title: Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer.
abstract: Patients with pancreatic cancer continue to have a poor prognosis, with a 5-y survival rate of less than 5%. Surgery is the only treatment that offers a potential cure. Determining resectability is the principal goal of staging in pancreatic cancer patients. Our objective was to evaluate the value of combined contrast-enhanced (18)F-FDG PET/CT in assessing the resectability of pancreatic cancer and to compare enhanced PET/CT with the performance of PET alone and unenhanced PET/CT.
  
  
  METHODS
  Fifty patients (25 women and 25 men; mean age, 64.3 y; range, 39-84 y) with biopsy-proven pancreatic adenocarcinoma underwent enhanced (18)F-FDG PET/CT for the evaluation of resectability. Criteria for unresectability were distant metastases, peritoneal carcinomatosis, arterial infiltration, or invasion of neighboring organs other than the duodenum. The performance of enhanced PET/CT regarding resectability was compared with that of PET alone and unenhanced PET/CT. Histology, intraoperative findings, and follow-up CT with clinical investigations were used as the reference standard.
  
  
  RESULTS
  According to the reference standard, 27 patients had disease that was not resectable because of distant metastases (n=17), peritoneal carcinomatosis (n=5), or local infiltration (n=5). In the assessment of resectability, PET alone had a sensitivity of 100%, specificity of 44%, accuracy of 70%, positive predictive value of 61%, and negative predictive value of 100%; unenhanced PET/CT had respective values of 100%, 56%, 76%, 66%, and 100%; and enhanced PET/CT, 96%, 82%, 88%, 82%, and 96%. In 5 patients, unresectability was missed by all imaging methods and was diagnosed intraoperatively. Enhanced PET/CT was significantly superior to PET alone (P=0.035), and there was a trend for enhanced PET/CT to be superior to unenhanced PET/CT (P=0.070).
  
  
  CONCLUSIONS
  The use of enhanced PET/CT as a 1-stop-shop imaging protocol for assessing the resectability of pancreatic cancer is feasible and accurate. Enhanced PET/CT is significantly superior to PET alone.
authors.affiliation: Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Zurich, Switzerland. klaus.strobel@usz.ch
authors.forename: Klaus
authors.initials: K
authors.lastname: Strobel
authors.forename: Stefan
authors.initials: S
authors.lastname: Heinrich
authors.forename: Ujwal
authors.initials: U
authors.lastname: Bhure
authors.forename: Jan
authors.initials: J
authors.lastname: Soyka
authors.forename: Patrick
authors.initials: P
authors.lastname: Veit-Haibach
authors.forename: Bernhard C
authors.initials: BC
authors.lastname: Pestalozzi
authors.forename: Pierre-Alain
authors.initials: PA
authors.lastname: Clavien
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Hany
mesh_terms: D003287:Contrast Media; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007472:Iohexol / Q000031:analogs & derivatives*; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D018579:Patient Selection; D049268:Positron-Emission Tomography / Q000379:methods*; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D007472:Iohexol; C038192:iopromide