Limitations of dual time point FDG-PET imaging in the evaluation of focal abdominal lesions

N. Döbert; N. Hamscho; C. Menzel; L. Neuss; A. F. Kovács; F. Grünwald

doi:10.1055/s-0038-1625195

Nuklearmedizin - NuclearMedicine, Inhaltsverzeichnis

Nuklearmedizin 2004; 43(05): 143-149
DOI: 10.1055/s-0038-1625195

Original Articles

Schattauer GmbH

Limitations of dual time point FDG-PET imaging in the evaluation of focal abdominal lesions

Grenzen der 2-Phasen-FDGPET zur Evaluation fokaler abdomineller Läsionen

N. Döbert

¹Department of Nuclear Medicine

,

N. Hamscho

¹Department of Nuclear Medicine

,

C. Menzel

¹Department of Nuclear Medicine

,

L. Neuss

¹Department of Nuclear Medicine

,

A. F. Kovács

²Maxillofacial and Facial Plastic Surgery, University of Frankfurt am Main, Germany

,

F. Grünwald

¹Department of Nuclear Medicine

› Institutsangaben

Abstract

Summary:

Aim: For the evaluation of the diagnostic potential of dual time point FDG positron emission tomography (PET) in patients with suspicious focal abdominal up-take, dual time point PET imaging was compared with clinical findings. Patients, methods: In a prospective study, 56 patients exhibiting a solitary suspicious, intense abdominal FDG uptake, underwent dual time point PET imaging for staging or restaging of different malignant tumors, maximal standardized uptake value (SUVmax) measurements included. The first acquisition was started 64.8 ± 19.5, the second 211.3 ± 52.5 min after FDG injection. The final diagnosis based on CT or MRT imaging and a follow-up period of 12.6 ± 2.8 months. Additionally, colonoscopy was done in 6 patients. In another 6 patients histopathology was obtained from CT guided biopsy. Results: Malignant focal abdominal lesions with a SUVmax <2.5 (n = 4) showed an uptake increase of ≥30%. In the remaining malignant cases with an uptake of ≥2.5 (n = 11), up-take increased in 64% and decreased in 36%. Malignant lesions showing FDG uptake decrease (n = 4) had an initial SUVmax value ≥2.5 and remained with a SUVmax ≥2.5 in the second imaging. In benign lesions with an initial SUVmax ≥2.5 (n = 31), the uptake increased in 17 patients (55%) and decreased in 14 patients (45%). All lesions which changed configuration (33%) were confirmed as benign (n = 5). Conclusion: Using dual time point PET abdominal lesions show a very hetergenous uptake pattern regardless of their dignity. Malignancy can only be reliably excluded in lesions which change their configuration and in lesions with an initial SUVmax value <2.5 combined with an SUV decrease in the delayed imaging. Particularly abdominal lesions which show an initial SUVmax ≥2.5 combined with a SUV increase in the delayed imaging are suspicious for malignancy and need further clarification.

Zusammenfassung:

Ziel: Zur Bestimmung des diagnostischen Wertes der 2-Phasen-FDG-PET (PET) bei Patienten mit suspektem, fokalen abdominellen Uptake wurde die PET mit den klinischen Untersuchungsergebnissen verglichen. Patienten, Methoden: Bei 56 Patienten, die im Rahmen des Stagings oder Restagings einer malignen Grunderkrankung einen solitären fokal suspekten abdominellen Focus aufwiesen, wurde in einer prospektiven Studie ein 2-Phasen-PET mit quantitativer Analyse des maximalen standardisierten Uptake-Wertes (SUVmax) durchgeführt. Die erste Akquisition erfolgte 64,8 ± 19,5, die zweite 211,3 ± 52,5 min nach der FDG-Applikation. Die endgültige Diagnose basierte auf CT- oder MRT-Aufnahmen und dem Follow-up von 12,6 ± 2,8 Monaten. Eine zusätzliche Koloskopie erfolgte bei 6 Patienten und histologische Ergebnisse aus CT-gesteuerter Biopsie lagen bei weiteren 6 Patienten vor. Ergebnisse: Alle malignen fokalen abdominellen Läsionen (n = 4), die einen SUVmax <2,5 aufwiesen, zeigten in der Zweitaufnahme einen SUV-Anstieg von ≥30%. In den übrigen malignen Fällen, die einem SUVmax-Wert ≥2,5 aufwiesen (n= 11), wurde bei 64% ein SUV-Anstieg und bei 36% ein SUV-Abfall beobachtet. Die malignen Läsionen, die einen SUV-Abfall aufwiesen (n = 4), hatten initial und auch in der zweiten Aufnahme einen SUVmax-Wert ≥2,5. In benignen Läsionen mit einem initialen SUVmax ≥2,5 (n = 31) wurde bei 17 Patienten (55%) ein Uptake-Anstieg und bei 14 Patienten (45%) ein Uptake-Abfall beobachtet. Alle Läsionen, die ihre Konfiguration änderten (33%), waren benigne (n = 5). Schlussfolgerungen: In der 2-Phasen-PET weisen abdominelle Foci unabhängig von ihrer Dignität ein sehr heterogenes Uptake-Muster auf. Ein zuverlässiger Malignitätsausschluss gelingt lediglich in abdominellen Läsionen, die ihre Konfiguration ändern und in Läsionen, die einen initialen SUVmax-Wert <2,5 in Kombination mit einem SUV-Abfall in der zweiten Aufnahme aufweisen. Insbesondere abdominelle Foci, die einen initialen SUVmax-Wert ≥2,5 in Kombination mit einem SUV-Anstieg in der zweiten Aufnahme zeigen, sind malignomsuspekt und sollten weiter abgeklärt werden.

Key words:

Dual time point PET imaging - focal abdominal uptake - standardized uptake value (SUV) - dignity

Schlüsselwörter:

2-Phasen-PET - fokaler abdomineller Uptake - SUV - Dignität

Volltext

Referenzen

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