Respiratory gated and prolonged acquisition 18F-FDG PET improve preoperative assessment of colorectal liver metastases.

Abstract

BACKGROUND:

Detection of small liver metastases from colorectal cancer by 18F-FDG PET/CT is hampered by high physiologic uptake in the liver parenchyma and respiratory movements during image acquisition.

PURPOSE:

To investigate whether two tailored 18F-FDG PET liver acquisitions (prolonged liver acquisition time [PL-PET] and repeated breath-hold respiratory gated liver acquisition [RGL-PET]) would improve detection of colorectal liver metastases, when added to a standard whole body PET (WB-PET).

MATERIAL AND METHODS:

Twenty consecutive patients referred to our hospital for surgical treatment of colorectal liver metastases diagnosed with contrast-enhanced CT underwent preoperative 18F-FDG PET/CT tailored for detection of liver metastases. Concordance between preoperative imaging results and true findings (histology and/or follow-up imaging) as well as changes in clinical management, based on 18F-FDG PET/CT findings, were documented. Background noise, defined as the standard deviation measured in a reference region within the normal liver parenchyma, was compared between the three 18F-FDG PET/CT protocols.

RESULTS:

WB-PET, PL-PET, and RGL-PET showed suspicious liver lesions in 18 out of 20 patients. Compared to WB-PET alone, the combination of PL-PET and RGL-PET showed additional lesions in the liver in seven out of the 18 patients. The combination of all three PET acquisitions changed clinical management in four patients. Two patients with negative PET results were later found to have benign liver lesions.

CONCLUSION:

The addition of tailored liver-specific 18F-FDG PET/CT protocols (PL-PET and RGL-PET) to a WB-PET, improved the detection of intrahepatic colorectal metastases, compared to WB-PET alone. Such add-ons can change clinical patient management of potentially resectable colorectal liver metastases.

• Authors: Mona-Elisabeth Revheim, Sven-Petter Haugvik, Kjersti Johnsrud, Øystein Mathisen, Jan Gunnar Fjeld, Arne Skretting
• Journal: Acta radiologica (Stockholm, Sweden : 1987) (Acta Radiol) Vol. 56 Issue 4 Pg. 397-403 (Apr 2015) ISSN: 1600-0455 [Electronic] England
• PMID: 24682406 (Publication Type: Journal Article)
• Copyright: © The Foundation Acta Radiologica 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Chemical References

• Radiopharmaceuticals
• Fluorodeoxyglucose F18

Topics

• Aged
• Aged, 80 and over
• Colorectal Neoplasms (pathology)
• Female
• Fluorodeoxyglucose F18
• Humans
• Liver (diagnostic imaging)
• Liver Neoplasms (diagnostic imaging, secondary)
• Male
• Middle Aged
• Positron-Emission Tomography (methods)
• Preoperative Care (methods)
• Radiopharmaceuticals
• Reproducibility of Results
• Respiratory-Gated Imaging Techniques (methods)
• Time Factors