title: FDG-positron emission tomography/computed tomography and standardized uptake value in the primary diagnosis and staging of hilar cholangiocarcinoma.
abstract: BACKGROUND
  The diagnosis and staging of hilar cholangiocarcinoma (HCCA) remain challenging despite recent advances in imaging. Little is known about the use of positron emission tomography/computed tomography (PET/CT) in HCCA.
  
  
  OBJECTIVE
  This study aimed to evaluate the additional value of FDG-PET/CT and standardized uptake value (SUV) in patients with highly suspected HCCA.
  
  
  METHODS
  Between February 2006 and August 2009, PET/CT was performed in 30 patients with highly suspected HCCA, all of whom were deemed resectable by conventional staging methods, including laparoscopy. The results of PET-CT and SUV were compared with intraoperative and histopathological findings.
  
  
  RESULTS
  The primary tumour was (18) F-FDG-positive in 88% of patients. Sensitivity and specificity for the detection of regional lymph node metastases and distant metastases were 67% and 68%, and 33% and 96%, respectively. The median SUV in the primary tumour was significantly (P < 0.05) higher in patients with (mean: 8.9) than without (mean: 6.1) distant metastases. The SUV in patients with benign disease (n= 4) showed a trend towards lower values than in patients with cholangiocarcinoma, although this was not significant.
  
  
  CONCLUSIONS
  After conventional staging including diagnostic laparoscopy, the additional value of PET/CT is limited. This somewhat disappointing finding may reflect the fact that extensive staging studies were carried out prior to PET/CT. The SUV potentially predicts patients with distant metastases and may differentiate between HCCA and benign lesions that mimic malignancies.
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
authors.forename: Anthony T
authors.initials: AT
authors.lastname: Ruys
authors.forename: Roel J
authors.initials: RJ
authors.lastname: Bennink
authors.forename: Henderik L
authors.initials: HL
authors.lastname: van Westreenen
authors.forename: Marc R
authors.initials: MR
authors.lastname: Engelbrecht
authors.forename: Olivier R
authors.initials: OR
authors.lastname: Busch
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000328:Adult; D000368:Aged; D001650:Bile Duct Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D018281:Cholangiocarcinoma / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000556:secondary / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009426:Netherlands; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D011379:Prognosis; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18