TY - JOUR
T1 - Detection of recurrence in patients with rectal cancer
T2 - PET/CT after abdominoperineal or anterior resection
AU - Even-Sapir, Einat
AU - Parag, Yoav
AU - Lerman, Hedva
AU - Gutman, Mordechai
AU - Levine, Charles
AU - Rabau, Micha
AU - Figer, Arie
AU - Metser, Ur
PY - 2004/9
Y1 - 2004/9
N2 - PURPOSE: To assess diagnostic accuracy of combined positron emission tomography (PET) and computed tomography (CT) in detection of pelvic recurrence in patients with rectal cancer who underwent abdominoperineal or anterior resection. MATERIALS AND METHODS: Sixty-two patients were enrolled; 37 were men, and 25 were women. Seventeen patients underwent abdominoperineal resection and 45 underwent anterior resection with an anastomosis in the pelvic region before referral for PET/CT. Pelvic sites of fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake were rated separately on PET and PET/CT images as benign or malignant on the basis of shape, location, and intensity of 18F FDG uptake (1-2 = benign and/or physiologic, 3 = equivocal, 4-5 = malignant). Two readers interpreted images in consensus. Altered pelvic anatomy and presence of presacral abnormalities were assessed with CT. Pelvic recurrence was confirmed with histologic analysis or clinical and imaging follow-up. Sensitivity, specificity, positive and negative predictive values, and accuracy of PET and PET/CT in the detection of pelvic recurrence were compared with lesion- and patient-based analyses by using the χ2 test. Clinical relevance of PET/CT assessment was determined. RESULTS: Of 81 pelvic sites with increased 18F FDG uptake, 44 were malignant. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for differentiating malignant from benign 18F FDG uptake in the pelvis were 98%, 96%, 90%, 97%, and 93% for PET/CT and 82%, 65%, 73%, 75%, and 74% for PET, respectively. The most common cause for false-positive interpretation of PET findings was physiologic 18F FDG uptake in displaced pelvic organs. Presacral CT abnormalities were present in 30 (48%) of 62 patients, and seven (23%) abnormalities were malignant. PET/CT was used to distinguish benign and malignant presacral abnormalities with a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 96%, 88%, and 100%, respectively. PET/CT findings were clinically relevant in 29 (47%) of 62 patients. CONCLUSION: PET/CT is an accurate technique in the detection of pelvic recurrence after surgical removal of rectal cancer.
AB - PURPOSE: To assess diagnostic accuracy of combined positron emission tomography (PET) and computed tomography (CT) in detection of pelvic recurrence in patients with rectal cancer who underwent abdominoperineal or anterior resection. MATERIALS AND METHODS: Sixty-two patients were enrolled; 37 were men, and 25 were women. Seventeen patients underwent abdominoperineal resection and 45 underwent anterior resection with an anastomosis in the pelvic region before referral for PET/CT. Pelvic sites of fluorine 18 (18F) fluorodeoxyglucose (FDG) uptake were rated separately on PET and PET/CT images as benign or malignant on the basis of shape, location, and intensity of 18F FDG uptake (1-2 = benign and/or physiologic, 3 = equivocal, 4-5 = malignant). Two readers interpreted images in consensus. Altered pelvic anatomy and presence of presacral abnormalities were assessed with CT. Pelvic recurrence was confirmed with histologic analysis or clinical and imaging follow-up. Sensitivity, specificity, positive and negative predictive values, and accuracy of PET and PET/CT in the detection of pelvic recurrence were compared with lesion- and patient-based analyses by using the χ2 test. Clinical relevance of PET/CT assessment was determined. RESULTS: Of 81 pelvic sites with increased 18F FDG uptake, 44 were malignant. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for differentiating malignant from benign 18F FDG uptake in the pelvis were 98%, 96%, 90%, 97%, and 93% for PET/CT and 82%, 65%, 73%, 75%, and 74% for PET, respectively. The most common cause for false-positive interpretation of PET findings was physiologic 18F FDG uptake in displaced pelvic organs. Presacral CT abnormalities were present in 30 (48%) of 62 patients, and seven (23%) abnormalities were malignant. PET/CT was used to distinguish benign and malignant presacral abnormalities with a sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 96%, 88%, and 100%, respectively. PET/CT findings were clinically relevant in 29 (47%) of 62 patients. CONCLUSION: PET/CT is an accurate technique in the detection of pelvic recurrence after surgical removal of rectal cancer.
KW - Computed tomography (CT), technology
KW - Positron emission tomography (PET), technology
KW - Radionuclide imaging, comparative studies
KW - Rectum, neoplasms
UR - http://www.scopus.com/inward/record.url?scp=4143116591&partnerID=8YFLogxK
U2 - 10.1148/radiol.2323031065
DO - 10.1148/radiol.2323031065
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C2 - 15273334
AN - SCOPUS:4143116591
SN - 0033-8419
VL - 232
SP - 815
EP - 822
JO - Radiology
JF - Radiology
IS - 3
ER -
