title: The role of 18FDG PET/CT in the management of colorectal liver metastases.
abstract: BACKGROUND
  Surgical resection remains the only potentially curative treatment for colorectal liver metastases (CLM). However, involvement of both the hepatic lobes or extrahepatic disease (EHD) can be a contra-indication for resection. The aim of the present study was to examine the addition of combined positron emission and computed tomography (PET/CT) to CLM staging to assess the effects upon staging and management.
  
  
  METHODS
  All CLM patients referred to a single centre between January 2005 and January 2009 were prospectively included. All underwent routine staging (clinical examination and computed tomography), followed by a whole body (18) fluoro-deoxy-glucose ((18)FDG)-PET/CT scan and Fong clinical risk score calculation.
  
  
  RESULTS
  Sixty-four patients were included [63% male with a median age of 63 years (age range 32-79 years)]. The addition of PET/CT led to disease upstaging in 20 patients (31%) and downstaging in two patients (3%). EHD was found in 24% of low-risk patients (Fong score 0-2) as compared with 44% of high-risk patients (Fong score 3-5) (P= 0.133). There was a trend towards a greater influence upon management in patients with a low score (44% vs. 17%; P= 0.080).
  
  
  CONCLUSIONS
  The addition of PET/CT led to management changes in over one-third of patients but there was no correlation between alterations in staging or management and the Fong clinical risk score; suggesting that PET/CT should be utilized, where available, in the pre-operative staging of CLM patients.
authors.affiliation: Department of Surgery and Interventional Science, University College London, UK. alecengledow@hotmail.com
authors.forename: Alec H
authors.initials: AH
authors.lastname: Engledow
authors.forename: James R A
authors.initials: JR
authors.lastname: Skipworth
authors.forename: Farrokh
authors.initials: F
authors.lastname: Pakzad
authors.forename: Charles
authors.initials: C
authors.lastname: Imber
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Ell
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Groves
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging / Q000379:methods; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18