Hai Jeon Yoon1, Jong Jin Lee2, Yu Kyeong Kim1, Sang Eun Kim1. 1. Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul, Korea. 2. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyungwon-gil, Songpa-gu, Seoul, 138-736 Korea.
Abstract
PURPOSE: This study aims to compare the performance of contrast-enhanced computed tomography (CeCT) and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting small tumor implants and metastatic lymph nodes (LNs) in the abdominopelvic cavity in patients with colorectal cancer. METHODS: We enrolled 16 patients who were clinically suspected of experiencing a recurrence (6 male, 10 female; mean age 61 ± 14 years). All subjects underwent CeCT and PET/CT, and the performance of these methods was compared with regard to detecting recurrences. The final diagnosis of a recurrence was made clinically. RESULTS: CeCT identified 38 lesions in 12 patients, all of which were detected by PET/CT. PET/CT found 27 additional lesions in 8 patients, comprising 9 seeding nodules (2 in the right upper quadrant of the abdomen and 7 in the pelvic cavity) and 18 LNs (2 celiac, 2 paraaortic, 2 hepatic hilar, 11 common iliac, 1 external iliac). Most additional lesions were located in the pelvic cavity (approximately 78% of seeding nodules and 67% of lymph nodes). The maximum standardized uptake value (SUVmax) of the additional seeding nodules that were detected solely by PET/CT was significantly higher compared with the CeCT- and PET/CT-confirmed nodules (5.5 ± 4.2 vs. 2.9 ± 2.5, p = 0.03). The seeding nodules that were detected only by PET/CT were significantly smaller than the CeCT- and PET/CT-confirmed nodules (long axis: 1.0 ± 0.3 cm vs. 2.0 ± 1.1 cm, p = 0.001; short axis: 0.8 ± 0.3 cm vs. 1.4 ± 0.8 cm, p = 0.004; mean of both axes: 0.9 ± 0.3 cm vs. 1.7 ± 0.9 cm, p = 0.001). Similarly, PET/CT-only-detected LNs were significantly smaller than CeCT- and PET/CT-identified LNs (0.7 ± 0.1 cm vs. 2.3 ± 1.2 cm, p < 0.0001). CONCLUSION: PET/CT is superior to CeCT in detecting seeding nodules and metastatic LNs in patients with recurrent colorectal cancer. Specifically, PET/CT detects subcentimeter lesions in anatomically deformed pelvic cavities.
PURPOSE: This study aims to compare the performance of contrast-enhanced computed tomography (CeCT) and 18 F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) in detecting small tumor implants and metastatic lymph nodes (LNs) in the abdominopelvic cavity in patients with colorectal cancer. METHODS: We enrolled 16 patients who were clinically suspected of experiencing a recurrence (6 male, 10 female; mean age 61 ± 14 years). All subjects underwent CeCT and PET/CT, and the performance of these methods was compared with regard to detecting recurrences. The final diagnosis of a recurrence was made clinically. RESULTS:CeCT identified 38 lesions in 12 patients, all of which were detected by PET/CT. PET/CT found 27 additional lesions in 8 patients, comprising 9 seeding nodules (2 in the right upper quadrant of the abdomen and 7 in the pelvic cavity) and 18 LNs (2 celiac, 2 paraaortic, 2 hepatic hilar, 11 common iliac, 1 external iliac). Most additional lesions were located in the pelvic cavity (approximately 78% of seeding nodules and 67% of lymph nodes). The maximum standardized uptake value (SUVmax) of the additional seeding nodules that were detected solely by PET/CT was significantly higher compared with the CeCT- and PET/CT-confirmed nodules (5.5 ± 4.2 vs. 2.9 ± 2.5, p = 0.03). The seeding nodules that were detected only by PET/CT were significantly smaller than the CeCT- and PET/CT-confirmed nodules (long axis: 1.0 ± 0.3 cm vs. 2.0 ± 1.1 cm, p = 0.001; short axis: 0.8 ± 0.3 cm vs. 1.4 ± 0.8 cm, p = 0.004; mean of both axes: 0.9 ± 0.3 cm vs. 1.7 ± 0.9 cm, p = 0.001). Similarly, PET/CT-only-detected LNs were significantly smaller than CeCT- and PET/CT-identified LNs (0.7 ± 0.1 cm vs. 2.3 ± 1.2 cm, p < 0.0001). CONCLUSION: PET/CT is superior to CeCT in detecting seeding nodules and metastatic LNs in patients with recurrent colorectal cancer. Specifically, PET/CT detects subcentimeter lesions in anatomically deformed pelvic cavities.
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