title: The additional value of PET/CT over PET in FDG imaging of oesophageal cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the value of combined PET/CT compared with PET reviewed side-by-side with CT, in patients with oesophageal cancer, before and after surgery.
  
  
  METHODS
  Forty-one FDG PET/CT studies were performed in 32 patients with oesophageal cancer, before surgery (n = 18) or during follow-up after resection of the primary tumour (n = 23). One hundred and fifteen sites suspicious for malignancy were evaluated. PET/CT was prospectively compared with PET reviewed side-by-side with CT, for detection, accurate localisation and characterisation of malignant sites. PET/CT performance in different anatomical regions was compared before and after surgery. The impact of fused data on patient management was retrospectively assessed.
  
  
  RESULTS
  PET/CT had an incremental value over PET for interpretation of 25 of 115 sites (22%), changing the initial characterisation of ten sites to either malignant (n = 1) or benign (n = 9), and defining the precise anatomical location of 15 sites. PET/CT provided better specificity and accuracy than PET for detecting sites of oesophageal cancer (81% and 90% vs 59% and 83% respectively, p < 0.01). Fusion was of special value for interpretation of cervical and abdomino-pelvic sites, for disease assessment in loco-regional lymph nodes before surgery and in regions of postoperative anatomical distortion. PET/CT had an impact on the further management of four patients (10%), by detecting nodal metastases that warranted disease upstaging (n = 2) and by excluding disease in sites of benign uptake after surgery (n = 2).
  
  
  CONCLUSIONS
  PET/CT improves the accuracy of FDG imaging in oesophageal cancer and provides data of diagnostic and therapeutic significance for further patient management.
authors.affiliation: Department of Nuclear Medicine, Rambam Medical Center, Haifa, Israel. r_bar_shalom@rambam.health.gov.il
authors.forename: Rachel
authors.initials: R
authors.lastname: Bar-Shalom
authors.forename: Ludmila
authors.initials: L
authors.lastname: Guralnik
authors.forename: Medy
authors.initials: M
authors.lastname: Tsalic
authors.forename: Max
authors.initials: M
authors.lastname: Leiderman
authors.forename: Alex
authors.initials: A
authors.lastname: Frenkel
authors.forename: Diana
authors.initials: D
authors.lastname: Gaitini
authors.forename: Alon
authors.initials: A
authors.lastname: Ben-Nun
authors.forename: Zohar
authors.initials: Z
authors.lastname: Keidar
authors.forename: Ora
authors.initials: O
authors.lastname: Israel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004938:Esophageal Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013382:Subtraction Technique; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18