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Journal of Nuclear Medicine Vol. 44 No. 8 1200-1209
© 2003 by Society of Nuclear Medicine

Clinical Investigations

Clinical Performance of PET/CT in Evaluation of Cancer: Additional Value for Diagnostic Imaging and Patient Management

Rachel Bar-Shalom, MD1, Nikolai Yefremov, MD1, Ludmila Guralnik, MD2, Diana Gaitini, MD2,3, Alex Frenkel, DSc1, Abraham Kuten, MD3,4, Hernan Altman, MBA5, Zohar Keidar, MD, PhD1 and Ora Israel, MD1,3

1 Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel
2 Department of Diagnostic Imaging, Rambam Medical Center, Haifa, Israel
3 School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
4 Department of Oncology, Rambam Medical Center, Haifa, Israel
5 Elgems, Tirat Hacarmel, Israel

This study assessed the clinical performance of a combined PET/CT system using 18F-FDG in oncologic patients. Methods: 18F-FDG PET/CT was used to evaluate 204 patients with 586 suspicious lesions. All patients had available follow-up data, enabling assessment of the clinical significance of hybrid PET/CT findings. Differences in interpretation between PET, CT, and fused PET/CT data were prospectively documented for detection, localization, and characterization of each evaluated site. The additional value of PET/CT for data interpretation over that of separate PET and CT was classified into several criteria, including change in lesion characterization to either definitely benign or definitely malignant, precise anatomic localization of malignant 18F-FDG uptake, and retrospective lesion detection on PET and CT. The clinical impact of information provided by PET/CT on patient management was assessed on the basis of follow-up data concerning further diagnostic or therapeutic approach. Analysis of data was performed for the whole study population, for different types of cancer, and for different anatomic sites. Results: PET/CT provided additional information over the separate interpretation of PET and CT in 99 patients (49%) with 178 sites (30%). PET/CT improved characterization of equivocal lesions as definitely benign in 10% of sites and as definitely malignant in 5% of sites. It precisely defined the anatomic location of malignant 18F-FDG uptake in 6%, and it led to retrospective lesion detection on PET or CT in 8%. The results of PET/CT had an impact on the management of 28 patients (14%). Hybrid PET/CT data obviated the need for further evaluation in 5 patients, guided further diagnostic procedures in 7 patients, and assisted in planning therapy for 16 patients. Conclusion: Hybrid PET/CT improves the diagnostic interpretation of 18F-FDG PET and CT in cancer patients and has an impact on both diagnostic and therapeutic aspects of patient management.

Key Words: hybrid PET/CT • coregistration • 18F-FDG • cancer imaging




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