predict preoperative pathologic response to neoadjuvant therapy in patients with pancreatic cancer and determine prognosis.
• Several novel non-FDG tracers, such as 68-Ga prostate-specific membrane antigen and 68Gafibroblast activation protein inhibitor PET/CT, show promise for imaging hepatobiliary and pancreatic cancers with potential for radioligand therapy.
Quarter-Century PET/ Tomography Transformation of Oncology Hepatobiliary and Pancreatic Cancer
Asha Kandathil et al.
PET Clin (in press) 2024 - “18F-FDG PET/CT has reported sensitivity of 85%to 100%, specificity of 61% to 94%, and accuracy of 84% to 95% in diagnosing pancreatic cancer.39–42 FDG uptake by pancreatic cancer correlates with increased Ki-67 and is highest in poorly differentiated tumors. Medium- or well-differentiated pancreatic cancers may not have increased FDG uptake. Inflammatory lesions such as chronic lymphoplasmacytic pancreatitis, autoimmune pancreatitis, and tuberculosis may have increased FDG uptake.”
Quarter-Century PET/ Tomography Transformation of Oncology Hepatobiliary and Pancreatic Cancer
Asha Kandathil et al.
PET Clin (in press) 2024 - In a multicenter prospective study conducted in 18 UK pancreatic tertiary referral centers, Ghaneh and colleagues evaluated the performance of multidetector CT (MDCT) in 589 patients and FDG PET/CT in 550 patients with suspected pancreatic cancer. MDCT had a sensitivity of 88.5%and specificity of 70.6%; FDG PET/CT had a sensitivity of 92.7% and specificity of 75.8% for the diagnosis of pancreatic cancer. Pancreatic cancer had a higher median SUVmax of 7.5 compared with median SUVmax of 5.7 for other lesions. Adding PET/ CT to standard workup improved pancreatic cancer diagnosis, staging, and management.
Quarter-Century PET/ Tomography Transformation of Oncology Hepatobiliary and Pancreatic Cancer
Asha Kandathil et al.
PET Clin (in press) 2024 - “Surgical resection is the only curative option for pancreatic cancer; however, more than 80% of patients present unresectable disease due to locally advanced disease or distant metastases. Borderline resectable pancreatic cancer (BRPC) patients who could be eligible for radical surgery following neoadjuvant chemotherapy may have local arterial or venous (superior mesenteric vein/ portal vein) invasion.44 PET has less spatial resolution and accuracy than CT in assessing locoregional involvement, which is critical in therapeutic decision-making in pancreatic cancer. CT, MR imaging, and endoscopic ultrasound are better at defining tumor’s border and local spread.45 However, PET/CT performs better than CT in identifying unsuspected metastases, reducing the frequency of futile surgeries.”
Quarter-Century PET/ Tomography Transformation of Oncology Hepatobiliary and Pancreatic Cancer
Asha Kandathil et al.
PET Clin (in press) 2024 - “In a study of the utility of 18F-FDG PET/CT in assessing treatment response in 20 patients with LAPC treated with neoadjuvant chemo-RT, Choi and colleagues observed that mean survival was longer (23.2 months) in patients with 50% decrease in SUV between pre-study PET scan and PET scan after the first cycle of chemotherapy, as compared with 11.3 months in patients with less than 50% decrease in SUV.”
Quarter-Century PET/ Tomography Transformation of Oncology Hepatobiliary and Pancreatic Cancer
Asha Kandathil et al.
PET Clin (in press) 2024
- “ 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 - “ In difficult cases, at PET/CT the presence of diffuse uptake of FDG by the pancreas or concomitant extrapancreatic uptake by the salivary glands can be used to aid in differention of autoimmune pancreatitis and pancreatic cancer.”
Utility of 18F-FDG PET/CT for Differentiation of Autoimmune Pancreatitis with Atypical Pancreatic Imaging Findings from Pancreatic Cancer
Lee TY et al.
AJR 2009; 193:343-348