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Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent uterine cancer: comparison with PET and enhanced CT

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Abstract

Purpose

To evaluate the accuracy of integrated positron emission tomography and computed tomography (PET/CT) with iodinated contrast agent and 18F-fluorodeoxyglucose (FDG) in the diagnosis of suspected uterine cancer recurrence and to assess the impact of PET/CT findings on clinical management, compared with PET alone and enhanced CT alone.

Methods

Of 103 women who had undergone treatment for histopathologically proven uterine cervical or endometrial cancer, 90 underwent FDG-PET/contrast-enhanced CT examination for suspected recurrence. PET-alone, CT-alone, and fused PET/CT images were interpreted by two radiologists by consensus for each investigation. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months. Differences among the three modalities were tested using the Cochran Q test, followed by multiple comparisons using the McNemar test with Bonferroni adjustment.

Results

Patient-based analysis showed that the sensitivity, specificity, and accuracy of PET alone were 79.5% (35/44), 73.9% (34/46), and 76.7% (69/90), respectively, whereas those of CT alone were 68.2% (30/44), 87.0% (40/46), and 77.8% (70/90), respectively, and those of PET/CT were 90.9% (40/44), 93.5% (43/46), and 92.2% (83/90), respectively. PET/CT findings resulted in a change of management in 38 of the 90 patients (42%) with an additional effect on patient management in 13 patients (14%) diagnosed by CT alone and 14 patients (16%) diagnosed by PET alone.

Conclusion

FDG-PET/contrast-enhanced CT is a more accurate modality for assessing recurrence of uterine cancer, and led to more appropriate subsequent clinical management than that resulting from PET alone or enhanced CT alone.

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Acknowledgments

We thank the gynaecologists, especially Ichio Fukasawa, Noriyuki Inaba for recruiting patients to undergo PET/CT. We also thank Kennichi Kobayashi, Kouichi Asano, Kazufumi Suzuki, and Kaoru Ishida for their excellent technical assistance and generous support.

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Authors and Affiliations

  1. Department of Radiology, Dokkyo University School of Medicine, Mibu, Japan

    Kazuhiro Kitajima & Yasushi Kaji

  2. PET Center, Dokkyo Medical University Hospital, Mibu, Japan

    Kazuhiro Kitajima, Koji Murakami, Erena Yamasaki & Yasushi Domeki

  3. Department of Radiology, Tokyo Women’s Medical University Medical Center East, Tokyo, Japan

    Satoru Morita

  4. Department of Environmental Medicine, Kochi University Medical School, Kochi, Japan

    Narufumi Suganuma

  5. Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan

    Kazuhiro Kitajima & Kazuro Sugimura

  6. 880 Kita-kobayashi, Shimotuka-gun, Mibu, Tochigi, 321-0293, Japan

    Kazuhiro Kitajima

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  1. Kazuhiro Kitajima
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  2. Koji Murakami
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Correspondence to Kazuhiro Kitajima.

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Kitajima, K., Murakami, K., Yamasaki, E. et al. Performance of integrated FDG-PET/contrast-enhanced CT in the diagnosis of recurrent uterine cancer: comparison with PET and enhanced CT. Eur J Nucl Med Mol Imaging 36, 362–372 (2009). https://doi.org/10.1007/s00259-008-0956-1

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  • DOI: https://doi.org/10.1007/s00259-008-0956-1

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