title: A prospective diagnostic accuracy study of 18F-fluorodeoxyglucose positron emission tomography/computed tomography, multidetector row computed tomography, and magnetic resonance imaging in primary diagnosis and staging of pancreatic cancer.
abstract: OBJECTIVE
  To prospectively compare the accuracy of combined positron emission tomography/computed tomography using F-fluorodeoxyglucose (FDG-PET/CT), multidetector row computed tomography (MDCT), and magnetic resonance imaging (MRI) in the evaluation of patients with suspected pancreatic malignancy.
  
  
  BACKGROUND
  FDG-PET/CT imaging is increasingly used for staging of pancreatic cancer. Preliminary data suggest a significant influence of FDG-PET/CT on treatment planning, although its role is still evolving.
  
  
  METHODS
  Thirty-eight consecutive patients with suspicion of pancreatic malignancy were enrolled. Patients underwent a protocol including FDG-PET/CT, MDCT, and MRI combined with magnetic resonance cholangiopancreatography, all of which were blindly evaluated. The findings were confirmed macroscopically at operation and/or by histopathologic analysis (n = 29) or follow-up (n = 9). Results of TNM classification of different imaging methods were compared with clinical TNM classification.
  
  
  RESULTS
  Pancreatic adenocarcinoma was diagnosed in 17 patients, neuroendocrine tumor in 3, mass-forming pancreatitis in 4, cystic lesion in 6, and fibrosis in 2. Six patients had a finding of a normal pancreas. The diagnostic accuracy of FDG-PET/CT for pancreatic malignancy was 89%, compared with 76% and 79% for MDCT and MRI, respectively. In the differential diagnosis of suspected malignant biliary stricture at endoscopic retrograde cholangiopancreaticography (n = 21), FDG-PET/CT had a positive predictive value of 92%. In 17 patients with advanced pancreatic adenocarcinoma, FDG-PET/CT had a sensitivity of 30% for N- and 88% for M-staging. Both MDCT and MRI had sensitivities of 30% for N- and 38% for M-staging. Furthermore, the clinical management of 10 patients (26%) was altered after FDG-PET/CT.
  
  
  CONCLUSIONS
  FDG-PET/CT was more sensitive than conventional imaging in the diagnosis of both primary pancreatic adenocarcinoma and associated distant metastases. In contrast, the sensitivity of FDG-PET/CT was poor in detecting local lymph node metastasis, which would have been important for an assessment of resectability. We recommend the use of FDG-PET/CT in the evaluation of diagnostically challenging cases, especially in patients with biliary strictures without evidence of malignancy in conventional imaging.
authors.affiliation: Turku PET Centre, Turku University Hospital, Turku, Finland. saila.kauhanen@tyks.fi
authors.forename: Saila P
authors.initials: SP
authors.lastname: Kauhanen
authors.forename: Gaber
authors.initials: G
authors.lastname: Komar
authors.forename: Marko P
authors.initials: MP
authors.lastname: Seppänen
authors.forename: Kirsti I
authors.initials: KI
authors.lastname: Dean
authors.forename: Heikki R
authors.initials: HR
authors.lastname: Minn
authors.forename: Sami A
authors.initials: SA
authors.lastname: Kajander
authors.forename: Irina
authors.initials: I
authors.lastname: Rinta-Kiikka
authors.forename: Kalle
authors.initials: K
authors.lastname: Alanen
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Borra
authors.forename: Pauli A
authors.initials: PA
authors.lastname: Puolakkainen
authors.forename: Pirjo
authors.initials: P
authors.lastname: Nuutila
authors.forename: Jari T
authors.initials: JT
authors.lastname: Ovaska
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D049448:Cholangiopancreatography, Magnetic Resonance / Q000379:methods*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000175:diagnosis*; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18