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Comparison Between ¹⁸F-FDG PET, In-Line PET/CT, and Software Fusion for Restaging of Recurrent Colorectal Cancer

¹ Department of Molecular and Medical Pharmacology, Ahmanson Biological Imaging Center, UCLA David Geffen School of Medicine, Los Angeles, California
² Department of Oncology, UCLA David Geffen School of Medicine, Los Angeles, California
³ Department of Radiology, UCLA David Geffen School of Medicine, Los Angeles, California

View larger version (12K): [in a new window]   FIGURE 1. ROC curves for detection of recurrent CRC by PET, in-line PET/CT, and software fusion of PET and CT in region-based analysis. Analysis was based on 143 evaluable regions in a total study population of 51 patients. According to the reference standard, 35 regions were positive and 108 regions were negative for tumor tissue. Area under the curve is 0.82 for PET and 0.95 for in-line PET/CT (P = 0.01). TPR = true-positive rate; FPR = false-positive rate.

View larger version (62K): [in a new window]   FIGURE 2. PET/CT scan of patient with peritoneal carcinomatosis. Transaxial (top) and coronal (bottom) images show biopsy-proven tumor deposit in lower abdomen (large arrow). This lesion demonstrated increased 18F-FDG uptake but was read as unspecific bowel uptake when PET scans were evaluated independently from CT scans. Small arrow marks right ureter and dotted line in coronal image indicates position of transaxial section.

View larger version (47K): [in a new window]   FIGURE 3. PET/CT scan of patient with pulmonary metastases of rectal cancer. Top row shows images evaluated as part of this study. At this time, CT scan demonstrated 5 small pulmonary nodules in both lungs, which were considered as suspicious for metastatic disease. CT images of 2 representative nodules are shown on left image (long arrows). All nodules were not visible in corresponding PET images. A follow-up study performed 3 mo later showed marked increase in size of nodules (long arrows) as well as a new nodule (short arrow) and confirmed presence of metastatic disease.

View larger version (13K): [in a new window]   FIGURE 4. ROC curves for detection of recurrent CRC on a patient basis. Analysis was based on total study population of 51 patients. According to the reference standard, recurrent CRC (in addition to already known sites in patients referred for tumor staging) was present in 16 patients. Area under the curve is 0.82 for PET and 0.90 for in-line PET/CT (P = 0.09). TPR = true-positive rate; FPR = false-positive rate.

View larger version (40K): [in a new window]   FIGURE 5. Example of a failure of software fusion of independently acquired PET and CT scans (transaxial, coronal, and axial slices). Heart (large arrow) and kidney (small arrow) of PET study are deformed and completely misregistered.

View larger version (11K): [in a new window]   FIGURE 6. ROC curves for detection of recurrent CRC on a region basis for in-line PET/CT and software fusion of PET and CT. Analysis included 67 regions in the subgroup of 26 patients with successful fusion of PET and CT. According to the reference standard, recurrent CRC was present in 14 regions. Area under the curve is 0.96 for both in-line PET/CT and software fusion of PET and CT. TPR = true-positive rate; FPR = false-positive rate.