PT  - JOURNAL ARTICLE
AU  - Jan D. Soyka
AU  - Patrick Veit-Haibach
AU  - Klaus Strobel
AU  - Stefan Breitenstein
AU  - Alois Tschopp
AU  - Katja A. Mende
AU  - Marisol Perez Lago
AU  - Thomas F. Hany
TI  - Staging Pathways in Recurrent Colorectal Carcinoma: Is Contrast-Enhanced <sup>18</sup>F-FDG PET/CT the Diagnostic Tool of Choice?
AID  - 10.2967/jnumed.107.048249
DP  - 2008 Mar 01
TA  - Journal of Nuclear Medicine
PG  - 354--361
VI  - 49
IP  - 3
4099  - http://jnm.snmjournals.org/content/49/3/354.short
4100  - http://jnm.snmjournals.org/content/49/3/354.full
SO  - J Nucl Med2008 Mar 01; 49
AB  - 18F-FDG PET/CT has gained wide acceptance for evaluation of recurrent colorectal carcinoma. However in clinical practice, contrast-enhanced CT (ceCT) is still the first-line restaging tool. The aim of this study was to investigate the value of contrast-enhanced PET/CT (cePET/CT) as a first-line restaging tool with a special focus on the importance of the use of intravenous contrast. Methods: Fifty-four patients (17 women, 37 men; mean age, 60.3 y), referred for restaging of colorectal carcinoma, were examined with cePET/CT. Retrospective analysis was performed by 2 experienced readers by consensus: first, ceCT alone; second, non-cePET/CT; and third, cePET/CT. The number, localization, and diagnostic certainty of lesions were evaluated. Additionally, the therapeutic impact of the findings was determined. In 29 patients, histology, clinical imaging, and clinical follow-up served as the reference standard. In 25 patients, clinical follow-up and imaging served as the reference standard. Results: Overall, non-cePET/CT delivered correct additional information to the ceCT findings in 27 of 54 patients (50%). This occurred in (a) 20 of 30 patients, where ceCT was found to be inconclusive, and in (b) 7 of 24 patients with conclusive ceCT findings, where non-cePET/CT found additional lesions, leading to a therapy modification in 5 patients. Compared with non-cePET/CT, cePET/CT revealed additional information in 39 of 54 patients (72%), with therapeutic relevance in 23 patients. This large number was primarily due to correct segmental localization of liver metastases, which is crucial for surgical therapy planning. Conclusion: On the basis of its higher accuracy and therapeutic impact compared with ceCT, our data suggest that cePET/CT might be considered as the first-line diagnostic tool for restaging in patients with colorectal cancer.