Value of 18F-FDG PET in the detection of peritoneal carcinomatosis.
OBJECTIVE
Peritoneal carcinomatosis can be difficult to diagnose using computed tomography (CT). The purpose of this study was to evaluate the role of 2-(fluorine 18) fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in the detection of peritoneal carcinomatosis.


METHODS
We reviewed the CT and FDG PET radiological reports and clinical charts of 18 patients with peritoneal carcinomatosis and 17 cancer patients without peritoneal carcinomatosis. We also assessed FDG PET scans from 20 healthy volunteers as a baseline study. The maximum standardised uptake values (SUVmax) over peritoneal lesions in cancer patients and over the area of most intense intestinal uptake in healthy volunteers and cancer patients without peritoneal carcinomatosis were measured.


RESULTS
The sensitivity and positive predictive value (PPV) of combined FDG PET and CT were superior to those of CT alone for the detection of peritoneal lesions (sensitivity: 66.7% vs 22.2%, p<0.025; PPV: 92.3% vs 50.0%, p<0.05). The most frequent pattern of FDG uptake in patients with peritoneal carcinomatosis was abnormally intense focal uptake near the abdominal wall. An SUVmax threshold of 5.1 produced a diagnostic accuracy of combined FDG PET and CT of 78%. The additional information provided by FDG PET allowed a more accurate diagnosis in 14 patients (40.0%), and led to alteration of the therapeutic strategy in five (14.3%) of the enrolled cancer patients.


CONCLUSIONS
We found that use of an intra-abdominal FDG uptake cut-off value for SUVmax of >5.1 assists in the diagnosis of peritoneal carcinomatosis. FDG PET may play an important role in the clinical management of patients with suspected peritoneal carcinomatosis.
Suzuki
Akiko
A
Department of Radiology, School of Medicine, Yokohama City University, Yokohama-shi, Kanagawa-ken, Japan. akiko225@yokohama-cu.ac.jp
Kawano
Tsuyoshi
T
Takahashi
Nobukazu
N
Lee
Jin
J
Nakagami
Yoshihiro
Y
Miyagi
Etsuko
E
Hirahara
Fumiki
F
Togo
Shinji
S
Shimada
Hiroshi
H
Inoue
Tomio
T
D002277:Carcinoma / Q000000981:diagnostic imaging*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D010534:Peritoneal Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D011859:Radiography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18