TY - JOUR
T1 - 18F-FDG Uptake at the Surgical Margin after Hepatic Resection
T2 - Patterns of Uptake and Differential Diagnosis
AU - Peungjesada, Silanath
AU - Aloia, Thomas A.
AU - Fox, Patricia
AU - Chasen, Beth
AU - Shin, Sooyoung
AU - Baiomy, Ali
AU - Loyer, Evelyne M.
N1 - Publisher Copyright:
© 2015, European Society of Radiology.
PY - 2015/8/22
Y1 - 2015/8/22
N2 - Objective: To evaluate the patterns of 18F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Methods: Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. Results: There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUVmax was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. Conclusion: F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. Key Points: • Marginal uptake exposes patients to the risk of false positive diagnosis of recurrence. • Benign and malignant patterns of marginal uptake overlap. • Diffuse marginal uptake in our experience, has a high chance to be inflammatory. • Focal marginal uptake can be due to recurrent tumour or inflammation. • Contrast-enhanced CT or MR allows the differentiation between benign and malignant uptake.
AB - Objective: To evaluate the patterns of 18F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Methods: Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. Results: There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUVmax was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. Conclusion: F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. Key Points: • Marginal uptake exposes patients to the risk of false positive diagnosis of recurrence. • Benign and malignant patterns of marginal uptake overlap. • Diffuse marginal uptake in our experience, has a high chance to be inflammatory. • Focal marginal uptake can be due to recurrent tumour or inflammation. • Contrast-enhanced CT or MR allows the differentiation between benign and malignant uptake.
KW - 18F-Fluorodeoxyglucose
KW - Computed Tomography
KW - Hepatectomy
KW - Neoplasms
KW - Positron-Emission Tomography
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U2 - 10.1007/s00330-015-3631-5
DO - 10.1007/s00330-015-3631-5
M3 - Article
C2 - 25678079
AN - SCOPUS:84937640822
SN - 0938-7994
VL - 25
SP - 2453
EP - 2459
JO - European Radiology
JF - European Radiology
IS - 8
ER -