title: Clinical applications of (18)F-FDG PET in the management of hepatobiliary and pancreatic tumors.
abstract: The assessment of hepatobiliary and pancreatic tumors is commonly achieved by ultrasound, computed tomography (CT), and magnetic resonance. The 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) detects increased glucose metabolism associated with neoplastic lesions, provides high accuracy in most cancer imaging applications and is now widely used in clinical practice. However, PET is not always useful and accurate knowledge of appropriate indications is essential for a proper clinical management. (18)F-FDG is transported into cells and phosphorylated by the enzyme hexokinase to (18)F-FDG-6-phosphate, which cannot proceed down the glycolytic pathway and therefore is accumulated in the malignant tissue. PET allows accurate quantification of FDG uptake in tissue, and previous studies have demonstrated that standardized uptake values provide highly reproducible parameters of tumor glucose use (Weber et al., J Nucl Med 40:1771-1777, 1999). The recent development and diffusion of hybrid PET-CT scanners allows functional and anatomic data to be obtained in a single examination, improving lesion localization and resulting in significant diagnostic improvement (Wahl, J Nucl Med 45:82S-95S, 2004). Moreover, CT can be performed diagnostically with the use of intravenous and oral contrast and simultaneous PET-contrast-enhanced CT scanning appears to be an efficient method in cancer evaluation. However, in most centers, a low-dose CT is routinely performed without contrast media infusion.Proper patient preparation, scanning protocol, combined assessment of PET and CT data, and the evaluation of conventional imaging findings are essential to define disease and to avoid diagnostic pitfalls. The role of PET and PET-CT in malignancies of the liver, biliary tract, and pancreas is here reviewed; normal patterns, representative cases, and common pitfalls are also presented.
authors.affiliation: Department of Bioimaging and Radiological Sciences, Institute of Radiology, Agostino Gemelli Hospital, Catholic University of the Sacred Heart, Rome, Italy. adegaetano@rm.unicatt.it
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: De Gaetano
authors.forename: Vittoria
authors.initials: V
authors.lastname: Rufini
authors.forename: Paola
authors.initials: P
authors.lastname: Castaldi
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Gatto
authors.forename: Laura
authors.initials: L
authors.lastname: Filograna
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bonomo
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy; D001650:Bile Duct Neoplasms / Q000000981:diagnostic imaging / Q000628:therapy; D001653:Bile Ducts, Intrahepatic; D001661:Biliary Tract Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000628:therapy; D018281:Cholangiocarcinoma / Q000000981:diagnostic imaging / Q000628:therapy; D015179:Colorectal Neoplasms / Q000473:pathology; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000628:therapy*; D064847:Multimodal Imaging; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18