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Detection of Klatskin’s Tumor in Extrahepatic Bile Duct Strictures Using Delayed ¹⁸F-FDG PET/CT: Preliminary Results for 22 Patient Studies

¹ Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany
² Department of Radiology, University Hospital Bonn, Bonn, Germany
³ Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany

Detection of cholangiocarcinoma in extrahepatic bile duct strictures is a continuing challenge in clinical practice because brush cytology taken at endoscopic retrograde cholangiography has an average sensitivity of 50%. The aim of this study was to evaluate the effectiveness of dual-modality PET/CT using ¹⁸F-FDG for noninvasive differentiation of extrahepatic bile duct strictures. Methods: Twenty-two PET/CT studies were performed on 20 patients (10 women, 10 men; mean age ± SD, 63 ± 14 y) with extrahepatic bile duct strictures on endoscopic retrograde cholangiography. PET imaging was started 101 ± 22 min after injection of 369 ± 48 MBq of ¹⁸F-FDG. Blood glucose was 100 ± 20 mg/dL. PET images were reconstructed iteratively with attenuation correction based on a rescaling of the CT image. CT was performed within 1 min before the PET study, with the patient in the same position. CT was used to place a volume of interest 5 cm in diameter at the liver hilus for quantitative evaluation of PET images by means of standardized uptake values (SUVs). Results: Final diagnosis was histologically proven cholangiocarcinoma in 14 cases and benign causes of strictures in 8 cases without evidence of malignancy during a follow-up of 18 ± 3 mo. All patients with cholangiocarcinoma presented with focal increased uptake in the liver hilus with an SUV of 6.8 ± 3.3 (range, 3.9–15.8), compared with 2.9 ± 0.3 (range, 2.5–3.3) in patients with benign causes of strictures (P = 0.003). There was a clear cutoff SUV of 3.6 for detection of malignancy in the liver hilus. Conclusion: ¹⁸F-FDG PET/CT provided high accuracy for noninvasive detection of perihilar cholangiocarcinoma in extrahepatic bile duct strictures.

Key Words: FDG • PET • CT • cholangiocarcinoma

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