title: The clinical impact of camera-based positron emission tomography imaging in patients with recurrent colorectal cancer.
abstract: OBJECTIVE
  F18-fluorodeoxyglucose (FDG)-positron emission tomography (PET) studies have clinical value in suspected recurrent or metastatic colorectal cancer cases. Because this modality is not accessible for many patients, a camera-based FDG (CB-FDG) coincidence imaging was suggested as an alternative. Although inferior in resolution to a dedicated PET system, it can make FDG studies available to more patients. We assessed the clinical value of CB-FDG in patients with recurrent colorectal cancer.
  
  
  METHODS
  The disease stage and treatment approach in 83 patients were twice determined by an oncologist and a surgeon, first based on the patient's records and blind to CB-FDG findings and then with the inclusion of FDG results in the decision-making analysis.
  
  
  RESULTS
  On a lesion-based analysis, the sensitivity of CB-FDG was 95% and the specificity was 81% compared with 88% and 64%, respectively, for computed tomography. Adding FDG findings led to disease-stage alteration in 47 patients (57%), upstaging in 35 (42%), and downstaging in 12 (15%). FDG localized the tumor sites in 21 of 26 patients (81%) with suspected clinical recurrence and a negative conventional imaging workup. In 8 patients, FDG ruled out viable tumor tissue suggested by other modalities. The oncologist's suggested treatment approach was altered in 54% of the patients and the surgeon altered the decision on operability in 28%.
  
  
  CONCLUSIONS
  CB-FDG assessment has clinical value for both staging and selecting treatment in patients with recurrent colorectal cancer and can be considered an alternative to an nonaccessible dedicated PET system.
authors.affiliation: Department of Nuclear Medicine, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel.
authors.forename: Elka
authors.initials: E
authors.lastname: Miller
authors.forename: Hedva
authors.initials: H
authors.lastname: Lerman
authors.forename: Mordechai
authors.initials: M
authors.lastname: Gutman
authors.forename: Arie
authors.initials: A
authors.lastname: Figer
authors.forename: Genady
authors.initials: G
authors.lastname: Livshitz
authors.forename: Einat
authors.initials: E
authors.lastname: Even-Sapir
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging*; D019275:Radiopharmaceuticals; D014055:Tomography, Emission-Computed / Q000295:instrumentation*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18